Most people spend a lot of time building capacity – very few train expression.

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By RunTeach – Pain-Free Performance Through Neuroscience

Every coach has said it at some point:

“Keep your legs warm so you don’t get injured.”

It sounds sensible, it feels intuitive, and every athlete hears it at some stage. But is it actually true? And more importantly, is it true for the reasons we think?

At RunTeach, we look at everything through a brain-first lens, not the old, mechanical model of running. And when it comes to warmth, performance, and injury risk, the real story is both simpler and more interesting.

Let’s unpack what the science actually says — and what matters for real-world running.

1. Yes, warm muscles perform better… but only above a certain temperature

Research¹ shows that muscles generate more force, absorb impact more effectively, and become more elastic when they reach around 38–39°C. At rest, your quads might sit at 34–35°C.

Here’s the surprising part:

You don’t get to 38–39°C just by putting tights on.
You get there through running at a moderate or hard effort for about 15–20 minutes.

Studies using intramuscular probes consistently show that:

• Light jogging barely moves the needle
• Clothing raises skin temperature, not deep muscle temperature
• The temperature that affects elasticity only happens after sustained effort

So if the old advice was literally true — “warm muscles prevent injury” — you wouldn’t reduce injury risk until the middle of your tempo run!

But athletes feel better long before that, which means something else is going on.

2. The real reason warmth helps: It improves the nervous system, not the muscles

This is where the myth starts making sense.

Warm legs feel:

• Looser
• More coordinated
• Less “stiff”
• More confident

These changes happen far too quickly to be caused by deep-muscle warming.

They are caused by the nervous system, not the tissue.

Cold skin changes how the brain controls movement

Cold reduces:

• Nerve conduction speed
• Joint position sense
• Reflex timing
• Coordination of hip/ankle mechanics
• Confidence in landing and push-off

And that stiffness you feel when you’re cold?
That’s not tight muscles — it’s your brain increasing co-contraction as a protective strategy.

Warmth sends a “safety signal”

Warm skin improves:

• Sensory clarity
• Proprioception
• Rhythm and timing
• Stride fluidity
• Impact absorption
• Running confidence

Most runners interpret this as “my muscles are warm.”
What’s actually happening is “my brain is happy.”

3. Injury risk is reduced through “neural safety,” not muscle temperature

Running injuries don’t come from cold muscle tissue.
They come from:

• Poor gait coordination
• Inconsistent movement patterns
• Loss of proprioception under fatigue
• Inefficient impact handling
• Protective guarding
• Stress accumulation from suboptimal control

Warmth helps because it improves movement control, not muscle mechanics.

This is why you can feel “stiff” in the cold even after a warm-up — the tissue isn’t cold, the skin is, and your brain is still interpreting that as threat.

4. The practical truth for athletes and coaches

Here’s the distilled version:

Warm clothing does not meaningfully warm deep muscles.
But it does improve neural control, which improves performance and reduces injury risk.

So wearing tights or layers is absolutely worthwhile —
just not for the reason most people assume.

The benefits are real, but they are neuro-driven:

• Better movement quality
• Lower co-contraction
• Better proprioception
• More fluid stride
• Enhanced force absorption
• Lower perceived threat
• Improved running economy

In other words:
Warm legs run better because the brain works better when it’s warm.

5. The RunTeach takeaway

If you want to reduce injury risk, you need to think brain-first, not muscle-first.

Warmth matters, but because of how it influences the nervous system, not because it heats muscle tissue.

When athletes understand this, they stop chasing “warm muscles” and start optimising neural readiness — which is what RunTeach is all about.

1. See the research above ↩︎

The post Do Warm Muscles Reduce Injury Risk? appeared first on RunTeach.

Here’s a 60 second overview:

Warm tights or leggings don’t significantly warm the deep muscles that matter for performance or injury risk. To do that, you actually need around 15–20 minutes of moderate-to-hard running to raise quad or hamstring temperature to the levels that improve elasticity (studies at the end).

So why does warming up or wearing layers still help?

Because it affects the nervous system, not the muscle tissue.

Cold skin slows down nerve signals, reduces proprioception, increases muscle co-contraction, and makes your brain feel less confident in your movement. That “cold, stiff” feeling is really your nervous system protecting you.

Warm skin, in contrast, improves sensory feedback, movement coordination, stride fluidity, and confidence.

Warmth helps the brain run better — not just the muscles.

So yes, keeping warm reduces injury risk, but indirectly:
better neural control = better movement = lower risk.

Wear layers for comfort and neural quality,
not because you think it’s magically “warming the muscles.”

For a deeper look at this, read the full article here.

The post Should I wear leggings in winter? 60 Second Overview appeared first on RunTeach.

Like many runners who have pain, Sam’s first angle of attack was to look at his running form. In fact, almost every runner who comes to see me starts by asking for a gait analysis as they believe it must be their ‘poor’ running form that’s resulting in their pain or lack of performance. While on the surface it may look like their running form is the cause of it all, but believe it or not, it’s rarely the case – and Sam’s case highlights this perfectly.

Your running form is simply an output – it’s a set of movements produced by your ability to control and coordinate your muscles, joints and other tissue. You can think of it a bit like the final product of a cake-baking process. If your ingredients, method or process are substandard in any way, the resulting cake will not be what you want. The best way to get a good cake is to ensure that the ingredients, method and process are exactly what’s needed to produce the cake you want.

This is exactly the same with your running form. In the case of human movement, the ingredients are the sensory input signals from all over your body; the method and processes are what your brain does with that sensory input and how it integrates it; your running form is the eventual output.

Given that Sam’s shin and calf pain only came on beyond 10k tells us that something about the quality of his inputs or processing and integration wasn’t quite right. And yes, this probably was being displayed somewhere in his running form and I could have gone down the route of measuring angles, looking for muscle weakness and all the traditional stuff – but I chose a much more direct route first.

I started by testing what he could feel from his right calf and shin. Sam had his eyes closed and was to tell me what he experienced. I applied hot and cold touch. I followed this with pressing a sharp point or a dull point at various points. I tested light tough, heavy tough and vibration. In all areas we tested, except one, Sam could feel all these sensations so I knew that his brain was getting a pretty clear map of where his calf and shin were: but not a totally complete map. There was a very small area, no bigger than 2cm round, where Sam couldn’t feel any sensation at all. It was a tiny paler area of skin from a very old scar that Sam didn’t even know was there. Could that be the issue? 

I then did some skin stretch testing on that specific area and found there were some barriers, indicating further that this tiny area was messing with Sam’s braid-body map. I did a bit of work to release the barriers and we retested Sam’s movement quality: in this case we were testing ankle range of movement and calf tightness. We immediately saw an improvement so I knew we were onto something. Then came the really weird bit!

I wanted Sam to get more in touch with the sensory information that was coming in from that area of his skin. To do this, I wanted to dull down two of his primary sensory inputs – vision and hearing. Sam then stood up tall, put on a blindfold and a pair of ear defenders. His drill was to find his way down to the ground, roll over on the outside of his calf where the target area of skin was, and then come back up to standing. He was to do this five times.

The retest after doing this exercise was outstanding! Sam’s calf tightness had all but disappeared and his right-side ankle range of movement increased dramatically.

Sam’s homework for the next few days was to repeat this exercise at home once or twice per day, and just five reps.

Within five days Sam’s shin and calf pain had gone completely! Totally vanished! When he came in for his first proper session with me a couple of weeks later, he had already increased his long run to 14km and was completely pain-free. That was a couple of months ago (June 2025) and Sam has had a couple more sessions with me, and this time we were able to go straight to improving his technique – which he did in a single session – because the stability of his right side was now not an issue and we could look at optimisation. But just from that first exercise, Sam’s pain resolved and it has never come back even though he is now a good way through his half marathon training.

Why was this area causing Sam pain? Because his brain-body map was incomplete, Sam wasn’t able to effectively stabilise his knee and ankle joints reactively (unconsciously) as he was running. When he increased his distance, the skill requirement for stability also increased, especially as fatigue creeps in. The incomplete brain-body map was stopping this from happening so his brain produced the pain experience to get him to stop – it was red-flagging him that something wasn’t right.

As soon as we completed the brain-body map, he was suddenly able to stabilise his joints again and his brain was perfectly happy and safe with him increasing his distance.

Your brain and nervous system are amazing, and by working at their level and communicating with them directly, you really can make life-altering transformations – just like Sam did.

My Runner By Design membership takes everything I do with my clients on a one to one basis, and makes it available online as a set of assessments, courses, education and live coaching calls. It’s designed to take you on your next steps of your running journey, including helping you get out of pain and enjoying your running again.

To find out more, click here. 

The post The Tiny Scar That Solved Two Years of a Runner’s Pain appeared first on RunTeach.

Jeff, a male runner in his 60s, contacted me about his persistent right-sided runner’s knee pain. For over three years, it had been a constant companion, sometimes completely stopping him from running.

He’d seen his local doctor, and when they couldn’t find anything definitive, he turned to a physiotherapist. Jeff had one session every week for three months! Think about that for a moment: 12 weekly sessions, a significant investment of both time and money, all hoping to get back to the sport he loved.

Sadly for Jeff, 12 sessions of physiotherapy made no difference to his knee pain at all. In fact, Jeff also had very tight hamstrings, a problem he’d lived with since his younger years, and the physiotherapy hadn’t solved that either.

Jeff told me he’d managed to get back to running himself by using a neoprene sleeve over his right knee. This allowed him to run almost pain-free, which was incredibly intriguing. He actually had three different knee sleeves: a thin neoprene one, a more robust one with a small hinge, and an even thicker one with a stronger hinge. None were solid, just varying thicknesses of neoprene. While these sleeves allowed him to run almost as far as he wanted, they were a real inconvenience to lug around and wear on every run.

Unlocking the Nervous System: The First Breakthrough

So, Jeff came in for a running and movement assessment. We went through a thorough, personalised set of tests and observations. As with all my assessments, some tests are designed to discover the effectiveness of certain drills or sensory stimulation methods. As part of this, using specific drills and sensory stimulation, we actually solved Jeff’s long-standing tight hamstring issue in about 45 seconds! No joke – 45 seconds! This immediate improvement hinted at the power of working with his nervous system.

His knee pain, however, was a different story. Satisfied that the various scans Jeff had undergone over the past three years showed no specific tissue issues, I carried out extensive sensory testing around Jeff’s right knee. We discovered he couldn’t feel the sensation of cold on a small patch of skin on the outside of his knee. This was a crucial clue, suggesting that his brain wasn’t getting clear signals from that area, almost like a ‘blurry GPS signal’ for his knee. When your brain doesn’t have a precise sense of where a body part is, it can’t control and stabilise it properly, often leading to pain. We confirmed this by doing some squats; his right knee pain was instant, and I could see his control was poor.

There was a possibility then, that when Jeff wore one of the knee sleeves, his skin was heating up, and this extra warmth was making up for the lack of cold sensation, helping to sharpen the brain’s map of his knee. I applied cold sensory therapy to Jeff’s knee for the rest of the assessment, and we retested the squats. This massively improved his squat control, and there was virtually no pain. Running on the treadmill was also much better with less pain. I sent Jeff home with some cold therapy drills and other knee-mapping exercises.

In our next session, Jeff reported he could now run a couple of kilometres pain-free without the knee sleeves, but any longer, and it became very painful. However, he could now walk completely pain-free. I felt we were on the right track with sensory input, so I did more testing and re-testing. I gave Jeff some more mapping exercises to do at home. At his next session, Jeff said he could run a bit further now, but was still lugging one of the knee sleeves around in a backpack because beyond 3 or 4 km, he was still getting terrible pain.

Decoding the Knee Sleeve: The ‘Aha!’ Moment

So, I took to my large whiteboard, and together, we reverse-engineered exactly what the knee sleeves might be doing. Now, Jeff was like a lot of runners I see in that when he has pain, he immediately associates it with some form of tissue damage. Even though I had spent considerable time explaining and demonstrating that actually, it was his nervous system reporting false alarms of threats, Jeff struggled to move away from “it must be a tissue-issue, and I might be making it worse by running on it without the sleeve.” This made it even more important to figure out what the sleeve was actually doing.

Given that the sleeves were all made of neoprene, they offered minimal muscle bracing or structural support. This was a tough concept for Jeff to grasp initially. But by demonstrating how his knee could still freely move in all directions, even with the thickest sleeve, he started to understand that it wasn’t providing the external structural support he assumed.

So what was it doing for him? We knew his knee was probably heating up a bit, and therapy around the cold sensory deficit helped, but there was something else more important for his brain. Then Jeff mentioned something that made my brain go into overdrive: sometimes he would stop his run and massage the outside of his knee, and this helped reduce the pain. Bingo! It suddenly clicked.

Through a specialist technique, I tested how his brain responded to different types of touch on his skin – specifically, how it reacted to skin being stretched and skin being compressed. I discovered that by applying decent pressure directly onto his skin, compressing it in that specific spot, he could squat completely pain-free. This included single leg squats, which he could never do before due to pain and lack of control. This was it! This was the missing piece!

The Ingenious Solution: A Small Piece of Tape

But obviously, I wasn’t going to follow him around pushing on his knee! So I came up with an ingenious, simple solution: a small, 6cm strip of kinesiology tape. I applied the tape in a very specific way, creating that precise skin compression in just the right spot. Jeff tested this on the treadmill, and just like that, he was pain-free! I cut some more strips for him to take away and taught him how to apply it, sending him a supporting video of him applying it to his own knee for reference.

At his next session, he was over the moon! He could now run more than 21km completely pain-free without hauling around those bulky knee sleeves. All he needed was a small, easily portable piece of tape. He carried several pieces with him when he went for a run; they’re so easy to pop into his pocket – no more heavy backpack!

We did some other mapping work at that session, but Jeff decided that now he could run pain-free and race half marathons again, compromising by sticking a small bit of tape onto his knee was the perfect cost/benefit ratio for him.

Your Brain is the Key to Pain-Free Running

I love stories like Jeff’s because they illustrate that even when someone holds onto the ’tissue damage’ belief, their running and their life can be profoundly transformed by working with their brain and nervous system. You don’t need to be a “believer” in neuroscience for it to work!

So, if you’ve been battling pain for more than a few months, and scans show no specific injury, or perhaps a past injury has long healed, it’s time to look beyond the obvious and start exploring the incredible power of your brain and nervous system.

To help you understand this often-overlooked aspect of pain, I’ve created a completely FREE mini-course specifically for runners which you can find here.

To access the FREE course you will need to create a free account on the course platform.

Important Note:
Jeff had already seen medical professionals before he came to see me. He had also undergone several scans so was confident there was no physical injury.

It is very important that if you suspect at all that you may have a physical injury then you must go and get it checked out by a medical professional. Nothing in this article nor in anything that I teach, suggest or recommend, replaces the knowledge and experience of a trained medical professional when it comes to acute injury. Please do not ignore the fact that physical injuries do happen, so ensure you receive the care you need.

The post From Three Years of Runner’s Knee to Pain-Free Half Marathons: Jeff’s Story appeared first on RunTeach.

If you are like most of the runners I speak to, you’ll only do a warm up selectively – usually before a race. The rest of the time you just get out and run. Now, I’m not here to pass judgement, and in fact there is very little hard evidence that supports the standard type of warm up most of us would do in terms of reducing your injury risk or improving your performance. The key is personalised neural primers.

That’s not to say your standard warm up is not doing anything at all – you’ll find some runners swear by a warm up where others say it does nothing for them. Interestingly, part of the reason for this polarity in results is the effect of prediction. Your brain gets good at what you do most, and starts to expect it in certain contexts. So, if you’ve always done a warm up and then you suddenly stop, your brain may see that as a threat and is wondering why you’re not doing it. As a result, you don’t get to feel as good as normal and may be more tense, not quite feel balanced or just a little off. The same goes for those runners who don’t normally do a warm up: they suddenly do a warm up and their brain is going “what’s going on – this is strange”.

In both cases, there will be runners who benefit from not doing a warm up who used to do one, and runners who’ll benefit from doing a warm up when they never used to do them – such is the uniqueness of your nervous system. Either way though, doing something before you run can be thought of as a neural primer.

As the name suggests, a neural primer is getting you ready for what’s coming next. To take full advantage of the power of neural primers, it’s best to design them purposefully. So while any old warm up could possibly help to some extent, if it’s not designed specifically for your nervous system and for the aims of the race or session you are about to do, it could set you back before you’ve even started. How could that be the case?

The problem with ‘generic’

We live in a world of personalisation, from tailored social media feeds to glucose monitor-based diets and of course, personalised feedback and recommendations from your favourite running watch and apps.

It’s widely recognised that personalised services are more effective than their generic counterparts, if the data used and the algorithms are accurate of course. However, when it comes to warming up and preparing for a running session or race, the closest most of us get to a personalised warm up is making it run-specific rather than for a different sport. But is settling for a generic warm up setting you back?

Generic is easy; much easier than tailoring services and advice for an individual. However, there is a trade-off in that the generic solutions simply won’t be as effective for 30% to 50% of people. This is not a scientific figure I admit, but it’s a rough split based on all my clients over the years and from discussions and observations from and with other professionals in this space. 

You have most likely experienced this yourself as well. In a group fitness class there are some people who’ll love it and do really well and there will be others who just don’t get on with it at all. How about that mobility course you bought online – how did that work out for you? Maybe you’ve done some Yoga and have tried several different types of Yoga before you found one you got benefit from.

When it comes to warm ups and neural primers, personalisation is the way to go if you want to enjoy your running more, reduce pain and improve performance. But why?

Your uniqueness

Just like your fingerprints, your nervous system is unique to you. In fact, it’s even more unique than finger prints because even identical twins with identical DNA will have different nervous systems because they’ve had different variations in their experiences throughout their life, no matter how small those variations may have been.

You see, your nervous system is being shaped and moulded in every moment of every day. Every experience you have at any given moment in time results in changes in how your brain is wired. Sometimes these are very small changes and sometimes they can be large changes – but change is guaranteed and is a continuous process. This is what creates the uniqueness of your nervous system: it has been shaped and moulded like no other nervous system.

This uniqueness is what you can target to improve your performance, reduce your pain and increase your enjoyment of running.

There are, of course, some baseline similarities between your nervous system and everyone else’s. There are some generic exercises and drills that most people seem to benefit from, and there is a general process by which you can improve your nervous system’s performance. It’s a bit like lifting weights will make most people stronger and achieve bigger muscles (if that’s their goal), but if you really want to perform then you need to tailor those muscle-building exercises for you.

And just like tailoring what you do to improve your running is important, tailoring what you don’t do is just as important – perhaps more so. And this is often why generic solutions just don’t work for many of us.

Performance, Neutral, Rehab

Whenever I design a session or exercise stack for someone, whether it’s to help them get out of pain, improve their performance or to enhance their enjoyment of sport and life, I always look to categorise the exercises for them. The categories I use are:

The only way I can help categorise the drills and exercises for you is to assess them with your nervous system. A performance drill for someone else may be a rehab drill for you. For example, leg swings in a running warm up may make one runner feel loose and amazing. But when you do them they stiffen your hamstrings up, and you start your race with slightly wooden legs and feel terrible.

This is why a generic warm up may make you worse before you even start your session or race.

I’m sure you’ll agree that if most of the exercises you are currently including in your running warm up are either neutral or rehab exercises for you, then at best you’re not doing much to positively prime yourself, and at worst are negatively impacting how you move and run before you even cross the start line.

The same goes for pain. Well-meaning friends, family and even some professionals often give out advice and exercises that have worked for them or clients of theirs, but could make you worse! If they are not taking the time to assess and re-assess the impact of those exercises on your nervous system, then they don’t really know that those drills and exercises aren’t holding you back instead of helping you.

Designer warm ups

So the only way to improve your running and reduce your pain is to use solutions that work for you. And this is the power of a personalised warm up with neural primers designed to work with your nervous system and not against it.

In the next article we’ll get into some of the base neural primers that most people get a good return from. But of course, I’ll show you easy ways to assess and re-assess so you can be sure. Sometimes, just a small variation to an exercise or drill is all that’s needed to move it from one category to another. 

An important note: Even though the rehab exercises and drills can make you worse, these are often the ones you need to do in a controlled environment and at an appropriate time if you really want to improve. But you need to make sure the timing of these matches your goals. The last thing you want to do is a rehab exercise and then go and race. But you might sandwich a rehab exercise between two performance exercises on a rest day, after a run or even a couple of hours before an easy run. 

This is such an exciting area where you can make real gains in performance and enjoyment as well as pain modulation. I’ve been blown away by some of the results I’ve personally experienced and seen from my clients from well-designed routines and exercise stacks including tailored versions of base neural primers.

To find out more about pain and how individualised it really is, click here.

The post Is Your Warm Up Slowing You Down? appeared first on RunTeach.

Common running injuries – what the research says

According to various research studies, Runner’s Knee (Patellofemoral Pain Syndrome) is the most common running injury, followed by Plantar Fasciitis (foot and heel pain). The graph below shows some more details:

The data for this graph has come from research studies conducted mainly between 1980 (Noble, 1980) and 2018 (Mulvad et al., 2018; Sahu et al., 2018) with the most often cited in blogs, articles, courses and presentations coming from 2002 (Taunton et al., 2002). It strikes me that more updated research is due, although there are a couple of more recent studies we can look at but it’s not enough to get a full picture of the current situation.

The first is a one-year study by Desai et al., 2020 where they found a 46% cumulative incidence of running-related injuries, with the knee (27%) and Achilles tendon/calf (25%) being the most common injury locations. As this study looked at runners who had a previous history of injury, it was slightly different from some of the other research. What is most interesting in terms of location is that again, the knee was the most common site of pain.

I’m always interested in what the definitions of a running related injury are in studies, and in how the experience of pain is reported. In this particular study, they used the following consensus statement:

“a running-related musculoskeletal pain in the lower limbs or back that causes restriction of running (distance, speed, duration, or training) in more than 66% of all training sessions in 2 consecutive weeks or in more than 50% of all training sessions in 4 consecutive weeks, or that requires the runner to consult a physician or other health professional.”

To me, the really interesting part about that qualification of a running-related-injury is that it is self-reported, and even if the runner consulted a physician or other health professional, there is no mention as to whether there needed to be any actual tissue issue – something that will become relevant shortly.

The other recent study was by Stenerson et al., 2023. This was a survey driven study, so again it relied upon self-reporting – in this case the responses were submitted anonymously. The aim of the study was to look at the relationship of overuse injuries and training parameters. They found that most runners (84.4%) had an injury history with 46.6% experiencing a running-related injury in the previous year. There was a slight difference in location with the foot and ankle (30.9%) being the most common site of reported pain followed by the knee (22.2%).

What is clear to me from all of these studies is:

1. The existence of an injury is determined by an experience of pain rather than any evidenced tissue issue such as fractures, lacerations, torn muscles, muscle strain or any other physical damage. This itself is actually a positive, or would be if it weren’t for most people’s current understanding and beliefs around the word injury.
   
2. The experience of pain is self-reported, and only provides information on the location of the pain, not necessarily the site of an injury, if indeed one exists. It is now well understood across several professions that where pain is experienced and where a physical injury may be present, are often not the same place.

There are other limitations as well, such as the researchers’ own biases and beliefs around pain and their interpretation of what pain might mean in the context of a runner. But let’s put these things to one side for now, as the two primary limitations I highlighted above are more than enough to be concerned with.

What we need to do is start making some distinctions around injury and pain, and update ourselves on what is really happening when we feel pain. This is exactly what this article, and the next few articles, are all about. Sit back, buckle up and open your mind – we’re going on a journey into the wonderful world of pain!

I’m injured!

But are you? How do you know? Did a running buddy say it was runner’s knee or ‘plantar f’? Yes, you’re in pain – but does that mean you are injured? Perhaps it depends on your definition of injury. Here are some of the common ones:

Medical Definition

“Injury”: Damage or harm caused to the structure or function of the body due to an external agent or force.

Source: World Health Organization (WHO). The WHO includes injuries in its International Classification of Diseases (ICD), defining them broadly as any physical damage caused by external factors, including trauma and poisoning.

​​Sports and Physical Activity Definition

“Injury”: Any physical complaint sustained during training or competition that results in the athlete needing to stop, limit, or modify their activity.

Source: Consensus documents from sports medicine organisations, such as the International Olympic Committee (IOC) and the American College of Sports Medicine (ACSM).

Occupational Health Definition

“Injury”: Physical damage arising from a specific incident or exposure in the workplace, such as cuts, fractures, burns, or musculoskeletal strains.

Source: Occupational Safety and Health Administration (OSHA) or similar regulatory bodies worldwide.

There are also legal definitions and psychological definitions, but they take us a bit wide of the mark for what we are learning about here. 

You’ll notice that two out of the three definitions above state that tissue damage has taken place, while the Sports and Physical Activity definition just mentions a physical complaint. Why is it important to notice this? Well, it highlights the fact that most official definitions, like most of our beliefs, support the idea that an injury has a physical damage element. This in itself isn’t really an issue, except for the fact that almost all of us link pain to injury, and therefore are linking pain to physical damage. This is the problem.

It is encouraging though, that the sports definition recognises, perhaps indirectly, that physical damage doesn’t need to be present for an injury to exist. This is helpful because we can say in this context that we have an injury without there necessarily being any physical damage. It frees us to have a pain that stops us from running without there needing to be an assumption that physical damage exists. If we all thought like this, some of the research would be more helpful: instead of looking for a physical tissue issue reason for a runner’s knee pain, we would automatically be taking lots of non-tissue issue possibilities into account as well. 

You may think I’m being really picky (I am!), but I feel it’s important because those studies on common running injuries are all based on some variance on the medical definition of an injury that includes an assumption (or foregone conclusion) that physical damage is present as well as pain. This is very limiting to us as runners as it brings in feelings of fear that we may further ‘damage’ our tissues, or that we need to spend weeks or months seeing injury specialists that are basing their (almost always well-intentioned) solutions around the fact that there is some aspect of physical damage or physical movement issue when there may be none at all.

In fact, there is some research (Van Mechelen, 1992; Vincent & Vincent, 2017; Salzler et al., 2020) that suggests that between 20% and 56% of runners report pain even though the original physical damage has long-since healed. This is what we call a chronic pain state. But I would suggest that even that percentage is on the low side; the research isn’t there to determine this one way or the other unfortunately, and with the varying definitions of injuries and outdated beliefs around pain, it is more reliable to look at what is happening in the pain neuroscience fields and learn from that.

It may seem like you’ve read a lot in this article so far and not moved forward much, but getting a background to what you hear and are told (even by medical professionals) about injury and pain is important as it allows you to put it all into context with your own pain.

The real point I want to make here is that we say “I have a running injury” when what would be far more helpful is to say “I have a running pain”. This frees us from making a possible incorrect assumption that there is always physical damage that we need to be wary of.

I know, this can be challenging and it’s far easier to carry on thinking as you have done, but making this paradigm shift can open up a whole new selection of possible solutions that could get you out of pain and back to running very quickly – and at a fraction of the financial cost.

To summarise this section:

• Most definitions of injury include some aspect of physical tissue damage.
• Most of the research around running injuries use some variation of these definitions of injury, so an assumption is made that there is a physical tissue damage element – even if that is only how we as non-scientists interpret it.
• We have read, listened, watched, been instructed about, taught, and been convinced that pain and injury are inseparably interlinked.
• This thinking is limiting our pain modulation and rehab options, and is often the primary cause for runners not being able to return to running sooner.

It’s time to break away from these limiting beliefs with a new understanding of how pain works and what we can do about it. Join me for the next article where we’ll dive right in.

The post Running Injuries and Pain – 1 appeared first on RunTeach.

I’ll present one case study here, and follow up with more over the coming weeks.

Firstly though, for the avoidance of doubt, tissue issues are real things. Strains, sprains, tears, breaks – they are very real and just because they may not always be associated with pain (but in most cases they are for the reasons mentioned in Part 1), if you are in any doubt whether you have a physical injury or not, then you need to get seen by a medically trained professional – ideally someone who has experience of dealing with active people and specifically runners.

OK, now we have established that, let’s start looking at some case studies where runners have come to me with painful knees, hamstrings, ankles, IT Band etc. In many cases they have had this pain for months and months, and a few of them have had the pain for years and have seen a wide variety of very well meaning professionals that have helped somewhat but not quite got to the source of the issue. I want to give you a high-level overview of how they presented, some of the things I tried; what didn’t work and then what did work (with varying degrees of success).

Runner 1: Outside of right knee very painful for the last three years.

Introduction

Runner 1, we’ll call him Jim as that’s not his name, came to me for a running assessment as he had been getting pain in the outside of his right knee for the past three years. The only way he could run without pain was with a knee brace. He had a number of different types of knee brace from simple thin neoprene ones to more sturdy neoprene ones with built in hinges. This last type was the one he used most often as it gave the best relief, although it was quite cumbersome and very hot to wear.

Over the previous three years he had seen different practitioners, and at one point saw a physio once per week for three months. Unfortunately, nothing worked and the end result was always the same – he had to go back to running with a knee brace.

He eventually came to me on a recommendation. Jim’s thoughts were that something about his biomechanics (running technique) was leading to the knee pain and if he could improve his technique the pain would go away. Jim was also very concerned that if he ran with the knee pain (i.e. without the brace), he would be doing himself damage and severely injure the tissues.

The assessment

I always start my assessments with some basic pain and neuro education. After listening to Jim’s background and discussing his pre-submitted health forms, I explained how pain and movement works through an applied neurology lens. I often begin this education piece with the information in Post 1 of this mini series and expand from there as necessary. I find this helps to relieve some of the fear that you may have over damaging tissue when you run in pain. Let’s be clear though, running through pain is never a good idea, but the reframing of pain Vs injury helps you to take a step back and look at your situation more objectively.

Following this discussion, I stuck a load of dots on Jim and observed him walking up and down my office; taking video for discussion later in the assessment. How you walk gives me a wealth of information about how well your brain and nervous system is integrating with your muscles, and how well you unconsciously control certain movements. Jim then walked on the treadmill as it gives me slightly different data, and then he did a very small amount of running (both barefoot and in shoes) so I could capture the most important movement patterns as he ran. Now onto the really fun bit.

The rest of the assessment was made up of lots of brain-based tests and drills designed to look at Jim’s movement patterns specific to running. So in this section, I’m looking for things like coordination, agility, stability (both conscious and reflexive), balance, and your ability to express and control strength in certain movements. In Jim’s case, I also wanted to look at his sensory system in depth. From Jim’s pre-submitted forms, I had designed some tests to specifically assess how his sensory input may be contributing and impacting his knee pain.

Sensory Mapping

You may not be able to fully appreciate why this is important, so let’s take a very brief detour into the world of sensory mapping…

Without wanting to go into any complicated explanations, science has revealed to us that you have a number of virtual maps of your body that sit in various areas of your brain. These maps detail parts of your body with particular reference to controlling movement. The only way these maps can be kept to date is through the sensory input that comes in from those areas. If the maps go out of date or get blurry, your brain cannot accurately identify where that body part is so cannot move and control it well.

If the brain doesn’t feel ‘safe’ in knowing where a body part is, you won’t be able to be strong in that area and you may well be inaccurate when trying to move. Let’s just say that the body part in question is your knee. If this map is blurry, then your brain cannot identify where your knee is, so it can’t move it well. In addition, this inability to move well spills over into not being able to stabilise your knee joint.

As I’m sure you can imagine, when you are running your ability to stabilise your knees is very important. If you aren’t able to do this, your brain doesn’t feel ‘safe’ and predicts that this could lead to a physical injury. In order to get you to do something about it (initially, to stop this threatening activity of running), it gives you the experience of pain. But get this, it may not be the map of your knee that’s blurry. It could be your ankle or your hip and your brain is using pain in the knee because it knows you’ll pay attention to it.

Updating Jim’s Brain Based GPS

Through the sensory testing, I discovered that Jim’s right leg had a much lower sensitivity to vibration, heat and cold. This was most pronounced around his right knee and right ankle. The maps of these areas, therefore, were not being properly updated as there were significant sensory mapping data missing. So the first part of my mission to help Jim run without knee pain was to begin updating those brain maps.

To help update the maps and to also start to improve Jim’s right sided reflexive stability, we spent a couple of sessions where we combined cold sensory input around his right leg with loaded coordination and accuracy drills. This involved exercises such as accuracy shoulder circles, banded punch outs using my reaction lights, and mobilising the nerves around his right side pelvis and right leg.

As we started to make changes, Jim started to feel better about his running and was doing a bit more – and he had ran twice the preceding week without the knee brace. We then started to see the impact of not having the required level of skill to stabilise his joints to the degree needed for an increase in his running. Over the past months, Jim had also had left heel pain but this had been secondary to his right knee pain so wasn’t an initial priority. Now, however, it started to feel worse. Jim had changed running shoes which may also have been a factor, but the main challenge was that he still hadn’t developed the necessary stability skill, and clear brain maps, that he needed in order to increase his running. Determined as ever, Jim was due to run a trail half marathon in a couple of days.

Although that race went well, it was clear that Jim’s left heel pain was now the priority. We shifted focus slightly to deal with that while Jim was still doing the brain mapping exercises for his knee. After a few weeks of doing the exercises, Jim’s heel pain had improved and we put our focus back onto his right knee.

We spent some more time clearing up Jim’s brain maps with a variety of exercises designed specifically to challenge his brain and nervous system to clear the maps up.

The Big Breakthrough

Jim could do a few runs a week now without the brace, and even went for a period of a couple of weeks where he didn’t wear it at all. However, he had become somewhat reliant on it from a comfort perspective. Jim had used his knee brace for so long that his entire belief system about his knee pain was firmly attached to his use of the knee: with the brace, he had no pain and felt fully confident in running up 13 miles. Without the brace he could run without pain, but was always on edge about the possibility of impending tissue damage because he didn’t have the knee brace supporting him.

So now I had the added challenge of changing Jim’s belief system so we could reduce his anxiety around running without a knee brace. As part of this process, we also looked together in some detail at what the knee brace was actually doing for him.

The first thing I did was to demonstrate that his knee brace wasn’t giving any real support to his knee joint at all. It was just a neoprene brace with some plastic hinges built in. Although it was a bit weighty and felt the part, the truth was that Jim could move his knee into every angle very easily and the brace didn’t stop him. If it truly was providing any kind of positional or rigid joint support, he shouldn’t have been able to do that. So if it wasn’t providing significant joint support, what was it doing that was making his running completely pain free when he wore it?

We looked next at whether the heat being generated by the brace was making up for the lack of cold sensory input that Jim had in his knee, and therefore helping to update his map on the fly. There was good logic around this, and if the brace was heating the skin then this would help clear up the map as he was running. This in turn would help his brain activate the muscles better and stabilise the joint: no threat, no pain.

Then Jim told me that at the times when he wasn’t wearing the brace, if his knee hurt he would massage it in the painful area and this often allowed him to continue running for a bit longer. So I decided to get Jim to do some safe exercises that nevertheless irritated his knee, so I could do some testing. Jim started doing single leg squats and sure enough his knee pain came back. So I checked the skin mobility around the relevant area and discovered that it didn’t move very well. Skin stretch and fascial stretch (the deeper layers of tissue) are important sensory inputs that also help to map out your joints, and for Jim the skin stretch sensitivity in that area was poor.

I had Jim squat again but this time I made contact with his skin in the relevant area around his knee at an appropriate firmness and depth, and his knee pain simply vanished. I learned from this experiment that Jim’s knee brace was giving him firm pressure and pushing layers of his skin together which was providing the necessary sensory input to complete the brain map and allow his brain to control and stabilise his knee.

After some more experimentation, I came up with a personalised taping strategy that provided the same pushing together of Jim’s skin and fascial layers. So I managed to replicate the benefits the knee brace was giving him with a simple single piece of kinesiology tape strategically applied, that was both more comfortable and more practical than lugging a hinged knee brace around. Jim found he could complete all of his runs totally free of any knee pain as long as he had used the taping strategy before he ran.

So the big lesson here is that Jim’s lack of sensory input from his skin and deeper layers of tissue in a small area near his right knee, was confusing his brain and stopping the brain maps of his knee from being correctly updated. Combine this with the other sensory deficits and the brain maps were constantly out of date. Because the maps were blurry, his brain couldn’t properly control his knee when he was running. This meant he wasn’t handling the forces correctly which was creating a large threat level for his brain. His brain interpreted this as being unsafe and produced a pain experience to get Jim to stop what he was doing.

Was Jim’s issue fully resolved? No, he still needs to use the tape until such a point where the sensory deficit has been improved. This is going to take time and dedication, and Jim may decide it’s easier just to use a small piece of tape on his knee each time he runs.

So No Strength Work Then?

It’s very common in cases of knee pain for you to be given a load of strength work to improve the activation and strength of the knee and surrounding areas. While this can work in some people at some times, I often find that this doesn’t address the source of the issue. Is strength the ultimate output we want? Yes, but how you go about achieving it is the key.

Jim, like you, already has an abundance of strength in his muscles without doing additional lifting. The goal wasn’t to add more strength. Jim simply wasn’t able to access the existing strength available to him. The goal then, was finding a way for Jim’s nervous system to effectively activate his current strength and help his brain in stabilising his ankle, knee and hips.

Through all of the mapping exercises we did, and then finally with the specialist taping, we were able to do just that. We did use resistance bands at times, but I used these to stimulate stability with light and moving resistance rather than direct lifting work.

As an added benefit, Jim had always had very tight hamstrings – so much so that he couldn’t forward bend towards his toes very far at all. In problem solving his knee and heel pain, we also hugely improved his hamstring flexibility and strength without ever directly working on his hamstrings. Things like that happen a lot when I work at the level of the nervous system.

Main Takeaway

If you’ve had knee pain (or ankle, hamstring, hip pain etc) for more than six to twelve weeks, maybe you need to be looking wider than just some calf raises, clams, squats and lunges. Perhaps your sensory system needs testing to see if there are reasons why your brain won’t allow you to access your current strength. My motto, learned directly from two of the experts I’ve been following for many years, The Gait Guys, is:

1. Develop the skill first.

2. Add endurance to that skill.

3. Finally, add more strength to that skill if it’s needed.

In Jim’s case, he had to develop a joint stability skill that was currently beyond what he had. We achieved this through mapping exercises, sensory therapy and taping. He is currently adding endurance to this skill through his running and other exercises, and a natural part of this process is accessing more of the strength you already have.

The post Why Does My Knee Hurt? Case Study 1 appeared first on RunTeach.

Earning The Injury – A Bigger Problem Than Just Knees

Along with the monumental growth of recreational running over the past 10 years or so, there has also been a huge increase in the number of runners getting injured. You may think that’s logical and it does make sense that if the total number of runners increases, so does the total number of injuries. So far so obvious.

But I think the ratio of injuries to runners has got all skewed and the same runners are getting more and more injuries in a shorter and shorter time. In fact, I think that running related injuries in some sectors of recreational running are so common that they are almost worn as a badge of honour! Injuries almost seem to be an inevitable part of being a runner.

This may be common, but it’s NOT NORMAL!

When is it alright to just accept that we get injured? Never! But that’s what seems to be happening and I get disheartened whenever I read about runners getting injured over and over again and often ask myself the question “why?”.

Back To Knees

OK, mini rant over.

So, why does your knee hurt? To answer this question we need to put injuries into two distinct camps:

1. Acute injuries that have just happened. For example, you’ve slipped off a curb (or stepped off the promenade which I witnessed an unfortunate gentleman do the other day on the beach) and twisted your knee and ankle. Or, two days ago you banged your knee really hard on the table leg and it’s swollen right up. Or, you’ve unfortunately tripped on a tree root and face planted like a good’un.
   
   I used to split the above type of injuries from the more common running injuries that tend to sneak up on you over time. But in this context it’s more useful to keep them together as ultimately if there are tissue issues, it’s a single point in time where the threshold has been breached and led to those issues – even if it’s been a slow burn to get to that point.
   
   All these are examples of an acute injury that may or may not have resulted in some tissue related issues (strains, tears, breaks etc). In all these cases, your brain thinks you’re pretty stupid and in order to punish you releases huge amounts of pain… No, not really – but your brain does think the behaviour that led to the acute injury was a bit uncalled for and creates a small packet of data called a Neurotag that it can push in front of you next time, just to remind you that doing it again may be a little silly and this can trigger caution – a good thing.
   
   What actually happens at the brain level is that the area that received the physical injury goes on heightened alert and special threat sensors in the tissues send signals to your brain alerting it that there’s either an issue or a possibility of an issue.
   
   If your brain thinks the situation is important enough (based on a lot of past and current data), it will produce an output to get you to change your behaviour. In the case of acute injuries it’s normally quite a bit of pain so you pay attention to not using the injured area until it’s had time to heal.
   
   The threat sensors, called nociceptors, stay at a high sensitivity until such a time that the tissue has recovered enough that you can go back to using it. Essentially, the nociceptors create a buffer zone around the injured area that if you try to access (i.e. move, put weight on, put force through, etc) the brain’s response is to create an experience of pain to remind you to back off.
   
   Under normal circumstances, most injuries will have recovered to a state where the sensitivity of the nociceptors has gone almost back to normal within six weeks. Under certain conditions this can take longer, but rarely more than 12 weeks for most of the common injuries. Of course, there are always exceptions so it’s always a good idea to get things checked out by medically trained bods if you are in any doubt at all.
   
   So, in summary: acute injuries, whether they actually result in tissue issues or not, are injuries that have happened somewhere in the last 6 weeks. They usually cause an increase in sensitivity in your threat receptors (nociceptors) that in turn triggers the creation of a buffer zone. This buffer zone is closely monitored by the nociceptors and they inform the brain if you try to breach it. In response, your brain creates the experience of pain to remind you to reign it in. Usually, but not always, this buffer zone shrinks as the tissues recover and the sensitivity of the nociceptors returns to normal.
2. “But I’ve had my pain for months!” I hear you cry. I know, I know, we’re coming to that now. The second category or injury was what used to be called chronic injury. This is the pain and apparent injuries that just go on and on and on. So what’s happening here?
   
   At this point it’s really useful to separate out injuries from pain. You may have gathered from the acute injuries section that injuries and pain aren’t necessarily linked. “Whoa!!! Wait, what???!”. That’s right, injuries and pain don’t need to be bed buddies – you can have one without the other. I know, mind-blowing isn’t it. But you actually already knew that. Here are some examples:
   1. Military personnel injured on a battlefield that don’t feel any pain until they are in a hospital.
   2. The guy in Australia who walked down the high street with an axe in his head, even stopping to buy a sandwich from a convenience store on his way to the hospital – didn’t feel a thing.
   3. That cut you just noticed on your finger and now hurts because you’ve seen the blood.
   4. Phantom limb pain where the pain is somewhere in the limb that’s no longer there.
   5. And countless other examples, both major and minor.
      

So what we are really talking about in this section is chronic pain rather than injury, now often referred to as long-term pain. This will make more sense in a minute, I promise.

Remember in the acute injury section I mentioned that usually, the buffer zone reduces within six weeks? Well, sometimes the system just doesn’t work very well for one reason or another. This means the buffer zone stays put and the sensitivity stays high. In fact, the sensitivity can even increase and this can become a real problem. The key thing here is that while the buffer zone stays where it is and the nociceptive sensitivity stays high, the actual tissues themselves are recovering exactly as they should. This results in…dun, dun, dun…..

Pain without injury.

So it is completely feasible, and actually very, very common, that if you’ve had pain for more than at least six weeks, your are moving into a chronic pain state where the injury (if there even was one at all – don’t worry, that’s for a different day) is recovering well but the system isn’t resetting. This results in your brain being tricked into thinking it needs to keep giving you the experience of pain so you avoid using the now non-injured area. 

Does that mean you should just push through the pain if you’ve had it longer than six weeks? NO! STOP! DON’T EVER DO THAT!

Pain MUST Be Paid Attention To

Even if you’ve had the same pain for many weeks, months or years, you should always pay attention to it. Pain is an output from your brain to let you know something isn’t right and you need to take action. Even if your nociceptive sensitivity and buffer system hasn’t reset properly, you still need to pay attention to the pain experience.

There are many things that could be triggering the threat levels in your nociceptors and stopping the system from resetting. Often, I find this is connected with a poor sensory or motor map of a joint at one side (or both sides) of the painful area.

If, as part of the original injury (even if it was years ago) some of your sensory ability may have been affected, the joint maps may be incomplete. Your brain uses this sensory input to help determine where a joint is, and how to activate and control the muscles and connective tissue in supporting the functioning of that joint.

This can also impact your ability to stabilise your joints when running, and you can probably guess that this itself presents a huge threat to the brain. In turn, your brain produces a pain experience to get you to stop doing the actions leading to the threat, and you get in a cycle of threat-pain-threat-pain etc.

This can be hard to break, particularly with traditional strength-type training and rehab as they almost completely miss the mark of how your system needs to be treated for those sensory systems to be up-regulated and stimulated.

Paying attention to your pain experience can give many clues as to the underlying cause(s) and is often not directly related to the painful area at all. Ignoring your pain experience can lead to unhelpful compensations that can then lead to other acute injuries, whether of the immediate kind or the slow burn kind.

So, Why Does My Knee Hurt?

Hopefully, this article has helped you to understand that injury and pain aren’t necessarily linked, and you can have one without the other. You will also appreciate that sometimes your system doesn’t reset correctly following an injury (or perceived injury), and this can lead to long-term pain because something is still causing a threat to your brain and until you deal with that something, it can be a very long road back. This is often the reason why you may get recurring pain in the same or a similar area.

So the real answer to “Why Does My Knee Hurt? AKA Runner’s Knee” is:

It Depends…

Over the next few weeks I’m going to write up some of the case studies of runners that I’ve worked with where we’ve approached their knee pain, as well as other “injuries”, at the level of the nervous system rather than just always going for “strengthen, strengthen, strengthen” in the traditional way.

This means that I’ve assessed how and why their nociceptive system isn’t resetting as it should, and we’ve designed specific drills and exercises, as well as things like specific taping strategies, to make incredible progress – even when they have already seen everyone else and done everything else.

I hope you’ve found this article interesting and it’s raised some questions about how you currently approach your running injuries and pain. As for the answers… you’ll need to open your mind and stay tuned for more articles.

The post Why Does My Knee Hurt? AKA Runner’s Knee appeared first on RunTeach.

Getting confused?

With up to 80% of runners being struck down by a running related injury in every 12 month period, it’s about time you took action to reduce your own injury risk.

All over the Internet you can find many ways to do this from Yoga for runners, a million different ways to stretch, mobility for runners, and of course everyone’s favourite, strength for runners.

Do you really have to do all of these? If not, which is best? How can you decide where to invest your time and money? Do you even need to invest any money because there are literally thousands of free posts and videos in all of the categories I mention above. Where do you start?

Stripping it back

Let me help by peeling it right back to bare bones – well, hopefully not literally, but you get my point. Let’s strip this thing down!

There is only one reason you get injured – your body’s tissues cannot handle the forces being applied to them. It actually is as simple as that… and as complicated as that!

Let me elaborate with a little more detail. Your physical tissues don’t know about miles or kilometres. They don’t know about trail runs, road runs or track sessions. They don’t even know about running. You could be swimming, cycling, rock climbing, digging out your allotment, skiing or rock climbing. All your physical tissues know about is mechanical force.

Mechanical force is simply the load that’s applied to your tissues (bone, muscle, connective tissue, skin, etc) at any given time. They can either withstand the force, or they can’t. If they can’t, they fail and injury occurs – simple.

When looking at mechanical force, we need to look at the three primary elements:

1. Intensity
2. Frequency
3. Duration

Intensity

Intensity is the amount of force; it’s the level of loading or impact. For example, if you whack yourself on the thumb with a hammer (don’t do this by the way), there is a higher intensity than if you poke your thumb with your finger (unless you are mega strong of course).

When running, the level of intensity tends to be influenced by how efficient a runner you are, your bodyweight (although you’d be surprised on this one), the speed you are running at, and the surface you are running on including the incline/decline, your ability to control how you land and your reflexive stability (joint stability).

Frequency

Frequency is the number of times the force is applied in any given period.

When running, you can look at frequency at both a micro and macro level. At a micro level, frequency is the number of steps you take in a minute. This is commonly known as your cadence, and most running watches will give you this number. Contrary to popular belief, there is no ideal cadence.

It was commonly thought that 180 beats per minute (or steps per minute to be more accurate) was the ideal, but this was misinterpreted from some track sessions of a very few elite athletes quite a few years ago. These days, most professionals and coaches accept that we find our own cadence to a certain extent, but under certain circumstances there is a range that appears to be more efficient in terms of performance and injury prevention. 

Personally, I like to help people achieve between 176 spm and 186 spm as I’ve found that to be a good range to encourage efficient form while also encouraging good performance. Current research isn’t conclusive in terms of injury prevention and cadence, but this is often because the research itself is flawed. There is some evidence that if runners with a slower cadence, who are also experiencing pain in certain areas, increase their cadence they can reduce their pain. But higher quality research is required to provide us with the data we need in order to make better decisions around cadence and injury risk.

Anyway, back to the point. If you have a cadence of 176 spm, your tissues are exposed to the forces of running 176 times per minute. You may think then, that a lower cadence is good, but it’s a bit more complex than that as with a lower cadence your feet are on the ground for longer – see Duration for more on this. As a side note, this is why some evidence points to a higher cadence – feet are on the ground for less time.

When viewed at a macro level, frequency becomes about the number of runs per week, month, year etc. Not paying attention to this is a leading cause of overtraining that in turn can result in your tissues not being able to handle the forces involved.

Duration

Duration is over how long the forces are being applied – it’s a period of time. Like Frequency, duration can be viewed at both a micro and macro level.

At a micro level we need to consider how long your feet are on the ground with every step, known as ground contact time and is measured in milliseconds. Most efficient runners have a ground contact time of 220 ms or less, whereas most recreational runners tend to trend from 250 ms to 350 ms or higher. Now, this is still a fraction of a second, but that small difference in time exposes your tissues to the forces of running for that little bit longer, and it makes a difference to both injury risk and performance.

At a macro level, you can view duration as the time you are out on each run, and your overall time running in a week, month, year etc. 

Why tissue fails

As you’ve just learned, mechanical force is applied to your tissues every time you go for a run. In fact, it’s applied all of the time in every moment of your life. It is present in an almost infinite combination of the three elements mentioned above, and how well your tissues are adapted to each combination determines whether they handle it or fail – or breach the threshold for your nervous system to be happy, and this then results in niggles and pain.

To reduce your injury risk you need to train your tissues to adapt to these forces – again, it’s as simple as that. There are ways to reduce the forces through improved efficiency (elements of technique for example), but there will always be forces your tissues need to handle.

To adapt, your tissues need two critical components. If these aren’t present, your injury risk  increases. These are:

1. Load: you need to overload your tissues for them to adapt
   
   
2. Recovery: I always say that “the magic happens in the recovery”. During recovery, your tissues are rebuilding and reorganising so they can better handle the same overload of forces the next time they are exposed to them

It is crucial to understand though, that:

1. If the overload is too much (any excessive combination of the elements of mechanical force), your injury risk increases
   
   
2. If the overload is too little, no or minimal adaptation is forced

The skill is finding the balance between these two, combined with appropriate recovery, and in line with your goals.

How to use this info

Now you have a simple overview of why injuries occur, let’s have a brief look at how you can use this knowledge to reduce your own injury risk. Again, at a foundation level there are some easy things you can do:

1. Frequency: This is probably one of the easiest areas to address, although not all runners actually want to take action here. When looking at frequency you need to look beyond just running. You need to look at what else you are doing in your life that’s exposing your tissues to overload. Remember, your tissues don’t have any concept of running, going to the gym or any other activity – all they know is mechanical force.
   
   Increasing the number of runs per week increases your frequency of loading while also reducing potential recovery time.
   
   Reviewing your overall loading activity, both running and non-running, and the amount and quality of your recovery can highlight areas where you are doing too much and not giving yourself appropriate time to adapt.
   
   
2. Duration: Another area that’s relatively easy to review if you are allowing your tissues to adapt or not. Look at the length of your runs and the length of your recovery periods. Similar to above, the longer your runs, the less time you have for recovery and the more you expose your tissues to the mechanical forces of running.

It’s very common when building up to longer distance events that we increase our mileage. While your body has no physical sense of distance, increasing your mileage will generally result in an increase in the duration of your runs. This exposes your tissues to potential overloading for more time before they get some recovery.

Paying attention to any sudden increases, as well as looking at your overall duration of both running and non-running loading activities can help you identify if you are allowing your tissues to adapt or gradually wearing them down.

I have deliberately missed out Intensity here as it’s more complex to address. This is where we need to look at efficiency which brings with it a whole bunch of skills training and skill endurance – my main passion and the focus of most of what I teach.

For now, making sure you are reviewing both Frequency and Duration will help you to reduce your injury risk and improve your overall running performance.

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