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Ten Laws of Running Injuries

from Lore of Running, 4th Edition, by Tim Noakes, MD.
  1. Running injuries are not an act of God.
    They result from the interaction of the athlete’s genetic structure with the environment through training methods.

  2. Each injury progresses through four grades.
    Grade 1: An injury that causes pain after exercise and is often felt only some hours after exercise has ceased.
    Grade 2: An injury that causes discomfort, not yet pain during exercise, but which is insufficiently severe to reduce the athlete’s training or racing performance.
    Grade 3: An injury that causes more severe discomfort, now recognised as pain, that limits the athlete’s training and interferes with racing performance.
    Grade 4: An injury so severe that it prevents any attempts at running.
  1. Each injury indicates a breakdown point.
    This law simply emphasizes that once an injury has occurred, it is time to analyze why the injury happened.
  1. Most true running injuries are curable.
    Only a small fraction of true running injuries are not entirely curable by quite simple techniques, and surgery is required in only exceptional cases.
  1. Sophisticated methods are seldom necessary.
    Most running injuries affect the soft tissue structures (tendons, ligaments and muscles), particularly those near the major joints. These structures do not show up on X-rays. As with any injury, a correct diagnosis requires a careful, unhurried approach in which the injured athlete is given sufficient time to detail his or her story and training methods.
  1. Treat the cause.
    Because all running injuries have a cause, it follows that an injury can never be cured until the causative factors are eliminated. Thus surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies are likely to fail if they do not correct all the genetic, environmental and training factors causing the injury.

  2. Complete rest is seldom the most appropriate treatment. 
    Complete rest is unacceptable to most serious runners because running involves a type of physical and emotional dependence. Our advice to injured runners is generally to continue running, but only to the point at which they experience discomfort.

  3. Never accept as final the advice of a non-runner.
    – Your adviser should be a runner. 
    –  Your adviser must be able to discuss in detail the genetic, environmental and training factors likely to have caused your injury. If the practitioner is unable to do this, together you will go nowhere.
    –  If your adviser is unable to cure your injury, he or she should feel as distressed about it as you do. It is patently ridiculous to accept advice from someone who is antagonistic or indifferent to your running in the first place.
    –  Your adviser should not be expensive as most running injuries can be cured without recourse to expensive treatments.
  1. Avoid surgery.
    The only true running injuries for which surgery is the first line of treatment are muscle compartment syndromes, interdigital neuromas, chronic Achilles tendinosis of six or more months’ duration, lower back pain due to a prolapsed disc, and the iliotibial band friction syndrome – but only when all other forms of non-operative treatment have been allowed a thorough trial.

  2.  There is little evidence that recreational running causes osteoarthritis.