Myth 1: Injuries are the result of bad luck.
Truth: Scientifically there is no such thing as bad luck, thus that can't be the cause of running injuries. All running injuries are caused by something concrete and with enough investigation the underlying cause can be found and fixed or eliminated, which will help that injury heal faster and more completely and help prevent future running injuries.
Myth 2: Injuries are from overuse.
Truth: Most running injuries are not from overuse (running too much etc.) but caused by posture imbalances, especially left to right imbalances in your body. You don’t get right Achilles tendon pain (save the tendonitis vs tendinosis debate for another time) because you are running too many miles, but because your right foot strike is compromised. Why is it compromised? There could be many reasons, but some examples are: your right shoulder blade is locked up and out of position; or your right hip is not flexing and extending from the hip joint correctly; or your left hip is unstable and you’re overloading your right leg; or your right ankle lacks dorsiflexion; or…The point is, it is not an overuse issue like running too many miles, running too fast, running too much vert., it is a posture imbalance issue that needs to be addressed.
Myth 3: Most running injuries are caused by inflammation.
Truth: Most running injuries RESULT in inflammation but are not caused by inflammation. If you sprain your ankle, either straining or tearing ligaments, your body senses the damage and instability created by the sprain and inflames the area for several reasons. The inflammation creates a natural brace to limit movement at the ankle until the ligaments have healed – brilliant! The inflammatory fluid also contains many substances that help with the pain and healing including neutrophils, macrophages, and satellite cells. The last thing we want to do is reduce this inflammation after an acute injury. The inflammation is actually helping us in multiple ways to heal faster. Running injuries are not caused by inflammation but result in inflammation.
Myth 4: Running injuries are caused by a weak core.
Truth: Most running injuries are not caused by a weak core. Most running injuries are caused by posture imbalances. Most running injuries are one sided. Think about it: you injure your right knee, or left ankle, or right foot, or left hip. Most injuries are not to both feet at the same time or both knees - it's either your right or left side. Why? Because you have posture imbalances left to right in your body. Yes most physical therapists will immediately tell you your core is weak and give you exercises to strengthen it, but that is doing nothing to fix the underlying cause of your running injury.
Myth 5: Your knee hurts, so it must be a knee problem.
Truth: Knee injuries are almost never caused by a knee problem, just as foot injuries are almost never caused by a foot problem. Knee injuries and foot injuries are related to your ankles, knees, hips, spine, and shoulders because your body is a unit and everything works together. If you injure your right knee it could very well be because your left hip is weak causing you to overload your right knee. If you injure your lower back it is probably because your hips and upper back have lost mobility and function, putting increased stress on your lower back. Again the key is finding and fixing the underlying cause of your injury, not just treating the injury itself.
Myth 6: Once you injure a joint, it will always be prone to re-injury.
Truth: It is true re-injury rates are alarming: ACL up to 60%, disc herniation up to 20%, rotator cuff up to 80%, ankle sprain up to 30%, etc. The reason re-injury rates are so high is because most people treat the injury, but never fix the underlying cause of the injury. It's like this: You spilled a box of nails on your driveway and you drive over them and your car gets a flat tire. You repair your tire and then get another flat the next day as you drive over the nails again. It's no surprise you got another flat tire! You forgot to pick up the spilled nails on your driveway! When we correct or fix the cause of the running injury we can prevent future re-injury.
Myth 7: It’s important to RICE or PRICE after an injury.
Truth: RICE which stands for Rest, Ice, Compression, and Elevation or PRICE which adds Protect to the start, do not help running injuries heal faster and research is showing they most likely slow healing. Why? Post injury inflammation is helpful to healing. We want to allow the body’s natural inflammation to remain to allow faster healing of the damaged tissues. Ice, compression, and elevation were all designed to decrease inflammation, which is what we now know is the opposite of what we want to do. What about Rest? Resting the injured area is a good idea initially but once the initial pain has decreased it’s important to start slowly and carefully moving the injured area. Movement helps improve blood and lymphatic flow which is important to remove waste products from the injured area and to bring more nutrients and healing cells to the injured area. Movement can decrease scar tissue from forming which can lead to future problems. The key is keeping movement gentle, slow, easy, and as pain free as possible.
Myth 8: A stress fracture is caused by RED-S or low energy availability.
Truth: Stress fractures are caused by imbalances in your posture and gait not low energy availability. Why? The stress fracture almost always happens on one side of the body – like one tibia, or one femur, or one side of the pelvis. Pure nutritional issues wouldn’t show up on one side of the body. Posture imbalances left to right in the body have caused increased load and stress on one side of the body and one part of the body causing the stress fracture. Fix the imbalances and the stress fracture wouldn’t happen. (Don’t take this to mean that RED-S and low energy availability isn’t a big problem in sports and especially ultra-endurance running – it is. And I encourage everyone to eat enough and not restrict eating at all. Food is vitally important for health and performance. It’s just not the cause of injuries like this.)
Myth 9: After a running injury we should always take anti-inflammatory drugs (NSAIDS) like Ibuprofen, Aspirin, or Naproxen.
Truth: NSAIDS slow healing because they decrease natural and positive inflammatory cells around the injury site. Those inflammatory cells (like neutrophils, macrophages, and satellite cells) play an important role in tissue healing after injury. It’s also important to remember pain plays an important role after injury – it keeps us from using/loading the injured tissues before they are healed and ready to be loaded. NSAIDS decrease pain which might encourage someone to start using the injured area too soon which could lead to more injury.
Myth 10: Running injuries are genetic.
Truth: Genetics determine our hair color and how tall we are, but not whether we get running injuries or not. Just because your father and two brothers have had plantar fasciitis, it does not mean you are going to get plantar fasciitis.
If you'd like to discuss your injury and learn what's really causing your injury and how you can fix it and get back to running pain free, contact me and let's have a conversation about it.