The Runner's Decision Matrix

“Training errors” are regularly indicated as a strong contributing factor to running-related injury (RRI) development. We don’t actually know that much about what a training error is (there’s also a lack of agreement on what optimal training even looks like), but for the sake of this post let's use the generic definition of "a component in the training plan that results in either injury or failure to achieve desired performance."

This component could be running frequency, volume, or intensity-related. It could be recovery/stress-related. It could be a known or unknown component. There’s a lot of impact that training load has on injury development, but nothing concrete enough to apply a blanket statement above common sense-level. This is likely because of the variable influence training load has on different subgroups of runners (novice versus D1 collegiate-level), within-population variability, and the multi-factorial complex nature of RRI development.

The known/unknown component is where it gets interesting. Let’s say we could simplify “known” into both good and bad decisions. As far as our current common sense-recommendations go, those could look something like this:

“Good"

• Deciding to modify a planned workout due to fatigue, running aches/pains
• Increasing training volume/intensity gradually, whatever that means
• Getting an adequate amount of sleep and recovery between training sessions

“Bad”

• Basically doing the exact opposite

We make a decision and get a result. The results could look something like this:

“Good”

• Improved running performance
• Not sustaining a RRI
• Maintaining the ability to regularly train

“Bad”

• The opposite (let’s keep this simple)

Everyone reading this is likely well-acquainted with good and bad decisions and results. We’d like to think there’s some predictability there, but sometimes it ends up like this:

Again, we’re keeping it simple. You can make the case that if it isn’t dichotomous then “very bad” decisions more frequently lead to “very bad” results. There are other variables at play influencing how bad or good a decision is given the current context. There’s also a magnitude component, but in its simplest form we have four conditions:

1.       Good decision / good result

2.       Good decision / bad result

3.       Bad decision / bad result

4.       Bad decision / good result

Which, practically, could look like this:

1.   “Runner A” works back into half-marathon shape from an episode of plantar heel pain. The injury has mostly been sensitive to running intensity changes; anything faster than 5K race-pace creates a symptom flare-up >24 hours. Easy running and marathon race pace are symptom-stable. While Runner A has typically performed better off of higher intensity training, they decide to increase volume so that they can train more with fewer symptom flare-ups before the race. Runner A races and nearly PR’s with minimal symptom response.

2.   “Runner B” recognizes that they didn’t train for a long enough period prior to their first marathon. While planning for their second marathon, they add an extra 8-week block of gradual base volume building. Runner B feels great psychologically going into the second marathon and the conditions are great, but they just feel sluggish on race day and fall off pace by mile 18. Runner B finishes the race, but in a slower time than their first attempt.

3.   “Runner C” knowingly takes the first lap of their 800m race out in 53 seconds, nearly 6 seconds faster than their 800m pace. Runner C fails to hold the pace and runs significantly slower in the final lap, coming through in their slowest time of the season.

4.   “Runner D” has been feeling some lingering Achilles soreness all week without modifying their training in the first two weeks of the cross-country season. Runner D decides to compete in the low-stakes meet at the end of the week, despite it being early season and not feeling fully healthy. Runner D runs an 8k PR with no significant symptom response following.

What’s most important to note is that because of the multi-factorial nature of RRIs, we shouldn’t mistake the decision as the primary reason for the result. Runners are often focused on the singular reason they suspect led to injury (asymmetries, shoes, increases in volume or intensity) without considering the several inter-related factors that led up to that point. The thought process behind why runners believe what they believe and make the decisions that they make has also rarely been investigated. That really sets the basis for determining if someone is knowingly making a “good” or “bad” training decision. Should we strive for good decisions? Clearly, yes. Realistically, making a good decision is difficult because it requires considering:

• Long- and short-term training load
• History of injury
• Sleep/recovery
• Nutrition
• Stress
• Age
• Genetics
• Concurrent disease
• Running biomechanics
• Running speed
• BMI
• Terrain/surface
• Footwear

…and that becomes pretty non-quantifiable pretty quickly. All in all, try to make good decisions using the best information available. Sometimes a bad result still happens. Don’t over-attribute your result to your decision.

Jason Tuori, PT, DPT, CSCS


References:

1. Talking to Derek Miles about bad decisions (https://www.barbellmedicine.com/the-team/derek-miles/)
2. Nielsen RO, Buist I, Sørensen H, Lind M, Rasmussen S. Training errors and running related injuries: a systematic review. Int J Sports Phys Ther. 2012;7(1):58-75.
3. Hulme A, Nielsen RO, Timpka T, Verhagen E, Finch C. Risk and Protective Factors for Middle- and Long-Distance Running-Related Injury. Sports Med. 2017;47(5):869-886.
4. Hulme A, Finch CF. The epistemic basis of distance running injury research: A historical perspective. J Sport Health Sci. 2016;5(2):172-175.
5. Saragiotto BT, Yamato TP, Lopes AD. What do recreational runners think about risk factors for running injuries? A descriptive study of their beliefs and opinions. J Orthop Sports Phys Ther. 2014;44(10):733-8.
6. 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.