Training Injuries: Overuse Due to Underuse

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Overuse injuries are relatively common in running.
U.S. Army Capt. Zachary Schroeder, Headquarters and Headquarters Company commander, Army Public Health Center, gets in a distance run May 23, 2019, as part of his training for the October 2019 Army Ten-miler. (Graham Snodgrass/U.S. Army photo)

Overuse injuries are highly common in military and Special Ops preparation training.

Pushing your limits in events like running, calisthenics and even weightlifting is something that is not limited to the advanced-level fitness spectrum. Overuse injuries occur most often when athletes who are starting a new fitness program, or those try to pick up where they left off after a layoff of several weeks or a month from regularly scheduled training. This layoff can be due to illness, a crazy work schedule or even overuse pain itself.

This category of injury is not as simply defined as it sounds. Most people will agree that an overuse injury is defined by doing too much, too soon or too fast, which lacks a logical progression. In the sports science world, the use of the word has caused much debate, as noted in the abstract of this study from PubMed.  The concluding statement is: "Overuse injuries are characterized by (1) a mechanism of gradual onset, and (2) an underlying pathogenesis of repetitive microtrauma."

So how does this apply to military training?

A common and primary "overuse injury" often can be seen at boot camp whenever running is a part of training. If you are deconditioned and did no running before training because you thought that basic was going to get you in shape, you likely will experience overuse injuries very quickly. Injuries such as shin splints, iliotibial band (ITB) flare-ups, stress fractures and tendinitis issues will occur in a relatively quick time with minimal running (relatively).

To prevent these basic training injuries, students need a minimal foundation of running and other load-bearing experience progressing over at least 3-4 months. Having a longer foundation of running will decrease your overuse injury potential statistically.

Building up to 10-12 miles a week for basic training over 3-4 months of steady running should be sufficient. The longer you spend building up your running experience, the better off you are.

Do not wait one month before boot camp to start your workout and running program. If you do not have a lifetime of fitness under your belt, you need to give yourself several months to prepare in order to reduce your chances of injury.

Overuse injuries are relative; running programs are not one size fits all.

Special Ops students also see these same types of injuries, but that's typically due to not having a strong foundation in running (30+ miles per week). Add load-bearing events (rucks, logs, boats, etc.) to a student's foot travel in combat boots, and you have a perfect storm for these types of injuries. 

It may take many miles over time for these advanced levels of fitness students to see the same injuries, but they will occur with even greater frequency for the underprepared Special Ops candidate.

Don't skip training for long runs. Many Special Ops candidates are guilty of not progressing into high-mileage running programs. Many even sign up for a marathon, untrained, just for the gut check and mental toughness factor received from the lack of progression.

How to prevent these types of Injuries:

1. Build a better foundation over a longer period of time.  Starting a running program a few weeks prior to boot camp is not enough time to build a running foundation.  You truly need many months of training, especially if you are new to running and joining a military service profession that requires many miles of running, rucking and other load-bearing activities. See sample Beginner Running Plan

2. If overweight, go non-impact first. The above running plan may not be your best option, especially if you have 25+ pounds of weight to lose before joining the military. You still should work out, but get your cardiovascular training in the form of challenging intervals on the bike, elliptical, rowing machines or swimming. Some non-impact options.

3. Logical progressions are required. It takes time to develop a logical progression. Typical standards are to increase your running by 10%-15% each week, with a beginning week of shorter but more frequent runs per week. One of my best running programs was co-created with sports medicine physician Michael Cassat, which takes a foundation of 15 miles a week and builds up to 35-40 miles per week over 26 weeks. 

4. Learn to stretch, ice trouble spots and foam-roll. If you train hard, overuse pains and injuries will happen.  Listening to your body and learning how to recover, rest, nurse hot spots and foam-roll will save your ability to run and train as "overuse pains" start to expose themselves. Simple icing, stretching and foam-rolling can keep you running longer and prolong or even prevent overuse injuries. Even if you're not in pain, after a long run or ruck, you should stretch for 10-15 minutes at least and ice for 10 minutes on and 10 minutes off for up to an hour, if feasible. Ice typical injury spots such as shins, knees and feet.

Overuse injuries slowly creep up after continuous repetitive motion over time. People who do not train and start off way too hard with weightlifting, calisthenics or running will see severe post-exercise soreness and joint pain.  The overuse injury category is relative. A workout that may not challenge someone could cause severe pain and injury to a deconditioned student. 

So, be smart and remember:

If you have not done an exercise ever or in a very long time, take it easy. Treat yourself like a beginner and enjoy the following 2-3 days of your new training program, versus being so sore that you cannot move.

Stew Smith is a former Navy SEAL and fitness author certified as a Strength and Conditioning Specialist (CSCS) with the National Strength and Conditioning Association. Visit his Fitness eBook store if you're looking to start a workout program to create a healthy lifestyle. Send your fitness questions to stew@stewsmith.com.

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