Q&A: I keep getting injured while running. What am I doing wrong?

The world’s greatest runners speak poetically about how they deal with physical pain.

Eliud Kipchoge, the world’s greatest marathoner, says pain is nothing more than a mindset. He has a habit of smiling when it sets in.

In running six marathons in six weeks, Shalane Flanagan was reminded "just how temporary pain can feel and just how permanent memories can be".

Sprinter Allyson Felix said the pain is always there. It's all about how it can fuel you.

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Then there's long-distance runner Molly Seidel. Her coach, Jon Green, says her pain tolerance is almost too high. But, he said, "Molly will not tell me something is hurting unless it's getting to the point where she feels I need to know."

Therein lies the issue. There’s the pain you can work through, and then there’s the need-to-know, take-a-pause kind of pain.

Differentiating between the two is difficult even for the professionals. It’s no wonder that most runners, including our readers, have dealt with or are dealing with injuries.

Yera Patel, a physical therapist at NYU Langone Health, answered some questions about training, injuries and staying healthy. Of course, if you are dealing with an injury, the best advice is to see a medical professional.

Q: I keep getting shin splints or stress fractures. What am I doing wrong?

Shin splints and stress fractures happen when an activity has surpassed the load capacity of the bone. This can happen for various reasons, including nutritional deficiencies, lack of strength or flexibility, or poor biomechanics. That said, I find the most common reasons people develop shin splints are errors in programming their training.

Make sure you are gradually ramping up mileage without sudden changes in speed or distance. Also, it may be worthwhile to have an expert check out your running mechanics to see if you demonstrate high loading patterns like a pronounced heel strike.

A simple modification you can make is to turn over your feet faster or increase your running cadence to about 180 steps per minute. That change can reduce loading impact while changing very little regarding how you run.

Q: Everyone talks about the importance of cross-training. But what kind of non-running training do you recommend? Roller-skating? Biking? Elliptical? Swimming?

There have been studies that show transfers in aerobic capacity between cycling, swimming and running, which are great forms of aerobic cross-training. But not all cross-training is equal. If you want to complement your running, I’d argue the most important form to include is actually strength training.

Deadlifting, squatting and single-leg strengthening are great ways to improve running performance and reduce risk of injuries.

There’s also a fair amount of research on how plyometric work can improve running economy, so incorporating the occasional box jump or jump squats into your programme can be valuable, too.

Q: What about upper-body injuries, ones that may affect how I swing my arms while running? Can I run through a shoulder or arm injury?

Our shoulders are important in powering the arm drive in running. When it’s done efficiently, that arm drive can maintain tempo and reduce the overall energy cost of running.

If the shoulder or arm pain when running is less than a three on a 0-10 pain scale, and that pain usually dissipates while running, you’re likely safe to keep going. If the pain is above a three or if the pain increases while running, I’d recommend holding off as to not worsen the injury.

Regardless, it’s worthwhile seeking help from a medical professional to diagnose your shoulder pain and manage symptoms.

Q: I have bad form when I run, which leads to back pain. Are there any exercises you recommend to improve running form?

There are many reasons an athlete may develop back pain while running. It could be a lack of hip extension, decreased core strength or hip weakness, among other things. A thorough running analysis can be really helpful in determining why back pain may be provoked during running.

Generally, it can be helpful to strengthen your core with isometric exercises like a Pallof press or plank variations. I’d also focus on ensuring your glutes are strong and activated to push your hip into extension when you run.

If runners aren’t able to adequately drive their hip back into extension, they can put undue stress on the low back and develop pain.

Q: What's your advice on returning to running, whether it's after a short break or years since I last ran?

A gradual and well-planned programme is critical when returning to running after a long hiatus or injury. Generally speaking, you want to ensure you’re ramping up distance first versus any other variables like speed or incline.

Once you can run at a distance that you were comfortable with before, you can begin to increase your pace.

A good rule of thumb is to pick one run a week and ramp up that run’s distance by 5 per cent of the total week’s volume. For example, let’s say you run 5km three times a week, making your weekly distance 15km. Add 5 per cent of 15km to one of your weekly runs, so do two 5km runs and one 5.75km run.

Repeat that increase every week until you reach your desired long-run distance.

If this seems tricky, it may be worthwhile to consult a professional who can guide you through navigating pain and running post-injury. – This article originally appeared in the New York Times