Extracts from the book “Make Sure of Your Comrades Medal” by the late Don Oliver.
Article by Toni Hesp – Graduate in Physiotherapy from Witwatersrand University and honours degree in Sports Science, University of Cape Town. Holds 21 Comrades Medals and 11 Two Oceans Medals

Runners are about the fittest group of recreational athletes and also the most frequently injured. By its very nature of repetitive loading, running places incredible stress on the body and even though the injuries that result are not too serious, they do hinder and disrupt one’s training programme.

The most common causes of running injuries are:
1.            Traumatic injuries
2.            Structural imbalances
3.            Overuse injuries.

1. Traumatic Injuries

These are caused by a single incident and, depending on the severity, may require a period of rest. Examples are sprained ankles and broken bones.

2. Structural Imbalances
This group includes:

•             Leg length discrepancies
•             Muscle strength imbalances
•             Foot biomechanical problems, that is, too much pronation or supination.

3. Overuse Injuries
This group results in by far the most injuries. These injuries occur in runners who are straining, not training. Finding the proper balance is the key to successful running. Some runners have a tendency to under train and go into a race unprepared, while others become obsessed with their running and over train. Both types of runners will be susceptible to the typical overuse injuries.

Common overuse running injuries include:

Achilles Tendonitis: Pain in the tendon connecting the calf muscle to the heel bone.
Plantar Fasciitis: An inflammatory condition resulting in pain in the arch of the foot.
Anterior Knee Pain: A broad term used to describe pain around or under the knee cap.
Iliotibial Band Syndrome: A sharp, stabbing pain on the outside of the knee joint.
Muscle Tears: Pain in the muscle bulk, predominantly felt in the hamstring or calf of a runner.
Shin Splints: Pain experienced on the inside of their shin bone. Especially common in beginner runners.
Stress Fractures: Chronic overload in the while running and insufficient rest periods. An actual crack in the bone.

The first line of treatment is to stop running immediately, ice and gently stretch the affected area. Continue resting until the pain and inflammation subside.
Knowing when to run and when to continue resting is vitally important.

Avoid running if

•             You have pain during everyday activities
•             You have pain on the first few steps getting out of bed or after prolonged sitting
•             You have pain while running
•             You are limping while running, as this generally indicates some form of compensation which can result in exacerbating the injury or causing other injuries.

Run cautiously if

•             None of the above is present
•             Running is pain free with or without the aid of minor assistance from taping or heel raises.
•             Run very cautiously, at your comfortable training pace. Keep distances relatively short; avoid hills, over striding, and any increases in speed.
•             If within three to four days you are still unable to run comfortably, seek medical help.

Everyone differs in relation to their biomechanics and susceptibility to injuries. Fortunately, most running injuries are seldom serious, especially if they are treated early. In my experience, many of the injuries we treat could have been avoided or should never have reached the stage of requiring physiotherapy. There are a few rules to follow in order to avoid injuries.

Stretching

Stretching is a vital part of preventing injuries. Running has been shown to cause shortening of muscles, especially the hamstrings and calves. These are the muscles used predominantly during long distance running and consequently are the muscles most often injured. There is also a strong connection between poor hamstring flexibility and lower back pain.

It is important to stretch correctly, as bad stretching can cause more harm than not stretching.
•             Stretch to the point of discomfort, not pain
•             Do not bounce
•             Hold each stretch for 30 seconds and repeat three times

Stick To Your Training Programme

You are going to get plenty of advice from every runner you meet, either that you’re doing too much or too little, or that their programme is better. What works for someone else may not be best for you and everyone’s ability to adapt to exercise is different. Choose a programme designed for novice Comrades runners and set achievable goals. Have confidence in the training programme you have chosen and stick to it as best you can but do not become over-dependant on the training schedule. While training for Comrades you will miss runs due to illness, injury or family and work commitments.

Most running programmes have a built in buffer for such occasions. Don’t panic and try to make up the lost mileage as there is a good chance this could result in an injury. Ease slowly back into your training programme and if you train consistently the runs missed will not impact on the end result.

Training Errors

Most overuse injuries occur due to training errors; doing too much, too soon, too quickly and not allowing your body to adapt to the repetitive strain of running. It is important to build up slowly with gradual increases in your weekly mileage or long runs. This will result in less muscle pain and injuries and allow for more consistent, uninterrupted training.

This principle also applies to returning to running after a layoff for whatever reason. The longer the layoff, the more gradual the return to running should be.

High Intensity. Quality Training

Overuse injuries can also be caused by introducing hill work or speed training too quickly or too frequently. You should have a solid base mileage before attempting to introduce speed or hill sessions as the body often does not adjust to this added stress while still trying cope with increasing mileage.

If training for your first Comrades, I would recommend that you avoid the risk of specific hill and speed sessions as neither are necessary for a comfortable finish. Most training runs will include sufficient hills and your speed will improve as you get stronger and by running sections of your training runs a bit faster. Once you have completed your first Comrades, your body will be more road hardened and better able to cope with the challenge of quality, high intensity sessions.

Listen to your Body

When your body says slow down, do so without hesitation. Pain is a warning and responding to injuries immediately can stop the damage and reduce the time needed to recover.

Fatigue

Fatigue is often a sign of overtraining, resulting often in an increased incidence of illness and injuries. Other important factors are insufficient sleep, poor diet and stress. All programmes should include recovery days and easy days. A complete break of one or two days during the week is recommended, preferably the day before and after a long run.

For those of you who have to exercise daily, substitute your run with non-weight bearing sports. These activities will not place the same degree of stress on your body. Swimming, running in the pool or cycling can be used as a substitute for running on your rest days, or in order to maintain fitness while recovering from an injury.

Know Your Limitations

It is important to know what your body can do. Don’t try to do the same training as someone going for a top position or silver – they will generally cope with a lot more mileage, as will someone who has completed several Comrades and is already road hardened.

Weight Training

Finding time to train with weights is another good way to help prevent injuries and to feel more comfortable on runs. Weight training will also aid recovery between runs by reducing the amount of muscle damage that occurs while running. Having stronger muscles also increases the support of the weight bearing joints and thereby protects them from some of the loading stress that occurs while running. A few high repetition exercises, concentrating on the major leg muscle groups, is all that is required to improve muscle strength, endurance, and recovery. Weight training is particularly important for the Comrades down run as the braking action while running downhill is especially damaging to the muscles, in particular the quadriceps.

Avoid Racing Too Much

Don’t try for personal bests at every race. Start at a comfortable pace and avoid racing everyone ahead of you. Generally, races should be used as training runs, as a chance to gain race experience and to experiment with food, drinks, clothing, and shoes. Keep your goal in mind; if you race too much in training, you may miss out on the race that really counts.

To summarise

•             Treat injuries immediately
•             Don’t try run through pain
•             Don’t train on tired legs
•             Don’t be afraid to rest
•             Stretch regularly
•             Resume training slowly after an injury or layoff from running
•             Train don’t strain
•             Seek medical advice if your injury persists with rest

Don’t ruin your chances to experience an unforgettable day by picking up unnecessary injuries. It is better to arrive at the start injury free with less mileage than over trained and nursing injuries and niggles. A large percentage of your success at Comrades is dependent on your mental strength, the ability to keep going when you get into unknown territory and your body starts to hurt.

Fortunately, the incredible atmosphere and encouragement of the crowds and fellow runners along the route go a long way to help you through the bad patches. Take time to enjoy the day without the pressure and added stress of trying to do a ‘good’ time. Aim for a comfortable finish for your first race and enjoy the day. You only have one first Comrades, make it memorable.