Gradual gains the ideal conditioning for long-distance running

Running injuries due to overuse can affect up to 80 per cent of recreational runners, with the knee accounting for close to 50 per cent of the injuries. Common lower-limb injuries include iliotibial-band (ITB) syndrome, patella-femoral pain syndrome (PFPS) which is also known as runner's knee, shin splints and plantar fasciitis.

A 2015 prospective cohort study published in the Journal of Science and Medicine in Sport found that there is a correlation between a higher running volume and weekly frequency with running injuries.

For runners with high BMI (body mass index), there is also a predisposition to running injuries with increased training volume and frequency.

Experience also plays a role in minimising running injuries, as experienced runners seem to know their injury threshold better than novice runners.

Hip and core muscle weakness may also contribute to the increased overall injury risk. Hip muscle weakness has been identified in several studies done on injured runners, in particular the hip abductors (gluteals) and hip flexors (iliopsoas).

The hip is one of the most powerful joints in the body and any dysfunctions arising from weakness or tightness can have an effect on the body's lower kinetic chain, decreasing one's running performance.

Other causes of running injuries may include a sudden increase in running distance, inadequate recovery, improper warmup, strength imbalance in stabilising muscles and sub-optimal running mechanics. The jury is still out on what type of shoes - running or orthotics - can help to prevent running injuries.

As a sports physiotherapist, I have seen many patients who either do too much, too late or lack the proper conditioning for them to cope with a long-distance run. A properly planned training schedule and sufficient conditioning in the lead-up to your race can definitely prevent any injuries before, during, and even after the run.

If you are a new marathon runner, try to let your body get used to running for a certain distance three to four times for two to three weeks prior to increasing it. Another way to increase training distance will be to follow the widely known 10 per cent rule - not more than a 10 per cent increase in running distance per week.

Running every other day will also be a good idea to avoid increasing distance too quickly per week. Pacing your runs is also important, while tracking your runs and recovery sessions will be useful information to help plan subsequent sessions.

However, running injuries may be linked to a few factors such as running pace, sprint training or other training errors. You can choose to consult a physiotherapist who can help to customise a personalised and safe running programme comprising musculoskeletal strengthening, running drills and training progressions.

Other ways to prevent running injuries will be to warm up properly before your run, stretching to prevent a tight hip after your run, as well as put in conditioning and strengthening workouts for the core and legs. For some runners, orthotics such as insoles or cushioned shoes can help with pain relief. Adequate rest is also key to recovery and preventing overuse injuries.

Recreational runners usually run as a means of keeping fit, while experienced runners aim to improve on their timings or to increase distances. However, it is easy for runners to be disappointed and turned off by running as a sport once they overtrain and suffer an injury as a consequence.

Prevention and having a structured workout plan with progressive resistance is key to avoid falling into the trap of overtraining, and to enjoy the experience of completing your first race, and many more races to come.

• Yvonne Yap is a physiotherapist with the National University Hospital, Singapore.



Iliotibial band (ITB) syndrome occurs when the ITB, a thick band of connective tissue starting from the hip down towards the outside of the knee, gets irritated or inflamed. It can cause pain or swelling over the outside of the knee, progressively worsening unless sufficient rest is taken. Pain may also occur with bending or straightening the knee, or when pressing over the sore region of the knee.


Patello-femoral pain syndrome (PFPS) is an umbrella term to cover knee pain, otherwise known as runner's knee in distance runners. It is characterised by pain under or around the kneecap on exertion, or even post-runs and can last for a few days.

For the middle-aged population, it can also be signs of early knee or patello-femoral osteoarthritis, in which high-impact activities such as running and jumping can trigger pain and stiffness. In worse cases, acute flare-up of arthritis can result in swelling and stiffness for a few days.


Shin splints, also known as medial tibial stress syndrome (MTSS), usually happens as a result of overloading and most runners will feel pain over the front of their shin when running.

Pain can be felt with just gentle pressure applied over the inside of the shin. More often than not, the onset of pain occurs with the impact from foot-strike patterns and is resolved with rest.


Runners can also get plantar fasciitis. The plantar fascia is a connective band from the heel to toes, supporting the arch of your foot.

With overloading, it can get weak and inflamed, causing pain at the heel or sole. Most runners get pain with their first few steps of the day, or after prolonged sitting. Running also aggravates the pain with increased force exerted on the feet.

A version of this article appeared in the print edition of The Straits Times on September 09, 2017, with the headline 'Gradual gains the ideal conditioning for long-distance running'. Print Edition | Subscribe