In recent years there has been an exponential increase in the number of runners, much associated with healthy lifestyles that are increasingly present in our lives and also due to a greater awareness of the associated health benefits.
As a consequence, running injuries become more frequent. Physical therapy has, therefore, assumed a predominant role in the prevention of associated running injuries.
According to recent data, half a million of the resident population practice running regularly, two to six times a week, and 82% will experience some kind of injury.
The common and main objective of those who practice running, independently of personal goals (competition/leisure), is to avoid associated injuries. However in shape the athlete may be, injuries are a consequence of the effort which the human body is subjected to during intense physical exercise.
Injuries will generate frustration, the desire to give up, and hours of training and dedication that are lost due to inactivity when the athlete must stop to recover from his/her injuries.
The National Health Board has suggested that the physiotherapist, as a health professional, should provide guidance to athletes on warming up exercises before physical activity, cooling down exercises, and appropriate running shoes and clothing, depending on age and various conditions (e.g. health, economic, social and geographic).
Consequently, prevention is of particular importance from the physiotherapist’s point of view on various levels:
■ Primordial prevention – in encouraging running as a regular practice of physical exercise
■ Primary prevention – avoiding injuries through the control of risk factors (footwear, stretching exercises, muscle strengthening, running technique)
■ Secondary prevention – early detection of an injury, sometimes even when it is asymptomatic (screening).
■ Tertiary prevention – Treatment of the injury and functional recovery.
■ Quaternary prevention – detecting individuals who are at risk, due to over treatment, without functional improvement.
In primary prevention, it is necessary to control the risk factors that could lead to an injury, being extrinsic and/or intrinsic to the athlete.
Extrinsic factors include atmospheric conditions, poor training/competition planning, type of paving/tread, footwear used for training/competition.
On the other hand, intrinsic factors include the athlete’s morphology, previous injuries, alterations related to posture (dissymmetry, valgus knees, flat feet), muscle weakness in various key groups (core and gluteal), muscular shortening due to systematic contraction, failure in warming-up and cooling down exercises, running technique (positioning of feet, foot support).
Physiotherapy may provide some valuable support in the prevention of injuries:
1. Injury prevention programme (warming-up, stretching, strengthening, myofascial release, adequate training).
2. Preparing for a competition.
3. Recovery after training and/or competition.
4. Professional advice: choice of running shoes, running technique, types of paving, compression socks.
By David Alves
David Alves is a physiotherapist working at the Hospital Particular do Algarve, with experience in biomechanical diagnosis and treatment of running injuries.