Running, Warm Up and Injury Prevention

  

Does it matter? My bias is no….There simply is not enough good quality research for us to confidently say that a warm helps to prevent injury in runners. So if you don’t want to, don’t worry. 

Now here is my caveat 

What is a warm up?

For the purpose of this article, I am defining it as ‘a set of drills or exercises that are set aside prior to a run to prepare for a run’ 

Why am I making this point?

This reasoning is three-fold for me, a question of education and why injuries occur; of convenience; and of evidence. 

1. Education and why injuries occur

Every week I see a runner who relates their injury or pain to the fact that they didn’t warm up or they didn’t stretch properly. Interestingly, Saragiotto et al (2014) found that to; they asked a load of runners what they think can cause injuries and two of the most regular answers were “not warming up” and “not stretching”.

Every week I hear these words. And it just isn’t true, but commercial publications and tradition feed us this information that warm up is important and we get it in our heads that this is the reason why, we then get hurt. This can then become a problem when runners try to change their habits, start warming up but their pain and injury don’t go away. It can also be a problem because runners then focus on warming up and doing things like stretching and missing the important reasons why we get injured (read here for how stretching can actually reduce your running performance).

These important reasons being training load and error in this; and not having the capacity to tolerate what we are asking the body to do. 

80% of running injuries are thought to be due to training error and overuse. This is too much too soon, and it’s the too soon which is often the issue as rapid increases in training load is associated with injury. Gabbett et al (2016) found that we should only increase 10-15% week on week and 50% dramatically increases our risk of injury. So if you go from 10km to 15km you are 80% more likely to get pain or injury; up to a four times greater risk!

The second point relates to ground reaction force and the load going through the body. Ground reaction force during running is thought to be 2.5 to 3 times body weight. Therefore we, as runners, need to be able to cope with this load. For example: a runner who weighs 80kg who makes 500 foot contacts per mile would have to cope with 100,000kg of load per mile (80 x 2.5 = 200kg of load per step, x 500 steps per mile = 100,000kg).

So how do we cope better with that? 

  1. we increase our running slowly so the body has a chance to adapt and 

  2. we carry out a strength and conditioning programming 1-2 times a week.

And it is these exercises – strengthening exercises, and not stretching exercises, which will make the biggest impact on your running and injury. 

Lauerson, Bertelsen and Anderson (2014) found that resistance training reduces risk of overuse injuries by about 50% and good news for runners is that it improves running economy and increases speed as well; Karston et al (2016) found that 6 weeks of 4 sets of 4 reps of 80% 1 repetition max lunges and heel raises improved 5km race time by nearly 4%…and those who didn’t train, didn’t improve. Note, that it is heavy resistance work, light resistance training does not improve running performance, however it is good to have this baseline to start with (Mikkola et al, 2011, via Willy, 2018).

2. Convenience 

Running is very much a convenience sport / activity. I run because I can fit it into my working days and weeks in an often very precise timeframe. I want to maximise my ‘running’ time and do not want to be ‘wasting’ my time going through drills and stretches if they are not going to benefit me (see below). Running improves running at the end of the day. 

A warm up is all about preparing the body for the task ahead. Footballers, start light, go through some running, bring in some dynamic movements, go through some change of direction work and then bring in the ball and finish with some sprints. All things they have to do during a game. So what do we have to do in running….we have to run. So how do we prepare the body for that? 

We can run.

So to warm up for running, I just run. If its a steady run, you’ll be fine. If you are doing a pacing session, then start with 10-15 mins of steady running, to prepare the body for running. But you can build it into your session to maximise your output, start at a gradual pace and ease your self up to the pace you want to run as you feel comfortable. 

3. Evidence 

I received a lovely compliment this week, from a Doctor, saying that I am “so evidence based”. On one hand, it’s my job to be. I owe that to the people who place their trust in me to help them, if I am not then how can I say I am giving them my best duty of care. On the other hand, I want to know what works. And as I mentioned above, if it is not going to be beneficial to me, then I am not going to waste my time. I don’t have much spare. 

We mentioned the Saragiotto study above which showed what runners think cause injury. So what risk factors do we know have been proven: Training error, high body mass index and previous injury. Other than that we can’t truly say there is any other causative link. 

So what about warm up then. We actually don’t have much research on runners and warm up. However a study in 2010 looked at a number of modifiable factors including strength, biomechanics, stretching, warm up, nutrition, shoes and psychological factors and on the point of warm up concluded that there is “not enough high-quality research to determine whether warm-up helps prevent running injury”. 

We can go as far back to 1993 when one of the great researchers in our field Van Mechelen and co found that a standardised intervention including warm up, cool down and stretching exercises in an intervention group and control group with a total of 421 male recreational runners all matched for age, weekly running distance and general knowledge of preventing sports injuries, found that the intervention was not effective for reducing the number of running injuries. There was 23 injuries in the control group (those not doing warm up) and 26 in the intervention group (those doing the warm up). Although it must noted that within the control group around 70% did some form of warm up, but not prescribed and often didn’t include stretching). 

There is some research, that shows warm up has some positive benefits. But this is not in runners. This mainly relates to team sports, football, basketball etc where there are lots of changes of directions, balance and landing activities, which the body needs to be prepared for. Thorberg et al (2017) found that the FIFA 11+ warm up programme reduced football injuries by 39%. Herman et al (2012) completed a systematic review looking at mainly football injuries but with some basketball and army recruits in there as well, and concluded that a warm up consisting of stretching, strengthening, balance, sport specific agility and landing drills can reduce lower extremity injuries. 

So what does all this tell us. There is no documented evidence that completing a warm up in runners reduces the risk of injury. Warm up is likely to be effective in sports that involve lots of twisting, turning, cutting, landing etc. 

There is not going to be a warm up which is going to allow you to run big distances or increase your training amount. Nielsen et al (2014) found that all runners that picked up an injury had large increases in their training in the week prior to their injury (more than 30% left runners vunerable), and Gabbett (2015) suggest this effect can last for 4-6 weeks. There is no warm up that would have prevented that, therefore being sensible with how much you run and how quickly you increase your distance is the kicker. 

Summary points:

  1. A warm up does not reduce injuries in runners

  2. A warm up may be beneficial when returning from injury 

  3. If warming up helps you to prepare, and to put you in a psychologically ready state, then keep doing it. If it works for you, then it works.

  4. Keep things simple 

  5. We haven’t talked about performance. There is some research (here and here) that shows doing a bout of race pace as a warm up for middle and sprint distances can result in a faster running performance. Which matches up with our “use running as your warm up”.

Thanks for reading.