Chronic: persisting for a long time or recurring.
Chronic running injuries, whether they are the same injury or a multitude of injuries are extremely frustrating. Take time off to heal, return to training, and then 6wks-6+ months later another injury pops-up. Take time off AGAIN, return to training and then another 6wks-6+ months later another injury occurs. UGH! If we know consistency is the key to success as a runner, this cycle is really putting a damper on that goal.
This is a common occurrence that I see in the clinic and there is a way out of the vicious cycle, but it’s rarely just one thing contributing to the chronicity. If you’re finding yourself battling chronic injuries, here are a few things to consider that may contribute to the pattern:
Tissue Capacity: can the muscles, tendons, bones, and ligaments withstand the frequency, duration, intensity of running asked of them? Is your current strength training routine specific to your needs? Do you know your specific needs?
Training Intensity: how hard you’re working during each workout? If you find that you’re spending >20% of your total weekly training time above RPE 3 or >75% of your maximum heart rate it’s possible your total weekly training intensity is too great for the body to fully recover between each bout of running.
A few questions to ask yourself to assess your training training intensity: are you fatigued after every workout? Do you often lack an appetite after each run? If you answer yes to both questions, it’s possible your training intensity distribution is not suitable for recovery.
Training Progression: are there major swings in training frequency, duration, or intensity of your training? I find this is one of those topics that most endurance athletes are very cognizant of as a contributing factor to injury. However, execution of a gradual increases in frequency, duration, and intensity can be very tricky when training with friends or when having high performance expectations within a short time frame.
Energy In vs. Energy Out: is your daily caloric intake matching your daily energy expenditure? Every organ in our body is affected by caloric deprivation: brain, heart, muscles, lungs, immune system, bone, skin, etc. all experience a downturn in function associated with the downturn in caloric intake.
To maintain energy balance a typical athlete should consume: 45 kcal per kg of Fat Free Mass (FFM) per day.
Sleep Quality and Quantity: how would you rate your overall quantity and quality of sleep every night? How many times do you find yourself waking at night and for how long are you awake? Do you find that your sleep quantity and quality worsens as your training intensity increases?
Research supports 7-9 hours of sleep per night as a general guideline for athletes. However, we all have different needs and these needs will vary throughout a training cycle, the year, and our lifespan.
The above information is by no means an exhaustive list of contributing factors to the chronic injury cycle. However, the list offers a place to begin the analytical process.
When working with patients in the chronic injury cycle, I often collaborate with their primary health care provider in obtaining blood work to assess other factors that may contribute to their health as an athlete. And, often times a registered dietician and/or a sports psychologist are pulled in to the recovery Team to assist with solidifying the necessary changes.
If you are experiencing a chronic injury cycle, please never hesitate to reach out as it would be my pleasure to help. This year I’ve seen more athletes than ever bravely take the plunge to engage in the process of making systematic changes to break the chronic injury cycle. There is nothing better than seeing an athlete run injury free for greater than a year when that was a far off dream previously.
Cheers to finding your consistency!
This blog post is not meant to provide specific medical advise.
References:
McConville, R. (2019). Finding your sweet spot: How to avoid RED-S (Realtive Enregy Deficit in Sport) by optimizing. Place of publication not identified: Rebecca McConville.
Seiler, S., & Tonnessen, E. (2009). Intervals, Thresholds, and Long Slow Distance: The Role of Intensity and Duration in Endurance Training. Sportsscience, 32-53.
Walsh, N. P., Halson, S. L., Sargent, C., Roach, G. D., Nédélec, M., Gupta, L., . . . Samuels, C. H. (2020). Sleep and the athlete: Narrative review and 2021 expert consensus recommendations. British Journal of Sports Medicine. doi:10.1136/bjsports-2020-102025
