Beginning in 1983, and continuing each year since, the month of May has been declared National Physical Fitness and Sports Month. In the United States, an estimated 110 million people walk and another 50 million either jog or run to maintain their fitness each year. While many who participate in such activities go unscathed, countless others experience a variety of injuries. In fact, about 50 percent of runners get injured each year, with 25 percent of runners dealing with an injury at any given time.  Running injuries can range from simple sprains, strains, and tendinopathies to avulsion fractures and chronic exertional compartment syndrome.

An ounce of prevention is worth a pound of cure. During regular health checks, here are some tips to share with your runners to reduce their risk of injury:

Stretching - While many practice stretching prior to running, the efficacy of stretching on injury prevention remains unclear. Interestingly, attempting to increase flexibility above normal ranges may negatively impact running performance. A 2011 Cochrane systematic review concluded that post-exercise stretching may reduce soreness up to one week after exercise, but the difference is likely not clinically significant. Additional research is needed to determine the efficacy of stretching in both the pre- and post-exercise periods.

Running Form – There is not one ideal running form that fits everyone. Adequate running form should reduce loading forces and stresses, pre-activate muscles, and minimize biomechanical risks. Runners should try to increase their step cadence (> 170 steps/minute), land softly with each step, squeeze their abdominals and glutes, and keep their knees pointed forward. Importantly, fatigue can lead to the breakdown of good form. If a runner has noticeable signs of fatigue (louder steps, longer stride, arms swinging across the body), they should stop and introduce walk periods. After a sufficient walk period, runners can then focus back on resuming the run with proper form to reduce the risk of injury.

A quick way to determine if one's exercise intensity is appropriate is the “talk test". Tell your runner to try to have a verbal conversation (perhaps with a training partner) and evaluate how difficult it is to carry on a conversation while engaging in the activity. If breathing is labored, but they can speak in full sentences without taking additional breaths, they are likely training at a moderate intensity. If talking is a struggle, requiring extra breaths between every few words, they are probably performing vigorous exercise.

Training Regimen – For many, warmer weather leads to an increase in physical activity, and safely ramping up exercise is crucial to avoid injuries. Gradually increase training volume and intensity (no more than 10 percent per week of total weekly mileage). Avoid rapid fluctuations in training patterns. Ensure adequate weekly training mileage for longer-distance races.

About 50 percent of runners get injured each year, with 25 percent of runners dealing with an injury at any given time. 

Tips for treatment and prevention if a running injury does occur:

For minor injuries, the American College of Physicians/American Academy of Family Physicians (ACP/AAFP) strongly recommends using topical nonsteroidal anti-inflammatory drugs (NSAIDs), with or without menthol gel, as first-line therapy to reduce symptoms and improve function and treatment satisfaction. Oral NSAIDs or acetaminophen may be considered to reduce pain.

Correcting training errors may reduce injury recurrence. When taking the patient’s history, ask about weekly mileage, sudden changes in training duration and intensity, changes in running surfaces, and footwear fit and age. Avid runners should consider replacing running shoes that have > 350-600 miles on them.

Recovering from an injury is a good time to encourage your patients to engage in cross-training to preserve cardiorespiratory fitness during rehabilitation. Depending on preferences, cycling, swimming, rowing, elliptical, stair climbing, or jump roping are good options.

After a long winter, getting back outside for exercise can be rejuvenating, fun, and exciting. Remind your patients that gradually re-introducing activity as opposed to diving headfirst into high-intensity, long-duration exercises is important to reduce the risk of injury. For your runners, this advice is key for keeping them on track and out of the pain zone!