Running is one of the most popular sports in the world. This not only covers marathons and track and field running - running is also part of the training in virtually all other sports, including soccer, rugby, handball and triathlon. Running is a very efficient method for maintaining or improving cardiovascular, respiratory and musculo-skeletal fitness and increasing the structural strength of the musculo-skeletal system. It is also an effective way of improving the tensile strength of the lower limbs. Modified levels and intensities of running can also be used as alternative training for most athletes with certain types of injuries. However, before running on a hard surface, such as roads or astroturf, the patient must be able to withstand the repetitive eccentric impact to the lower limbs, as each stride will create an impact force of five to ten times body weight for a fraction of a second. Since each stride stresses the same structures, their tensile strength and endurance lie between positive training effects and injury.
Running can be over a distance, in a variety of intervals or as a varied running-jogging-walking programme. The intensity and the distance must be proportionate to the runner's ability and objectives. Running on a hard surface mainly loads the lower limbs, where 90 per cent of running injuries are found. The most common error an inexperienced runner makes is to run too fast and too long too early, so that training causes new injuries instead of
14 promoting the healing of another. It is important to use common sense when prescribing hard-surface running. For an inexperienced runner the safest way to build up performance after an injury is a slow and steady running tempo, including a proper warm-up.
The best test of improvement in running capacity is repeatedly to measure the runner's effort and time in a simple test race. For a fairly unfit but otherwise healthy person who wants to improve their general fitness and aerobic performance, running can be recommended as part of a progressive programme. From a reasonable starting point, such a programme would usually increase less than 15 per cent in distance and intensity per year. An elite marathon runner with an over-use injury may simply reduce their running time from two hours to one hour per day; not pushing over the pain threshold but gradually increasing the time day by day. A 130 kg rugby player, even though extremely fit, is not a good candidate for long-distance or road running. Their knees will undoubtedly say 'no!' to this madness. This type of exercise also cannot be recommended for obese or generally unfit recreational athletes or people with structural knee or hip problems, such as osteoarthritis. A reasonable running tempo that can be maintained for 30 minutes is essential for a persistent training effect. Runners should aim for a pace at which they can chat with a running mate while breathing almost normally; this is equivalent to 60 to 70 per cent of maximum aerobic capacity. The subjective experience of running is far more important than the heart frequency, which is not directly proportionate to the runner's feeling. Even with the same heart frequency, for example 160 beats per minute, running can be very easy one day and very uncomfortable the next.
The subjective experience of training is very important for a non-runner's motivation. Since the surface is consistent for each stride the same structures in the lower limbs will be put under repeated stress. While this leads to a functional adaption of the strength of the structures it can also lead to injuries in the short term. This also highlights the importance of proper, comfortably fitting running shoes with a cushioned sole, which can reduce the impact from touchdown in the stride, distribute the forces and provide stability to the ankle and foot. The commercial running shoe market is unfortunately mainly fashion-orientated and new models are pumped out every six months. Despite improved biomechanical knowledge, which manufacturers claim has revolutionised the market, and lighter high-quality materials and technology within the sole to compensate for different individual factors, modern running 15
shoes do not last long. It may also be questioned whether they have reduced the incidence of injuries. When Arthur Lydiard introduced his running shoes around 1970, I could hardly run out a pair in two years' intensive running, and new soles could be reattached at least once before the shoe broke up. Today, most running shoes are worn down by regular running within 6-12 months. Regular runners will soon find their own style, but might have more trouble getting a consistent style of footwear.
Most running injuries are caused by training errors. In some cases, bio-mechanical factors, such as excessive pronation, contribute to the injury. If such factors are suspected, an experienced podiatrist may be able to help.
Running on a hard surface is a very efficient training method but as a primary alternative training form for the untrained, overweight or those with major injuries to the lower limbs, it should be prescribed with care.
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