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The Running Paradox - A fundamental human movement that seems to get everyone injured. Why?

I have been curious about this for quite some time; why is it that something we are born to do, something our bodies seemed designed around doing, injures people so often? As I have mentioned before on this blog, studies show that about 80% of people are doomed to injury within the first 6 months of taking up running. If we are "Born to Run", as the famous runner's bible says, then why is everyone getting injured doing it?

An Evolutionary Perspective

A good way of thinking about such problems is to look at our modus operandi for the majority of human evolutionary history and see if it matches very well with what we are doing today. It doesn't take a rocket scientist to see that there are a whole host of mismatches, including:

  • Activity levels and the kind of activities being done on a regular basis.

  • Diet

  • Footwear or lack of

  • Lifestyle

  • Life expectancy

  • Genetics

  • Adaptive change

  • Survival of the fittest?

All of the above could play a role, but I am going to first focus mainly on the unique adaptive advantages humans have over almost all other animals, how they might have come about and how this links in with running and injury.

Humans are amazingly good at filling a niche. There is no better animal at it. Even before the agricultural and industrial revolutions, humans filled a range of niches in a number of different environments; some hunted big game on the plains of Africa, some fished on the shore, some foraged in the jungle, others speared seals and whales in the arctic. As a species we have so many ways that we can survive and thrive.

Each different situation our ancestors found themselves in encouraged them to adapt mentally and physically to the task of surviving in their specific circumstances. Most people understand the behavioural changes required to achieve this, but few realise that the human body also adapts physically, with incredible speed and flexibility as well.

The reason for this incredible adaptability is of course based in the exceptional level of intelligence humans have, but it is also a result of being such a social animal. The combination of intelligence and teamwork really fast-forwarded our ability to adapt.

The Cheetah

You might be wondering why I have suddenly veered-off to talk about cheetahs, but they are a good comparison, especially when it comes to physical adaptability.

Cheetahs are generally solitary hunters that sometimes work together with others to take down prey. They have to be at their peak physical performance to do this, which is why you rarely see a cheetah with a torn hamstring, a pulled hip flexor, or an ACL tear. Why? Because they need to hunt regularly to survive, and any injury basically dooms them to starvation. You don't see cheetahs in the wild that have recovered from a broken leg or almost any injury at all, beyond cuts and scrapes.

Humans on the other hand, have long been documented to have survived such physical catastrophes. How? Because they were looked after and nursed back to health by others. But if an individual in a group can't pull their weight physically, what is the benefit in the rest of the group picking up the slack and keeping them alive? It rarely happens with other social animals.

For a start, intelligence, experience, and wisdom play a very important role in human survival, and this is something older people tend to have. In tribal societies today you can see how the group or village elders take prominence. Many of these elders passed their physical prime long ago and are not anymore suitable for war, hunting or even gathering. Their age has however made them very well-qualified to lead and make better decisions in an ever-changing environment that they have had years of experience in adapting to and recognising patterns in, which help them identify dangers and potential opportunities in the world around them.

Acute Injury Adaptation

Our ancestors would have lived much more physical lives, far more in tune with our evolved biomechanical characteristics. They wouldn't have sat in front of the TV or desk all day, or even ploughed the fields or worked machinery. Their lifestyles were far less likely to compromise their innate biomechanics. They would have been prone to acute injury, however, perhaps more so than we are today, despite their likely increased robustness against injury. After all, they were living in a time where they were preyed upon by predators and had to survive in potentially dangerous environments and had little medical knowledge or equipment.

Imagine being injured by a predator, breaking a leg after a fall, or having a disease that harmed musculature, bone, or other tissue. This must have occurred fairly commonly and after being cared for, the bodies of our ancestors would have needed to adapt to survive. They didn't have to recover perfectly in most cases as they were still valued by the group.

Thus, humans have developed this fantastic ability to adapt to different lifestyles and to recover from injury. It comes at a cost though, there are always trade-offs. The trade-off is that with every adaptation to a practice not attuned to the everyday lives of our ancestors, with every injury most animals wouldn't survive from, we become a little less efficient at moving in the way nature intended. As the years pass, our range of motion deteriorates. With this comes chronic pain, chronic injury, dehydrated fascia, muscle and connective tissue, and in general less efficient movement, which in turn can lead to more acute injuries if our bodies are called into action and they can't cope with it.

Chronic Injury Adaptation

Think of someone sitting at a desk on the computer, head pushed forward towards the screen. While doing this they are straining neck muscles, which become fatigued, which in turn encourages the body to adapt to avoid injury. If the muscles and connective tissue in the neck didn't thicken and grow stronger, the repeated forward head position would lead to a debilitating acute injury. However, this strengthening and thickening of tissues around the neck causes forward head posture (along with other contributing factors).

Postural adaptation is at its heart an injury prevention mechanism. For most of our evolutionary history, it made sense to adapt to an injury or lifestyle in the short-term so that you could avoid a potentially catastrophic acute injury, so you could pass your genes on. So what if you died at 40, but sired 4 children? Maybe that's not what you think, but your genes don't mind that much. Being able to pass genes on through sexual reproduction is the priority and you are the vehicle for that. How you are going to feel when you are 50+ years old was and still is not - in the grander scheme of life and your genetic legacy - that important (though grandparenting does have advantages in ensuring the survival of children).

You can think of every physical adaptation you make to a novel lifestyle or practice as a reaction to minor injuries. Indeed, when we go to the gym and try and build muscle, we are creating micro-tears in muscle, fascia and other connective tissue, which stimulates our body to build back stronger. In principle, the same thing is happening with almost every activity you do that causes a physical stress response.

Also remember that mental stress can cause physical stress, and it is definitely not a coincidence that the typical stressed-out, over-worked person has rounded shoulders. Think of what humans and other animals do when threatened, they curl up, protecting their organs and making themselves smaller. It is even possible that once bad posture in this way settles-in that it can encourage the very same mental state. People who go outside and strut down the street with their chest out tend to feel more confident and relaxed. Even faking a smile has been shown to improve mood and levels of happiness.

Positive Feedback Loops

The above point leads me on to the concept of positive feedback loops. I have mentioned this before in other blogs, but it is extremely relevant to things like chronic injury. This concept is incredibly powerful, and it can work both in the positive and the negative. Like I said above, mental stress can encourage bad posture and then bad posture can encourage mental stress. This circular pattern then keeps making the problem worse.

You see this pattern all through life; you get sick, you can't work, you get stressed, you get sicker, you lose your job, you get sicker, you have no money, you get sicker. Conversely, everyone knows that once you have a little money, you can make a little more, and the more money you have the easier it is to make a shedload of it. It is any real surprise that as time goes by, societies tend to stack quite unevenly into haves and have-nots, with precious little in the middle. Deterioration happens quickly, but equally so can success and improvement be rapid.

The positive feedback loop is something to fear but you can definitely use it to your advantage to improve things as well. This is really what the form of training and lifestyle habits I would advocate are all about. In a nutshell, from a biomechanical standpoint, once you start improving your posture, you can start improving your movement, and once your movement starts improving it starts improving your posture. As your physical well-being improves, so does your mental well-being. And around and around it goes.

Back to Running and Trade-Offs

As you can see, there is a lot going on with our modern-day lives that are at odds with our primary evolutionary physical adaptations to hunter-gathering. That said, since the development of our extreme intelligence, being able to adapt successfully is hard-wired into being human. As William Shakespeare put it:

a jack of all trades is a master of none, but oftentimes better than a master of one.” - William Shakespeare.

Humans are a jack of all trades, which has made us masters of planet earth and now a problematically successful species. It doesn't come without its trade-offs though. A big trade-off for us is that we are the most physically compromised animal on planet earth, able to perform the widest array of physical tasks and movements, yet being particularly adept at none, and not especially good at the ones we evolved to do. We are designed around standing, walking, running, and throwing, but the further we move away from doing these activities as part of our everyday existence, the more long-term health consequences we set ourselves up for and - quite obviously - the worse we get at doing each of these core functions.

Is it any wonder then why most of us suck at running? And throwing? Don't even get me started.

The Problem May be Far Deeper than we Imagine.

Consider the following article from the bbc: Caesarean births 'affecting human evolution' - BBC News

The regular use of Caesarean sections is having an impact on human evolution, say scientists. More mothers now need surgery to deliver a baby due to their narrow pelvis size, according to a study. Researchers estimate cases where the baby cannot fit down the birth canal have increased from 30 in 1,000 in the 1960s to 36 in 1,000 births today. Historically, these genes would not have been passed from mother to child as both would have died in labour.

Why am I writing about C Sections? Well, this is clearly a case of a trade-off of human success. We get better at saving people in childbirth, and this has the effect of making childbirth more dangerous without the intervention, causing us to rely more and more on C Sections. A noticeable difference in a mere 50 or 60 years.

For a moment consider the cheetah again. What if cheetahs started helping each other out and a few cheetahs managed to survive and reproduce despite being born with malfunctional hip structure, or knees prone to cartilage tears, or generally less physically robust specimens managed to survive in general. How would it affect the physical performance of the cheetah population?

I think it is very likely that humans are the victims of their own success. Basically, anyone can survive these days. Even the severely disabled can survive and pass on their genes. Don't get me wrong, this is a wonderful thing, a true testament to a flourishing, functional and moral culture and society. What it is not good for, however, is building genetically robust human bodies. This we just have to accept. Physically-speaking, we are likely shadows of our ancestors, much like many current dog breeds are of their wolf forefathers.

A Sea of Problems

When I walk around Cairns, the city I live in here in tropical Far North Australia, all I see is physical problems. It can be seen best from a biomechanical perspective down the esplanade where many people go running. Hardly anyone runs the same. There are kinks and asymmetries going on everywhere, it is fascinating to watch once you get an eye for it, but also a little disturbing. In a few years where this is going to lead? Is the human race doomed to ever more physical inefficiency, causing more and more pain and injury problems? All I know is we look sick, and young people don't seem as robust as I remember either. One wonders how many of our problems we are passing on to our children both in our genes and our behaviours.

Running is the Hardest Exercise

Running is a series of jumps from one foot to the other. The impact of hitting the ground after each jump magnifies the force of gravity on your joints and connective tissue. Nature had us designed rather well to mitigate this impact, just like it does with most other animals (though being on two feet definitely makes gravity more of a problem for us). That was until we started being ultra-effective at manipulating all sorts of different ways of surviving and thriving with our intelligence and teamwork. Then the need to be super-efficient at mitigating the force of gravity on our bodies was not necessary anymore to pass our genes on.

As you can see, the reasons we as a species seem to struggle doing one of our key movements without getting injured are complex and deep-seated, and probably not something we are going to conquer any time soon.

Before you go, Something to Think About

I noticed this picture shared in a Facebook group I am part of "Squash Stories". It was read how many people read the results of such studies that playing racket sports and running make you live longer, so get out and do them! In reality, the truth is almost certainly that the people who can run and play racket sports into old age tend to live longer, and this is an important difference.

On rare occasions, I see someone running with excellent form. On even rarer occasions I see someone of 50+ years of age running with excellent form. These are those mainly lucky people with good genes and excellent mechanics. Let's not take it all away from these people. They've kept fit and been disciplined with their health, no doubt. But their ability to exercise well into old age is not mostly down to discipline and a good work ethic. Their genes, upbringing, environment, and general living circumstances have played a major role and most of this is something they had no control of whatsoever.

I realised this after my squash days were over. I trained pretty hard. I flogged myself for months training for marathons and my fastest time was 3hrs 45 minutes. The world record for the marathon is 2hrs 1min 39secs. Is it simply down to work ethic that I can't run that fast?

No, I trained so hard that after my fastest marathon my body was a mess. My back, ankles, and hips were painful for probably 2 months. I then learned to run properly, following the best advice and changing my technique the best I could, without making fundamental postural changes. I then ran a slower marathon by 5 minutes but wasn't injured afterwards. Simple technique, the likes of which you can be taught by a running coach can help, but I was never even coming close to even a 3-hour marathon time. My mechanics simply would not allow it.

Finally, running is simultaneously one of the most fundamental movements humans make, along with one of the toughest and the most likely to get us all injured. Running tells you how physically functional you are as a human being. If you can run fast and for long periods, without getting injured, you are one of the lucky few that have efficient gait and excellent biomechanics.

The ability to run well is a dying ability in the human species as a whole, but all is not lost. Strides are being made (pardon the pun) in the world of functional movement scientists and practitioners that are beginning to reverse the dysfunctional nature of modern human bodies. People literally need to be taught how to walk and run all over again, and to go back and learn from our ancestor's existence before we can move forward in a manner that makes us more athletic, better-looking, and free from pain and injury.

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