What does the evidence show?
Researchers explore the psychology of running injuries
If you ask your doctor or physical therapist why you’ve been felled by yet another running injury, she might ask you about your shoes and your running form, test your flexibility and strength, and give you some advice about training plans and running surfaces. Chances are she won’t blame it on your personality. After all, stress fractures aren’t psychosomatic.
But lately, researchers have begun to pay more attention to “psychosocial” factors—the influence of your mind and the environment around you on your behavior—that may contribute to running injuries. One of the most intriguing abstracts presented at the American College of Sports Medicine Conference in Minneapolis earlier this month was a preliminary look at potential links between perfectionism and injury risk. It’s early days for this line of research, but the ideas are worth considering.
The study comes from a team at the University of Wisconsin-Oshkosh led by Lace Luedke. They asked 34 college cross-country runners (18 men, 16 women) to complete a questionnaire that measures perfectionist tendencies, and then followed their progress for eight weeks to see if the psychological profile could predict who was most likely to get injured. The apparent answer was yes—definitely. Runners who exhibited “perfectionist concerns” were, remarkably, 17 times more likely to suffer an injury that forced them to miss training compared to the rest of the runners.
The perfectionism scale picks out three distinct sub-factors: high personal standards, which can be helpful; concerns over mistakes, which can be harmful; and doubts about actions, which can also be harmful. When you compare the individual sub-factors, there were some statistically significant differences between the 15 runners who got injured and the 19 who didn’t. The injured runners scored higher on both concerns over mistakes (23.5 vs. 19.9 on that particular scale) and doubts about actions (14.5 vs. 11.4). But it’s the combination of high personal standards with either concerns over mistakes or doubts about actions that seems to be particularly toxic.
The obvious follow-up question is: why? Do perfectionists simply train harder, and get injured more as a result? If so, it’s possible that their lofty goals produce faster race times despite the heightened injury risk, in which case it’s not clear this is a problem. But it’s also possible that perfectionists are more susceptible to bad training decisions—refusing to take a day off in the early stages of an injury, or ramping up training more quickly than their body can handle. (My personal guess, as always, is that both factors likely play a role.) Luedke and her colleagues may eventually be able to shed some light on these questions with further analysis of the data they’ve already collected, which includes details on the training levels and race performances of the subjects.
The mental stress associated with perfectionism may also play a role. When I contacted Luedke to ask about the study, she mentioned another recent study that was published last month by researchers at Wake Forest University in the American Journal of Sports Medicine. This was a much broader study that followed 300 recreational runners for two years, trying to figure which factors predicted who would get injured. They measured all sorts of typical injury predictors—but found that “contrary to several long-held beliefs, flexibility, arch height, quadriceps angle, rearfoot motion, lower extremity strength, weekly mileage, footwear, and previous injury” didn’t have any predictive value (in this cohort, at least).
Instead, the significant predictors in this group were knee stiffness (a measure of how much the knee bends when a given force is applied), along with “worse mental health-related quality of life and more negative affective states, such as being jittery, irritable, and nervous.” The authors speculate that stressed-out runners may be less careful about heeding the warning signs of impending injury. There’s evidence, for example, that negative moods are associated with having a narrower range of attentional focus, so that you may miss cues from your body that are telling you to back off your training.
To Luedke, one of the key questions that’s still open to debate is whether perfectionism is a personality trait that you’re stuck with. In that case, the goal for coaches (and for future research) should be to figure out ways of guiding training programs and progressions to reduce the risks associated with perfectionism. Alternately, if perfectionism is a modifiable state, then the goal should be to figure out ways of dialing it down. Psychologists are still arguing about this question, according to Luedke.
The main point here, I should re-emphasize, isn’t that running injuries are all in your head, or are a punishment for your psychological weaknesses. Still, for anyone who’s been around runners, it’s not hard to believe that there are some personality traits that are associated with injury risk. One of the arguments I’ve frequently made over the years is that we should pay more attention to training errors—increasing mileage too quickly, failing to take enough recovery, and so on—as a cause of running injury, rather than spending all our energy pursuing magic shoes or the perfect running stride. The deeper question, and the one Luedke and others are starting to explore, is why we keep making such obvious errors.
My new book, Endure: Mind, Body, and the Curiously Elastic Limits of Human Performance, with a foreword by Malcolm Gladwell, is now available. For more, join me on Twitter and Facebook, and sign up for the Sweat Science email newsletter.