Introduction to running

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Running has many health benefits associated with lower risk of all-cause mortality¹ and is a great way of performing exercise which is convenient, low in cost and requires very little equipment or facilities.

Before embarking on running for the first time consider a gradual approach involving walking and resistance exercises to prepare your body for running using a prehabilitation approach. Prehabilitation for running uses exercises, education and advice with the aim to improve performance and reduce likelihood of injury.

Firstly build up your walking. You may already have a high level of fitness from performing cardiovascular exercise such as cycling and swimming, and although these are great forms of exercise they are lower in impact and emphasize different muscle groups. Walking however has similar gait sequences to running but less joint stress and muscle activation,²  and therefore helpful in gradually building up to the higher loading of running. Walk briskly ensuring alternate arm swings with each step. This encourages reciprocal movement of the pelvis engaging the muscles of the hips which is important conditioning training for running. When comfortable at a brisk pace over a distance of about 3-4km or 30-40 minutes consider substituting ³ sessions a week for running using a recognized beginners running programme.

A graduated running programme that builds up to a running distance of 5k over 9 weeks such as the C25K is more likely to reduce risk of having a running-related injury than a self-devised programme.³ Such a programme gradually and safely conditions your tendons, muscles, joints and bones to different impact forces you may otherwise not be accustomed to. Research shows that runners new to running are most likely to give up in the first 6 months due to running-related injury,⁴ therefore reducing risk of injury by increasing in small, incremental stages, as well as doing some graduated resistance training such as heel raises and mini single leg squats to help condition the body is beneficial.

1. Pedisic Z, Shrestha N, Kovalchik S, et al., 2019 Is running associated with a lower risk of all-cause, cardiovascular and cancer mortality, and is the more the better? A systematic review and meta-analysis. British Journal of Sports Medicine. 1-9
2. Lohman EB, Sackiriyas KSB, Swen RW, 2011 A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking. Physical Therapy in Sport. 12:151-163
3. Linton L, Valentin S, 2018 Running with injury: A study of UK novice and recreational runners and factors associated with running related injury. Journal of Science and Medicine in Sport. 21:1221-1225
4. Fokkema T, Hartgens F, Klutenberg et al 2019 Reasons and predictors of discontinuation of running after a running program for novice runners. Journal of Science and Medicine in Sport. 22:106-111

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Running should always incorporate some preparation before and afterwards. By establishing good practices such as warming-up, cooling-down, and allowing sufficient recovery after a run, your body and mind will be in a better pace for performance and you will be helping reduce risk of injury. Before your run perform a dynamic or active warm-up, spending <15 minutes slowly increasing your heart rate and body temperature through brisk walking and/or gentle jogging then performing dynamic stretching movements.¹ Dynamic stretching such as walk lunges, squats, high knees, butt kicks and openers will prepare the muscular, articular and neural systems for running. This preparation for running can be particularly important if your run takes place during or after a day where you may have spent many hours sitting whilst working, driving or studying. 

Following your run try not to stop abruptly when your heart rate is still high. Instead jog slowly or walk until you feel you are breathing more normally. This promotes a faster removal of blood lactate.² Runners often perform some static stretching following a run. Although stretching has not been shown to reduce injury risk, improve performance or stop the muscle soreness sometimes experienced 24-48 hours after running known as Delayed Onset Muscle Soreness (DOMS), it does not appear to have any detrimental effects if a runner performs this after running.² However authors investigating long distance runners found it held no specific advantage for this specific group of runners and that other methods of recovery should be utilized.³  

There are several recognised recovery strategies during the 1-2 days following your run that you can be engaging in that will help further, and we have suggested 3 that are easy routines to adhere to. Nutritional intervention is required to accelerate recovery of muscle function and this can be provided simply through a balanced diet.⁴ In addition ensure good sleep habits, aiming for a minimum of 8 hours sleep, as even partial loss of sleep has been related to submaximal performance, alteration in mood states, reduction in cognition, altered glucose metabolism and an impaired immune response.⁵ Ensuring adequate rest days from running are also advised^,6 however, rest from running doesn’t necessarily mean complete cessation of activity on your days off. Walking and taking part in other sports such as cycling or resistance training can still be performed during the days you don’t run. 

1. McGowan CJ, Pyne DB, Thompson KG, Rattray B 2015 Warm-up strategies for sport and exercise: Mechanisms and applications. Sports Medicine. 45:1523-1546 
2. Van Hooren B, Peake JM 2018 Do we need a cool-down after exercise? A narrative review of the psychophysiological effects and the effects on performance, injuries and the long-term adaptive response. Sports medicine. 48:1575-1595 
3. Baxter C, McNaughton LR, Sparks A, Norton L, Bentley D 2015 Impact of stretching on the performance and injury risk of long-distance runners. Research in Sports Medicine. 25:78-90 
4. Tarnopolsky M, 2004 Protein requirements for endurance athletes. Nutrition. 20:662-668 
5. Halson SL 2014 Sleep in elite athletes and nutritional interventions to enhance sleep. Sports medicine. 44:13-23 
6. Kellman M, Bertollo M, Bosquet L, et al., 2018 Recovery and Performance in Sport: Consensus Statement. Sports Physiology and performance. 13:240-245  

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When choosing a shoe for running you are confronted with terminology such as minimalist or maximalist, neutral or motion control, zero drop or higher drop, cushioned or less cushioned. As such, there have been multiple debates in the literature regarding which is the best shoe to use to reduce risk of injury, but despite the many different types of shoes available, the scientific opinion is that choosing the right shoe can come down to comfort and an individual’s preferred movement path.¹ A comfortable running shoe improves your running economy and thus performance, but not only should the shoe feel comfortable, the type of shoe chosen should also be selected based on the individuals personal profile ^2. 

Experienced runners who used more than one pair of shoes concomitantly, were found to have a lower risk of running-related injury and the authors suggested that by alternating shoes, the loading on the musculoskeletal system during running was more varied.² In a recent study of 848 recreational runners investigating shoe cushioning, the authors found those who ran in hard shoes had a higher risk of a running-related injury.³ Therefore if you are new to running choose a more supportive and cushioned shoe as your bodies’ musculoskeletal system is already adapting to the increased ground reaction forces of a higher impact sport, and for this reason starting running in a more minimalist shoe should be cautioned. 

Although minimalist trainers have not been shown to increase risk of injury,⁴ they do increase Achilles tendon stiffness, and toe and ankle joint loading,⁵ therefore if new to running and your musculoskeletal system is already adapting as you gradually increase your running, it is sensible to avoid more undue pressure on the musculoskeletal system. If you are a more experienced runner and switching from maximalist trainers to minimalist trainers, or even changing from old trainers to new trainers, the transition must be gradual in order to allow time for the body to adjust.   

1. Nigg BM, Baltich J, Hoerzer S, Enders H 2015 Running shoes and running injuries: myth busting and a proposal for two new paradigms: ‘preferred movement path’ and ‘comfort filter’. British Journal of Sports medicine. 49:1290-1294 
2. Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D, 2015 Can parallel use of different running shoes decrease running-related injury risk? Scandanavian Journal of Medicine and Science in Sports. 25:110-115 
3. Malisoux L, Delattre N, Urhausen A, Thiesen D 2020 Shoe cushioning influences the running injury risk according to body mass: a randomized controlled trial involving 848 recreational runners. The American Journal of Sports Medicine. 48:473-480 
4. Malisoux L, Chambon N, Urhausen A 2016 Influence of the heel-to-toe drop of standard cushioned running shoes on injury risk in leisure-time runners: a randomized controlled trial with 6-month follow-up. The American journal of Sports Medicine. 44:2933-2940 
5. Sun X, lam W-K, Zhang X, Wang J, Fu W 2020 Systematic review of the role of footwear constructions in running biomechanics: implications for running-related injury and performance. Journal of Sports Science and Medicine. 19:20-37 

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Increasing step rate or stride frequency in running otherwise known as cadence, is an established gait retraining strategy that doesn’t require specific clinical or professional feedback and can be self-taught. In general, trained runners tend to be better at self-optimizing their cadence than untrained runners,¹ and often don’t need to increase their cadence, particularly if they don’t have an injury. Even beginner runners have been demonstrated to use a self-optimization strategy to develop their running gait in the first 10 weeks of running thus improving running economy.²  However, if a runner tends to over stride or have knee or lower leg discomfort when running then a small increase in cadence may prove beneficial. 

Running at a faster cadence of up to 10% has been shown to improve running economy by minimizing the metabolic cost of running.^₁ In addition it has demonstrated beneficial biomechanical, kinematic, and kinetic changes related to injury risk reduction. A 10% increase in cadence has been demonstrated in runners to give significant improvements in patellofemoral knee pain and function.³ An increased cadence of 7.5% has also been shown in runners to reduce excessive impact forces associated with stress fractures, and to reduce eccentric knee joint work and hip adduction which is associated with reducing patellofemoral knee pain^.4 Furthermore an increase in 10% cadence was shown to increase pre-activation of the gluteus medius and maximus muscles of the hip during the late swing phase of running. Such enhanced muscle activity has beneficial effects on subsequent energy absorption during landing, likely to benefit knee pain.⁵ 

The best way to calculate your average cadence (steps per minute/ spm) is by using wearable technology such as a fitness tracker device that has a cadence feature,² or simply use your phone or watch to time 1 minute whilst you count how many times one foot hits the ground over 1 minute then multiply this by 2. Once your average cadence has been established, increase your cadence in small increments of 5%, progressing up to 10% over several runs. Think about taking “shorter faster steps”, listen to music that has the cadence you are aiming for, use a mobile metronome app, or a GPS smartwatch.³ On average, cadence can range between 160 bpm to 185bpm, but this is dependent on factors such as running experience, height and type of running terrain etc., thus trying to achieve the maximum cadence is not the main goal.   

1. Moore IS, Willy RW 2019 Use of wearables: Tracking and retraining in endurance runners. Current Sports Medicine Reports. 18:437-444 
2. Moore IS, Jones AM, Dixon SJ 2012 Mechanisms for improved running economy in beginner runners. Medicine and Science in Sports and Exercise. 1756-1763 
3. Bramah C, Preece SJ, Gill N, Herrington C 2019 A 10% increase in step rate improves running kinematics and clinical outcomes in runners with patellofemoral pain at 4 weeks and 3 months. The American Journal of Sports Medicine. 47:3406-3413 
4. Willy RW, Buchenic L, Rogacki K, Ackerman J, Schidt A, Wilson JD 2016 In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Scandanavian Journal of medicine and Science in Sports. 26:197-205 
5. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. 2012 Changes in muscle activation patterns when running step rate is increased. Gait Posture. 36:231-235. 

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In other sports, incorporating an injury prevention exercise programme into a warm-up has demonstrated significant reductions in sport specific injuries.^{1 2} However, this has been less investigated in running, and the few studies available have not seen a similar reduction in running- related injuries (RRI) in response to exercise interventions.³ This is most likely due to the multifactorial nature of factors associated to RRI which are related to both training errors, but also related to the runners’ individual tolerance for load.⁴ Being mindful of using graduated running training load programmes following the acute:chronic workload ratio where distance, intensity, and frequency of running don’t increase significantly in a short period of time,⁵ as well as ensuring you have the resilience of the musculoskeletal system to tolerate progressing your volume and intensity of running will provide a good balance to help reduce RRI.

Strength and balance training were considered the most important exercise interventions to reduce risk of injury in an umbrella review of studies on team sports,⁶ and similarly a meta-analysis on multi sports found strength training also most beneficial particularly for the reduction of overuse injuries.⁷ A review of the literature in runners of all abilities found strength training to improve running economy and performance.⁸ The authors suggested amongst other physiological effects, that as strength training increases tendon stiffness, this then improves the effectiveness of elastic energy during running which could account for the positive effects seen on running economy.⁸

If new to running and exercise, body weight resistance should be the starting point, and balance training should be incorporated into the programme to ensure each leg works independently and challenges proprioception. Over time, loading can be increased by adding weights. The main muscle groups to target are the gluteals, hamstring, quadriceps, and calf muscles, and exercises such as single leg squats, single leg calf raises, Bulgarian split squats, modified single leg dead lifts, and monster walks focus on these muscle groups. The ideal time for performing exercises for running has not yet been established but in other sports, neuromuscular facilitatory exercises and body weight exercises have been incorporated into a dynamic warm-up,^{1 2} but as loading increases, these prehabilitation exercises could be performed on separate days to running.

Being stronger and more resilient also relies on sensible planning for your volume and intensity of running. Runners with over 2 years running experience are less likely to have an injury than a runner with less than 6 months experience suggesting as you continue to run over time, your body will be adapting to the impact and getting stronger,⁹ therefore start your running at a steady pace using the C25K programme. When you feel established at a 5k distance after several months and want to run further then set your goals at small increments over the next 2 years. There are many improver 5k, 10k, half and full marathon programmes online that can be followed dependent on your level of experience, and you should use a recognized programme to progress distance gradually if you have a goal in mind rather than using a self-devised programme.

1. Herman K, barton C, Malliaras P, Morrisey D 2012 The effectiveness of neuromuscular war-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine. 10:1-12
2. Thorburg K, Krommes KK, Esteve E, Clausen MB, Bartels EM, Rathleff MS 2017 Effect of specific exercise-based football injury prevention programmes on the overall injury rate in football: a systematic review and meta-analysis of the FIFA 11 and 11+ programmes. British Journal of Sports medicine. 51:562-571
3. Baltich J, Emery CA, Whittaker JL, Nigg BM 2017 Running injuries in novice runners enrolled in different training interventions: a pilot randomized controlled trial. Medicine and Science in Sports. 17:1372-1383
4. Bertelsen ML, Hulme A, Petersen J, Brund RK, Sorensen H, Finch CF, Parner ET, Nielsen RO 2017 A Framework for the etiology of running-related injuries. Scandinavian Journal of Medicine and Science in Sports. 1-11
5. Drew MK, Finch CF 2016 The relationship between training load and injury, illness and soreness: A systematic and literature review. Sports Medicine. 46:861-883
6. Brunner R, Friesenbichler B, Casartelli NC, Bizzini M, Maffiuletti NA, Niedermann K 2019 Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review. British Journal of Sports Medicine. 53:282-288
7. Lauersen JB, Bertelsen DM, Andersen LB 2014 The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomized controlled trials. The British journal of Sports medicine. 48:871-877
8. Balgrove RC, Howatson G, Hayes PR 2018 Effects of strength training on the physiological determinants of middle- and long-distance running performance: a systematic review. Sports Medicine 48:1117-1149
9. Linton L, Valentin S, 2018 Running with injury: A study of UK novice and recreational runners and factors associated with running related injury. Journal of Science and Medicine in Sport. 21:1221-1225