Professor Noakes: 10 Laws of Injuries

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.

For Laws 6 – 10, click here.

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5 Responses to “Professor Noakes: 10 Laws of Injuries”

  1. Anton says:

    Dear Sir, I would like to find out something please: I started running plus minus 2 years ago…
    My goal is to run my first marathon and then ultra and then comrades. My weight is 112kg and very big bone structure, I was 122kg.
    Everytime after a long run lets say 10km or even a race 21km i struggle with a pinching muscle in my hip and it effects my lower back and knees and its very sore and sometimes it takes long before its feels better.

    I went 8 x to the phesios and that did there stuff but the injury came back after my runs. I done the 2 oceans half marathon this year and bang its back. I stop for 5 months and bang its back after my 7 x 5.5km runs training run….what can it be? and what can i do to fix it ? I dont have lots of money but i love running and i dont want to stop because of the injury…..Thanks you very much for the time reading my comments
    Regards
    Ants

    • Travis says:

      Hi Anton, I’m no Doc, but have been running for a number of years including a few Ultras. First focus on your running form, thats the biggest key factor. THere after ensure you have a good core strength…My Dad had similar pinched “nerve” in his hip, how ever after shortening his stride, dropping a few kg and adding alot of core strength exercises he’s now pain free….good luck on reaching your goals….

    • Heather says:

      I am dealing with a back/hip issue now. Core strengthening is definitely the way out of this injury.

    • Jus says:

      And what about pain that did not exist before and during exercise, but appears around 3-6 hours after? (not muscle soreness)

    • Marius Stegmann says:

      Dear Sir

      My daughter, Megan is 15 years old and started running about 18 months ago. She run cross-country and 3000 and 1500 metres on the track. Lately she has experienced pain on the oursides of her lower calves and extends down into the ankle. The pain progresses in such a way that she can not continue.. I took her for a few sessions to a physio, who suggested that it was not an injury yet, but it is due to improper balance. She suggested exercises to strengthen certain musles etc. The injury persisted and I took her to the doctor, who prescribed anti-inflamatory pills and suggested 2 weeks of complete rest. This did not help at all. I am at wits end, because my daughter is totally addicted to running and is very unhappy because she can’t train. My income is limited because I have just started a new company and can not afford to send her from doctor to doctor. Could you please point me in the right direction? I think that it is shin-splints. Years ago, I had a running injury and went to see Prof Tim Noakes and a group of students for a consult. He used it as a training aid for his students, who first tried to diagnose the problem. Is such option still available?

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