Distance Running – Is It Healthy?

Distance Running and Joint Health

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A few days ago, I reviewed a NY Times article which espoused the benefits of running on joint health.  If you’d like to see my entire write-up, I’ve provided the blog link below:

Running Blog

The biggest issue I had was when the author stated that the best way to keep your knees healthy was to “not get injured.”

Really?  It’s that simple, eh? (Cue Canadian Flag and maple syrup)

So that got me thinking – how many runners get injured every year?

And while I know people love to run, what can they do to prevent injuries?

Part of the problem at hand is you have people like Jillian Michaels from the Biggest Loser espousing that “distance running is the best way to lose weight.”  Obviously I’m biased because I think strength training and other forms of energy system training (EST) are superior, but let’s see what kind of information is out there.

My goal was to go into this without my typical bias towards running.  I did, after all, compete in cross country in high school!

Let’s begin by going over some of the relevant research that’s available first and foremost.

Jacobs SJ, Berson BL.  Injuries to runners: a study of entrants to a 10,000 meter race.  Am J Sports Med.  1978;6(2):40-50.

In this study, Jacobs et. al provided a questionnaire to 451 entrants of a 10k race.  47% of the entrants had suffered an injury in the past 2 years.  After digging a little bit deeper, the following factors were associated with injury:

–       More miles per week

–       More days per week

–       Faster race pace

–       More races per year

One final note:  The questionnaire also covered treatment of said injuries, and in this case 76% who received care had reported good to excellent recovery.

Lysholm J, Wiklander J.  Injuries in runners.  Am J Sports Med.  1987;15(2):168-71.

In this study 60 runners were followed over the course of a year.  Out of those 60, 39 suffered injuries.  What’s even scarier, out of those 39 participants they actually suffered 55 injuries!  That means that many of these runners suffered multiple injuries within the same calendar year!

The study goes on to compare the differences between sprinters, middle distance runners, and marathoners.  I was most interested in the middle distance runners, because this description covers the “recreational” runner who saunters into your facility.  Not surprisingly, the most often injured  areas to these runners are backache and hip problems.

This confirms a lot of what we see at IFAST – the prototypical “rec runner” has terrible core and hip stability.  Typically their first 2-3 months with us is just building these up to more normal levels so they can resume training.

One final point to note: This study mentions that marathoners were actually injured less frequently than sprinters and middle distance runners per 1,000 hours of training.  Now, I’m not ready to take this 100% at face value, as a whole host of factors need to considered here.  Quite simply, there’s a profound difference between the training styles of all three types of athletes including training intensity, what constitutes “training” (marathoners just run for a long time, sprinters run really fast then take long breaks, etc.) , but it leads me to the following question:

Could it just be that people who run marathons are biomechanically more efficient and basically born to run compared to their lesser counterparts?

It’s definitely something to take into account.

Macera CA, Pate RR, Powell KE, Jackson KL, Kendrick JS, Craven TE.  Predicting lower-extremity injuries among habitual runners.  Arch Intern Med.  1989;149(11):2565-8.

In this study, 583 runners were followed for one year.  In that time frame, 252 men (52%) and 48 women (49%) suffered injuries.  This study wasn’t particular illuminating, but it did confirm that

–  One of the greatest risk factors for future injury was a previous injury

–  You were at increased risk if you’d been running less than 3 years

Marti B, Vader JP, Minder CE, Abelin T.  On the epidemiology of running injuries.  The 1984 Bern Grand-Prix study.  Am J Sports Med.  1988;16(3):285-94.

The researchers in this study used a questionnaire to determine the injuries of participants in a 16 km race.  Out of 4,358 male runners, 45.8% had sustained injuries in the previous year.  Risk factors for injury included more mileage, and a history of previous running injuries.

Following our earlier thinking, this study went on to describe that in 33-44 year olds (1,757 participants) the number of years running was inversely related to the incidence of injuries.

Walter SD, Hart LE, McIntosh JM, Sutton JR.  The Ontario cohort study of running-related injuries.  Arch Intern Med.  1989; 149(11):2561-4.

In this study, 1680 runners were followed for one year.  In that time frame, 48% suffered at least one injury.  Again, the greatest risk factor for injury was a high mileage.

Most importantly for our purposes, runners who were injured the previous year were at 50% higher risk for a new injury during the follow-up period.

Summing up the Literature Review

While this is definitely just a cursory review of the literature, it definitely provides us with some food for thought.  Here are the cliff notes, in case you didn’t read all that!

–       Per the research above, anywhere from 45-65% of runners will be injured in a given year.

–       Running mileage seems to be heavily associated with injury.

–       Previous injury is a great predictor of future injury.

–       New runners seem to be at increased risk when compared to older runners (not necessarily in regards to chronological age, but “running” age).

My Current Thoughts on Running

After reviewing the literature, here are some thoughts I have in regards to recreational distance running:

–       I’m starting to think that running isn’t that far off from the Bulgarian system of weightlifting.  If you’re unfamiliar with the Bulgarian system, it’s best described as a meat grinder.  Take a ton of athletes, put them through intense workouts multiple times per day, and whatever comes out on the back end comprises your Olympic team.

Is recreational running really that much different?  It’s not on the same level with regards to volume and intensity of training, but sit back and think about that general premise for a second.

Several of the above studies mention that those who have been running longer are actually less likely to get injured. Again, it comes down to biomechanics – who is biomechanically designed to run?  Those people who are genetically gifted and built to run typically do so more successfully, and with fewer injuries than their counterparts.  The Bulgarian weight lifting team is going to be comprised of the guys who can best tolerate the workloads associated with their sport.

Running is no different.  While everyone thinks the can run, it’s more selective than we give it credit for.

Let’s take it a step further and think about it in this regard:  Michael Phelps wouldn’t be the greatest swimmer in the world if he was 5’2″ with a short spine.  Usain Bolt wouldn’t be the greatest sprinter in the world if he was 5’10” or had stubby legs.

I’m sure people will hold me to the stake for comparing elite/Olympic level athletes to recreational runners, but the point I’m trying to get across is that whether you want to admit it or not, genetics play a role.  Great runners are genetically predisposed to run.  Recreational runners, on the other hand, are not only going to be less successful, but they’ll generally take more lumps along the way as well.

–       I’m still shocked at how many runners think “time off” is a magic bullet. Research clearly shows that if you’ve been injured before, you are at an increased risk to get injured again!  The car analogy gets a little overplayed, but it makes great sense – if a car is out of alignment, putting it in the garage for a few weeks will keep it from getting worse, but it won’t address the problem.  The second you take it back out on the road and start cranking things up, the underlying issues are still there.

–       Along those same lines, if you DO get injured, it’s in your best interest to determine what your biomechanical issues are and address them ASAP.  There is no magic bullet – but if you really enjoy running, you’re going to have to do MORE than simply run to get healthy.

At IFAST we typically use a multi-faceted approach that incorporates soft-tissue work, mobility training, acute corrective strategies, strength training, and even static stretching to address the underlying issues.

If you don’t fix what needs fixed, you’re going to be left spinning your wheels.

–       Finally, for those of you just getting into running (or getting back into running), you absolutely, positively must ease into your mileage. Again, it’s been proven time and again that running mileage is heavily correlated to injury.

Returning to our car analogy, the longer you drive that car the more any little issues are going to be exposed.  The same thing holds true for your body – the further you run, the more those little flaws or asymmetries are exposed.

This was meant to be a quick and dirty blog post, but it turned into something much, much larger.  Hopefully if you are a runner, or work with runners, it’s provided you with some insight into getting (and keeping) people healthier over the long haul.

In the future, I’ll be sure to review some more literature on the topic, along with provide insight into our training methods.  Until then, good luck and good training!

Stay strong



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  1. Another variable to look at is the running style itself. Just like lifting weights with an improper pelvic tilt can pre-dispose injury, running with your foot contact too far to the heel can increase ground force attenuation through the leg and low back, pre-disposing to injury. We can do all the soft tissue release and core strength we want, but if they keep running with poor mechanics, they will be hitting the ground for 50,000 impacts with 2-3 times their body weight per stride with improper balance of force, leading to injury. Looking at a run stride and adjusting it will pay more of a dividend than increasing or decreasing, or even ceasing running, as it will allow for a more balanced force application through the lower body and help with speed, power, and injury prevention.

  2. Good post. What do studies on weight training show, on all the same variables? Most importantly, injuries per 1000 hours of training.

  3. @NealW
    According to figures in Hedrick, 2008 the injury incidence within competitive Weightlifting is given as 0.0017per 100 participation hours. This is relatively low when compared to many other sports within the article e.g. Basketball at 1.03 and Track and field at 0.57.

  4. The running community has certainly gotten better in terms of recognizing the importance of "supplementary" training but there is still a long way to go.
    I love this comment:
    "So while I agree 1000% that technique should be addressed, until the physical qualities are brought up to snuff, I still feel like people are going to get injured."
    Oftentimes, what we see as "bad form" is simply the visual manifestation of a runner trying to protect against some underlying movement limitation. If we go in an "clean house" by trying to force visually appealing technique onto someone, we'll end up causing more problems than existed in the first place. That flailing arm or those uneven shoulders could be the duct tape that holds the contraption together! Don't remove the duct tape until you understand the ramifications and have an idea of a corrective strategy. Many runners, especially in the scholastic ranks, do tons of drills thinking they are making progress on technique, when in reality they're just killing time.
    I think it is helpful to understand how different sub-groups within the running population approach this issue (obviously these are generalizations, but I come directly from the endurance sport world, so I am around these groups more frequently than most gym or clinic based practitioners).
    1. "Old school" – Just run Baby! Sees injuries as inevitable part of the sport. Why go to the weight room when you can just run more? Sees mobility training as a waste of time, usually because their only form of mobility training was a bunch of random static stretches.
    2. "I don't have time" – Working folks who have enough trouble getting their miles in. "If I'm exercising, I better be running. I took up running since I don't like the gym scene"
    3. The weightlifters. Think that a basic strength program will keep them healthy. Add some strength, then all my problems are solved!!
    4. Triathletes. Have greatest access to technology and love to parse the minutiae of running form nuances with the hope that a tiny technique improvement will solve all their running woes. However, most of this technique work is wasted because 1) basic movement skills are poor and 2) they usually are too shelled after the bike to maintain decent form anyway in races.
    5. High school/college. Since they have up to two hours of practice time available, coaches will just assign a generalized battery of drills that have been passed down by posterity designed to mold their runners' form into what they think running form should look like. The kids who move well on a fundamental level will end up with beautiful form. For the kids who don't move well, the drills end up being a waste of time (since form encouraged by the drills doesn't mesh with the kid's basic movement abilities and they just go back to what is comfortable during their workouts) or the drills end up causing weakness/injury because the form encouraged by the drills is inconsistent with what the kids are capable of (see comment above about visually "bad form" being the duct tape that holds everything together).

  5. Couple of points to add as a former college cross country/track coach.
    1. Change needs to start at the college level. Distance running is a sport that is passed down from coach to athlete. The number one prerequisite to be hired as a college distance coach is to have been a college runner. Former college runners also fill the ranks at running shoe companies and stores.
    2. Strength and conditioning and distance coaches are scared of each other. A team approach needs to be adapted. The strength and conditioning coaches just do not get why a top college 10k runner needs to be running 80 miles a week when his race is 6.2 miles. Distances coaches think the strength and conditioning coach just wants to put big muscles on their runners. Each part of the team needs to understand what the other is trying to accomplish and why.
    3. Strength and conditioning has to make an effort to come to distance coaches. Two reasons why:
    A. Head distance coaches at the high school and college level have three seasons to coach (cross country, indoor, outdoor) and most of the time two teams (men and women). In many programs the distance coach is head track coach and has a couple of part time assistants. On top of writing workouts they have to act as travel agents, meet directors, recruiters, budget balancers, driver and the list goes on. Going down the hall to talk to strength and conditioning either does not enter the thoughts of a distance coach or is on their wish list.
    During workouts distance coaches are supervising around 25 athletes, juggling the stop watches and making sure runners do not take too much rest between intervals. Not much time to look for movement dysfunction.
    B. Many distance coaches do not know strength and conditioning can keep their athletes out of the training room! The idea of corrective exercise is completely foreign them and often they see the weight room as social hour. From experience I can say a distance coach will be much more receptive to strength and conditioning if we come to the track, screen the team and do some corrective exercises. Something is better than nothing and lots can be done on the track. At the recreational level runners will show up to clinics at the running store.
    4. In general distance runners and coaches see strength and conditioning as good or bad. Not much middle ground and that needs to change.

  6. Mike,
    Many folks (professional and non-professional strength and fitness enthusiasts) that I speak with are beginning to take the 'why run when you can swing the kettlebell?' approach now.
    I can see the value in this for your average trainee but how far do you think this mantra of replacing running with swings or snatches etc with a KB can be taken when you are training athletes who run in their given athletic pursuit?
    Hope that my comment is not too far off topic.

  7. A very interesting thread and some good comments,. As a 160 lb 69 year old who started running at age 42 weighing 216 lbs. who also has been coaching 10-20 club runners for 10 years and providing weekly track workouts for 20-40 club runners for 12 years I'll add my 2 cents worth.
    Disregarding the subject of injuries I'd like to know what combination of weightlifting and HIIT or complexes or circuits or whatever you want to call them can burn at least 4000 NET calories/week. At 160 lbs. I do that by running 40 miles in some weeks and it doesn't even include any EPOC I get from interval workouts, typically 2-3 miles @ > 90% of Vo2Max and/or 3 miles of "tempo" runs at 85-90% of VO2Max.
    I have read many internet trainers tout the value of weightlifting for runners including a good one by Eric Cressey a few years ago. However, for many of the reasons mentioned above it is easier said than done. I currently lift weights and run as well. Although not professionally certified in S & C or USATF, I'm very well read in both fields and have most of Mike and Eric's products and am FMS certified. I've screened a few runners and most of them could use something beside running.
    Assuming a person's sport is long distance running, the major problem as I see it is that it is difficult to weight train and be a distance runner at the same time without impacting either weekly mileage or the quality of the workouts run. Unfortunately, how much mileage and how much and what kind of quality is needed to run a race in a given time is very subjective. I have yet to see an integrated training program that combines the two that provides any research that says if you do this weight workout you can eliminate this much of your running and still run the race as fast as if you just ran. It's not only a matter of available time but of recovery. It gets even harder as you get older.
    Yes there is research that shows if you follow a certain protocol you will improve your 5k time by x minutes, but they are usually done with a small sample size over a short sample period and usually not experienced or advanced runners.
    There is a big difference in giving somebody a weight workout to do while they are simply running, but if someone comes to you and says I want to run a Boston qualifier how much do I need to run and, oh yeah, what weight workouts will keep me from getting injured that won't interfere with the training I need to do to run that time?
    Even most training programs can't reliably answer the question of what training do you need to run the required pace. They may have schedules for certain time zones, but not much help in knowing if you can train at the required level. In his book Daniels' Running Formula, he has some tables to predict longer races from your shorter race times and his methods for training, but it includes no weight training. He also has 24 week schedules for the marathon so that if you are going to run 2/year you don't have a lot of time when you're not running much.
    In deciding to train for a fall marathon to qualify for Boston again, one thing I did is to approach weightlifting as a GPP activity and did Jim Wendler's 5 3 1 program for 4 months, During that time I always followed a squat or deadlift day with a day off, a short easy run the next day, and then a long or quality day on the third day. I often did interval workouts in the a.m. and leg workouts later in the day. However I'm retired and have the luxury of doing that as well as a 10 month training plan. After the 4 months the deadlifts were requiring more recovery so I took the advice in Joe Defranco's "Westside for Skinny Bastards " and cut my leg workouts to 2 x 3 at 80% of 1 RM. I can now usually run the day after a leg workout without having dead legs and have increased my weekly mileage from 25-30 to 40.
    That all sounds great since I sort of have it figured out for me, but besides time, I have the advantage of a big cushion in running a Boston qualifier. At age 70 I have to run a 4:30 marathon, a 10:17/mile pace but theoretically I'm in condition to train for a 4 hour marathon about a 9:09 pace. Contrast that with a runner who needs to run a 3:10 but his theoretical time is 3:05. How much of his running can be replaced by weight training? What can he recover from and still run.? I have a very good idea of what he needs to do to run that BQ, because I've been helping runners do that for 10 years with about a 90% success rate. But adding weight training to his schedule, even if I could convince him to do it, I'm not so sure about that.

  8. Excellent Mike! Amen at what Allen said, too.
    Bob D: one execise modality to burn 4000 calories per week? I don't know if that's sustainable (or very healthy) for anybody outside elite endurance athletes. And I think Mikes "genetics" rules apply there.

  9. Quick question: How would one fit strength and conditioning in to a typical training week? I feel like I become more prone to injury (long time sufferer of ITB – which has been corrected mostly by strengthening) when my muscles have become sore/tight from heavy strength work – deadlifts and squats mostly.
    I'm interested how people deal with this.

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