5 Tips to Safely Start and Advance a Running Program
Updated: Nov 13, 2019
Running is a fantastic fitness activity, but it continues to be a high injury sport as approximately 80% of runners experience an injury over the course of their running career. (1) However, not all injuries are inevitable and runners can learn strategies to reduce injury rates.
Some of the most vulnerable scenarios for running injuries are:
1. A beginner who is starting running for the first time.
2. A runner returning to the sport after some time off.
3. A runner who is progressing either speed or distance.
Just knowing that these may be more risky situations can help runners learn to program in strategies to reduce injury.
1. Walk before you run
Your bones, muscles and tendons need to be able to tolerate the load of running. If you have never run before or have taken some time off from running these structures may not have the capacity to tolerate running and are at risk for injury. First, you should be able to tolerate 60 minutes of brisk walking without pain before you attempt running. If you are coming off an injury or any other break in running it might help to start with a walk-run progression and gradually work your way up to full running. If it has only been a few weeks since you last ran then you can try a run tolerance test: relatively easy run for a short distance. If you start to get pain then stop. That is your tolerance point. For example, if pain starts at 5 minutes you can begin with 5 minutes and slowly progress from there.
2. Warm up and strengthen
As a society we are relatively sedentary during the day and our body adjusts to that level. If you go from sitting at a desk straight to a run with little transition, the bones and tendons may again not be ready to manage the load. Warming up is crucial to preparing the body for a run. Contrary to popular belief, stretching is not adequate for warm up and has not been shown to reduce injury. (2) A good warm up consists of dynamic movements that increase mobility and prepare us for the task at hand. Squats and skipping are some great activities to incorporate into warmups. Walking, again, can be useful to prepare for running. I recommend walking for 5 to 10 minutes and gradually increasing speed until you are walking so fast that you feel like you have to run.
Strength training is also crucial to injury prevention. Full body strengthening is important but the lower extremity programs are essential to improving load tolerance. Squats, lunges, deadlifts and especially single leg activities are great starting points to to prepare the legs to absorb shock and push off. An awareness of the core and breathing patterns during these activities can also translate to injury reduction during running.
3. Progress slowly, but don't drop off.
The rule of thumb for running progression has always been do not increase more than 10% a week, and this may be a good general rule for some casual runners as well. For those who want a more quantifiable approach to injury prevention, the acute-to-chronic workload ration may be interesting. (3) This formula calculates an individuals' training work load over the last month (chronic workload) as compared to their current training load (acute workload). Dividing the acute load by the chronic produces a ratio. Currently, the safe zone for training is a ratio of 0.8-1.3. Interestingly, falling too low and under-training may be more harmful than over-training (4). Runners can calculate their workload by multiplying the amount of time they ran by the rate of perceived exertion (see RPE scale below). They can average their workload to get a weekly number. The past 4 weeks would be averaged to get the chronic work load and the current week's load is the acute work load. Runners can progress by staying closer to the 1.3 side of the ratio and may benefit from backing off every 4th week or so to have a "recovery week", but should never drop below the .8. Furthermore, an injury from over-training may not appear right away and may flare a few weeks later. Knowing this, if you inadvertently go over 1.3 you can always back off for a week or so to help prevent an overtraining injury.
Not all runners are going to calculate the acute-to-chronic workload ratio but I believe understanding the concepts can help them be aware of over or under-training pit falls.
Rate of Perceived Exertion Scale
0 – Nothing at all 0.5 – Just noticeable 1 – Very light 2 – Light 3 – Moderate 4 – Somewhat heavy 5 – Heavy 6 7 – Very heavy 8 9 10 – Very, very heavy (Reference 5)
4. Know yourself
Pain isn't just related to load on the tissues. Pain is a fight or flight response from our nervous system, trying to protect us from some perceived threat. Anything that winds up the nervous system can sensitize us to pain even at loads we can normally tolerate. Knowing if you are really tired, overly stressed or haven't eaten well can help you gauge what your run that day should look like.
For example, if you are really tired and didn't sleep well the night before you might want to opt for a lighter run or maybe even no run for that day. This can be hard when following structured training runs, but being aware of other factors that contribute to pain is an important part of injury reduction.
5. Don't stop moving
One of the most important thing for runners to learn is when to go and when to slow. Traditionally, when something hurts, runners have been told to stop and rest, but this may not be the best advice. Looking back at the acute-to-chronic workload ratio, resting completely can take that ratio into an under-training scenario and risk a flare up upon return to run. This creates a scenario of repeated recovery and flaring of the injury. Better advice would be to back off some, guided by tolerance level. This may mean backing off of speed, hills, distance or even backing off to walking but keeping some load through the joints. Then gradually increase back as advised above. It is also okay to run with a little pain, as long as it's tolerable to the runner, it does not cause a change in running gait (no limping), and it eases off to baseline level of pain within 24 hours. I would recommend staying at that level and doing some strength training in between runs until the pain decreases and then gradually progress from that point. If pain exceeds those rules then it is time to back off to a level that stays within those rules. These are just guidelines and if you have pain that is not going away, reach out to a physical therapist or doctor for advice.
1. Lobby, M. (n.d.). Avoid a running injury with the 10 percent rule. Retrieved October 21, 2019, from Actice.com
2. Witvrouw, E., Mahieu, N., Danneels, L., & McNair, P. (2004). Stretching and injury prevention an obscure relationship. Sports Med, 34 (7), 443–9.
3. Windt, J. (2017). How do training and competition workloads relate to injury. (T. Gabbett, Ed.)British Journal of Sports Medicine, 51, 428–435.
4. Bowen, L., Gross, A., & Gimpel, M. (2019). Spikes in acute:chronic workload ratio (ACWR) associated with a 5-7 times greater injury rate in English Premier League Football players: a comprehensive 3- year study. British Journal of Spots Medicine. DOI: 10.1136/bjsports-2018-099422
5. Borg GAV. Borg’s Rating of Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics, 1998.
This program, videos and content is not intended to diagnose or treat any illness or injury. It is for educational purposes only. If you chose to try any of the exercises presented here do so at your own risk. Please consult a physician before you start any new program.
Not every exercise is safe for everybody. Correct execution of all exercises is imperative to prevent injury. Please consult a healthcare professional if you have any questions about your exercise execution or if an exercise is right for you.
You are responsible for yourself and will not hold Kelly Kuhn or Kelly Kuhn Physical Therapy liable for any injury or illness.