This blog post serves as my submission for the Running Assignment in the course Advanced Orthotics and Prosthetics.
In one of my Physical Therapy (PT) courses, we learned about the phases of running, and how different joint motions and musculoskeletal dysfunctions can result in running-related injuries (RRI). While I aspire to run a 5K without stopping or walking, I never enjoyed running as a sport or form of exercise. [However, I will run from point A to point B in a sense of urgency.] There are a few reasons for my love/hate relationship with running, and based on the community survey I created, 44.2% of you share my same sentiments. My limited running experience proposed a question that my student peers (that I know of) have not investigated: What are the differences between novice runners and experienced/trained runners? Is there a biomechanical predisposition to my poor (or lack of) running skills? As a future physical therapist, I went to the databases to see what research has to say. Additionally, the research will be compared to the results and responses of my community survey. You can view (and take) the survey here.
Before we hit the ground running [pun intended], it must be known that the terms “novice” and “experienced” fall into a spectrum. A person who has been running at least 10 miles a week for 1 year may still consider themselves to be novice in comparison to a multi-marathon runner who has been running for 10+ years. All this to say research articles have different definitions of novice running, so they will be clearly defined below. Also, I did my best to define terminology, but some of the results occur at different phases of the running cycle. The picture at the top of the post provides a visual guide.
Prognosis of RRIs in Novice Runners
Two studies in Europe surveyed novice runners to investigate factors related to running-related injuries. After completing a 6-week long Start to Run program, almost half of the participants acquired a RRI – the most common being knee, Achilles tendon, and low back/hip. The recovery these injuries lasted on average 8 weeks. Compared to the community survey, runners who have been running at least 1x/week for less than 6 months suffered injuries (42% at the knee) that typically lasted for 1 week. The limitation to this comparison is the unknown progression of mileage in both the running program and the survey group. While only 4 people in this particular survey group reported calf muscle injuries, another significant finding in this was a good prognosis in recovery from calf-realted injuries. This could be due to the fact that muscle can heal quicker than tendon.1
In the other study from the UK, Linton and Valentin found those who have not acquired a running injury within the past year were 1.43 times more likely to be injured. In addition, running with orthotics was correlated with 2 times increased rate of injury. This is not to say that orthotics cause injuries as the origin of RRI can be many factors. Lastly, the study highlights the pain/recovery threshold of beginner and experienced runners. Almost half of the runners who participated in this UK survey continued to run amidst their injury. Although, the UK survey does not specify intesnity of run while injured, the study alluded to experienced runners and their ability to adapt to their RRI based on their pain/recovery threshold.2 In the community survey conducted, 65.6% of all runners continue to run with their RRI but decrease the mileage/intensity. Of this percentage, 60% are those with 3+ years of running experience continue to run with thier RRI. However, the community survey revealed novice runners (with experience of less than 1 year) have more varied responses to running. Some stop running altogether, while others run as usual prior to injury.
Kinematic Changes in Exhaustion
After running for long periods of time, muscles become fatigued and the body has to adapt. In a study by Maas et al., they observed differences between runners who ran less than 6 mi/week and competitive long-distance runners who averaged 30-43 mi/week. Upon exhaustion, novice runners resort to a pattern of increased trunk flexion throughout the running phases as well as hip abduction and ankle plantarflexion during limb advancement. These may occur in response to weak quadriceps and/or weak hip musculature.
However, both competitive runners and novice participants had the tendency to bring their leg to midline upon foot strike. This motion, known as adduction, is associated with other rotational forces in the leg and could lead to injuries such as iliotibial band (ITB) syndrome and patellofemoral pain.3 According to the community survey, 26% of runners with 3+ years of experience have complaints of knee pain. A few from this percentage mentioned complaints of ITB syndrome as well.
Core Stability in Running
In Phyiscal Therapy, core control is really important as a PT may address a patient’s weak core prior to assigning arm or leg exercises. Core stability, one’s ability to maintain trunk position under internal and external forces, is part of running form. A study from the Official Journal of the American College of Sports Medicine investigated running mechanics after performing dynamic and isometric core exercises. Significant findings include increased knee flexion when the runner’s limb is on the ground (stance phase). This puts more demand on the quadriceps to absorb the reaction forces from the ground and puts the runner at risk for a knee injury like patellofemoral pain syndrome (PFPS).
Out of the survey participants who regularly run less than 10 miles per week (the same conditions of participants in the study), 35% of them have experienced knee pain. While the type of knee pain is not specified, less than half of this particular group do not work on core stability/strengthening on a everyday basis. Most runners in the community survey who run regularly at least 10 mi/week also work on core stability/strength everyday, but they still report injuries in various areas of the lower extremity. With this in mind, his study proposes that core stability training can be beneficial for runners, but it is unknown if increased core stability actually improves running mechanics.4
Step Lengths and Reaction Forces during Changes in Velocity
Spatiotemporal measures (i.e. stride length, cadence, and speed/velocity) are factors that also influence running performance. If the goal is to run longer distances at a faster rate, runners should decrease time in contact with the ground and increase time in flight. In 2019, the Journal of Human Kinetics published a study comparing such parameters in novice and elite runners as treadmill velocities increased. Their findings showed that experienced runners spent longer times in flight and less steps, meaning they cover a greater distance between each step at higher velocities.
While the community survey did not cover spatiotemporal measures, it’s important to highlight that adapting to increasing speeds will involve changes in rate and magnitude of impact forces in stance time. In the study, novice runners experienced increased ground reaction forces as velocity increased. Again, depending on their position and alignment of the leg, these repetitive forces at high amplitudes could be risk for injury.5
While there are kinematic and spatiotemporal differences in novice runners and experienced runners, running-related injuries can happen at any time no matter how long one has been running. After running the numbers, 42% of runners who completed the community survey reported more than one running-related injury. Even though novice runners are more at risk for running-related injuries, this should not discourage people from running as a form of exercise.
Based on the findings of these studies and what I have learned in class, here is my advice for those interested in running on a regular basis.
- Do research beforehand. Be educated on the various biomechanical techniques (i.e. rearfoot vs forefoot) and see what works for you. How you run intuitively may or may not be the most efficient pattern for greater cadence, speed, or distance.
- As we discussed, incorporate strength training in your routine so your muscles help to absorb ground reaction forces and could help prevent injury.
- Seek an expert and purchase appropriate running shoes (and orthotics, if needed) that suits your body alignment.
Lastly, the evidence emphasizes the idea that great runners become great by running. If you are starting to run, remember that it takes time for your body to adapt to your environment. However, if you do get an injury, listen to your body and rest if needed. Consult a physical therapist or your doctor if your injury worsens and/or interferes with activities in your daily life.
Thank you for reading! Also, a huge thank you to the 120 or so who participated in my running survey. I hope this motivates you to run like the wind. Please feel free to leave comments as feedback is part of my grade. You can email me at firstname.lastname@example.org if you have any further questions.
- Fokkema T, Burggraaff R, Hartgens F, et al. Prognosis and prognostic factors of running-related injuries in novice runners: A prospective cohort study. J Sci Med Sport. 2019;22(3):259-263. doi:10.1016/j.jsams.2018.09.001
- Linton L, Valentin S. Running with injury: A study of UK novice and recreational runners and factors associated with running related injury. J Sci Med Sport. 2018;21(12):1221-1225. doi:10.1016/j.jsams.2018.05.021
- Maas E, De Bie J, Vanfleteren R, Hoogkamer W, Vanwanseele B. Novice runners show greater changes in kinematics with fatigue compared with competitive runners. Sports Biomech. 2018;17(3):350-360. doi:10.1080/14763141.2017.1347193
- Chaudhari AMW, VAN Horn MR, Monfort SM, Pan X, Oñate JA, Best TM. Reducing Core Stability Influences Lower Extremity Biomechanics in Novice Runners. Med Sci Sports Exerc. 2020;52(6):1347-1353. doi:10.1249/MSS.0000000000002254
- García-Pinillos F, García-Ramos A, Ramírez-Campillo R, Latorre-Román PÁ, Roche-Seruendo LE. How Do Spatiotemporal Parameters and Lower-Body Stiffness Change with Increased Running Velocity? A Comparison Between Novice and Elite Level Runners. J Hum Kinet. 2019;70:25-38. Published 2019 Nov 30. doi:10.2478/hukin-2019-0036
Creator of #forthedpt | follower of Jesus | trying to live my best life