Subjective Assessment of a Runner

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Pierre Roscher, Jess Bell, Tarina van der Stockt, Kim Jackson, Lucinda hampton and Aminat Abolade  

Introduction

Running is a popular sport. Running is an acceptable and well-known choice of health, sports and leisure activity. It is well promoted and highly desirable for many people. Endurance running has benefits on body mass, body fat, resting heart rate and cholesterol levels. Runners live an average of 3 years longer than non-runners, with a 25-40 percent reduction in risk of premature mortality.

Running, like most sports, can also lead to injury and or dysfunction, as running puts specific high loads and demands on joints and soft tissue. Statistically speaking, 25 percent of long-distance runners are currently injured, and about half of these injuries interfere with daily activities and cause restrictions for a period of time.

The incidence of running-related injuries (RRI), ranges from 18.2% to 92.4%, with a prevalence rate ranging from 6.8 to 59 injuries per 1,000 hours of training. It has been found that there are 7.7 injuries per 1000 hours in recreational runners - this figure increases to 17.8 injuries per 1000 hours in novice runners.

Running-related injuries (RRI) are defined as musculoskeletal ailments that are attributed to running, which cause a restriction of running speed, distance, duration, or frequency for at least 1 week. These injuries are usually induced by overuse and repeated musculoskeletal microtrauma. RRIs are influenced by several risk factors such as the personal characteristics of the runner, training overload (volume, overall weekly distance) and running experience.

A systematic review showed the overall injury rate was 20.8 injuries per 100 female runners and 20.4 injuries per 100 male runners.

Subjective History Considerations

Types of Running

Not all running is the same. Different types of running have different characteristics and specific aspects should be considered for each. When asking your patient about the type of running, it is good to know about external factors that influence running such as running ground, gears, type of shoes and the runner's rhythm or style of running. Specific shoes for specific terrains are important, as they protect the foot structure and provide better gripping for the runner.

Road running: Road running is free, easily accessible and will offer the largest continuous route to run on. From a safety aspect, road runners may have their safety compromised by sharing the road with vehicles in areas where there is no dedicated running lane. Some roads may be in hilly areas, which may in turn make road running less desirable for beginner runners.

Trail running: Trail running is always different. The dynamics change based on the type of trail. The rhythm tends to be slower in long, sandy roads or long dirt roads. Mountainous or local trails involving uneven surfaces or grounds cause cadence and step rate to change rapidly when compared to road running where cadence remains similar throughout the run. Running uphill and downhill create different loading. Side to side movement might be expected when a runner is climbing unlike on the road. Trail running usually requires special trail running shoes.

Treadmill running: Treadmill running is convenient, but it is always difficult to recreate natural "road" conditions on a machine. Many long-distance athletes will stay away from treadmill running or training as the biomechanics demands are so different to road running. The treadmill surface is smoother compared to the road and more bouncy. However, the biggest factor to consider is that the runner and treadmill belt move on the treadmill, whereas the road does not move during road running. Thus. the treadmill impact factor may need to be considered. Treadmill running is ideal for someone who wants cardiovascular exercise in combination with other gym-based exercises. There is also a safety aspect to consider with treadmill running/walking, especially with older people.

Track running: Track running is unique. It is ideal for short to middle distance athletes. Track athletes often do warm-ups in the opposite direction of running in order to avoid muscle shortening on the one side if they are leaning into the corners the whole time. Track shoes are also different. They have very little to no cushioning, and they have studs underneath for gripping. Track runners generally are going to be faster athletes with a very different running style. They mostly run on their toes and high power is needed.

Triathlons: Running is the third and final discipline in a triathlon after swimming and cycling. The success of the running leg of a triathlon is determined by the performance of the athlete during the swim and the cycle. If athletes push too hard during the swim and cycle, they may struggle during their run. Many triathletes have one strong discipline and one weaker one. Training for a triathlon may involve focusing on individual disciplines initially and then combining multiple disciplines during a training session closer to the event.

Pace

Pace refers to the average speed of running. Pace is usually tracked on a sports watch or smartphone application such as Strava. We can classify runners by their pace.

• Average runner tends to run at 5:30 minutes/ km
• Medium runner tends to run at five, 5:40 to 6-6:30 minutes per/km
• Slower athlete tends to run at 6:30-7 minutes and above per/km

Tracking your pace can help when the athlete is returning to running after an injury, as they can compare their speed to their pre-injury speed as a baseline. It is also an excellent way to set goals.

Cadence

Cadence refers to steps per minute. Cadence can be tracked on a smartphone application. Cadence can indicate over-striding, which refers to the position of the foot placed in front of the midline when running which predisposes the runner to injuries. Depending on the trail, faster runners tend to be over 180 steps per minute on a trail run.

Stride Length

Stride length is dependent on the height of the runner, and their cadence should also be taken into consideration when measuring stride length. This objective measure is used to reflect the effort and energy expenditure into running. Different styles of running will have different energy expenditures for different people.

Running Experience and Races

Some runners have been running regular specific distances for years, and have completed many races successfully and injury-free. Over the years of running, they build running capacity and their connective tissue has been primed to take the load. This gives an idea of their duration of running, the capacity of their lower limb muscles and connective tissue, their history of injuries and the races a runner has participated in. Some runners are very new to running, and they are still unsure about what kind of a runner they want to be, or whether they want to take up running as a long term sport at all. Some runners are only training for one or two specific events. All of these factors are important as they will give a baseline of what the runner is expecting, or hoping to achieve. Some of the running goals set by patients may also be unattainable in short time frames and busy training schedules. The more experienced runners are often more reasonable when it comes to seeking help, and often know when to back off from running at the right time to prevent a niggle from turning into an injury. This can help plan out the injury rehabilitation, prevention and next race.

Strength Training

Strength training is an essential component of running, especially when it comes to building running capacity. Strength training may involve running related strength training such as hill work, and non-running related strength training such as free weight functional exercises. It is important to ask a runner about their strength training regime (if they have one at all).

Coaching

A running coach is often the next step for a novice runner who wants to move up in the ranks and improve their performance. Running coaches could be employed on a short term basis (to improve technique), or more long term to improve long term performance. Coaching could be face to face or online, especially with running smart watches and applications to track your running statistics. Collaborating with coaches as a physiotherapist can yield benefits in addressing the runner's injuries and training programme.

Running Clubs

Running clubs are a great way of committing to running. Running clubs offer the social support and training structure and opportunities that many runners need for motivation. Other runners in the club can offer training tips and support, and there is often secondary support for club members during major races. Some running clubs are also more professional, and specifically only recruit runners to join who have achieved threshold race paces. Some of these runners may be financially remunerated to be a member of the club.

Goals of Running

Understanding the reasons why people run (e.g. weight management) is important to help motivate and address the psychological aspects of running. The language that patients use to describe their motivation for running is key to understanding any emotional pressure they experience and also to learn what drives their running. Some runners may never lack motivation or drive to run, and some runners may not be happy with advice to manage their running load during or after an injury. Establishing a baseline for every patient gives the physiotherapist insight into the runner's goals. Wearable technology such as tracking devices may also help to improve adherence to specific training programmes that would enable a runner to reach specific goals, and if wearable technology is combined with motivational emails on a weekly basis (from a running club or support group), the adherence to programmes and reaching of running goals is even better.

Caution for Ultra Marathon Runners

Ultramarathon runners are particularly at risk of developing the following conditions during and or directly after an ultra marathon.

• Digestive problems
• Gastrointestinal bleeding
• Cardiovascular changes
• Renal impairment
• Upper respiratory infections
• Musculoskeletal problems

These factors may need to be considered during a subjective assessment of a ultramarathon runner.