“I have no business doing a running commercial. Fifteen months ago, I was dead.”

Sometime in January of 2023, actor Jeremey Renner, a.k.a. Hawkeye in the Avengers series, figured in a snow plowing accident.

He was helping his nephew out of the snow at his Lake Tahoe home when the Sno Cat ran him over. Eight of his ribs were broken in 14 places while his right knee, ankle, clavicle, and shoulder were crushed.

Doctors who attended to him say he probably would never walk again, much less run.

Last week, a running shoe company released a commercial of the actor running in their shoes. The actor had obviously defied his doctor’s predictions and the odds.

This commercial hit home because, for runners, injury is a perennial risk, especially as training intensity increases. Unfortunately, runners are also notorious for ignoring niggles and end up being sidelined by injury.

Which is perhaps why when I started running, some well-meaning friends warned that I would hurt myself and, specifically, ruin my knees (a myth).

When, after months of running, I began feeling knee pain, I received even more discouraging remarks. One orthopedic doctor I consulted questioned my decision to get into running and insinuated that I was too old to get into endurance sports.

I did not change my hobby, of course. I changed my doctor.

Why do we get injured? Unless the injury was caused by a single event (“acute”), it is most likely “chronic,” i.e., caused by the repeated use of certain muscles and joints.

The mainstream sports medicine follows a structuralist paradigm of injury.

Running is a high impact activity. It’s a series of repetitive and jarring movements. Each heel strike is said to produce a force that is equal to three to four times of one’s bodyweight. For a 150-pound runner, this means that each heel strike will generate approximately 600 pounds of pressure.

This massive force doesn’t just impact the foot. The impact travels up the shin, through the knee, up through the thigh and hip, and into the pelvis and trunk.

To ensure that the body is able to attenuate these forces, according to the structuralist paradigm, there should be proper mobility at the lower extremity joints, and adequate strength, endurance, and balance of muscles that control the leg, pelvis, and trunk.

As long as the muscles and joints are working properly the chance of injury is greatly reduced.

In my case, I am slightly knock-kneed and tend to overpronate, especially on my left side. This has resulted in what is called patellar maltracking.

The solution is not to give up running though. I underwent rehab and incorporated strength training in my routine.

It appears that I am muscularly weak throughout the so-called kinetic chain. My other muscles, such as glutes, external rotators, etc. are unable to adequately support my movement as I run so these had to be strengthened.

Happy to note that after working on the imbalance, my left knee has, over the past year or so, been very behaved.

Nonetheless, there are those who, despite great effort of doing prehab and strength and mobility exercises, still get injured. Could it be genetic?

I unearthed a 2015 article of The Atlantic about studies showing that being injury prone may be genetic. The studies focused on variations in the genes that control the production of collagen, the main component of tendons and ligaments.

One study published in the British Journal of Sports Medicine in 2009, found that specific variations of a collagen gene named COL1A1 were under-represented in recreational athletes who had suffered ACL, Achilles tendon and shoulder dislocation injuries.

Another gene called the COL5A1 gene, on the other hand, was implicated in perennial muscle cramping.

Aside from these, there are also genetic markers associated with bone-mineral density or bone strength that may influence a patient’s risk of fracture.

This is still an evolving science.

But as with most conditions, the cause of any injury is likely a combination of factors. Even if you may have won the genetic lottery, consistent overtraining, lack of sleep, improper fueling, or even stress can still impact your susceptibility to injury.

Does this mean, it is better not to run or exercise than to risk pain and injury?

As one of the health gurus I follow on social media has said, one of the most damaging messages that physicians have given is that when a patient has pain, they tell them to stop doing any activity.

He opines that as we go through life, we will have pain.

“You can be strong and have pain or be weak and have pain,” he said.

I say: Be strong. It makes it easier to address the pain.