The recent news that a six-year-old boy has completed a marathon in the US has sparked debate around what amount of running is safe for growing children. Here, soft-tissue therapist Anna Gardiner looks at the risks and provides advice for parents

I love that my girls (Layla, 11, and Jasmine, nine) run. It’s rewarding, involves minimal organisation and is something we can do together. It was also something that was a constant during the Covid lockdowns, left over from the ‘time before’.
Out went their clubs, walking to school two miles a day, school playtimes and tearing around the park with friends. Often during lockdown, the only time the girls exercised was the 2km a day they committed to.

But having seen children in my clinic suffering from overuse injuries, I worried whether increasing their running might be setting them up for injury.

What are the benefits of running for children?

Of course, before we worry about any potential harm that could come to young people from running, it’s important to consider the huge amount of good it can do them. The physical benefits of running and exercise for children are numerous and can last a lifetime. Recent studies suggest that, as well as improving cardiovascular health and warding off diseases like type 2 diabetes and conditions associated with excessive weight gain, weight-bearing exercise in early puberty is beneficial for long-term bone health.

Research has also shown that aerobic exercise can enhance brain plasticity (the brain’s ability to adapt and modify itself according to experiences and environment) and brain resilience (meaning the brain can better adapt to acute stress or trauma). Our hand-eye coordination, reaction speeds and the development of muscle fibres are established during childhood
The greater variety of physical activity carried out by children, research shows, the easier they find tasks and sports as adults.

Studies also support the link between exercise and positive mental health in children, with experts suggesting that running and exercise can help kids have a more positive outlook on life and help build their confidence.
My daughters have also learned that consistent training results in personal bests – the important life less on that hard work pays off.

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Exercise can even help manage anxiety and uncertainty in a changing world. A study published in the journal Pediatrics found that increased physical activity could prevent and treat childhood depression and manage other conditions.

What risks does running pose for children and young adults?

Still, when my daughter reminded me that finally she would be able to ‘race’ parkrun by herself when it reopened in the summer, it made me consider how we could incorporate that into her life, with athletics and running clubs already accounting for three sessions a week. I often see children and adolescents in my clinic with what are essentially overuse injuries.
Watching children and teenagers speeding around the 5K of our local parkrun, I wonder how often they’re running that sort of distance and pace. This is something to be mindful of at their ages.
As much as we want to get them active – particularly as Sport England found that, at the height of lockdown back in May 2020, 31% of the children interviewed were doing less than 30 minutes of activity a day – it’s important to remember that their bodies are still growing.
How do we gauge the balance between encouraging them to exercise to gain the physical and mental benefits running brings without overloading their growing bodies?

Overtraining burnout is a distinct possibility for children

Skeletal maturation happens over many years and is achieved when the growth plates have fused and adult bone shape and density have been attained,’ explains physiotherapist Claire Callaghan.
So repetitive stress on the growth plates when they’re soft and still growing could cause pain and swelling, bone ‘bumps’ or, worse, stress fractures.‘Teenagers are also undergoing hormonal changes and rapid growth, as well as changes in body shape and weight,’ says Callaghan.

These changes can affect the ability of the muscles and tendons to handle the load that impact activities place upon them, particularly where the tendons insert into the bone. Their bodies are already trying to adapt to normal growth changes, so they’re more vulnerable to further stresses.
As a result, adolescents, particularly active children, are prone to medial tibial stress syndrome shinsplintsPain in the anterior knee or heel (either unilateral or bilateral) is also often brought about by excessive running, jumping or quick changes in direction.

Then there are musculoskeletal issues such as Osgood-Schlatter and Sever’s disease. The most common and adolescent-specific, Osgood-Schlatter (sometimes called osteochondrosis), occurs at the patellar tendon insertion site at the tibial tuberosity – essentially at the top of the shin and below the kneecap. This is where your young runner’s quadriceps attach via the tendon to the growth plate at the top of the shin bone. Repeated traction and force caused by frequent high impact in this area can create microvascular tears and inflammation, which presents as pain, swelling and/or a bone prominence.

We don’t want to break our young athletes, but rather inspire them to love the sport

A review of Osgood-Schlatter data, published last year in the journal Current Opinion In Pediatrics, suggested that predisposing factors include the age of the child (12 to 15 for boys and eight to 12 for girls), sudden skeletal growth and poor flexibility of hamstrings and quadriceps.
Pain is usually a dull ache at the top of the knee during running, jumping, kneeling or squatting, which subsides between minutes and hours after the activity stops.

Former Olympic long-distance runner turned running coach Liz Yelling, who was coached from an early age, had mild Osgood-Schlatter. She remembers how her coach used to ask his athletes to measure their height weekly to ensure training was modified during a growth spurt.
Treatments can range from rest (or at least modifying the inciting movement) or strength work, to ice or non-steroidal anti-inflammatory drugs. These should all be taken under the guidance of a professional. As Callaghan says, ‘If problems aren’t correctly diagnosed and treated, or if an adolescent pushes through pain, long-term issues can occur.’

Sever’s disease is also predominantly a young athlete’s condition (most common between the ages of nine and 12). It’s an inflammation caused by force and traction of the tendon at its insertion point at the calcaneus, or heel.
Contributory factors are an increase in, or excessive, running and jumping, weak ankle dorsiflexion, ill-fitting shoes and running on hard surfaces – all at a time when a child is having growth spurts of both skeletal and soft-tissue structure.
Treatment is similar – rest, ice and modification to training routines. But again, specialised guidance is strongly advised as it can be a recurring condition if left untreated.
‘It’s more important to look at load management and improving strength and conditioning if required,’ says sports podiatrist Matt Hart.
‘It’s not about footwear, but reducing load.’ Thats said, ‘shoes do need to fit well’, adds Callaghan, ‘as poor support can place too much force on growing bones’.

How to mitigate the risks

With children and adolescents more susceptible to these types of conditions, training smarter and making preventative, rather than reactive, changes are key. With all the benefits of running in youth and later life, we don’t want to discourage young runners. Fortunately, there are many things we can do to mitigate the risks.

1.Listen to your child and any complaints they may have of pain

It’s easy to brush off a child’s or adolescent’s complaints of discomfort or pain – if you’re a parent or carer who runs, you know first-hand about daily niggles. But it’s important to be alert to complaints, particularly if the discomfort is in the same place, either during an activity or after.
Keeping a pain diary – not to encourage histrionics, but to be alert to patterns – can be useful. Then, if a professional’s help is sought, you’re armed with useful information for them to be able to quickly diagnose and treat the issue.

If a child constantly appears to have niggles, then they may be trying to tell you that they need a break. Running through pain isn’t good for adults or children and we don’t want to establish bad running habits.
Yelling offers this advice: ‘We don’t want to break our young athletes, but rather inspire them to love the sport and continue to be happy, active adults.

2. Get help from an expert

If your child is becoming enthused by running and wants to run more frequently or competitively, then it’s ideal to have input from experts who can help nurture their running.

Sometimes, we’re not our offspring’s best role models. That can be a difficult pill to swallow, but they’re not mini adults and – although, aerobically, they’re capable of running further and longer – physically, they can’t do this to an extreme level without it being potentially detrimental to their musculoskeletal health over time.
With the popularity of ultrarunning, virtual challenges and a trend edging towards the challenge of running further not faster, training with a club or a coach can remind us that our kids are just starting out and have many years of running in them.

Coaches at running or athletic youth clubs have had specific training on fostering healthy running practices. They can incorporate running games into sessions, helping to develop agility, speed and strength, rather than just linear movement. They’re also able to enhance the social aspect of an essentially individual sport and demonstrate how running with people can provide great motivation and encourage healthy competition.

3. Keep a diary of your child's training and sporting activities

Overtraining burnout is a distinct possibility for children. Keeping a note of runs (and, indeed, other sports on a family calendar) for both yourself and your young runner is a great way of visualising the frequency and quality of training.
Sometimes, it takes all their activities being written down to take a step back and consider whether they’re taking on too much.

In my clinic, I’ve seen young athletes whose parents only start to realise the degree to which they’re pushing their bodies when I ask them to go through a couple of weeks’ worth of activities. If the calendar flags that they’re overdoing things, we can then take steps to modify the training or look at active rest, recovery or a period of cross training.

Overtraining was particularly noticeable when children went back to schools and clubs after the lockdowns, and people threw themselves back into ‘normal’ life.

It was often overlooked that children were six months older, potentially in different stages of bone and muscle growth from where life was left off, and that going from minimal to maxed-out training doesn’t allow the body to adapt properly at any age, especially when still growing.

‘Children and teens aren’t “small adults” and can’t be treated as such,’ says Callaghan.

‘They need to gradually increase training so they don’t put too much pressure on growing joints and muscles.’

If a child constantly has niggles, then they may be trying to tell you that they need a break

4. Mix up their training

Mixing up their training miles to include a wide variety of surfaces is another sound strategy. Ideally, children would do most of their training on grass or at a track, because softer ground can reduce ground-reaction force.

Playing other sports or doing other activities is also really important at this age. My eldest prefers running above any other sport, but trains at an athletics club where she also does jumping and throwing events.

As is the case for adults, cross-training challenges children’s bodies in different ways, adding cardiovascular and musculoskeletal strength. Adapting soft tissue with different challenges also reduces the repetitive loads placed on the same joints, muscles and ligaments

5. Consider a personalised training plan

There are recommended running mileage suggestions for different childhood ages, but each child is an individual, and generalised recommendations don’t factor in the different speeds at which their bodies mature.

Plus, the two sexes have different biological maturation ages and are different in terms of hormones and musculoskeletal structures. So it’s key to look at the individual young runner, rather than set limits or targets based on generic advice.

‘As coaches, the athlete as a person should always come first,’ says Yelling. ‘We should focus on assisting optimal developmental processes, rather than focusing on results.’

6. Ensure your child is getting a healthy, balanced diet

It’s not all about training, though – diet and duvet time have roles to play. Ensuring children and adolescents eat a healthy, balanced diet – with a variety of food groups, plenty of fruit and veg, good protein sources and whole grains – is easier said than done

but it’s essential that, with growing bodies, they adequately fuel their runs and recovery. If too much is asked of soft tissue and bones without the essential ingredients for repair, sourced from food, bodies become fatigued and vulnerable to injuries.

7. ...and plenty of sleep

The importance of sleep in promoting recovery and repair from training is well documented. A recent study published in the British Journal Of Sports Medicine found that teenagers need eight to 10 hours of quality shut-eye per night.

Fitting in school work, after-school clubs, a social life and their running means kids often go to bed later than is ideal, so it’s important to notice when your child seems constantly fatigued and encourage them to take a session off and get an early night.

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How else can we encourage healthy habits in our children?

Tips and strategies to help ensure our kids are all right...

• Make it fun. Tag, shuttle runs, relay races – they all develop fast- twitch fibres, encourage agility and build social relationships
• Add strength/conditioning. Introduce circuits as part of drills and warm-ups. Just body weight with a little bit of everything.
• . Try geocaching. A great way to go a little further on mixed terrain with plenty of natural walk/recovery breaks.
• Run to feel. Encourage them not to push for times or pace in every session, but to listen to their bodies.
• Check clothes and shoes fit well. Keep an eye on growth spurts and ease off on training a little if you notice one is underway.
• Minimise pressure Remember, we want them to have a healthy lifelong love for running and exercise.

Red flags

Look for these warning signs that your young runner maybe overdoing it and in danger of burnout or injury:

• Complaining of pain at the anterior knees, shins and heels
• Inflammation or swelling
• Moving stiffly or awkwardly in everyday life or when exercising
• Feeling consistently tired
• Feeling consistently tired
• Pushing hard in every training session
• Reluctance to train
• Consistently disappointed with performance in sessions or races

Cr: www.runnersworld.com

The debate over running on a treadmill vs. outside is not a new one. Running outdoors can improve stability by forcing you to navigate ever-changing terrain. But a treadmill forces you to sustain speed and performance levels that might otherwise lag outdoors. Ultimately, there is no right or wrong answer to the debate over treadmill vs. outside running. Both methods have their pros and cons based on your individual training needs and goals and both can have their place in your running routine.

Is Running on a Treadmill Easier?

Athletes can get the same workout whether running on a treadmill or outside as long as they maintain the same level of effort. But "effort" can be a subjective measure.

Clinically speaking, effort is based not only on your heart rate but on a phenomenon known as perceived exertion. Perceived exertion refers specifically to how "hard" you consider an activity to be, irrespective of how your body responds to that activity.

Perceived exertion matters because we tend to give up sooner if something is perceived to be difficult. This psychological component can influence how much we get out of one exercise compared to the next.

However, if assessing the real, rather than perceived, benefits of running, outdoor running will usually come out on top. Even if you run at the same pace on a treadmill, you will generally expend more energy running outdoors. This difference in calorie burn is not only due to variations in terrain, weather, and wind conditions but also because the treadmill ultimately does a lot of the work for you by propelling you forward.

Treadmill Pros and Cons

Pros

Treadmills are one of the most popular pieces of cardiovascular equipment both at home and in gyms, thanks to the many advantages they offer.

No weather or temperature constraints

Running in inclement weather is uncomfortable, even if you dress for it. In hot weather, there is a risk of dehydration or heat exhaustion. And it's risky to run on snow and ice. Inside on a treadmill, you avoid these discomforts and risks.

If you're running at home or at the gym, you're in a climate-controlled environment and safe from any inclement weather. You also don't have to worry about sunscreen, or about over- or under-dressing and being caught far from home without the right gear.

You Can Simulate (Some) Race Conditions

If you're training for a hilly marathon, you can run hills on the treadmill even if you don't have access to a training route with hills. Study the course and plan your treadmill hills for the appropriate points.

You can even use treadmill runs to try out race day clothing and make sure your gear will work for you.

You Can Control Your Pace

Outside, it can be difficult to maintain a consistent pace. For this reason, treadmill training can be a good solution if you are coming back from an injury. The treadmill makes it easy to track your mileage and pace.

You can also stop anytime you want. But you can also use the treadmill pace to push yourself.

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It's Convenient

Home treadmills let you run on your own time, even in bad weather, late at night, or when you need to keep an eye on your children.

You Can Multi-Task

On a treadmill, it's safe to use headphones to listen to music or podcasts. You can watch TV or even page through a magazine or book.

It's Easier on the Joints

Treadmills offer better shock absorption than pavement or roads, which means less stress on the ankles and knees. And when you run at an incline on the treadmill, you build strength and endurance like you would running hills outside. But you don't have to run downhill, which can be hard on your body.

You Can Run Alone and at Any Hour

Running indoors on a treadmill means you avoid the hazards of running outside. It's also safer than running outside by yourself, without a running partner or group.

Cons

While there are many benefits to choosing indoor treadmill workouts, it's important to know some of the dangers and drawbacks of treadmill running.

You Can Still Get Hurt

While treadmills are considered the safer option by most users, the CPSC reports that there are more than 24,000 treadmill-related injuries in the U.S. each year. These include sprains, falls, head injuries,2 and cardiovascular events in people who either ran too fast or pushed too hard. (But the figures for outdoor runners are much higher.)

You Can't Go Downhill

Most treadmills don't have a downward incline feature which you need to strengthen the anterior tibialis muscles at the front of your legs. If you're training for a race with lots of elevation changes, you'll want to train for downhill portions of the course as well.

You Can't Make Turns

Similarly, there are no turns on a treadmill, limiting your ability to improve your lateral agility.

Can be boring

Even with music or TV to keep you company, treadmill running for a long period of time can be tedious. While treadmills may be great for short interval runs or speed training, they can be very monotonous for hours-long running sessions.

Outside Running Pros and Cons

Pros

From being outdoors with nature to people watching, there are many notable benefits of taking your run outside.

Inexpensive

Running outside is free and you aren't constricted by a gym's schedule or the availability of machines. You don't need to purchase a gym membership or a treadmill to enjoy running outdoors.

You Can Continue Training Even When Traveling

Hotels can often suggest nearby routes. Running is a great way to check out a new place. As long as you take safety precautions and use a pre-planned route, running can be a great way to explore a new destination.

It Provides Sport-Specific Training for Road Races

By running outdoors, your muscles and joints will be more conditioned to the varied terrain you'll encounter in a race. Depending on your race, train on a track, road, or trail, and you can closely mimic your final race conditions. You'll be better able to adapt to changes in weather and know when to exert extra effort when faced with elevations or known obstacles.

It Allows You to Enjoy Nature and Breathe Fresh Air

Some research has even shown that exercise is more enjoyable when it's done outside.3 And you can explore a new place more quickly and easily while running. You cover more distance, so you see more sights.

It Can Be Motivating

Running outside—whether you're planning a route to the end of the block or beyond—can be encouraging. It's also fun to complete a distance goal outside. Even if you're not motivated, if you're doing an out-and-back route, you still have to complete your route to get home.

Burns more calories

Thanks to wind resistance outside, you have to work a little harder to keep up your pace, which means a greater calorie burn.

Cons

There Is a Risk of Injury

According to research from the University of Applied Sciences in the Netherlands, knee injuries are by far the most common, followed by lower leg, foot, and ankle injuries, respectively.4 Throughout the course of an outdoor running route, you can experience different and uneven terrain, potentially increasing your risk for injury.

You're Dependent on Weather Conditions

Whether you're running in winter or summer, inclement weather can happen at any time, leaving you running outdoors in sudden rain or snow.

Additionally, running outside means you're watching the heat and humidity index to avoid potential heat exhaustion in the hot summer months.

Can be dangerous

In addition to overuse injuries, there are other hazards outside, including falls, darkness, cars, cyclists, dogs, and other people.

Making the Choice

If your sole intention is to meet and maintain your cardiovascular fitness goals, a treadmill may provide all you need. By pairing the exercise with an accurate pulse monitor, you can push yourself appropriately while keeping well within your maximum heart rate (MHR).

On the other hand, when training for a race event, you will clearly benefit more from running outside. While you can incorporate treadmill running to improve your cardio health, experts generally recommend limiting it to no more than 40% of your overall training.

No matter your fitness goals, remember that where you choose to run is a personal preference. If you prefer indoor running versus outdoor running, you're more likely to commit to the routine, and vice versa.

The choice between treadmill running or running outside doesn't have to be an either-or decision. When you lace up and get moving, choose the best route for you. A combination of both may work for you, and if it's practical and fits your schedule, you'll reap the benefits of each.

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Frequently Asked Questions

Is a treadmill or an elliptical closer to running outside?

Both the treadmill and the elliptical are great cardio machines if you're looking to work on your endurance. However, to most closely mimic the style and impacts of outdoor running, head toward the treadmill rather than the elliptical.

The elliptical can be a helpful cross-training tool, but a treadmill can best prepare you for outdoor runs or races.

How can a beginner start running outside?

Running can be an effective way to burn calories and to add movement to your routine. The many great benefits of the sport—especially if you're doing it outdoors—are that it requires few pieces of gear and can be done virtually anywhere.

To begin running, begin with an easy run/walk method that incorporates intervals of walking between short running intervals. With time, you'll begin to increase the running intervals and decrease the in-between walks. Follow a beginner's guide to running for even more helpful tips for new runners.

What treadmill incline is equivalent to running outside?

Because the treadmill belt propels your stride forward (unlike running on the road or track), many experts and treadmill runners adjust the treadmill include to 1% to account for the belt's motion.

Cr: verywellfit.com

As spring rolls in, many runners are grateful to be able to run outside without suiting up for freezing temperatures. But warm, sunny weather can also bring along another trademark of summer—air pollution.

In large cities and other areas with power plants, industrial centers, or just lots of cars, increased levels of pollutants in the air can become a real health hazard. When the air pollution gets bad, you’ll still probably want to get your run in. The question then becomes whether to put up with the drudgery of the treadmill or go outside and run in the polluted air.

This article will take a look at the effects of air pollution on athletic performance, with an eye both for training and racing in poor air quality.

Air Pollution And Running – The Studies

The first major studies on air pollution and endurance were undertaken in the ’60s, ’70s, and ’80s, after it was decided that the 1984 Olympics would be held in smoggy Los Angeles. Another big round of research followed in the early 2000s leading up to the Beijing Olympics.

Fortunately, these studies looked at all of the questions we’d be interested in: Does air pollution affect performance? Does it affect health? And are there any ways to mitigate its effects?

What studies say

In a fairly detailed review article published in the months before the 1984 Games, Roy Shephard at Toronto Western Hospital described the effects on the body of polluted air. These were broken down by whether the chemical pollutants were oxidants or reductants.

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Oxidants

• Oxidating smog, according to Shephard, includes carbon monoxide, unburned hydrocarbons, ozone, and oxides of nitrogen.
• While oxidating smog comes mostly from car exhaust, reductive (in the chemical sense) smog is the result of coal power plants and other industrial burners discharging sulfur oxides into the atmosphere.
• Among the pollutants in oxidant smog, carbon monoxide has a predictable, detrimental effect on your blood’s ability to transport oxygen using your red blood cells. The carbon monoxide diffuses into your blood through your lungs, occupying the oxygen bonding sites on red blood cells, and is very slow to be removed from your body. As the amount of carbon monoxide in your blood increases, your performance drops linearly, since there is steadily less blood available to carry oxygen. مونوکسید کربن از طریق ریه‌ها درون خون شما پخش می‌شود و نقاط پیوند اکسیژن روی گلبول‌های قرمز را اشغال می‌کند و بسیار کند از بدن خارج می‌شود. با افزایش مقدار مونوکسید کربن در خون، عملکرد شما به صورت خطی کاهش می‌یابد، زیرا خون کمتری برای حمل اکسیژن وجود دارد.
• In areas with heavy smog, like Los Angeles or Beijing, up to five percent of all of your red blood cells can be overwhelmed by carbon monoxide, and at these levels, even muscular coordination and perception of time can be impeded.
• The other oxidant chemicals, like ozone and hydrocarbons, irritate your throat, nose, and airways. When you exercise in polluted air, ozone in particular causes chest tightness and coughing. Shephard cites a study which demonstrated an 11% decrease in oxygen intake after two hours of exposure to levels of ozone similar to those in polluted areas.

Reductants

• The chemicals in reductant smog have a tendency to irritate your lungs, because the sulfur oxides combine with water in the air or in your lungs to create acidity, which causes airway restriction along with the particulate matter also present in polluted air. This problem is especially severe in athletes who already have asthma.
• Shephard also notes that the damage to the lungs and airways that results from air pollution exposure can also increase your risk for upper respiratory infections like the common cold. The reasons behind this—damage to the delicate tissue at the surface of the lungs and airways—appears to be the same reason deaths from chronic respiratory diseases increase when pollution is bad.

How does this impact your performance?

Other studies have also linked sulfur oxides, ozone, and carbon monoxide to decreased athletic performance. Exposure to pollutants generally leads to a predictable, linear drop in your ability to take in oxygen.

A study by Wayne Walborg and colleagues, for example, found that higher levels of oxidants in the air were correlated with slower cross country race times among high school boys in the Los Angeles area.

More work has also revealed that exercise exacerbates their effects, since the deep, heavy breathing you use while running both increases the total volume of air moving in and out of your lungs and also allows pollutants to bypass your nose, where the mucous tissues can trap some of the chemicals before they get to your lungs.

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Final Thoughts And Recommendations

Unfortunately, when it comes to mitigating the effects of air pollution, there is not a whole lot that can be done. Shephard recommends the following:

• Taking vitamin E and vitamin C supplements to mitigate the oxidizing effect of some of the chemicals in smog, but admits there is scant evidence for their usefulness.
• Aside from that, the best you can do is avoid the times of day with the worst air quality—rush hour in the morning and evening, for most American cities—and limit your time outside on days with particularly bad smog.
• Especially if you have asthma, it might make sense to move a longer or faster workout to a day without as much air pollution, or do it inside on a treadmill.

• You can check the air quality index and the forecast at airnow.gov, which comes with some useful maps and guidelines for air pollution levels.
• If you do decide to go ahead with a workout or race when air quality is poor, be aware that your oxygen intake will be impaired, so your times will likely be slower than on a day or in a city with clean air.

Cr: runnersconnect.net