The RISK of Running: Part 2

If you read part 1 of this blog, you know that my title is misleading and this isn’t about the etiology of running-related injury (while I do love talking about that). This is about load management in the injured runner. In part two, I’d like to talk about the “I” and “K” in RISK, that is:

I – improve load capacity

K – keep adapting to the runner’s goals and capacity

So, load capacity. If you have a low capacity to load, the demands of running will quickly exceed this capacity and tissue becomes intolerant. This is only one explanation for the framework of running-related injuries, which we know is multifactorial:

Bertelsen 2017

Either way, if we have a higher capacity to loading, we can take on more. Get a bigger glass, fill it up with more liquid loading. How do we get the bigger glass? You’re just waiting for me to say lift heavy weights, right? Well, yes and no.

THE YES:

So far (April 2019) the evidence on strength training for runners only covers the spectrum of performance. Blagrove’s 2018 systematic review shows notable gains in running economy, running performance, and maximal sprint speed for runners that perform heavy strength training 2-3x per week. Notably, no increase in body mass or change in VO2max is seen. This seems to be low hanging fruit to improve running performance, but it should be noted that we don’t actually know what the optimal dosage is, and how long it should be done for. It seems intuitive to think that a continuous, periodized strength training program that lines up with the runner’s competitive season would be optimal when performed at the minimal effective dose – we just don’t know what that is yet. Anecdotally, we also see that this isn’t always the case in our elite runners (Eliud Kipchoge recently set the world record in the marathon without strength training in the 12 weeks leading up to the race).

THE NO:

Surprisingly, there has yet to be a study looking at the efficacy of strength training to reduce running-related injuries. This doesn’t mean we shouldn’t be doing it, because of theoretical load capacity reasons, but it does mean we shouldn’t confidently tout it as the answer to injury risk-reduction. Again, running-related injuries are multifactorial.

According to the principle of specificity, running is the most specific way to make a runner better at tolerating the loads of running (woah). We also don’t know the optimal dosage for every individual. While strength and conditioning would be a non-specific way of improving load capacity for running, progressively increasing volume and intensity of running is the specific way. I’ve already talked a bit about the uncertainty surrounding volume and intensity progressions, and this also goes back to the idea that each runner is going to respond differently to loading as a result of a number of factors.

What about this keep adapting stuff? This part is split into two categories that demonstrate why our plans need to be flexible (and hopefully why a robot can’t do my job… yet). “Keep adapting to the runner’s goals” is situational dependent on the season; is the runner about to compete in the most important race of the year in two weeks, or are they in the off-season? Management of the runner here will naturally be different as far as conservative measures. “Keep adapting to the runner’s capacity” is more a matter of taking previous injury history and training experience into account. If someone has historically had difficulty increasing their volume a lot in short periods of time, we’re going to want to be more conservative with our approach. Basically, keep adapting means take all the non-quantifiable stuff into account with decision making and you probably don’t do the same thing for everyone.

In summary, run smart, lift heavy weights, and be flexible with your training to appropriately manage load.

Questions? Comments? Am I going to jump into another running-related Twitter thread that spans 3-4 days? Almost definitely.

Dr. Jason Tuori, PT, DPT, CSCS

References/cool running readings:

1. Barton CJ. Managing RISK when treating the injured runner with running retraining, load management and exercise therapy. Phys Ther Sport. 2018; 29: 79-83.
2. Barton CJ, Bonanno DR, Carr J, et al. Running retraining to treat lower limb injuries: a mixed-methods study of current evidence synthesised with expert opinion. Br J Sports Med. 2016; 50(9): 513-26.
3. Bertelsen ML, Hulme A, Petersen J, et al. A framework for the etiology of running-related injuries. Scand J Med Sci Sports. 2017; 27(11): 1170-1180.
4. Blagrove RC, Howatson G, Hayes PR. Effects of Strength Training on the Physiological Determinants of Middle- and Long-Distance Running Performance: A Systematic Review. Sports Med. 2018; 48(5): 1117-1149.