RELOADing your Running- Load Management for Runners

RELOADing YOUR RUNNING  

Following on from our previous two blog topics that covered energy deficiency in sport (RED-S) and bone stress injuries where both touched on managing your load as you train. Today we would like to delve deeper into load management, with a focus on running (since we love it so much!). It should give you an idea how to progress yourself safely and effectively, whilst not foregoing your performance targets in your weekly Park Run!

Load management in sport is both a science and an art. It can be thought of as the delicate balance between training and competition, and rest and recovery. It is the difference between a well beaten dollop of cream and clumpy cream but-not-quite-cheese result.

Correct load management will allow you to meet your fitness and performance goals while ensuring that you do not sustain an injury or burn-out. It will empower you to return to running safely after some time off, or to increase your speed and endurance for an event.

Alternatively, incorrect load management is one of the greatest contributors to overuse running injuries that we see in the clinic, and it contributes to injuries such as achilles tendon problems, recurrent calf sprains, lateral hip and knee pain, shin splints, stress fractures and so many more.

As a keen runner and physiotherapist, I have had an interesting relationship with load management over the years. I have tipped the scales a little too far in either direction on numerous occasions and suffered the consequences. As a result I have learnt some great lessons: how to monitor load, listen to my body and to get the results that I strive for. You are definitely not alone, and I hope that you can learn from my mistakes!

Okay, so you’ve also suffered from an overuse injury, or are currently suffering from one… where did you possibly go wrong?

Lets think back on your running history. When your symptoms started, what was your running program like? How have things progressed or regressed since then? There are many more questions that we will need answers to, as the key to where your load management went gone slightly askew lies somewhere in the midst of all the fog.

Common scenarios that make our ears pick up include:

• Returning to running after time off from an injury

• Returning back to training after a month or two of holiday (how good)

• Increasing intensity following a couple of weeks of illness where loads were reduced (shorter, less intense runs)

• Sudden changes in training goals or race distances

• A change in training surface, terrain (hills), intensity (e.g. intervals) or footwear

• The weekend warrior – someone who typically doesn’t do a lot during the week but goes all out in the weekend!

Do any of the above sound vaguely familiar?

If so, lets take a leaf out of my book and do things differently from here on out...

What is the best way to monitor and manage load? You might be wondering “how do I best structure your training program to get the best results?”

There are numerous ways in which athletes and health professionals choose to manage training loads. Here are a few ideas:

The 10% rule

The 10% rule is simply not increasing your weekly training loads by more than 10% from one week to the next. It is a very simple and often effective way to ensure that your loads are not increased too quickly. You need to consider what your baseline loads are, what surfaces you are normally training on (hills, grass, road etc), and the intensity of your training, as they will affect your overall training load and therefore injury and burn-out risk. Please note that the 10% rule has significant limitations at the different ends of the spectrum of runners, such as those who run less that 15-20km per week, or over 100+km per week, but is great for its simplicity for the majority of runners.

The Acute/Chronic Workload Ratio (ACWR)

The ACWR is becoming more popular and you might see it in your current program. It takes into consideration your baseline loads, training surfaces and training intensity to ensure that you are not over or under training. It’s a bit more tedious to analyse all the data that you need to collect, however it is a great tool to predict your future injury risk based off your current levels of loading. It looks into your rate of perceived exertion (RPE) alongside the distance or duration of your run; and compares your current training week to the previous three weeks. The acute/chronic workload ratio ensures that your loads remain between safe parameters. Speak to us if you would like to know more details about the ACWR.

Lastly,

Periodisation

Periodisation is used to structure training programs which involves planning a few weeks or months in advance. I know right, its time to get organised! Periodisation is often based around an end goal for example a certain distance or time that you would like to achieve. You also need to keep an eye on your overall well-being as your mood, energy and sleep quality are vital to your success. Your physiotherapist or coach will likely throw ‘easy’ or ‘recovery’ weeks in between challenging ones.

The most successful runners have followed one of the above principles, including all of Arthur Lydiard’s athletes. Whether or not you are a weekend warrior or a seasoned ultra marathon runner you need to make sure your running loads are safe to avoid getting injured. Structuring your program with periodisation in mind will help not only with injury prevention, but other health concerns such as relative energy deficiency in sport (RED-S).

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So here are my top tips for load management

• Remember that load can be affected by distance or duration, intensity, recovery and training surfaces!

• Do not increase your running load by more than 10% each week.

• Consistency is key. Put on those shoes year round and stay active!

• We are all different and hence, different training programs work best for different athletes because our capacity to adapt to mechanical stress is unique.

• It is best to follow a program from someone who is aware of load management principles – have a chat to your physiotherapist or your running coach, or come and see one of our running specialists at Reload.

At Reload Physio we offer one on one running programs, strength and conditioning and recovery work. If you would like more information, or just need some reassurance with your current program please reach out.

Book a Comprehensive Running Assessment and report session (60mins), or an Initial Injury Consultation below.  

Bone Stress Injuries a.k.a Stress Fractures

Have you ever wondered what a Stress Fracture is? Why they occur and what to do about it? Physiotherapist Carla Bywater outlines all the details in Part 1 of this 2 part Blog on all things Bone Stress Injuries (BSI’s)

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As summer is well and truly upon us, many, me included, are trying to make the most of the sunshine and extra daylight hours by heading outdoors for exercise. The amount of running trails and routes in Melbourne are endless, so needless to say, sometimes my runs end up longer than expected! As I increase my training load, I am becoming increasingly aware of the risks associated with long distance running, such as bony stress injuries.

In our official first week as Reload Physio in November, we had the privilege to listen to Dr Adam Castricum present on stress fractures and relative energy deficiency in sport (RED-S). Adam currently works at Olympic Park Sports Medicine Centre as a sport and exercise physician.

What are stress fractures?

Stress fractures are overuse bone stress injuries (BSI) that commonly result from a sudden change in training or exercise load. For example, increasing your training volume for a race or starting to train after a period of inactivity – “Hello New Year resolutions!” And in my case, I’ve decided to take my running more seriously again after giving birth to my daughter a year ago.

Why do they occur?...

Our bones are constantly remodelling based on what loads we place upon them. This is a good thing, and usually results in stronger bones. But if we do not allow enough time for our bones to rebuild and adapt after an increase in load, then BSI can develop.

BSI result from the “inability of bone to withstand repetitive mechanical loading, which results in structural fatigue and localised bone pain and tenderness”

There is a continuum of severity with BSI from mild to severe:

Yes, Bone Stress Reactions can develop into a Complete Fracture

Therefore, the earlier a BSI is detected, the better, and the quicker your recovery will be!

Who normally develops bony stress injuries?

Between one to two thirds of competitive long-distance runners or cross-country runners suffer from BSI. Other at-risk populations include competitive track-and-field athletes. Unfortunately, if you’ve suffered from a BSI, the likelihood of it happening again is relatively high (up to 12.6%).

Where do they most commonly occur?

Common injury sites include: the tibial diaphysis (shin), femur (thigh), fibula (shin), calcaneus (heel), metatarsals and tarsals (foot). Less common sites are the pelvis and lower back.

Are some worse than others?

Yes, as mentioned earlier, there is a continuum that your bone injury will fall on. To make things easier a classification system was developed. If we want to get technical, you have high or low GRADE, and high or low RISK.

High or low grade of a BSI refers to how your injury looks on imaging. Has it been present for a short time? Then it is likely a low-grade injury. Or has it been worsening over a longer time period? Which places it into the high-grade category. Classifying it into high or low grade allows us to give you an estimated recovery time. Low grade BSI tend to heal faster than high grade ones.

High or low risk refers to the location of the injury. The location is important as there are certain areas of bone that experience the most tension/load. Treatment of high-risk bone stress injuries are more difficult and require a more aggressive approach to avoid complications. For example, the BSI may develop into a complete fracture, or delayed union or non-union of the fracture site! Ouch!

 If a high-risk area is involved, an experienced sports physician will become involved to carry out an orthopaedic assessment. Surgery is a real possibility to fixate the bone in order to promote healing and avoid further complications.

I bet this all seems rather daunting, but do not worry! Healing time frames vary from just under nine weeks (low risk and low-grade BSI) to 20 weeks (high-risk, high-grade). High-risk sites take longer to return to running, regardless of if they are low- or high-grade. It is very important to remember that you and Sally next to you are completely different! Therefore, your return to running timeframes will vary, so don’t try to compare your progress. 

As a general rule, at Reload Physio we follow the mantra: “treat the patient not the X-ray”. 

“But why do some runners develop a BSI and others not?” You might ask, especially if a similar amount of distance is covered each week.

The answer is multifactorial. Some things are within your control, while others are not. For example, things such as genetics and bone diseases are bad luck and you are not able to change them. While it is easy to focus on the dire, there are other things you can do, or not do, to reduce your chances of developing a BSI.

Because bones are living tissue they respond, and adapt, to the load that is placed upon them. Your running technique influences the amount and direction of force that passes through your bones. If you think your running technique can use some fine tuning it is super easy to get a running analysis done, and to go home with a few things to work on.

Your running program (or lack of) can have a huge impact on your risk of developing a BSI. Have you recently started running from scratch, or increased your running pace, duration or frequency? A significant change in load management is central to disrupting the fine balance between bone ‘building and breakdown’ that occurs on a day to day basis.

Other things we need to think about: your footwear and running surface (trail vs road, or treadmill to pounding the pavements). Neither have been proven to have a direct causal relationship to BSI, however, if either has been changed recently and you have developed bony tenderness, then it is worth looking at as contributing factors!

 To reduce your chances of developing a BSI you need to consider the following ‘gems’:

• Stay active life long, and encourage your children to do the same, because a longer history of physical activity is thought to be protective against BSI.

• Strength training: add this bad boy to your training program to get your muscles stronger to help your bones to absorb ground reaction forces during running. Weaker muscles do not absorb the ‘shock’ as readily and fatigues faster, influencing your technique too!

• Nutrition: firstly, you need enough fuel to sustain your training load to avoid a relative energy deficiency. Secondly, your body needs adequate levels of vitamin D and calcium in your diet to support bone health. If we think that this is a contributing factor to your BSI, we will refer you to a dietitian to get the best guidance.

• Your hormone and endocrine function are closely related to your energy intake and expenditure. To learn more about relative energy deficiency in sport (RED-S) read our previous blog here.

• Avoid sudden changes in loading! If unsure, get professional guidance.

Did you know at Reload Physio we offer comprehensive running analysis, coaching, running technique training as well as movement and strength and conditioning classes to get you back to where you need to be in the future? 

Click below to book in for a thorough running assessment by one of our running specialist physiotherapists.

If you feel you may need your running assessed, a training program developed, or need a personalised exercise program to work on your weaknesses, then we have you covered.

If you are recovering from a running related Bone Stress Injury we recommend booking in for a Comprehensive Running Assessment with one of our Physios.

RED-S

Relative Energy Deficiency in Sport

Do you have to ‘make weight’ for your sport? Are you in a very physically demanding job? Have you increased your training load? If so, you need to be aware of the risks associated with “Relative Energy Deficiency in Sport” (‘RED-“S” or “REDS”).

What is RED-S?

You might be familiar with the term ‘the female athlete triad’, which is a classification system used to identify female athletes who suffer from athletic amenorrhoea (loss of their monthly period), osteoporosis (weaker bones) and eating disorders.

In 2014 the female athlete triad was ‘upgraded’ to RED-S to recognise the fact that both males and females, young and old are affected by it. Furthermore, it identified widespread and long-term health effects and a reduction in performance in those affected by RED-S.

The basic principle of RED-S is low energy availability. In other words, an athlete is not consuming enough energy through their diet to sustain their training load as well as day-to-day living.

 Just to ‘be’ requires energy and fuel. The athlete’s normal physiological processes such as bone health, hormone production, reproductive health and the immune system get placed on the ‘less important’ list as the athlete’s body is essentially in starvation mode.

Why would their body use energy to maintain their ability to reproduce if there is not enough food going around?

RED-S is defined as: “impaired physiological functioning caused by relative energy deficiency and includes, but is not limited to, impairments of metabolic rate, menstrual function, bone health, immunity, protein synthesis and cardiovascular health”

Sporting codes that have a high prevalence of RED-S include running, triathlon, cycling and dancing. In the past, it was favourable to lose weight in order to ‘go faster’, ‘jump higher’, be easier in ‘point’ if you were lighter. Unfortunately, the long term health effects of a sustained energy deficit are becoming more and more apparent in recent years.

RED-S is a continuum from mild, moderate to severe. Therefore, the earlier it is addressed, the better.

Common signs that you might be suffering from low energy:

Have you noticed a declined in performance? Are you unable to sustain high-intensity efforts like you used to? Taking longer to recover after training? Waking up tired in the morning? Suffering from body soreness?

Females – have you had any changes with your monthly cycle, especially if you have not had your period for six months or more? Males – have you noticed a decline in your sex-drive?

Have you had reoccurring colds, coughs or upper respiratory tract infections? Have you suffered from stress fractures in the past? Have you been diagnosed with low iron?

Are you relatively strict with what you should or should not eat? How do you feel if you miss a training session (anxious/angry or frustrated, or do you accept your circumstances)?

It is essential to identify low energy availability as soon as possible to minimise the impact on your health and performance.

 As an athlete, you might not be too concerned about your immune status or your ability to reproduce. What if I told you that RED-S has a significant impact on your ability to perform at your best, that it could be the one thing that is holding you back?

Performance consequences of RED-S

• Decreased muscle strength

• Decreased endurance performance

• Increased injury risk

• Decreased training response

• Impaired judgement

• Reduced coordination

• Reduced concentration

• Irritability

• Depression

• Depleted glycogen stores

If the above does not motivate you to seek treatment to improve your athletic ability, then I am not sure what will!

How do we treat an athlete who’s suffering from RED-S?

The treatment of RED-S requires an interdisciplinary team approach. Often a sports medicine doctor, dietitian, physiotherapist and psychologist are involved in getting the best outcome for the individual.

It is crucial to regain the balance between the athlete’s ‘energy in and energy out’; to restore their morning energy levels, regain regular menstrual cycles (females), return homeostasis to oestrogen and testosterone levels, alongside a graduated return to exercise.

Sounds simple right?

Please note – the oral contraceptive pill is NOT the answer to restore the athlete’s period.

If you would like further information, please do not hesitate to talk to one of the physiotherapists here at Reload Physio or do further reading. The following links offer great insight to both athletes, parents and coaches:

Ask a Physio:- I'm keen to start trail running, what should I be careful with?

Author:- Marcus Pain, Principal Physios and keen runner.

Trail Runner Magazine Aug/Sept 2017

Trail running is like the Rally sport of Motor Racing or the mountain biking of cycling, it is a fantastic alternative to running through the concrete jungles that many of us live in. But just like rallying and mountain biking, the risks are very different to the road alternatives. Try visualising a Formula 1 car doing the jumps like a rally car, or riding a Tri Bike down a dirty big mountain (offroad), I’m pretty sure neither would end well. With trail running there are many key differences that we must consider and prepare ourselves for, and from my clinical and practical experience, being informed is the critical first stage of injury prevention in this great sport.

All types of running, in fact almost all types of sport, have injury risks. Injuries in road running, like many endurance sports, are largely attributed to repetitive overuse injuries. Trail running has many similarities to road running, but there are many differences between road and trail running and some of these are much more obvious than others.

So, what should you be careful with? We could go in many directions with this question, such as getting lost, knowing the terrain that you are going to, the wildlife, especially the slithery type, and the first aid that goes along with these... but for this article I will stick to the physiotherapy side aspect, ie the injuries, we will cover the likely causes and will give you some general tips on what you can do to minimise the risks as you start.

The information provided here is important for all newcomers to trail running, whether already an experienced road runner, or a novice runner. In my clinical experience, it is often the roadies that suffer many injuries when they hit the trails, probably because it is not their cardiovascular fitness holding them back, but it is that their body is not prepared for the new conditions. One example is a friend who o is a 90minute half marathoner, he joined me for a trail session in the hills surrounding Melbourne for ‘something different’, we covered about 20kms at a cruisy pace over 2.5 hrs, and he was generally sore for days and it set off his Plantar Fasciitis.

The varied nature of trail running reduces the occurrence of the repetitive overuse running injuries, and in many cases I recommend injured runners incorporate off-road running as part of their return to running rehab because the loads on the body differ with each and every step, and this variety of load means that many different structures are sharing the strain rather than the same each step, there is less repetition. But there are things to be careful of, some more obvious than others. These I will simplistically classified under two categories, the acute injury and the load related injury.

Firstly the obvious, the acute injury...

Falls, Twists and Sprains

The uneven terrain on the trails means an increased risk of twists and sprains, any misplaced step can result in ‘going over’ on your ankle, or slips and falls resulting in bruises and impact injuries. As a newcomer to trail running an immediate difference you will notice is the need to watch the path ahead each and every step. Learning where to step, what surface is stable, what will move underfoot, how heavy is safe to land, and even simply how big your foot all takes time and practice, and they are things that rarely need to be considered when road running. Part of preventing these injuries comes down to proprioception, a key factor of balance, this is your own body’s sense of joint movement and position in space, more simply, do you know where your joint is? And, how quickly are you aware of any change in position? Proprioception, foot-eye coordination, strength, balance and stability are all very important to staying on your feet. If you have ever seen a top trail runner descending a steep, technical terrain, they are amazing, they have incredibly fast feet, every foot placement is perfect, they have great stability and it looks easy. This skill takes time, practice and experience. Be patient, it will come.

Now the load related injuries:-

When we think of trail running, we immediately think of the hills and the challenges attributed to them, the newbie will typically moan and groan at the thought of climbing the steep inclines, however, the climbing is not what will cause the groans the next day!

The bit you think is easy… is the hard bit on your body, the downhill.

Many running injuries are cause by load, and ‘flying down a hill’ is were load is at its greatest. The degree of decline is a huge factor here. The angle where a relaxed run down hill is now an effort, where you feel that relaxing isn’t possible as doing so will result in just going faster and faster until you lose control, this is where your body starts to whimper, the impact is high, and so are the loads. Your knees, quads (thighs), hips, they all feel the impact. This ‘putting on the brakes’ is where you are eccentrically loading your muscles, where they are working hard as they lengthen. This impact and eccentric loading causes that familiar day-after hobbling and cursing of every minor decline or flight of stairs that you never previously noticed. When your body is not conditioned to this impact and eccentric loading, it hurts, so gentle exposure and graduated loading over a period of time is the solution.

Another factor when it comes to downhill technique is that newcomers don’t immediately have the foot-eye coordination to have fast feet downhill, their risk of tripping is very high, so the tendency is to take long lunging steps, this allows more time to look and plan your next step, the bad news with this approach is that this magnifies the load even further, and the risk of twists and sprains. Once coordination improves, running downhill should be about fast, light feet, minimising impact and jarring, this reduces the load on your legs, causing less injuries and the bonus is that it will result in greater endurance.

So what can you do?

Three things, and ideally all three, especially number 3!

1. spend a bit of time planning where you are going, initially don’t try and climb Mt Everest if you usually run on the flat, use online platforms such as www.movescount.com to find a route that is gently undulating rather than all steep ups and downs, find areas that are not too rocky or covered in tree roots.

2. take it slow to start with, don’t push yourself, monitor your loads and don’t be a hero. Week by week gently progress as your body gets conditioned to your newfound love of this sport. Keep the distance well within your comfort and enjoy the day. Listen to your body and seek help from a Physio if any niggles develop.

3. This takes more work, but in my view, is a critical component, it will get you to achieve more, quicker, and aims to bulletproof you from injury, it involves specific exercises that strengthen your weaknesses, improve your balance and proprioception, your foot- eye coordination. The exercise program should involve exercises that target all the leg muscles, from your calves to gluts, as well as your core region and must include balance, proprioception and agility exercises, concentric and eccentric exercises. Speak to a Physio or trainer who knows the sport and can write a program that targets your specific weaknesses while being specific to trail running, ideally someone with experience in the trails themselves.

Also:- Footwear:

It is preferable to have specific trail shoes too, they have much greater grip, more lateral support to tolerate the side to side movement of trail running. Road shoes are primarily designed to go forwards. In my opinion, and I am sure I am not alone on this, one of the most fun parts of trail running a narrow single trail that winds side to side, and without appropriate shoes there will be greater risk of slipping sideways or rolling an ankle. So, save your road shoes for the road, spend a few dollars and get kitted out for he trails, and besides who doesn’t like a new pair of shoes… covered in mud?

Recommendations for trail newbies:-

1. don’t be a hero, your fitness may not be your limiting factor, it may be your ability to stay on your feet.

2. Initially choose gentle non-technical trails

3. Minimise distraction so you can focus on the trail ahead, this may mean no ipod, or not as much chatting on some parts of the run, enjoy the sounds of nature.

4. Bulletproof yourself

5. Have appropriate footwear

• First published in Aus TrailRunner Magazine Aug/Sept 2017

• Marcus has completed many trail run in Victoria, interstate and overseas- his greatest personal trail running achievements include the UTA100 (Blue Mountains- under 13hrs), Bogong To Hotham 56km, Tarawera 85km Ultra- NZ.