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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. |
