Female runners: Top 10 things that you can do to reduce your risk of injury.

The evidence for differences in injuries between male and female runners is not apparent, therefore you may argue that the following points could be utilised by males too! There are anatomical differences between male and female athletes which may alter biomechanics or the loading of tissues; but ultimately I have seen a number of runners, of both sexes, who exhibit similar running injuries. If you're reading this blog I presume that you either run yourself or work with runners - in which case, I'm sure that you understand the benefits of leading an active lifestyle both from a physical and psychological point of view. In addition strongly held beliefs, such as running being bad for the knees, is being blown out of the water by current research describing the protective effects of running. However, there are still some ways in which the risk of running injuries can be reduced.

Without further introduction or hesitation, here are the top 10 things that I believe a female runner can do in order to reduce their risk of injury based upon the current research and my own experience as a Sports Therapist and Exercise Physiologist:

1. Improvement in strength of muscles - High performance athletes already do this, but strength training should be a key ingredient to any running training programme. The literature and personal experience indicates that approximately two strength training sessions per week can improve performance (which is what most runners will be interested in); but we are also aware that being strong in all ranges of motion, especially in other sports, is way to reduce the risk of injury.

2. Attain full range of motion - What does full range of motion mean? Essentially it is whether the joint can achieve full movement to the end of the available range without restriction (sometimes termed flexibility). There have been studies to show that performers who have an increased range of motion and are strong are at the lower end of injury risk. Although running doesn't necessarily require you to go through the full range all of the time, there are faster sections within running performance when you may lengthen your stride, adding additional stress to those muscles propelling you along.

3. Nutrition - Often, I find that runners are aware of the nutrition that is required to fulfil the sporting requirements, however, Relative Energy Deficit Syndrome (RED-S) is seen when either male or female runners inadequately eat (or activity levels are so high) that there is an impact upon their bodies ability to repair and adapt. An example of physical change in the female athlete is the switch in menstrual cycle from normal pattern to irregular or absent. Another symptom of RED-S can be decreased bone health, that could lead to stress fracture in the presence of consistent loading to which the body struggles to adapt.

4. Adequate sleep - The evidence is not yet conclusive but it seems to show that those who have less sleep are more likely to be injured. That may be down to elements of fatigue, poorer decision making or lack of time to adapt to the imposed demand. Runners that I have worked with previously aren't the best at scheduling rest days and often fit in runs around full-time work, family and social commitments.

5. Appropriate recovery - Following on from point four... When do you schedule your rest? What is your recovery strategy? After you have run the marathon or half marathon do you know what to do? If you are competing in quick, successive running events there may be some evidence pointing towards the use of ice baths or cryotherapy treatment, but on the other hand, there are now question marks over whether this could blunt adaptations if performed regularly when there are already appropriate recovery times between competition. Reducing swelling with the use of cold water immersion is another conversation away from injury prevention and towards injury treatment. Foam rolling (and massage for that matter) - for me the jury is still out - perceived muscle soreness may reduce, but beyond some acute physiological effects I am yet to see the scientific evidence that supports writing it into your full recovery plan. Psychological effects of recovery is beyond my scope to discuss in a blog, but from personal experience I know that certain recovery methods have made me feel better the next day!

'What is your recovery strategy?'

6. High training loads - With appropriate recovery time, adequate sleep and nutrition, high training loads should be tolerated by athletes as long as the journey to get to that level has provided the body with enough time to sufficiently adapt. Consistent high training loads have been shown to be protective, with acute spikes in load or intensity increasing the risk of sustaining injury.

7. Continuous rehabilitation - Have you previously been injured? The largest predictor of sustaining an injury is having been injured to that area previously. As a Sports Therapist, it is logical to me that if the athlete can continue to rehabilitate and compensate for any damaged tissue by improving strength, ensuring the required range of motion and developing optimal neuromuscular activation (nerve signals to the muscles involved), then the athlete will be in the best position possible to prevent injury. I often see athletes attending for treatment who had an injury 12-24 months prior at the same anatomical area. When questioned about their continued development of strength in the area, they inevitably stopped once the injured area felt better.

8. Progression - As I alluded to in point 6, if you are looking to improve performance then you must challenge your body to run faster than before. During the planning of your progressions you should allow for a steady incremental increase in performance, whether this be for time or distance, in order to allow adaptation. Tissues must adapt to the increased loads, otherwise they will become unhappy or less commonly, be unable to cope. Planning with sensible load increases with a good running coach often helps.

9. Footwear - Everyone likes to have a good-looking pair of trainers to run in as well as runners getting hung up on the shape of their feet, the shape of the arch etc. I often say to runners, as long as they are not injured... to choose a trainer that is comfortable and feels supportive and make sure you use them walking around the house before going on a 10 mile run. Try not to change trainers (brand/model) shortly before an event because your body has not had time to adapt to how you run in the shoe (you may be starting to pick up on a theme) - this often leads to soreness on the arch of the foot, the achilles and inside of the tibia (shin bone).

'Your body needs time to adapt to new practices'

10. Last but not least - the planning of routes - You have planned your distance... you have planned your time... you know what zone you want your heart rate to be in... you know how many energy gels you are going to take... but you haven't thought about the elevation of the route. For those of you who have ran a particularly hilly route, will know that the demands of running up or down are different to running on a flat. Once again we come back to the load that you are placing upon your tissues. Plan routes that incorporate increasing amounts of elevation, just as you would plan for changes in distance.

I hope that you have found some of these tips useful and thought-provoking. I also hope that you will incorporate them into your own runs or when working with running athletes.

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