Too Much, Too Soon, Too Fast – revisited
“The Holidays” came early for me this year, in the form of the October issue of the Journal of Orthopedic and Sports Physical Therapy (JOSPT). The entire journal this month is dedicated to all things running, from a group of guest editorials on the problem of ever-increasing running injuries, to research and review articles on topics such as the minimal shoe revolution, the different risk factors for injury, and the changes in stress loads on hip muscles related to the rate of turnover.
One of the aforementioned editorials is authored by Amby Burfoot, the 1968 Boston Marathon champion and, since 1978, an editor at Runner’s World magazine.
Burfoot writes of his early career as a marathoner in the mid-1960’s when, he claims, none of his running contemporaries complained about injuries. Sure, there was the occasional sore knee, but after a few days of“rest” – i.e., easy running – these problems almost always resolved without any professional intervention.
Compare this to present-day runners who, according to one of the other articles, are injured at an alarming rate of 73% of all runners each year! The central theme of this special issue seeks to answer the question:What accounts for this increase?
Burfoot offers a rather simple, straightforward hypothesis:compared to the runners of his era, he speculates, runners today are simply not as well prepared to handle the physical stresses encountered in the events they choose to enter.
While lauding the incredible increase in the sheer number of runners participating in half and full marathons today (the result of two running booms in the 1970s and 1990s), Burfoot laments the lack of adequate preparation by most of these runners prior to these races. In his era, he says, virtually every runner who ran the Boston Marathon had been a high school and college track and/or cross-country athlete who continued to build on their extensive training base before attempting the ultimate challenge. Today’s marathon participant, by comparison, is likely to be a 30- or 40-something year old who just recently “took up” running and, within the space of as little as half a year elects to toe the line for a 26.2 miler. Many new runners, he writes,“…are more motivated, disciplined, and goal seeking than they are sufficiently conditioned. Their reach exceeds their grasp.”
What Burfoot is describing, of course, is the concept of training errors (“too much, too fast, too soon”) as the primary cause (60-70%according to several studies) of running injuries, surpassing all other factors such as biomechanical or footwear issues. But while this “fact” has become doctrine over the years – in large part because it just seems, well, logical – there are good reasons to question this conventional wisdom.
First, we have the inconvenient detail that several studies that have looked at the connection between so-called training errors and the incidence of running injuries fail to agree on exactly what those errors are in quantitative terms. How much is too much? How soon is too soon? As another paper in this issue of JOSPT argues, the much-vaunted “10% rule,” which states that increasing running mileage by more than 10% per week increases the likelihood of injury, is in reality questionable. (The actual figure, according to this study, may be closer to a 30% increase over a 2-week period.)
The real problem, though, with blaming training errors as a singular cause of running injuries is the fact that the overwhelming majority of injuries affect a part of only one limb. Assuming that most people run with both legs, it begs the question: Are injured runners going too far or too fast on one side only?
The obvious conclusion to be drawn from this is that injuries are always multifactorial. Some asymmetry in limb biomechanics almost always plays some role in the development of overuse injuries. Taken in conjunction with some training error, it only becomes a question of how much of an error it will take to cause a problem in any particular individual. As Burfoot himself notes, some runners will break down at 6 miles per week, while others – the “biomechanically blessed” – will tolerate much more abuse, if you will, before they sustain an injury.
These lucky people are far and few between, however, so the average runner – the ones Amby Burfoot refers to – would do well to heed his warning and be more patient and deliberate in preparing for long and/or hard efforts such as a first marathon.