Running injuries: A biopsychosocial approach to empower athletes

“Fragilista: Someone who causes fragility because of his naïve rationalism. Also usually lacks sense of humor. Often fragilistas fragilize by depriving variability-loving systems of variability and error-loving systems of errors.” – N Taleb

We are often told that running and injury go hand-in-hand. If you run enough or are pushing your limits then getting injured is something we just have to accept as athletes and coaches. As someone that has had their fair share of injuries as well as having coached athletes of most abilities, I can see how for the most part this is true. There is however, a part of me that wants to disagree. You see my own journey has shown me that there is a better way. Of course we cannot prevent all injuries but I do think we should steer away from believing that injury is inevitable. This mind shift and subsequent change in attitude might help take us in a direction of anti-fragility, where instead of breaking down we thrive off variability and chaos.

If we go into an endeavour with a belief that at some stage we are likely to break-down then the likelihood is that we probably will. Our mind is an incredibly powerful tool. This is one of the reasons I regard strength training so highly. This does not mean I advocate spending countless hours pushing an unnecessary amount of weight around, but I do think that the benefits of strength training go beyond the documented physiological adaptions. For me strength in the gym is a mere starting point, the shift towards anti-fragility takes place when we have re-developed the ability to sprint, jump, crawl and climb. If you watch any young child move through the world, instead of danger they see opportunity. Contrast this to most runners, particularly those that have experienced chronic injury of any kind and the world is a fearful place, run barefoot … no way, sprint … but my hamstrings … jump … my doctor says I can’t because of my dodgy Achilles.

I recently came across the term ‘over-recovery’, and I think it fits in perfectly with fragility. I know first-hand about the crutch / magician that may be your massage therapist or your chiro, physio, foam roller etc. While clearly there is a place for your very own magician, I firmly believe that for a high percentage of running related injuries (excluding stress fractures and the like) your therapist, if they are skilled in what they do, is likely to just create the right environment for your body to heal itself. Try to imagine what they are doing as a ‘reset’ of sorts. The best way to ‘save’ these changes down is probably going to be through a positive movement experience. Of course there is nothing wrong with going to your local magician but my question to you is; is this the best path to anti-fragility? If you believe that the only way you can stay injury free is with weekly or bi-weekly sessions with your magician then I would hazard to say you have an unhealthy crutch. I am sure there are a number of elite athletes swearing at me at this point, arguing that if you running 100 odd mile weeks year round then 3 massages and a chiro session a week is the bare minimum required.

At this juncture I am going to head off on a tangent but will come back to said 100 mile a week Fragilista. At the height of my very own fragilities as an athlete (and importantly human) I would spend countless hours on a foam roller each week, I started seeing Mike Watson; aka Gunshow for a weekly strength session. Mike is not a man of many words but when he speaks it is worth listening. It was one of the first sessions with him and I was rolling around on the foam roller, searching for the elusive ‘release’ when he turned to me and said that instead of spending all that time on the roller why didn’t I rather spend that time working on moving better. While the advice struck a chord right away, and I can honestly count the number of times I have used a foam roller on a single hand since, it was by no means an easy and linear journey. Six years later, while certainly not the finished article the journey I have gone on has been the most empowering of my life. Of course I too still get niggles, but instead of urgently phoning my ‘magician’ I wait a week, and I see if I can solve the problem with positive movement experiences myself. Structurally my body is far from perfect, I have scar tissue from 2 operations and I am certainly no Eliud Kipchoge when it comes to running genetics.

The important concepts I have grown to understand is that asymmetry is the norm, it’s not the exception. Accept the body you have been given and work with it rather than against it. Be mindful with how you move and how you breathe but remember that for the most part, the best and most efficient movement is subconscious.  Your glutes are probably firing and they probably not much more important than other muscles in your body and whether you land on your forefoot, mid-foot or rear foot is just as unlikely to cause injury as your so called ‘bad’ posture. Seek out medical professionals that combine passive techniques with movement rather than simply the former. Finally, to our Fragilista friend (aka the 100 mile a week runner), maybe cut that massage down to once per week, spend the additional 2 hours working on moving better, having an afternoon nap and preparing healthy and nutritious foods. Instead of that weekly appointment with the chiro begin to educate yourself on the body including the importance of breathing. My gut tells me that the psychological benefits from these changes will filter into your race performances. All else equal, anti-fragile beats fragile every time.