Professor Noakes: 10 Laws of Injuries – volume 2

Because all running injuries have a cause, it follows that an injury can never be cured until the causative factors are eliminated. Thus surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies are likely to fail if they do not correct all the genetic, environmental and training factors causing the injury.

If an injury is caused solely by running, then the logical answer for those who know no better is to advise no running as the obvious cure. Rest does indeed cure the acute symptoms, but as with any therapy that does not aim to correct the cause of the injury, it must ultimately fail in the long term, because as soon as the athlete stops resting and again starts running, the lower limbs are exposed to the same stresses as before, and the injury must inevitably recur.

Complete rest is unacceptable to most serious runners because running involves a type of physical and emotional dependence. Our advice to injured runners is generally to continue running, but only to the point at which they experience discomfort.

The only injuries that require complete rest are those that make running impossible, such as a stress fracture. Furthermore, if the injury does not respond to what should be adequate treatment within three to five weeks, then the alarm bells should ring loudly.

Almost everyone seems to consider themselves an expert on sport. How, then, do you know whose advice you can trust? There are four simple criteria to apply:

• Your adviser should be a runner. Without the first-hand experience of running, he or she will not have sufficient insight to help you. Of course, this does not mean that all the advice you get from runners will be sound, only that there is a greater probability that it will be more correct.
• Your adviser must be able to discuss in detail the genetic, environmental and training factors likely to have caused your injury. If the practitioner is unable to do this, together you will go nowhere.
• If your adviser is unable to cure your injury, he or she should feel as distressed about it as you do. It is patently ridiculous to accept advice from someone who is antagonistic or indifferent to your running in the first place.
• Your adviser should not be expensive as most running injuries can be cured without recourse to expensive treatments.

The only true running injuries for which surgery is the first line of treatment are muscle compartment syndromes, interdigital neuromas, chronic Achilles tendinosis of six or more months’ duration, lower back pain due to a prolapsed disc, and the iliotibial band friction syndrome – but only when all other forms of non-operative treatment have been allowed a thorough trial.

The obvious danger of surgery is that it is irreversible although arthroscopic surgery, in which a small, flexible fibre-optic cable is placed inside the joint through a small skin incision, may, however, be more readily considered.

Osteoarthritis is a degenerative disease in which the articular cartilage lining the bony surfaces inside a joint becomes progressively thinner until the bone beneath the cartilage on both sides of the joint ultimately becomes exposed. Some orthopaedic surgeons believe that this degenerative process can be initiated and exacerbated by long-distance running.

However, the more modern evidence shows that if running does indeed increase the risk of osteoarthritis, this occurs only in those more elite athletes who run many kilometres in their careers. Recreational joggers are not at any increased risk of developing the condition.

For the first 5 laws, click here.