Part 1: Avoid overreaching training errors, and learn to train consistently

Endurance running has many health benefits, but novice and experienced runners continue to encounter pain and injuries at a high rate. One of my roles as a doctor of physical therapy is to get injured runners back to running AND make them resistant to future injury.

Endurance runners know that musculoskeletal pain and soft tissue niggles from repetitive stress are going to happen. However, these innocuous tissue issues do not have to develop into months and years of time off from the activity and sport. Consistent training and recovery will not only promote gradual performance improvements, it will develop a more robust and injury resistant runner. The first step to training consistently is avoiding overreaching.

In my experience, there are 3 primary sources of overreaching: 

1. Impatience. 
2. Cardiovascular fitness to musculoskeletal fitness mismatch
3. Denial of coexisting stressors 

1. Impatience can result in an athlete accelerating training exposures faster than their body can recover from. For example, if longer durations and/or high intensities are clustered too closely together on a timeline the body may not have sufficient resources and time available to rebuild. In novice runners, for example, research has shown that increases of 30% or more of running volume (mileage) is associated with increased injury risk. In my experience, runners with a longer history of training MAY have more flexibility in volume increases from relatively low training volumes due to previous conditioning at higher mileage. 
2. When cardiovascular fitness and running coordination improve faster than musculoskeletal adaptations to running, overuse injuries can occur. This is the cardiovascular fitness to musculoskeletal fitness mismatch. How does this occur? Training improves running economy (RE), which is the speed one can run per measure of oxygen usage (VO2). The runner’s perceived effort also improves. Meanwhile as a runner moves faster due to these awesome adaptations, the musculoskeletal system undergoes greater impact and tensile forces. An analogy: Consider a standard car chassis (body) with a race car engine. The race car engine is a mismatch for the chassis of the standard car. The chassis is simply not equipped to handle the output of the high performance engine. After repeated exposures to the high speeds and longer distances the performance engine can provide, the chassis breaks down. Unlike cars, human tissue adapts. Tracking a runner’s training exposures becomes critical to avoid overreaching in training due to this mismatch (see Part 2 of this blog series). 
3.  Not recognizing and adjusting to coexisting life stressors is also problematic. While activity specific training loads may remain at a safe moderate to high level, these other stressors steal the resources the body needs to recover from training. If life stressors resolve quickly (within a few days/weeks), the runner may be able to recover. However, sustained pressure from emotional stress, lack of sleep, or inadequate nutrition will gradually deteriorate what otherwise would be a robust body. Creating a suitable internal physiologic environment for recovery and allowing enough time to recover are essential. Nutritional and sleep issues may require professional expertise in nutritional, medical, and/or or mental health intervention. 

Following an adaptive training plan is a great start to establish consistent, injury-free running. Part 2 of the blog series delves into how to track one’s training, and Part 3 discusses how to develop a training plan.