Today on the Doc On The Run podcast we’re talking about overtraining myths, and other B.S. that you need to know to avoid an overtraining injury.
Whether you’re training for your first 5K, a half-marathon, Ironman triathlon or 100 mile ultramarathon, you have to put in lots of miles. To keep logging miles, increasing your speed and building your strength…you have to avoid injury.
The real game with building strength and fitness in long distance running is to systematically stress your tissues so those muscles, bones, tendons and ligaments all have to rebuild themselves and become stronger.
So whether you are self-coached, you purchased an online training program, or you have hired a professional coach to help you, the task is to help you choose workouts that will deliver the maximum amount of tissue damage that your body is capable of rebuilding before your next key workout.
But if you do more tissue damage than your body is capable of rebuilding, and then you do another hard workout, you get an over-training injury.
I lecture to doctors on running injuries at medical conferences all over the U.S. When attending those conferences I have the luxury of listening to a number of different speakers talk about the latest developments in foot and ankle surgery, biomechanics and sports medicine. All of the speakers at these conferences are very well respected, bona fide experts in the field.
So it may surprise you that sometimes I hear what I consider to be B.S.
You made heard some of the same things, too.
There’s actually an ounce of truth to each of these ideas but everyone of these is a vast oversimplification of the problem. The central theme of all these ideas presented by so-called experts is that you have to just change one thing (most often….run less) in order to avoid an overtraining injury.
And that, is total B.S.
If you think about how an over training injury actually happens you will realize all that has really happened is you have applied more stress to one particular structure than your body was capable of repairing, before you stressed again. The cumulative stress added up to the point where you had a stress fracture, muscle strain or a case of tendinitis develop.
When you get an over training injury, the whole system isn’t broken, just one part. You just have one particular anatomic structure that has been stressed or strained to the point of causing pain. That pain is interfering with your training.
Maybe you have a fourth metatarsal stress fracture. If that’s the case, it’s only your fourth metatarsal that has a problem.
If you have Achilles tendonitis, obviously it’s just your Achilles tendon that is bothering you.
In either case, you didn’t run too much. You just applied to much stress to that particular structure… before it could fully recover.
When you go see the doctor and your doctor tells you to stop running, or slaps you on the hand and says you’ve been running too much, it’s easy to understand how you could become disenchanted with the doctor.
But I think telling runners to stop running is a copout.
It’s not the doctor’s job to tell you to stop running. It’s the doctor’s job to help you understand how to continue running and continue training without applying too much stress to that particular structure.
It’s the doctor’s job to help you figure out how to keep running.
I will readily concede if you stop running you will dramatically reduce the forces which have contributed to your running injury. So that’s what doctors are really trying to do when they tell you to stop running. They know running applies a lot of forced your lower extremities. So they tell you to stop running as a strategy to reduce the stress.
In addition to telling you the solution maybe to stop running you may also hear things like:
Of course all of these approaches are basically the same thing…”stop running, run less, or do something else.”
But as a runner, you don’t want to stop running.
If you press the doctor and you explain you really do want to keep running, she may suggest you’re running injury is caused by a “biomechanical defect.”
One of the experts I heard lecture at a medical conference said that 85% of all running injuries are caused by faulty biomechanics. Now, make no mistake this guy is a bona fide biomechanics expert.
But I find it very difficult to believe that 85% of injured runners are defective. Think about all of your friends who have ever told you they got a running injury. Do you really believe it’s possible that 85% of them are biomechanically defective?
Have you ever had a running injury? Did you get better? Did you get back to training? Did you ever run another race? If so, is it reasonable to believe that there’s an 85% chance you have “faulty biomechanics or some kind of biomechanical defect?”
I don’t think so.
The problem with this premise of course is that if there’s an 85% chance you have faulty biomechanics just because you got an over training injury, the doctor will want to do something to address your quote unquote “faulty biomechanics.”
If you happen to be seeing a podiatrist the chances are really good the doctor will tell you need custom orthotic inserts for your running shoes. Expensive, heavy custom orthotics.
While it is true that we can modify your running biomechanics and alter the forces applied to the foot and throughout your lower extremities if you run with custom orthotics, I don’t believe custom orthotics are necessary for most runners.
I don’t believe most runners are defective.
You are not defective. You are who you are. You have the anatomy and physiology you were born with. You have the strengths you have developed.
You may also have weaknesses that you have permitted to exist because of your inability to identify or work on your limiters. But even if that’s true, you are not “defective.”
An analogy to this is dyslexia. Malcolm Gladwell wrote a very interesting piece in one of his books were he discusses dyslexia. Many people who have dyslexia have to work around problems which develop from reading and dealing with standardized testing systems in school.
There’s no real effective way to treat, eliminate, or correct dyslexia. So the student with dyslexia has to find a way to work around lots of problems. As a result of learning how to work around those problems they can become incredibly effective in surprising ways.
As an injured runner, you have to learn how to work around an injury. You don’t have to stop running. You just have to be creative. You have to look for and identify all the opportunities to reduce stress and strain, increase your speed of healing and maximize your body’s capacity for strengthening that injured tissue without overdoing it.
So when you get an over training injury there are three basic approaches that can help you:
Most doctors (and injured runners) want to try to identify the one thing that will help them heal. But I’m willing to bet that you have opportunities in every one of these three areas.
The simplest form of decreasing the stress is to rest. You could run less but that’s not what I’m advocating here.
There are many ways to decrease stress. Instead of focusing on the specific stress associated with running, what if you considered other forms of stresses?
Do you have too much stress related to your job? Could you do something to reduce your workrelated stress?
What about environmental stressors? Do you run where there’s lots of traffic and associated pollutants in the air? Could you run somewhere else?
Have you had a full evaluation by your primary care doctor to determine whether or not you might have hormonal stressors contributing to your overtraining injury? Thyroid dysfunction, pituitary gland problems and low testosterone in runners who are in their 40s and 50s could be limiting your capacity for recovery and contributing to over-training injuries.
What about nutritional stressors? Apparently, in the last 10 years everybody on the planet seems to have developed an intolerance to gluten. Although I am often dismissive of anything trendy, it is true that if you have a gluten intolerance it’s harder for you to fight off inflammation. And over training injuries are really nothing more than accumulated inflammation and your body’s inability to deal with it.
Like I heard when I used working psych hospitals, just because you’re paranoid it doesn’t mean that they’re not after you.
You should think long and hard about all of these different potential sources of stress in your life. It’s just math. If you can reduce some of these stresses then you can add more biomechanical stress, in the form of running, so you can train more.
Once you have thought about all those other stresses and developed some strategies to reduce some stress in other areas, then you can focus on the biomechanical stress that overloaded that one structure that seems to become injured.
Here’s how to do that:
The way think about this is sort of like cross training. In the simplest sense we know that if you do different activities you’ll spread out forces so you can continue to build fitness while reducing risk. Swimming applies much different forces your body and running. Cycling also applies different forces to your body than running.
But as a runner, you want to run. I am not going to tell you to become a triathlete.
So let’s talk about some ways you can effectively spread out the forces without switching to a completely different activities.
Most runners are creatures of habit. They use one kind of running shoe. They run on a couple particular courses that they love. Maybe it’s at Memorial Park in Houston. Maybe it’s in your neighborhood.
The key here is to think about all the things you can alter in your running routine.
If you know that you got pain in your Achilles tendon after a series of hill repeats. Do less hill repeats. Run on a flatter surface. Running on flat ground is better than not running at all.
Mix up your running routine if you want to run more with less risk of injury.
I admittedly and truthfully have a few courses I use as staples. If I want to run 3 miles I typically run the same way through my neighborhood, in the same direction.
What about you? If I ask you where would you run 6 miles today? What comes to mind? Do you not picture a specific place for you would run 6 miles?
What about 10 miles? Do you do the same thing? Do you have a particular place where you know you would go?
What about 3 miles do you have a specific 3 mile course that you know you would run on if you had a three-mile tempo run to do?
You don’t necessarily have to find entirely new running routes but you have to mix things up.
I’m not even saying that you have to think about an entirely new location to run. What if you just did that same 3 mile run through your neighborhood in reverse direction? What if you did that same run on the opposite side of the street?
If you just introduce a slight variation like this to your routine you can significantly alter the forces that are being applied to all of those bones, tendons, ligaments and muscles in your feet as you run.
You can also look for slightly different surfaces.
For example here in the San Francisco if you run in Golden Gate Park, in most areas you actually have three choices of surfaces. You can run on the asphalt in the street. Because the street is slightly sloped you’re running on a slight angle and so it applies different stresses to the right foot and the left foot.
But just on the side of the street there’s a paved jogging path that’s basically flat. On the other side of the street there’s a dirt jogging path. So even if you’re running the same course in Golden Gate Park you can choose a different running surface that will apply different forces to your system.
You can also adjust your running form. Make no mistake…regardless of your stance on barefoot running, no one is going to argue about this point. If you run and land as a heel striker and then the next day you run its a fore-foot or mid-foot striker, you are going to be applying different forces to virtually all of the tissues throughout your lower extremities.
Altering your running form is one of the simplest ways to dramatically shift forces.
In much the same way you can alter your running shoes to spread out the forces. Again, the goal is to apply different amounts of forces to different tissues on different days so that you can allow those tissues to recover in between workouts.
I actually run in four different types of shoes during a given week. I use different shoes for different workouts. And if you run in different shoes you’ll notice they each feel very different. They feel very different because they’re applying forces differently.
That’s what you’re looking for here. Try to figure out how to apply forces differently on different days to reduce the risk by spreading out forces so that no one tissue, no one metatarsal, and no single tendon gets overworked.
The last thing is to vary your workouts. About 10 years ago I saw woman woman who was training for a marathon. Interestingly, she basically only did one workout. She ran 8 miles on a relatively hilly course that was right out her front door. Not only did she run the same distance on the same course, she ran in the same direction, on the same side of the street every time.
Not only would that be boring to me, it seems like a recipe for an over training injury.
Of course, if she had a coach, her coach would have been telling her to do different workouts. Most training plans have at least three different workouts every week. Most marathon training plans will include a long run on the weekend, some form of speed work and some sort of tempo run on a different day. All of these various runs have a specific place and purpose in your overall development as a runner.
You can’t expect to do the same run day after day and expect to get stronger. At least not consistently stronger over a long period of time. But if you’re foolish enough to try it, you just might wind up with an over training injury.
If you have a coach, make sure you talk to your coach about all these different strategies and see if there’s anything else you can add in terms of variability to further reduce your risk of injury. If you already have an over-training injury you need to evaluate very carefully what is stressing that tissue so much that it’s not recovering.
But please, don’t stop running.
Just figure out how to reduce the stresses and spread out the forces enough to continue running.
Once you get better and you’re back in your running routine you want to be diligent about evaluating any source of discomfort right as it appears. If you get any new pain you should immediately discuss it with your coach. If you have any pain that lasts for more than two days you should get it checked out immediately.
Do not ignore it!
The runners who call me for a second opinion have always waited way too long. In the overwhelming majority of cases when I do evaluations by phone or through a web conference, the runner has basically had to stop running.
I really and truly believe if they just would’ve taken some small action earlier, they wouldn’t have had to stop running.
And whatever you do if you see your doctor and your doctor just tells you to stop running…you definitely need to get a second opinion.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!
Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.
But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.
You can arrange a Virtual Doctor Visit with a true expert on running injuries. Right from the comfort of your own home you can meet online with the doctor, discuss your running history, talk about your running injury and figure out a customized recovery plan that will help you heal the running injury so you can get back to running as quickly as possible.
Book your Virtual Doctor Visit with Doc On The Run now!