Uhan’s Three Laws of Running Injury

Stay the CourseHappy one-year anniversary of Stay the Course! It’s been an honor and privilege to pen this column for the past year. Like a hard race, it is a challenge and assessment to take one’s professional knowledge, beliefs and values and open it to critique.

It’s also allowed me a valued opportunity to offer unique perspectives on issues and problems plaguing runners. Readers of StC might notice that there has been very little conventional sports medicine content in the columns. Why? Because frequently:

A. Runners already know a lot about conventional sports medicine approaches, yet they’re still in pain.

B. The key to sustainable improvement is to find and treat the cause, not the symptoms.

Having a platform to disseminate these alternative concepts has been rewarding for me, and I hope, for the readers, as well.

Treating runners is challenging. To relieve their pain, temporarily, is one thing; but to create sustainable improvement, is much tougher. Almost always, it requires analyzing and changing mechanics.

If you get ten PTs together in a room and asked them how the felt about changing someone’s running mechanics, at least eight of them would sooner sit in a dental chair, or be on the business end of an endoscope.

Why? Changing someone’s mechanics is difficult, and it is scary! Most of us aren’t comfortable doing it. But so it is for the doctor on the other end of that endoscope. However, daunting and difficult are not reasons to avoid what, for most runners, is what they need most.

I still remember the first runner whose mechanics I aggressively changed. It was intimidating, challenging, and at times frustrating. But in those initial experiences, you trial and error, and error some more. But you learn. And then you learn that, when you can create a sustainable, efficient change, pain evaporates.

Then it becomes fun. And deeply rewarding.

Based on those learning experiences, I’ve since developed some fundamental Rules that guide me – as a therapist, coach, and runner – with running injuries. They’ve served as guiding principles for not only sustainable pain-relief, but healthy, sustainable running:

Uhan’s Laws of Running Injuries

1. Every running injury invariably changes the way you run (The Pain/Brain Law).

Pain changes the brain. Clinically, we see this across the board with any serious injury: a fall, a surgery, a fracture. It changes how you move. It’s not simply due to fear (though it can be). It is a primitive fight-or-flight response: the brain will automatically find “alternative movement strategies” to keep you moving. Period. It’s a basic survival instinct. If something hurts – or is damaged – the brain will find another way for you to escape.

Too often, especially with running injuries, that new strategy becomes the “new normal.” Compensation becomes reality. The brain adopts it as normal. And most of us cannot tell that we’re different, as the brain blends this new strategy into your “normal movement” pattern.

It’s like we have an Excel spreadsheet for every movement pattern we do. For example, there’s a file called Run.xls in our brain. When we have pain, it’s as if one of the Board of Directors opens the file, changes one (or a hundred) functions, and hits save. Your brain still thinks it’s Run.xls. But it’s different.

And you move different. Less efficiently. Often pathologically, causing anything from aches and pains to further – and usually different – injury.

How do we combat this?

  • Take pain seriously. Never run through an injury unless it’s mid-race, or within days of a race. Even then, rest as much as you can.
  • Rest. Allow tissues to heal maximally.
  • Beware of “program overwrites.” Do Not Limp or Compensate! Ever! Even if running normally is more painful, compensating will foul up “Run.xls,” and you might never get the original back.
  • Keep a back-up copy of Run.xls. Know your normal! Keep periodic video of your good stride. Perform running drills consistently that will reinforce your most efficient running mechanics, so if and when you do become injured, you truly remember how to do it.

2. For every injury action, there is an equal, and opposite reaction (Uhan’s Second Law of Motion)

When I’m first working with an injured runner, I often channel my inner psychic:

  • For the runner with left foot pain, “Did you ever hurt your right knee a long time ago?”
  • For the person with right hip pain, “How many times have you sprained that left ankle?”

It’s not mysticism. In the course of a thorough exam, you’ll find issues on the opposite side – or end – of the body corresponding with the current injury. It’s part compensation, but it more about how running works. Running is reciprocal: push creates pull, short makes long, rotation makes counter-rotation. It’s how we propel. That said, any running injury will affect the opposing action to whatever is painful.

This concept is important to not only cover the bases with injury rehab, but also to find the true cause of a given injury. For example, many runners with unilateral hip pain (the driving, flexing phase) will have a history of foot, ankle or knee pain on the opposite leg (the extending, push-off leg). Another example is plantar foot pain: many runners will have a history of ankle, knee or hip pain affecting the push-off of the opposite side. A weak push off one side makes for a sloppy, painful landing on the other. Effectively treating both the flexing and opposite, push off leg is vital to ensure a complete recovery.

Lastly, my favorite:

3. A runner’s mechanics, without energy input, will devolve to greater and greater disorder until it reaches equilibrium – and they stop running. (Uhan’s Law of Running Thermodynamics)

My college coach used to say, “Injuries have a memory.” I used to think that pertained to the tissue somehow “remembering” it was hurt. This is sometimes true (with collagen fiber). But with the brain, it is nearly always true. It serves the brain well, in a survival sense, to remember pain. And with each injury, there is opportunity to compensate, however minor. Injuries – aches, pains, and stiffness – can cause brain and tissue changes, which in turn can cause run mechanics to gradually become more inefficient. Inefficiency causes greater stiffness, aches, pains, causing greater inefficiency…and a downward spiral forms.

Ultimately, this process results in more severe aches and pains, or injury, forcing a runner to severely curtain their running volume, or stop, entirely. Game over. Happy retirement. Talk to any “retired” runner; there are few, if any, who do so voluntarily. Instead, it is because of pain, stiffness, or misery that stole the fun, speed and distance from their running.

Maintaining efficiency – and pain relief, sustainable running, and enjoyment – takes consistent energy and regular attention to stride integrity. Without it, you risk becoming another early retirement case.

  • Take the time to do active stretching, before and after the run. Stiffness is progressive, like a room with wall closing in. Stop the progression with consistent range of motion. Consider periodic massage or weekly yoga classes – anything to maintain normal functional range of motion and strength.
  • Run speedwork regularly. The consistent performers with longevity in the sport all run speedwork. Speedwork, augmented with drills, maintains full range of motion and maximal stride efficiency. Without efficiency, you cannot run fast. Routine fast running, even in short volumes and relatively low intensity – keeps those walls from closing in.
  • Be mindful of your run mechanics. Know how you run, and be mindful of when something feels off.
  • Ask for help! We all run with others. And we all know how each other run. Yet seldom do we ask for input or reminders about form. Golfers do this, why don’t we? Running with mindful, helpful friends is like running with a coach every day.

* * * * *

I hope these concepts, and the articles from the past year, are helpful for you, keeping you on the trail, doing what you love. My entrance into medicine was motivated by my love of the sport, and my desire to see everyone be able to participate to their fullest potential. I wish for that for all of you in the next year and beyond.

Thanks for the support, and see you out on the trail!
-OOJ

Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There are 24 comments

  1. Charlie M.

    Great info, great laws. I'm one of those who will never find my way back to the old normal. I've tried everything (PT, minimalism, fanatical stretching, etc.) except surgery–and I don't want to go that route because I've adjusted to the new normal (chronic pain) and I don't want to make it worse than it already is (I feel like ankle surgery will create more scar tissue or damage a nerve, etc.). I basically run every day because I crave the endorphins, and the endorphins are what makes my injuries not hurt for that blissful window of time. I'm probably creating many more micro-injuries all over the place, but there ain't no way this old body is getting back to an original run.xls file. I will be the guy who looks bent over to the side, and not just in a 100 miler, but in my local 5K. I've accepted it, and it ain't gonna stop me from battling it out on the tarmac and trails. Long live the New Normal!

  2. Phil Jeremy

    I've found all your articles this year very helpful. Its good to have someone who 'knows his stuff' to remind us of mistakes in form and the part the brain plays in tricking us,(so to speak). I am more aware as a result … thank you.

  3. Jennifer

    This is a very helpful article. I too like to listen to my body when I'm in pain. To me pain is a warning signal telling me to stop doing what I'm doing. I never really thought about if one ankle was hurting that it might be due to the other knee. I guess you learn something new everyday. Thanks

  4. Dan Schuerch

    Your comment that speedwork is about efficiency and longevity (as opposed to getting faster) is something I STRONGLY resonate with. I've noticed that conventional speedwork is often de-emphasized in many ultra training plans/philosophies. This makes me feel slightly embarrassed by how much my body seems to enjoy speedwork, and how reluctant I am to stop it. True, the intervals I do will probably never allow me to clock 5:30 miles. But they do seem to open up my stride, encourage quick leg turnover, and increase my range of motion in a way that nothing else does. My body enjoys it, I'm inclined to trust that. And I believe it helps on my long trail runs, too. I think this is because, as you suggest, speedwork encourages a number valuable running habits, not just speed.

    1. OOJ

      Dan-

      Thanks for the comment.

      This is an "oldie" (2005) but goodie, written by Buzz Burell, about speedwork. In it, he writes:

      "Instead of first learning to go fast, they learn how to go long. This is backwards. They may not be able to run effectively, but rather than learning the most primal aspect of our sport, they instead learn how to suffer."

      http://www.trailrunner.com/trail_times/2005_trail

      This is not to advocate that we ALL must be able to run super-fast to run ultras; rather, I think he posits the notion that learning to run relatively fast will enable the least amount of suffering – and, if you believe the converse to be true, the most amount of enjoyment.

      But let's face it: folks in our sport embrace, if not cherish, the suffering. But for many, it comes at a physical price. There is a way to achieve that Zen-like fatigue-based suffering without orthopedic demise, and I feel efficient running is the key to that.

  5. olga

    Love the speedwork part as a mean to less injury and longevity in sport. In experiment of one it works, and I am not fast by any stretch of imagination. On a negative note, I can also advocate for the part that when one injury strikes and runners doesn't pay attention, the whole sequence of those drags in and makes things far worse…And yeah, stretching is good!

  6. Darren Winter

    Great article, I only found this from a retweet.

    I used to be a PT but am suffering from chronic pain in lower back and right leg/knee. Im at a loss what else to do but to stay on pain relief medication and i miss training so much.

    Im inspired by those like Charlie M (Second comment on this article) who just go out and suffer the pain, I might just do it this week but it may well be a slow jog.

    Thanks again for the article.

  7. ewlake

    Thanks for another great article, Joe. How wonderful it would be if all PTs and sports med doctors approached treatment like this. For irunfar readers in the Salt Lake City area, please check out Pinnacle Performance – http://www.pinnacle4performance.com/ The incredible PTs there will take this same approach, offering manual physical therapy and intelligent movement treatment. They have also developed a runners' training course focusing on biomechanical and neuromuscular movement patterns for efficient running. I'm a happy customer!

  8. BGD

    I, for one, can corroborate Joe's commitment and passion to bringing you guys the best he has to offer (both as a recipient of his knowledge and as an onlooker who has seen him work hours in prep for each column).

    Very thankful Joe! Looking forward to another solid year of this column.

  9. James Adams

    Great article OOJ :) The number of runners I know who run when injured is crazy. And they refuse even to slow down if they do.

    I like Matt Fiztgeralds simplicity of training too.

    Run as much as you can without getting injured

    Run fast sometimes

    Run when fatigued sometimes

  10. Brandon Swanson

    Wow, great article. Thankfully it reinforced, rather than refuted a lot of the things I've learned by listening to my body as I've trained for marathons and ultras. Us runners are a bullheaded bunch, believing the rules don't apply to our superhuman prowess until we are humbled by injury.

    In the end I've found running to be an exercise in intelligence, wisdom, and patience. Anyone can run. Not everyone can keep running.

    My appologies for the wordy comment. It's always a sign of a good blog post though. Thanks again.

  11. OOJ

    From an article in Portland (OR), "Oregonian" newspaper yesterday, about Galen Rupp/Mo Farah and coach, Alberto Salazar:

    " His runners still can run more efficiently. They can be more biomechanically sound, more powerful, kick harder.

    Salazar and Rupp have paid particular attention to Rupp's stride, which they have tinkered to make shorter, sharper and stronger.

    Salazar says it's tighter and more powerful now than it was the August night Rupp won the silver medal.

    This is particularly important at the end of a race, when Salazar wants his runners to shift from a distance runner's form to a sprinter's form.

    "A lot of people are quick to point out that guys are running well, so why would you want to change things," Rupp says. "Alberto has the courage and the guts to say, 'It's not what it could be.'

    "That's a huge thing. A lot of people say, 'If it ain't broke, don't fix it. It's good enough.' That's never been Alberto's way." "

    http://www.oregonlive.com/trackandfield/index.ssf

  12. Mario Starita

    I too like to listen to my body when I'm in pain. To me pain is a warning signal telling me to stop doing what I'm doing. I never really thought about if one ankle was hurting that it might be due to the other knee

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