Athletes with healthy knees running in a 5k race

‘Couch to 5k’ has proved to be a popular programme in helping beginners into running. But more runners means more injuries and, as Dave Duffy argues, the orthopaedic community could have been quicker to react.

You may have heard of ‘Couch to 5k’. It was an initiative developed by runner Josh Clark, who wanted a simple, gradual way of supporting his mum as she discovered running for the first time. It quickly became something of a sensation, supported by the NHS and prompting a whole raft of blog posts about how it had helped people go from never having run in their lives to happily clocking of the kilometres.

Then, as is the way of things, you start to see the backlash. Focusing on distance, not prep is leading to more injuries, say some. Couch to 5k kas rendered warm-ups “socially unacceptable” declared this article, which went on to say that a simple warm up routine “can reduce the incidence of an anterior cruciate ligament injury … by up to 70%.”

All of which prompts three points:

1. Increase the number of participants in any activity and you’ll see an increase in the number of injuries sustained as a result of that activity. That’s not only inevitable but rather obvious.

2. Warm-ups do matter, but a jog or run is relatively unlikely to result in an ACL injury because it’s a straight-line activity with few complex movements.

Compare the movement of your knee during a run with the forces placed on it playing rugby, netball or football, where there are constant changes of direction, explosive bursts of pace and (in two of those three sports) significant bodily contact. If there’s complex movement involved, that’s where ACL, meniscal and other major injuries are most likely to occur. Runners certainly aren’t immune to injury, but that injury is more likely to be muscular.

Runners Warming Up Before 5k Race

3. It’s a little unfair to place this entirely on the people who are getting active, some of them for the first time in years. As an orthopaedic community we’ve been a little slow in picking up on injury prevention.

To date, we’ve been all about treating patients post-injury and helping them return to sport. Yet we know, for example, that if you’ve already had an ACL injury on one leg, you’re at greater risk of tearing the ACL in the opposite leg compared with the baseline population. We know of the increased risks for young people returning from injury. We know women are 4-6 times more likely to suffer an ACL injury than men.

So yes, warm-ups make sense. They make sense for everyone but they make particular sense if you’re about to take part in a sport involving complex movements. And the more we know about the risks of injury, the more responsibility we have to play a proactive role in ensuring more injuries are prevented.

It would also be wrong to look at this from a purely orthopaedic perspective. Go from couch to 5k without a warm-up and you may risk a muscle injury and to a much lesser extent, a ligament injury. A warm-up reduces that risk. But not doing the run at all surely increases the long term risk that you’ll be needing the services of a cardiologist in a few years. There’s a risk balance to be struck and addressing that means looking more broadly at injury prevention, and at factors beyond the knee.

If you’ve suffered a sporting knee injury, our knee specialists can help. Please get in touch.

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Dave Duffy

Dave Duffy

Consultant Orthopaedic Surgeon & District NHS Foundation Trust

“Mr Duffy is a wonderful knee surgeon but he’s a very approachable guy as well… That makes a huge difference.”

Jean Drake,
YKC patient.

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