Minimizing Injury from Running: Considerations for Larger Athletes

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Perhaps one of the greatest yet most personally irrelevant books on running I have read would be Born to Run by Christopher McDougall- an outstanding novel that made several excellent points about human’s natural propensity for rapid and efficient bipedal locomotion.  The book is absolutely correct in asserting that certain humans are incredibly efficient in their running movement patterns- the act of running is nearly effortless and natural- their light frames glide smoothly across the ground at high speeds, legs eating away ground with a look of zen bliss on the runner’s face.

Image: Arnulfo Quimare (A Tarahumara ultra runner), left, and Scott Jurek (one of the top ultra runners in the world) right.
Image: Arnulfo Quimare (A Tarahumara ultra runner), left, and Scott Jurek (one of the top ultra runners in the world) right.

I am not one of those people.  This article is not intended for one of those people.  (Though the advice in here is equally applicable) This article is intended for strength/power athletes, especially the larger among us, who have an interest in running (whether for their sport, general conditioning, as part of job/PT requirements, or so forth) and who find that running is a painful, jarring, exhausting experience that usually results in stress fractures, knee pain, and the overall conclusion that if humans were born to run, we wouldn’t be slower than nearly every predator out there.

So why is running such a painful, injury filled prospect for us?  We tend to be heavier, of course, which increases the loads being borne, but we also tend to be larger up top, our upper bodies adding a heap of (at that moment) useless weight that needs to be managed.  We tend to be poorly practiced- though not all of us have avoided running, we do tend to view it with some distaste- meaning less time has been spent practicing our stride than even most casual exercisers.  We tend to have some interesting pre-existing injuries- torn muscles, damaged knees, bad hips…  that are UNRELATED to running, and cause changes to our running mechanics.  But quite frankly, most of us just don’t know how to run properly- those that argue it is a “natural” movement are rarely those who have spent significant time developing decidedly unnatural levels of strength and muscle, with the unique physiques to match.

So how do we identify potential issues and prevent them before they derail running efforts?  Note that this article is intended for either beginner runners, or those returning to running after an extended layoff, but if you’re an experienced larger runner still plagued by injury, several of the points may be worth reviewing.

Before you start a running program- finding your form.

No strength athlete would ever simply recommend an individual “walk into a gym and pick things up” if he or she is looking to get started in a given sport.  Similarly, simply stating “go out and run” is equally risky.  Running may be a “natural” movement, but so is a deadlift, and the latter certainly takes practice.  The first step in preventing injury I always recommend is doing a BASIC gait analysis.  Every individual out there has unique mechanics- this means a unique upper body center of gravity, unique lever arms ranging from their head to their torso to their arm swing to their leg movement- to assume everybody should run the same is foolish.

If anybody has ever (when you’ve asked for running advice) told you “try POSE running”, or “try to land on your forefoot”, throw something heavy at them.  Forcing a style of running is a straight shot for injury.  Learn your natural stride.

First we’ll examine the two basic types of stride and basic considerations for each, then follow with overall guidelines on beginning and developing a running program, and proactively managing injuries.

Determining footstrike

To do this, there is a simple test that will require a partner with a camera or camera phone- now please note, this is NOT a formal gait analysis, but simply a test I use to determine form.  Set a treadmill to a slow, EASY jogging pace- around a 10-11 minute mile for most beginner to intermediate runners.  Have an individual video you from the side (camera phone is fine), at hip height (with your feet in the frame) for 20-30 seconds.

What you will be looking for in the video will be overall footstrike- are you hitting the ground with your heel, with your midfoot, or with your forefoot?  An easy freezeframe will show this.

footstrike 1

Even with a blurry camera phone you can easily see this is a classic heel strike- the runner’s foot is hitting the ground slightly ahead of his body, with the heel impacting first and taking the majority of the impact.  This individual may need to shorten his stride a bit, but that will not fundamentally change his form.  If you display this pattern, perform another 30 second test barefoot or in socks.  (The reason for this will be below)

footstrike 2

This is a midfoot/forefoot strike- notice how the front of the shoe is deforming first, with the runner absorbing the impact with his foot arch and calf.

The important thing to remember here is that NEITHER ONE IS FUNDAMENTALLY INCORRECT.  I’m all but certain there will be plenty of internet hate for this, but at the end of the day there are excellent runners who utilize both styles, and neither one has a proven higher incidence of injury, the runner just needs to select the proper footwear and understand the proper movement cues for each.  (If you’re interested, scroll back up to the picture of the Tarahumara and Scott Jurek.  Scott is one of THE most dominant ultra runners who has ever lived, and you’ll notice he is a heel striker).

The Heel striker:

Common injuries- ankle stress fractures, mid knee pain, shin splints.  Heel striking imparts more force to the knees- since the ankle itself is essentially hitting the ground AT the joint (rather than distally, as a forefoot strike would be), the knee itself has to absorb the impact.

If you are a heel striker, there are several things you need to keep in mind:

1)   Select proper footwear.  Minimalist shoes are NOT the best idea for you.  (The exception would be if you immediately switched to a midfoot strike when running barefoot in the test above.  The padded heels in your current shoes may be forcing your heel to strike first, and this may not be your natural tendency.  If you find this to be the case, move to the next section.)  Assuming otherwise- understand that you will NEED a shock absorbent heel for maximum comfort.  When your foot hits the ground, every single strike imparts forces 7-8 times your bodyweight through your entire leg- directly through your ankle bones and through your knee.  When looking for a shoe, I would HIGHLY recommend the new wave of max-cushion shoes for larger runners- Hoka, Altra, and New Balance all make excellent footwear with large amounts of cushion that do greatly help distribute ground reaction force and reduce the jarring force on your ankle bones and within your knee.

2)   On that same topic, notice Altra mentioned above- they produce “zero drop” shoes- the “drop” in a shoe refers to the different in heel padding/height versus toe box height.  As an example, a pair of sandals is “zero drop”- the heel is the same height as the toe.  A pair of Adidas adiPowers (though obviously not running shoes) have a 20mm drop- 24mm heel, 4mm forefoot.  Most running shoes will mention their drop in their specifications, and I’d recommend most heel strikers use shoes with anywhere from a 4mm to 8mm drop.  Examine your current running shoes and determine what their drop specification is.  If you’ve used them for a while, make sure that any new pair you purchase is similar in terms of drop, as making large changes here could result in rapid injury.  In other words, if you’ve been running in an old pair of 12mm drop Sauconys, don’t go out and buy some Altra Olympus (0mm drop).  The change in running mechanics will greatly increase your chance for injury.  Note there is no inherent advantage (yet proven) to any particular heel drop- it just needs to fit your running style.

3)   Shorten your stride- do NOT over-stride- think less about clawing at the ground or taking big steps and more about letting yourself “fall” forward.  Your stride may feel almost comically short and rapid when you first attempt this, but you’ll find eventually this is actually less tiring.  Hitting too far ahead, besides being inefficient, also “slaps” your forefoot down, stretching your anterior tibialis muscle (the one to the side of your shin) and causing irritation…  one of many potential causes of shin splints.

4)   Vary your pace. As the heel striker varies stride length with speed more than the forefoot striker, varying pace is key to preventing overuse injuries.

5)   Keep your head up and lead with your chest.  Larger runners have a great deal more weight (proportionately and on an absolute level) in their upper body.  The consequences of letting shoulders round and the head drop are therefore magnified- a tremendous amount of strain will be felt in the lower back, and this will often lead to falling forward and overstriding, as well as easy knee hyperextension.

The Midfoot/ Forefoot striker

Common injuries: Calf/soleus pain, plantar fasciitis, ankle soreness, knee discomfort.

While this is a running style that is currently being lauded as “superior”, it is simply a different set of mechanics.  Having an additional active lever (the ankle and foot) to absorb impact does reduce the momentary peak forces involved, but also introduces new challenges.  Forefoot runners can often worry less about the terrain they are running on, and tend to have fewer knee issues than heel strikers.  Unfortunately, they are often plagued by calf and foot issues, and have fewer choices in running shoes.

Considerations for forefoot runners:

1)   Footwear choice is more limited- a proportionately larger heel (bigger drop shoe) will “interrupt” your natural stride, so forefoot/midfoot runners are strongly encouraged to wear shoes with a 4mm or less drop- it is these runners that minimalist shoes are intended for primarily, and it is these runners who can entertain thoughts of barefoot running for extended periods.  Generally, any zero drop shoe will work, however- zero drop does not mean zero cushion, and there are several brands of shoe out there with solid cushions but no difference between heel and forefoot height.

2)   These runners need to ramp their mileage more slowly than heel strikers, I have found- heavy calf and forefoot engagement are NOT things that strength athletes are typically accustomed to, and very often these individuals will experience severe pain in their soleus muscle or pain in their arch if they up their volume too quickly.  Being extremely conservative with weekly mileage increase is the recommendation here- even most beginner running programs may up the distance too quickly.  Note that the more minimalist your shoe, the more demand is being placed on your feet- a greater cushion shoe is recommended initially, since the sole itself will help reduce the demand on the foot to absorb the impact.  After mileage starts to increase, a less cushioned shoe can be worn.  Moral of the story- do not take out toe shoes or minimalist shoes for a ten mile run if you’re first getting back into running.  You will destroy your feet!

3)   Learn to lift your knees, even when moving slowly.  Forefoot/midfoot strikers can often encounter severe knee pain if they do not lift their knee enough when the leg is moving forward.  Too little knee lift often leads to the foot jamming into the ground with a pronounced scuffing sound, which puts tremendous shear pressure on the knee joint (as the leg below the knee is suddenly stopping, while the upper body continues forward).

4)   If you have flat feet, seriously consider orthotics- striking with your mid or forefoot without a fully functional arch (which is a shock absorbent structure) can lead to severe foot pain and arch pain- many larger individuals who work active jobs or spend a good amount of time walking or marching can develop flat feet without realizing it, and this can severely hamper their running if not managed.  Consult a podiatrist or similar specialist before starting a running program if you have this condition!

For all runners:

Though the above points are what I consider the most basic points specific to each style of running, they should be seen as a starting point- an initial checklist.  The following points apply to ALL runners:

1)   Change your shoes, often.  Even minimalist shoes will break down and provide less support over time.  Larger runners will tear shoes to pieces in a far shorter time than lighter runners.  Look for signs of uneven wear in the soles, creases or wrinkles on the sides of the sole (in the foam), small tears in the stitching- I do not necessarily agree that shoes need to be changed every 200-300 miles, but they do certainly need to be changed (or better yet, rotated) more often than the majority of us do.

2)   Get a running store to look at your gait- if you have a reputable running store nearby, many of them will let you try on shoes and watch you run in them.  They can often make some general recommendations on certain types of shoes to support pronation/supination while running, though I tend to find this less critical than many other factors.  If they have a good return policy, you can probably trust their advice, since it’s in their interest to have you love the shoe you buy.

3)   Do not run on the sidewalk.  Concrete is the WORST surface to run on.  Asphalt is superior, being somewhat softer due to the rubber in the compound, so running on the side of the road (please watch for traffic, and run TOWARDS traffic not away from it- you are not a vehicle) can be easier on your joints.  Grassy medians between the sidewalk and the road are also an option, though they are often slightly uneven terrain.  Trails are by far and away the best- undulating grades and soft surfaces force you to pick up your knees, take short steps, vary your pace, and pay attention to your stride- all by far and away the best ways to ensure healthy joints.

4)   Increase your volume slowly.  VERY slowly.  There is no fixed percentage here per week- some runners recommend 10% weekly volume increase, but listen to your body.  Running aches and pains do NOT go away- unlike some lifting pains, you cannot train through them.  Do not do “deload” weeks where you simply run shorter distances if you’re experiencing pain- far better to skip 3-4 days of running entirely than run shorter distances for a few weeks- the former will let the body heal, the latter will simply maintain the status quo.  And vary your pace, vary your terrain, your types of runs, and your distance.  Do not just run the same loop three times a week- if you’re running three times a week, do three different types of runs (interval, tempo, long slow distance, etc.) on three different surfaces or routes- variation helps prevent overuse.

5)   Do not run in your knee sleeves.  Really, don’t.  Please.  If you do this, then stop doing this. I see it entirely too often.  These alter your gait.  If you want support, purchase some thin, open patellar knee warmers- leave the Rehbands at home.  Even if you are running immediately after a workout (or mid workout), this is not an excuse for stupidity.  At the very least roll them down.

If you get injured regardless

If you have the proper footwear, you’re running on the proper terrain, you increased your mileage slowly, your gait is efficient and controlled, and you have STILL injured yourself, then you are the exception- 95% of athletes I have worked with who deal with running injuries have missed one of the above components.

All this aside, injury does happen.  The cure for nearly all running injuries is simply rest- avoiding doing what injured it in the first place.  Do not attempt to push through the issue, do not attempt to wrap your stress fracture to hope it goes away- certain issues like patellar tendonitis can be managed with patellar bands, and plantar fasciitis can sometimes be managed with inserts/arch support, but for the most part you’ll need to rest and recover before resuming activity regardless.

So how can progress be maintained if injury is sustained?  Cross training can keep fitness levels high, and can be incorporated into running routines even when healthy to improve running fitness without adding additional miles.

Cycling is outstanding for building your lactate threshold and overall fitness, though cycling fitness often does not directly translate to running fitness, due to the vastly different movement mechanics and stressors on the body.  Note that it is entirely too easy to be lazy on a bike- be aggressive and make use of a heart rate monitor, if needed.  Coasting is something you do not do when running, so a recovering runner should quite honestly stick to a stationary bike or bike trainer where this is not an option.

The elliptical machine is a decent zero impact substitute, though quite frankly it is to running what hard cider is to beer- you’ll need quite a bit of it to get the same effect, and you may often find that it is simply not worth the extra effort.  Though it similarly engages the entire body, it must be done at a very high intensity to get any real benefits.

Aqua jogging, or water running, can be an outstanding option- it mimics many running mechanics with zero impact, removes all load from the joints, and can be tremendously taxing.  The downside to aqua jogging is that you do tend to look completely and utterly foolish, which does tend to discourage many from even attempting it.  This is a shame, since it is an excellent supplement for larger runners even when healthy.

Regular swimming (lap swimming) may help maintain overall cardiovascular endurance and help teach controlled breathing, but the translation from swimming fitness to running fitness is extremely poor, given the major differences in muscle groups involved.

To wrap up

This has been far from a comprehensive guide to injury prevention in running, in fact, it’s more of an introduction with just enough detail to get you in trouble.  This should represent a good starting point, though- if you come away with nothing else, come away with the understanding that doing a bit of extra work before you start running can be worth the hassle in the long run (sorry).  Find the right shoe, understand your mechanics, vary your terrain, and respect the act of running as being as complex as any movement performed in the weight room, with equal potential for injury if performed incorrectly.

Related Articles: Podophillia by Ryan Brown

The Best Damn Squat Mobility Article, Period by Dr. Quinn Henoch

Alex Viada is a different breed of athlete, he is a hybrid athlete, combining tremendous strength and exceptional endurance, he pushes his body in ways that few even thought was possible. With PRs of 705, 465 and 700 raw w/ wraps in the 220 class and a mile time of 4:15, Alex has reached levels that even few specialists can match. At his Durham, NC based facility, Complete Human Performance, Alex works with athletes of all kinds helping them take their strength and conditioning to new levels through well thought out hybrid training and sound nutrition.

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