Preventing injuries is all about understanding why they happen. It serves no purpose to diagnose the injury correctly if no attention is paid to the cause, otherwise the injury is likely to recur, possibly more seriously than before.
Who better to explain further than Prof Tim Noakes? Here are his 10 laws of injuries.
1) Running injuries are not an act of God
In fact, they result from the interaction of the athlete’s genetic structure with the environment through training methods. They are intrinsic injuries that result from the interaction of three identifiable factors:
- The athlete’s training methods
- The environment in which training is performed (including the shoes that are worn), and
- His or her genetic structure.
Hereditary influences that may predispose us to running injuries relate to lower limb structure, which largely determines how our hips, knees and ankles, and their supporting structures (muscles, tendons and ligaments) function during running.
Because of differences in genetic structure, virtually no two runners function identically. Perfect mechanical function is extremely rare, and is restricted to the handful of runners who run as far as they like in whatever shoes they might choose without ever being injured!
2) Each injury progresses through four grades
The onset of a running-related injury is almost always gradual. Running injuries become gradually and progressively more debilitating, typically passing through four stages or grades:
Grade 1: An injury that causes pain after exercise and is often felt only some hours after exercise has ceased.
Grade 2: An injury that causes discomfort, not yet pain during exercise, but which is insufficiently severe to reduce the athlete’s training or racing performance.
Grade 3: An injury that causes more severe discomfort, now recognised as pain, that limits the athlete’s training and interferes with racing performance.
Grade 4: An injury so severe that it prevents any attempts at running.
Appreciating the distinction in the severity of running injuries allows a more rational approach to treatment.
The athlete with a grade 1 injury does not have to be excessively concerned about the injury as long as it does not progress to being a grade 2 injury. Secondly, you also need not fear that a grade 1 injury that you have had for some time will suddenly deteriorate into a grade 4 injury (the only exceptions to this rule are stress fractures and the iliotibial band (ITB) friction syndrome). Thirdly, the grade of the injury helps the doctor to define each athlete’s pain or anxiety threshold.
3) Each injury indicates a breakdown point
This law simply emphasises that once an injury has occurred, it is time to analyse why the injury happened. This is frequently because the athlete has reached his or her breakdown point, usually because a higher level of training has been sustained for longer than one to which the body can adapt.
Every athlete has a potential breakdown point, a training intensity and a racing frequency at which breakdown becomes inevitable, whether this point is a weekly total of 30km or 300km in training or racing frequency. The key to preventing and treating injuries is to understand that just as most of us will never win a big race because of certain genetic limitations, so our genes limit our choice of shoes, and they determine what training methods our bodies can handle, and on what surfaces we can train.
In short, athletes who are frequently injured do not yet understand or appreciate their bodies’ threshold.
4) Most true running injuries are curable
Only a small fraction of true running injuries are not entirely curable by quite simple techniques, and surgery is required in only exceptional cases. The only possible exceptions to this rule are the following types of injuries:
- Injuries that occur in runners with severe biomechanical abnormalities for which conventional measures are unable to compensate adequately.
- Injuries that result in severe degeneration of the internal structure of important tissues, in particular the Achilles tendon.
- Injuries that occur in those who start running on abnormal joints, in particular damaged hips, knees and ankles.
An important factor to this fourth law is that if you are not completely cured of your running injury by the experts whom you consult, it is time to look elsewhere. But treat even the advice of runners with some caution and do not accept it unconditionally without seeking a professional assessment.
5) Sophisticated methods are seldom necessary
Most running injuries affect the soft tissue structures (tendons, ligaments and muscles), particularly those near the major joints. These structures do not show up on X-rays. You should therefore be wary of being asked to have an X-ray. The diagnosis of most running injuries is made with the hands, so the advice of any caregiver who does not carefully feel the injured site before making a diagnosis must be treated with caution. As with any injury, a correct diagnosis requires a careful, unhurried approach in which the injured athlete is given sufficient time to detail his or her story and training methods.
Seldom is it necessary to use expensive tests to establish the diagnosis, and the treatment prescribed is usually very simple. However, if your injury persists, it may be necessary to undergo a more sophisticated evaluation with a magnetic resonance imaging (MRI) scan or a bone scan.