Doc On The Run Podcast: Running doesn’t cause running injuries

Running doesn’t cause running injuries

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Over and over patients tell me their doctor has told them to quit running. The doctor has said that running is at the root cause of the running injury. B.S.!

Breathing doesn’t cause lung disease.

Eating doesn’t cause stomach upset or heart disease.

Driving doesn’t cause automobile accidents.

Spending money doesn’t cause bankruptcy.

Running doesn’t cause running injuries.

Breathing clean fresh air does not cause lung disease. Breathing in lungfuls of coal dust, cigarette smoke or asbestos particles might cause lung disease. But breathing itself is not the problem.

Eating is the most common method used by runners to take in nutrients. Eating is not a problem. Eating too much of the wrong foods may cause indigestion. Eating foods associated with obesity and heart disease, on a regular basis for long enough may lead to heart disease.

Blood pumping through your veins doesn’t cause heart disease. But blood pumping through your veins when laden with fats, salt and inflammatory molecules might cause heart disease.

Driving an automobile does not cause automobile accidents. But driving an automobile too fast for the conditions of the roadway certainly might lead to an automobile accident. Driving an automobile while you are texting on your phone and not looking where you’re going might cause an automobile accident.

Spending money doesn’t cause bankruptcy. Spending more money than you have in your bank account, failing to meet your obligations on time, and having less money come in then is going out can lead to bankruptcy.

Running doesn’t cause running injuries.

Causing more tissue damage than your body can repair before your next workout can lead to running injuries. Running on surfaces that cause more tissue damage than your body can repair might lead to running injuries. Running in the wrong type of shoes might cause running injuries. Running with faulty biomechanics might contribute to running injuries. Running on the wrong side of the road might contribute to running injuries. Eating in a way that covers up your emotions and distress but doesn’t help rebuild the tissue you damaged in training might contribute to running injuries. Running in old worn-out running shoes, the wrong type of shoes for you, or the wrong type of shoes for the specific workout you were doing might contribute to running injuries.

Ignoring pain and continuing to run might contribute to running injuries.

Running isn’t the problem. It’s the choices we make when we are running (and recovering) that leads to a problem.

If you’re a runner it’s important you understand first and foremost that running does not cause running injuries. And if you happen to get injured and you seek treatment for your running injury it’s important you understand how to talk to your physician and convince your physician that running is not the problem.

You have to convince your doctor that running is the goal, not the problem.

For runners

If you are a runner, this is probably going to seem like preaching to the choir. Regardless of what you have read or what any doctor told you, I’ll bet somewhere deep down inside you don’t really believe running is the real problem. I agree with you.

My perspective is a little different than some other doctors only because I am a runner. I lecture to physicians at medical conferences about running biomechanics, treatment of complicated running injuries and how doctors should look at things differently to keep runners running.

But the intention here is not to preach to the choir. The goal here is not to reinforce your belief that running is good thing. The goal is not to defend your right to run.

So let’s start with the agreement that running doesn’t cause running injuries. But if running doesn’t cause running injuries, then what does? Obviously there’s a problem if you’re sitting on the couch. Obviously there’s a problem if you’re sitting in some doctor’s waiting room.

Something has to cause the running injury. The more you understand about the contributing factors to running injuries the easier it will be to avoid them.

Why are experienced drivers so much less likely to have an accident than a teenager? It’s not because older drivers have better eyesight. It’s certainly not because reaction times improve with age. Older drivers have more experience. Older drivers are safer drivers because they know what to watch out for.

If you are injured right now one of the best things you can do is attempt to view your injury as a learning opportunity.

Any running injury has the possibility of putting a spotlight on your unique anatomy, biomechanics and physiology. Some combination of factors has resulted in a running injury.

Most runners are getting away with mistakes. Most runners are getting away with slight biomechanical abnormalities that could put them at risk of a running injury. Most runners are getting away with some pollution in their diets.

If you’re just getting away with bad form, you’re just getting by eating a poor diet, even if only occasionally, and you’re unaware that you’re making some subtle mistakes in training, you may be completely unaware that a problem even exists. Although you could be at risk of a running injury you may be able to run for years without experiencing any real trouble.

But once you really ramp up your intensity, once you start training for a marathon, once you decide to take your fitness to a new level, that’s when trouble arises. That trouble shows up in the form of running injury.

Runners have to understand all of the little pieces, good and bad, that can contribute to the running injuries.

For doctors

If you are a physician and you took one of my courses or listened to one of my lectures at a medical conference in Seattle, Las Vegas, Lake Tahoe, Hawaii, Portugal or anywhere else for that matter, you already know that I think you need to be treating runners differently than your normal patients.

Last October I was speaking at a medical conference in Hawaii. After one of my lectures a foot and ankle surgeon from North Dakota approached me. He said that just last week he had an injured runner in his office. While he was talking to that runner he said, “I actually stopped to look at the runner and I said, ‘you know what, Dr. Segler says I need to treat you differently. And today we’re going to do that.’”

So look doctors, it’s not that you’re doing things “wrong.” It’s not that you don’t have the appropriate training. It’s just that we, as busy physicians, often just don’t take the time to stop and think about what we’re doing.

I understand if you contract with insurance companies and have to see patients at a reduced rate, you have to see a lot more patients to pay the rent. But just because you opted for lower insurance contracts in the hopes of increasing patient volume, that does not absolve you of your responsibility to provide individualized and customized care for injured runners who want to keep running. It is your job to help them figure out how to get back to running and how to make sure the same injury doesn’t happen again the future.

Your job isn’t done when you diagnose a stress fracture. Your job isn’t done when you get an MRI and see a partial rupture in the plantar fascia. Your job isn’t even done your runner gets back to running.

The physician’s job is only done when the runner is back to running, finishing races on pace and understanding how to train without getting re-injured.

Why do you tell runners to stop running? I want you to really think about that question.

Do you have kids? Let’s imagine your little girl wants to learn how to ride a bike. She’s been peddling around the driveway, tassels in the wind, and her doll in the basket on the front of the bike. But she says she’s ready to ride without training wheels.

So you roll her little pink bike into the garage, grab a crescent wrench and with a few spins of the wrench, the training wheels are off.

You give her some pointers and hold on to the seat. There you are, running alongside her as she starts wobbling and weaving trying to figure out how to pedal and stay upright.

You whisper, “You can do it!”

It looks like she has her balance, and you let go as you give the back of her seat just one light push.

Away she goes petals pushing, tassels waving.

But just as she passes the next driveway she starts to slow down. She starts coasting. And as she slows the bike starts to weave.

You start running to catch up. But before you can get there, your little girl is on the pavement crying.

You start to comfort her and realize she has skinned her knee. You pick her up and she quickly calms down. You reassure her and tell her it’s good to be okay.

Holding her in one arm, you grab the bike and carry her back to the house.

So what comes next?

Do you tell her that bicycling is dangerous and she shouldn’t do it?

Do you tell her riding a bike without training wheels is a stupid thing to do?

Do you feel like you need to shield her from the dangers of bicycling?

Do you tell the neighborhood kids not to ride their bicycles past the house so she won’t be tempted to do it again?

Do you donate her bike to Goodwill?

Of course not! You put a Band-Aid on her knee and you tell her we’ll be okay.

You help her understand what happened. You help her understand what would help her stay upright on her bicycle. You just explain to her that she slowed down to fast without maintaining her balance. You explain to her that since she doesn’t have training wheels to hold her up, she has to make sure she puts her feet down when she starts to slow down.

You don’t suggest that the bicycle is the problem. Instead, you help her understand what she could do differently. You help her get past her fears.

When you tell a runner to stop running you’re basically donating your little girl’s bike to Goodwill. And that is just ridiculous.

The key to getting over a running injury is looking at the details.

In training we often talk about how we need to work relentlessly on our limiters. We talk about how a chain is only as strong as its weakest link. We need to find our weak points and strengthen them.

We have to figure out what training errors we have made. We have to identify any faulty biomechanics and protect ourselves against them. We need to strengthen weak tissues. And we need to make sure that all of the tissues are sharing in the effort and absorbing their fair share of the stress when we run.

If you are a doctor you have to ask your patients about where they run. You need to find out what kind of surfaces they run on. Which side of the street do they run on? You have to watch them walk. You need to look at the wear pattern on their soles of the running shoes. Need to ask them about their nutrition. You need to ask them about their training schedule.

Remember, your job as a doctor is to take into account all of the factors that contributed to the running injury and then use that information to help the runner heal and keep running.

If you are runner, you have to figure all of the minor details that may have contributed to your overtraining injury. You have to realize your doctor is trained to focus on your injury. Your doctor isn’t trained to focus on your goals.

Make no mistake your doctor wants to help you. But don’t be confused, runners don’t think the same way as the doctor. A doctor does not think the same way as a runner.

So your job as an injured runner is to step back and carefully evaluate everything that can contribute to a running injury.

If you do that, if you really take inventory, if you really asses and pay attention to the details you will be armed with the information you need to share with your doctor so the two of you can heal your running injury.

Perhaps more importantly if you can identify the limiters that contributed to your running injury in the first place, you could actually come up with strategies to fortify and strengthen the system so that you not only decrease your risk of another running injury in the future, but you actually wind up running faster and longer than ever.

Mechanical stressors

The simplest form of mechanical stress in runners is the one doctors seem to bring up the most. They talk about the force and the pounding your body takes when you run. They talk about the force of gravity and your feet pounding the pavement.

For many years now, I have lectured on running injuries at medical conferences. There’s another doctor who I’ve often heard lecture. His name is Dr. Ed Glaser. Dr. Glaser is an undisputed leader in biomechanical thought relating to foot and ankle biomechanics and injuries associated with those biomechanics.

On dozens of occasions, I have heard Dr. Glaser state that 85% of all running injuries are caused by “faulty biomechanics.”

Whether or not there is a way to prove that, I do not know. But I would be willing to bet that the overwhelming majority of podiatrists, sports medicine doctors, chiropractors, physical therapists and foot and ankle surgeons would agree that some sort of biomechanical problem is at play when a runner gets injured.

Now, don’t take that to mean you’re somehow “faulty.” It doesn’t mean you’re broken. It doesn’t mean you are defective. It does not mean you’re a freak of nature. It does not mean you don’t know how to run.

It just means something in the way that you run, the way that you are shaped or the way that you train is forcing your feet hit the ground in a way that is applying excessive forces to some structure in your body.

If you’re a doctor, you have to remember that your job is not to tell runners to avoid the mechanical stress of running.

Don’t forget the Hippocratic Oath: “First, do no harm.” If you are a doctor and you are telling runners not to run, trust me, you are doing harm.

Your job as a physician is actually to use your knowledge of biomechanics and help the runner figure out how the runner’s style is unnecessarily increasing mechanical stress to this particular structure that has been injured.

The job is to help the runner figure out how to reduce that stress to that structure without overloading some other anatomic structure.

The doctor’s goal is to get the injured structure to heal and get the patient back to running without worrying about whether or not they are going to cause that same injury again.

Oxidative stressors

Have you ever thought about what kind of oil you cook with? Even if you’re using “healthy” oils like olive oil or coconut oil, if you burn the oil when you’re cooking it, the oil can break down and create free radicals that lead to oxidative stress. Have you ever thought about that? Did your doctor ask you about it?

If your doctor isn’t thinking about your exposure to oxidative stressors, you should probably bring it up when you are talking to your doctor.

Environmental stressors

What about environmental stressors? If you are running in California when there are wildfires filling the air with pollution, you are adding extra stress in your body when you breathe that air. If you run in a park that seems nice, peaceful and placid, but it’s surrounded by heavy traffic and has lots of automobile exhaust in the air, you are inhaling environmental stressors.

The truth is I love running in Houston at Memorial Park with my sister. But I know it’s not good for me. The massive I-10 freeway is on the north side of the park, the 610 freeway is on the west side of the park and Memorial Drive is on the south side of the park. So there are three major thoroughfares with thousands of cars driving by puking exhaust fumes right where we run.

If you are breathing air loaded with carbon monoxide and other airborne stressors you’re increasing the amount of work your body has to do before it can heal.

Don’t ever forget that every workout requires healing if you are going to get stronger. An over training injury is just an opportunity to evaluate your capacity for healing and figure out ways to strengthen it. If you figure out why you got injured, you can become a stronger runner. To become as strong as possible you need to heal and recover as efficiently as possible.

Hormonal stressors

If you are a doctor you should be asking the patient about whether or not they have any symptoms that might correlate with thyroid dysfunction or pituitary gland problems.

If you are a patient you should think about whether or not you feel tired all the time. Has your energy level changed? Are you having difficulty sleeping? Is there anything that might signify some shift in your hormonal balance? Did you have a baby recently? Are you pregnant? If you are a man and you have seen the commercials on television talking about low testosterone, do any of the symptoms they talk about hit home with you?


Are you taking non-steroidal anti-inflammatory medications on a regular basis? Are you taking ibuprofen so much that you think of it as “Vitamin I.” There is lots of evidence that non-steroidal anti-inflammatory’s can slow down musculoskeletal healing. There is also lots of evidence that non-steroidal anti-inflammatory drugs can decrease the effectiveness of your workouts.


Are your sleep patterns contributing to the injury? You don’t get stronger when you run. You get stronger when you rest. Are you really making sure you get a good night’s rest after every workout?

Running shoes

Are you running shoes causing the problem? Are you running in the right kind of shoes for you? Are you only running in one type of shoe? Do you need new running shoes? Do you even know how to tell when you need to replace your old running shoes?

It is unlikely that one single factor is cause by your running injury. It is more likely that there are slight improvements you can make in each of these areas to maximize your workouts, heal faster and run further without injury.

When you get injured you have to figure out what the problem is. Your doctor may think the problem is a stress fracture caused by running. Your doctor may think you have a partial rupture of your plantar fascia because you ran too much. Your doctor may think you got Achilles tendonitis because you did too many hill repeats.

But there is actually some combination of factors that limit your ability to heal the micro-injuries you sustain as a normal part of training. That combination of factors has prevented you from completely recovering and fully healing all of those structures before your next workout.

You really need to analyze what went wrong. You need to look for your limiters.

A running injury often points quite loudly and painfully at those limiters. Look for and identify the limiters. If you do that you’ll not only heal your running injury faster, but you’ll be able to run longer without sustaining another over training injury.