The Ten Laws of Running Injuries
By Tim Noakes
(An exerpt from his book The Lore of Running)
This article appears online at http://health.iafrica.com/fitness/running/injuries.htm
From his own extensive experience, Tim Noakes has formulated the ten laws of running injuries.
The ten laws of running injuries
1. Running injuries are not an Act of God. There are certain injuries which are intrinsic to an individual. Three main factors can be identified. The only constant factor is genetic; our lower limb structure. Tim Noakes describes those who run at the back of the pack as the 'Bad Genes Bunch' — and includes himself in this! In essence, most people have problems with their lower limb structure, which are likely to predispose to injuries of various types. The two variable factors are the environment in which you train, and training methods.
2. Each running injury progresses through four grades. Running-related injuries generally become progressively more debilitating, passing through four stages or grades:
* Grade I injuries are those which cause pain only after exercise, and are often felt some hours after exercising
* Grade II injuries cause discomfort, not yet pain, during exercise, but not enough to stop the person from training
* Grade III injuries cause actual pain, which limits the person's training and race performance
* Grade IV injuries are so severe that running is not possible
This allows a rational approach to treatment. Except in the case of stress fractures, or the iliotibial band friction syndrome, which can deteriorate very rapidly, you are not going to move from Grade I to Grade IV all of a sudden. A Grade I injury requires less attention than a Grade IV injury, although it is important not to let it progress.
3. Each running injury indicates that the athlete has reached breakdown point. This simply restates the fact that there is a reason for running injuries, which must be analysed before effective treatment can begin. The breakdown point is usually because of some change in training routine. You may be training harder or running further. You may be running on different terrain, or in different or worn-out running shoes. Injury resistance comes with an understanding of your own genetic limitations. These dictate whether or not you will win a particular race, your choice of shoes, the surfaces on which you can safely train, and which training methods you will actually survive.
4. Virtually all true running injuries are entirely curable. Only a very small fraction of true running injuries cannot be completely cured by simple techniques, and surgery is required only in exceptional circumstances. Exceptions to this are injuries which occur in runners with severe biomechanical abnormalities which cannot be compensated for by conventional methods. Injuries which result in degeneration of internal structures such as the achilles tendon, and those which happen to people who start running on already damaged or abnormal joints are also exceptions.
5. X-rays and other sophisticated (and expensive!) investigations are seldom necessary to diagnose running injuries. Most running injuries affect soft tissues - tendons, ligaments and muscles. These do not show up on X-ray. Rely on someone who takes a good history, and examines you thoroughly with their hands!
6. Treat the cause, not the effect, of injury. Surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies will probably fail if they do not address the genetic, environmental and training factors which have caused your injury in the first place.
7. Rest is seldom the most appropriate treatment. Rest will cure only acute symptoms, and is anyway, generally an unacceptable remedy to most runners who are obsessed with their sport! The only injuries which require complete rest are those which make running impossible. Tim Noakes' approach is to advise injured runners to continue running, but only to a point at which they experience discomfort. Pain is not recommended!
8. Never accept as a final opinion, the advice of a medical or other practitioner, who does not run. Make sure that your adviser is a runner. He or she should be able to discuss in detail the genetic, environmental and training factors which have caused your injury. Inability to cure you, should make your doctor or physiotherapist feel as bad as you do, and you shouldn't have to pay through the nose!
9. Avoid the knife! Surgery is the first line of treatment only in muscle compartment syndromes and interdigital neuromas. There may also be a role for surgery in chronic achilles tendinitis which has lasted for more than six months, back pain due to a prolapsed disc, and the iliotibial friction band syndrome, but, only after a more conservative approach has been thoroughly tried, and failed.
10. There is no definitive scientific evidence that running causes osteoarthritis in runners whose knees were normal when they started running. Indeed there is evidence that with age, runners show fewer musculoskeletal problems, and develop them at a slower rate, than do non-runners! Generally sportspeople who develop osteoarthritis have usually had previous joint surgery. This is often as a result of injuries sustained during contact sports, such as rugby. However, there may be evidence that long-term, long-distance and high-intensity running, may predispose to premature osteoarthritis of the hip. This finding comes from a single study, so clearly more research is needed