Wednesday, 29 April 2015

Running Form - from Injury Woes to Injury Goes

Ok, first things first; you'll notice I didn't title this "Injury Gone", but "Injury Goes". Admittedly this is partly because it rhymes, but primarily it's because I don't think that many runners ever totally get rid of their injuries - particularly not those caused by running form - but instead, they learn to manage them so that they don't ruin their running. I also don't want to tempt fate, as I'm very glad to say that at the moment, I'm one of those lucky runners whose injuries are under control, so I thought I'd share a bit about how I've managed that.

Ok, now that's out of the way, I think it's best that I talk about what I think is the key to running injury management - running form.

Everyone has their own running form, pretty much unique to them. If you look at Paula Radcliffe at her peak, her running form was entirely different to that of Kenenise Bekele, or even of Mo Farah, let alone how different it was from the average Joe Public runner (and still is based on her performance at this year's London Marathon). There are hundreds of articles, blogs, forums and even entire books about running form, and I'm no expert, but I thought it would be good to share what I have learned about it from my own personal experience, and how understanding it has helped me to manage my injuries.

When I first started running back in 2005 I did what most new runners do and went out and bought myself a pair of cheap Asics running shoes from Sports Direct or somewhere similar. I mean, how hard can it be? We've all been running since we were children and we never needed special shoes then! I ran my first half marathon in them without any major incident (other than a horrific lack of fitness and race preparedness!) and then went back to university for my final year, which was spent primarily drinking and only doing a very short run on a very infrequent basis.

On graduation in 2006, I moved in with my super-fit and running-obsessed girlfriend (now my super-fit and running-obsessed wife!) and it became clear that I was going to be doing more running in the future, so I thought it would be sensible to get someone to look at my running style to see what type of shoes I should wear. We went to a running shop down near my sister's place in Brighton and the owner watched me run up and down the street in front of the shop in various different shoes while asking me how they felt and talking to me about what should work for me. To this day, this is the best gait analysis I have ever had (and I've had a hell of a lot, using some ridiculously high-tech equipment) as he fully understood my stride pattern, how the different shoes would affect it and me, and what should work for me in the long run. He pointed out that, probably due to my very low arches, I was an over-pronator (entirely new language to me at the time) which meant that my foot was landing pointing slightly outwards, on the outside of the foot and then rolling towards the inside of the foot as it went under my body and I pushed off. The chosen shoe to help stop this causing me too many issues was the Brooks Adrenaline GTS - a shoe that I still have one pair of sat in my wardrobe.

A few examples of my over-pronation and over-striding from events between about 2006 and 2012

For the next two years or so, I had pairs of Brooks Adrenalines as I worked my way up from half-marathons to off-road adventure challenges, Tough Guy challenges, Hellrunner races, and up to the London Marathon in 2008. I remained fairly injury-free and thoroughly enjoyed my running (barring the last couple of miles of the marathon, during which I wanted to be anywhere else in the world but in London!) However, in September 2008, my wife and I both decided to try some new shoes which had just come out on the market; the Nike Lunarglide. The shoe was billed as having an "adaptive midsole" which adapted to your feet and your stride in order to provide the support where you needed it.

Now, I should point out now that my wife has a pretty-much perfect foot-strike, with high arches, a nice mid foot strike and a neutral running gait. Not that I'm jealous or anything you understand... Except that I clearly am, and especially that this meant that the gorgeous-feeling Lunarglides were absolutely great for her.

My running form on the other hand, was at least one step beyond what the Lunarglide was designed to cope with, and I found that out the painful way. Within the first couple of months of running in them, I got my first 'proper' running injury, the classic nemesis of over-promotors; runner's knee.

A quick trip to the physio soon identified my issue as being related to my running form and that my new shoes didn't provide the support I needed. A month or two of additional physio exercises combined with a pair of off-the-shelf orthotic insoles seemed to do the trick though, and I was soon out blasting the miles out in my Brooks Adrenalines again.

This approach kept me going for a year or so of running back up to about half-marathon distance, but at the end of 2009, things started to go badly wrong. It started with tightness in my glutes and quickly spread to pain in what felt like my lower back. I went to the physio and was told that I had issues with my sacroiliac joint (the little joint joining your sacrum at the base of your spine to the ilium - the main bones of your pelvis). Basically, due to a muscular imbalance caused partially by my running style, the joint wasn't moving very freely and this was leading to a lot of pain.

When I say "a lot of pain", over the following 18 months it progressed from being an annoyance when I ran through to something that woke me up at night - I was literally dreading going to bed at one point because I knew what was coming. In spite of a lot of physio, lots of trigger-point dry-needling, some custom-made orthotics and the world's supply of stretching, the pain continued in one form or another, no matter what I did, through my "three ultra-marathons in three days" challenge along Hadrian's wall in 2010 and on to the Manchester Marathon, Sandstone Trail 50K and Classic Quarter 45-miler in 2012.

It was after finishing this that I decided that enough was enough, and that I would take matters into my own hands. Back in 2009 I had read Chris McDougall's book "Born to Run" - what runner hasn't read it?! - and had become interested in the concept that we weren't evolved to run in the way that chunky, foam-soled shoes allow us to. So, like any enthusiastic amateur, I decided to invest in some Vibram FiveFingers barefoot shoes (review to follow) and give the whole barefoot running thing a try.

Needless to say, it was brutal and was a hell of a re-introduction to running; effectively having to re-learn how to run in a totally different way. With barefoot shoes on (or even totally barefoot as I tried once for about half a mile, generating 5 blisters!) you simply can't land on your heels with each step, because there's no padding there and it hurts! Instead, you learn to land on the ball of your foot, using the extension of your calf muscle and the muscles in your feet to absorb the impact. This, in turn, shortens your stride, as you need your foot to land nearer to underneath your body in order to foot-strike in this way, which lessens the amount of pronation your foot can carry out before it lands. That's the good side - the bad side is that you suddenly realise how little you used to use your calves with your old running style, and find that your calf muscles are burning and close to cramp within about a mile! Well that's what I found at first anyway.
However, it is worth persevering with this new style of running, because over time I found that my calves got stronger (or at least more used to the pain!) and I could go further, without having my normal sacroiliac joint problems.

Unfortunately though, I also realised that this wasn't going to get me back up to the sorts of I distances that I wanted to cover to run ultra marathons - my feet simply wouldn't have coped with that without some padding of some description, so I had to gradually migrate to wearing shoes, without losing all of my new hard-won change of running style.

This turned out to be surprisingly easy, as I bought some 'minimalist' running trainers and then gradually tried different pairs of shoes until I found ones that I could maintain my running style while also having some decent padding under the balls of my feet. This took some doing, and involved buying a few different pairs of shoes, but I figured that it was still costing less than physio every week would have done - plus, who doesn't like buying new shoes??

So now I run with my new style, but in fairly 'normal' trainers and - touch wood - all of my old over-use injuries are under control. This in spite of having trained for and run a 50K trail race and now being at the end of my training for a 45-mile run in a few weeks' time. Don't get me wrong, my new running form isn't perfect, and when I get very tired or am going down steep hills, I know that it gets worse, but it keeps a crippling injury at bay while allowing me to do what I love doing, and that's what matters.

A few shots of my "new" running form from the St Oswald's Way 50K Ultra Marathon in September 2014

So below are my compressed pieces of advice for trying to overcome injuries associated with running form:

1. Analyse your own running form.
I had lots of analysis of my running gait by all sorts of different experts, but what really showed me what I needed to change was looking at photos of me running, and looking at the soles of my shoes. These give really good clues as to how your feet are landing with each step. What you're aiming for is a forefoot to mid-foot strike, and this is where the majority of the wear will be, so the wear on the soles of your trainers is a really good clue as to how you're running.

A trainer from my "old" running form (left) and my "new" running form (right) - note the difference in wear to the outside of the heel.

2. If you're over-striding and heel-striking, try running barefoot.
A change to barefoot running will very quickly show your body how different it feels to forefoot/mid-foot strike. Don't expect it to be the final solution though, because it's not easy even for short distances, but it's a great training tool. Once you're back in normal trainers again, remember that feeling and keep your stride short to keep the best bits of both running worlds.

3. Take it slow.
You're trying to recover from an injury, so while changing your running style might help to fix yourself in the long run, don't think that it'll happen overnight, so take your time and enjoy being able to run again, no matter how long or short each run is.

4. Vary your running surfaces.
I firmly believe that changing my runs from being primarily on Tarmac to including various different surfaces including trails and hills has made a big difference to my running injuries. The variety of surfaces helps to force you to change your running style even throughout a run, helping to prevent repetition injuries.

5. Vary your shoes.
As a result of my trying of lots of different running trainers, I still have lots of trainers that I can wear at different times. I try to make sure that I wear different shoes for different surfaces, or for different runs within a week, so that my feet don't get complacent and I help to reduce my own overuse injuries.

I like a bit of variety!

6. Enjoy yourself.
That's why we all run after all isn't it? So try and find a way of running that both you and your body can enjoy, then go out and do it!

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