Running injuries trials & error.

"Have you had your biomechanics checked for an error in running form by a sports medicine expert?" is often heard advice. But the long leg and the short leg of it is that overuse injuries are extremely complex matters and finding an expert to evaluate running form is easier said than done. Part of the problem may lie in the fact that there is no consensus among published studies regarding alignment issues and overuse injuries.

Although it seems logical to assume that poor alignment would cause repetitive stress injuries, surprising little confirming research and much confounding research has been conducted. Many studies are subject to the "healthy runner effect," meaning that injured runners are largely unavailable to participate in studies. Many variables are hard to control (hold constant). Other variables are hard to quantify, are subjective, or they defy observation. While the yearly incidence of running injuries ranges from 37% to 56% of runners, much of diagnosis and treatment is largely based on conjecture and opinion.

In a review of the literature published in the American Journal of Medicine and Sports, authors conclude with a statement of the obvious: the predominant risk factor for running injuries is running. The authors do not intend to be glib. In fact they confirm an obvious point. Malalignment, overtraining, and training errors are difficult to define and study. It is likely that most running injuries are caused by multiple factors, in which case, the more you run the more likely you are to suffer a running injury.

The implications for the professionals who treat runners, and for the injured runners themselves, are simple. To treat a running injury, cut back on running during recovery. Beyond this simple statement of the obvious, there is very little definitive proof of the effectiveness of other widely accepted treatments and prevention advice--ice, anti-inflammatory medications, strength, and flexibility. These and other, common recommendations (like changing shoes, orthotics, and running surfaces), all seem logical and reasonable but still lack the confirmation of well-designed scientific studies.

Of course, it is important to recognize the inverse of this problem. Good studies are also not available to refute the standing theories behind running injuries and their treatment. The bottom line remains the same--running injuries, as logic and intuition would suggest, are probably caused by multiple factors with training variables, particularly running volume, acting on a predisposition to injury. All of which leaves runners right where they started--treating injuries with rest, ice, anti-inflammatory pain medication, and a rehabilitation plan that assesses running and training errors based on a best guess.

(American Journal of Medicine and Sports, 1999, Vol. 1, No. 3, pp. 126-134)