Every new runner who registers for multiple long distance races is likely to hear about injuries or, worse, suffer one. And it’s a very real threat.

Running too much, or unsystematically, the wrong gear, the absence of proper tracks, bad lighting: The causes can be many.

“Most runners get injured due to running too much without proper training," says Rahul Verghese, running coach and founder of New Delhi-based group Running and Living. Mumbai-based facility Heal Institute’s sports medicine physician, Rizwan Khan, adds: “Doing too much too soon is the most common training error and that results in an overuse/overload injury." Puma’s running ambassador and sports scientist Shayamal Vallabhjee concurs: “Ninety per cent of injuries are either attributed to overtraining or poor biomechanics (posture, wrong foot strike, etc.). The best way to prevent injury is to use the progressive overload principle of not increasing your training intensity or mileage by more than 10% week on week."

Gladson Johnson, a Bengaluru-based sports physiotherapist and a barefoot runner with 10 marathons under his soles, believes lack of flexibility and strength training are the main contributors to injuries. “One thing common among the runners who come to me for treatment is: They only run day in and day out. They don’t spend enough time on flexibility or muscle-strengthening workouts," he says.

Running injuries can also be caused by using the wrong gear. Improper or worn-out shoes can lead to serious leg injuries and blisters, while the wrong shorts, T-shirts and socks can cause considerable chafing and bruising.

To avoid recurrence of injuries, runners must be patient, spending as much time as required on recovery before starting again. If you are already nursing an injury, a proper recovery plan, rest and physiotherapy can get you back on track in good time.

“Most runners make the mistake of believing that if it’s not hurting, it’s fine to go out and run again. That’s how they get hurt again," says Dr Johnson. “Different injuries have different recovery periods: Bone injuries take the least time…about four weeks, while tendon injuries take anything between three-six months. Muscle injuries usually heal in six-eight weeks." Even when they return to running, runners are still likely to make mistakes such as improper stretching and cool-down recovery activities, adds Dr Khan. “Delay in replenishing vital nutrients and electrolytes post running is a cause of concern."

Since most runners face injuries either because of excessive running, unsystematic training or infrastructure issues (running on bad roads, etc.), here’s a lowdown on what to avoid, and how to recover from these injuries.

RUNNER-INDUCED INJURIES

Patellofemoral pain

This anterior knee pain is often a by-product of inadequate muscle firing, says Vallabhjee. “Simply put, runners have over-dominant quadricep muscles and insufficient hamstring strength, which results in patellar tendinopathy, an injury to the tendon connecting the kneecap to the shin bone. The runner will experience post-run knee pain which may be aggravated by overuse," says Vallabhjee.

Recovery: It’s advisable to rest, ice and strengthen the posterior chain musculature to bring about optimum balance.

Iliotibial (IT) band friction syndrome

The IT band is a muscular band that stabilizes the knee laterally. This band has a direct relationship with the gluteus medius muscle which is the primary mover in running. Inactivity or inadequate strength in the gluteus medius will lead to tightness of the IT band and a lateral knee pain.

Recovery: This can be treated by foam-rolling—using a foam roller to massage and stretch different parts of your body—the IT band regularly and strengthening the gluteus medius muscle.

Shin splints

It manifests itself as a severe pain in the shin. “This is often brought on by upping speed or distance too soon, or by running too fast with a heavy heel strike on the downhill sections of runs," says Verghese. “This could start off as a simple inflammatory response or be as severe as a stress fracture," warns Vallabhjee.

Recovery: Ice and a break from running-related activities. One may even take non-steroidal anti-inflammatory drugs under medical advice.

Plantar fasciitis

It is a degenerative condition of the foot’s plantar fascia (the thick connective tissue which supports the arch on the bottom of the foot). This can be caused by excessively tight calf muscles which, in turn, could be related to inadequate cushioning or flexibility in the soles of the shoes. Runners with extremely high and low arches are susceptible to this injury.

Recovery: This can be treated by strengthening and stretching the Achilles tendon and calf muscles, and regularly stretching the plantar fascia.

Hamstring strains

This is the most common muscle injury among runners. “It’s often a result of insufficient posterior strength, coupled with high-intensity hill or speed training," says Vallabhjee. It could also be brought on by cramps due to dehydration, adds Verghese.

Recovery: Rest and rehabilitate the muscle properly as the probability of a recurrence is high.

INFRASTRUCTURE-INDUCED INJURIES

Verghese says running injuries can be a direct result of where you run. Traffic and poor roads in big cities, where the sport is catching on, can lead to mishaps. Runners often suffer falls owing to improper street lighting and/or potholes, leading to twisted ankles, scrapes and bruises.

“Runners merely need a decent semi-hard track with reasonable lighting, since early morning, before sunrise, is the most popular and practical time for running," says Verghese.

“Many runners often report heel pain, which is caused by running on hard surfaces such as tile, stone and concrete tracks—the worst surfaces to run on—in our parks," Verghese points out. “We need more hard mud tracks and mud trails in our parks and gardens."

Another common complaint of runners is dehydration. “India’s parks need to be properly equipped with potable water, just like in many parts of the world," Verghese says.

PATH TO RECOVERY

We spoke to three runners who are grappling with injury:

Correcting posture

Mahasweta Ghosh, 36

Recovery: After a two-week rest and physiotherapy regimen failed, Ghosh started coming to terms with the idea of giving up running altogether. Then she met her current trainer, Sarandeep Grover. She now trains with him thrice a week. For the first month, Ghosh concentrated on corrections in her posture, mobility and focused workouts. It worked. She is back to running and was a pacer for the 2015 Standard Chartered Mumbai Marathon (SCMM). “Mobility and rolling with a foam roller are the magic words," she says. “I think as long as I continue these; along with a focus on posture, I cannot only continue running, but also move to full marathon distances this year."

Stress injury

Abhineet Awasthi, 23

He suffered the injury while completing the 24-hour challenge at the Bangalore Ultra 2014, when he covered 130km. Because of the injury, Awasthi had to pull out of the SCMM 2015 and ran a slow-paced half marathon instead.

Recovery: Awasthi has cut down on his weekly mileage and the intensity of his training regimen to avoid further damage. He sees a physiotherapist regularly and does the strengthening exercises that have been prescribed to hasten the recovery process. He also ices the affected area thrice a day. “I’ve realized the hard way that icing and strengthening for any running-related injury are the key to faster recovery," he says.

Stretching helps

Kiran Chulani, 46

This leads to a lot of pressure under the toes when she runs long-distance. Sometimes, the nerves under her second toe become very painful. When this happens, she has to stop running immediately.

Recovery: Hallux valgus cannot be reversed unless operated upon. Chulani uses orthotics, and has changed her shoes to minimize further bone deviation. She is also working on re-aligning her foot strike with the orthotics and does a lot of calf stretches to prevent the pressure build-up while running. She uses a night splint and toe spacers to prevent further deviation.

STAY ON TOP OF THE GAME

Recovery is one of the most neglected components of training. Some basic tips:

• Apply ice to joints and injured areas after training

• Foam-roll major muscles as a warm-up and cool-down

• Hydrate adequately

• Taper, or reduce exercise intensity, adequately prior to race day

• If you have an injured joint, taping the area could help prevent further injury

• Sleep. It’s your best weapon

• Ice-bath if you can. Contrast-bath (hot and cold) is also a fabulous method of recovery

• Use the correct gear

• Get massages to flush out lactic acid from the body

• See a physiotherapist every fortnight—prevention is better than cure

• Stretch

• Hydrate and sleep well before training and race day

• Keep reviewing your running form; look at photographs, get running buddies to view your run from every angle

• Adhere to a structured training programme designed by an experienced coach

• Watch videos of good running form and try and replicate after correcting some of the asymmetric issues with your running style

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