Endurance sports have a problem with overuse injuries. The stats are sobering: as many as 75 percent of runners will be injured in a given year. Many of those will come as a result of excessive and repetitive pressure on joints, muscles, ligaments, and tendons, according to a survey by Harvard Medical School. These injuries can sideline athletes for months on end, and permanently impact their capacity to perform.
You’ll never be totally safeguarded from possible injury; but you can take some preemptive action that might make falling victim to overuse far less likely, and develop an eye for warning signs to catch them early before they become a real problem. Follow these guidelines to make sure you’re doing all that you can to protect yourself.
#1. Always Be Moving
Though overuse injuries may appear suddenly, they’re actually a result of strain or stress building up over the course of days or even weeks. This accumulation of micro-traumas doesn’t just happen during exercise. Things like sitting at a desk all day or commuting long hours in a car can contribute to burgeoning back, neck, and hip injuries.
“We adapt to what we do,” says Jay Dicharry, a physical therapist and expert in endurance sport biomechanics based in Bend, Oregon. “And our lifestyle is constantly training our bodies, sometimes for the worse.” To avoid the repetition that leads to overworked muscles and joints, incorporate a bunch of different movements into your day. Sit, stand, walk, stretch—whatever you do, just move regularly.
#2. Strength Train Year-Round
Despite a significant uptick in endurance athletes who swear by their strength work, some people still believe that their weightlifting should halt once they enter their competitive season. That’s not the case. A 2015 study found that when elite cyclists stopped their strength training program for the first eight weeks of a competition period, their performance declined. What's more, Reed Ferber, an assistant professor of kinesiology and head of the Running Injury Clinic at the University of Calgary, says that his clinic has treated 92 percent of the knee injuries it sees through a strength routine focused on building muscle and mobility in the hips.
The key is to keep up the strength work, but to stop doing it 72 hours before a race to allow the muscles time to fully recover, Dicharry says. It’s a strategy echoed by Michael Fredericson, musculoskeletal physiatrist and director of the Stanford Runner’s Injury Clinic. “Strength training should evolve over a competitive season but not stop,” he says. “Closer to competition, athletes should decrease the number of sets and reps, thinking less about endurance and more about explosiveness.”
#3. Fix Your Gait
A tell-tale sign of an overuse injury is a change in stride—some part of your body can no longer do what you're asking it to do, so a different part picks up the slack, creating a limp.
For example, those with ankle or Achilles pain often don’t use their calf to push the heel off the ground when running. That type of compensation can both reinforce muscle weakness and joint stiffness and create problems elsewhere, as other parts of the body are repeatedly asked to do a greater share of the work. It’s one reason why the leading risk factor for these conditions is previous injury.
The only way to fix the issue is to re-train your body to execute the movement, specifically targeting the flaws in form. Even if you don’t have access to a biomechanics lab, apps like RunMatic and Saucony Stride Lab offer smart phone camera-based gait analysis. They’re designed to capture irregular movements and more severe imbalances, and provide recommendations and exercises on how to correct the problems.
#4. Focus on the Whole Body
The posterior chain—mainly your glutes, hamstrings, and lower back—has gained a reputation as the oft-neglected muscle group that’s responsible for many problems in the lower half of the body such as IT band, achilles, and knee or hip issues. While that’s true, putting in extra work to strengthen only your backside neglects other muscles groups like the quad, creating more imbalances. Strengthening your entire body is important for both treating and preventing injury, says Fredericson.
#5. Rest the Right Way
Barring an acute injury or surgery, total rest—a sequence of days without any physical activity—won’t do you any favors, says Fredericson. On the other hand, relative rest—trading in your usual sport for cross-training or light activity—allows your body to restore hard-working muscles and joints without going totally dormant.
While you should give stressed joints, tendons, and muscles the time to heal, it’s equally important to use the help of a PT or orthopedic doctor to correct the strength, mobility, and mechanical issues that caused the injury in the first place. Otherwise, those same problems might re-appear after a rest period.
#6. Eat Enough Calories
The Female Athlete Triad of low bodyweight, low bone density, and hormonal imbalance impacts as many as 60 percent of female exercisers every year. In the case of the Stanford cross-country team, 38 percent of female runners developed stress fractures over a three-year period because of the problem, says Fredericson. But the issue doesn’t stop with women. Fredericson and other researchers have discovered many of the same imbalances in male runners—inadequate nutrition, low testosterone, and low bone density. All of these factors greatly increase the risk of injury.
When your body isn’t getting enough calories, it stops producing normal levels of testosterone and estrogen, leading to hormonal dysfunction. Because your growth hormone levels go down, muscle mass decreases, which in turn lowers the metabolism and leads to lower bone density. That combined with the pounding that comes from high levels of activity can result in a stress fracture, a problem that takes months to heal.
Fredericson’s research explores how a change in diet can greatly alleviate these risk factors. Put simply: endurance athletes need to eat more calories. Focus on eating a balanced diet and listening to your body’s hunger cues, especially on days where you're working extra hard. If you struggle to know what that looks like, reach out to a sports nutritionist to help you develop a sound strategy.