By Musculoskeletal Physiotherapist |
The vast majority of injuries seen in runners can be attributed to increasing distance, pace, or training frequency more quickly than the body can handle.
The risk of sustaining an overuse injury can be significantly reduced with these proper management techniques.
The runners that I come across in clinic are all inherently hard workers and are among the most frustrated individuals when their training is set back by an overuse injury.
This can lead to a hasty return to competitive running or the temptation to “push through it”, both of which can have undesirable consequences. It is clearly best to avoid an injury in the first place, so ahead are some tips on how to keep yourself in the best condition possible.
Training Strategies Before An Event
Injury rates are highest in the run-up to any major event, where it may be tempting to ramp up the training intensity and frequency in order to feel best prepared for an event. There are a couple of reasons why this can lead to an overuse injury.
Some runners leave it too late to prepare for a long distance run, and find themselves rushing through a training programme 6-weeks prior to the event.
When the demands placed on the body are rapidly increased, certain tissues find it hard to adapt to accommodate these changes. This is especially apparent in tendons (Langberg et al., 2001) and these changes can lead to a tendinopathy if not managed correctly. Tendinopathies occur when demands placed on a tendon outweigh the recovery that is allowed to take place, and lead to micro-tears in the structure and inflammation (Rees et al., 2012).
✓ An influx of inflammatory mediators to the affected area leads to a nagging pain around the tendon that may be severe enough to completely halt training altogether. For this reason, I would always recommend runners start planning their training programme around 4 months pre-event.
Runners may choose to increase their running speed, running distance and training frequency simultaneously. Whilst manipulating one of these variables is enough to bring about improvements in performance, changing all three at the same time may put an athlete at risk of an overuse injury as the body simply hasn’t enough time to cope with the increased demand placed upon it.
✓ As a general rule, it is widely accepted that increasing just one of these variables by roughly 10% is enough to improve performance while minimising the risk of developing an overuse injury.
A common precursor to certain running injuries lies in imbalances in strength not just in the lower limbs but also in the trunk. A very common area for weakness in many runners is the hips – specifically gluteus medius and minimus.
These muscles sit in the upper lateral hip and are primarily responsible for abduction and medial rotation of the femur (upper leg.) Due to their primary action being keeping the knees apart during running gait, if there is a weakness in this particular muscle group the knees may have a tendency to bend inwards (called valgus).
This valgus force at the knee leads to increased pressure on the medial structures of the knee, and if an athlete runs for an extended period of time with this suboptimal force going through their knee joint, they may develop knee pain.
Strengthening Weak Areas
There are several ways to strengthen the abductors in isolation, but my preferred exercise prescription for this muscle group is to:
✓ Perform squats with a strong elastic style band/resistance band tied tightly around the knees.
This means that during the exercise the abductors are under constant tension to prevent the band from pulling the knees together. To increase the difficulty of this exercise, you can hold dumbbells for added resistance.
Especially in runners who also strength train, a strength imbalance can often be seen between the quadriceps and the hamstrings. This imbalance can pre-dispose a runner to an anterior cruciate ligament (ACL) injury, as the force of the quadriceps is so much greater than that of the hamstrings that the tibia is anteriorly displaced beyond the limits of the ligament.
Great ways to strengthen the hamstrings include:
✓ Straight-legged deadlifts and Nordic curls. As the hamstrings seem to be composed of predominantly fast-twitch (type 2) muscle fibres (Garrett et al., 1984), it is best to train the hamstrings with mostly high load and low rep exercises.
Another area of potential weakness that can lead to problems during demanding training regimens is the core. The core comprises mainly of the deep abdominal muscles that act as a dynamic corset in order to maintain control of the trunk. The upper and lower limbs have been shown to function better when they have a stable base to operate from (Kibler et al., 2006).
Increasing core strength in a cohort of 5000-m runners has also been shown to significantly improve running time (Sato & Mokha, 2009). The core should be trained both dynamically and statically in order to improve running (Fredericson & Moore, 2005).
Good options for increasing static core strength include:
✓ The plank and side plank, and these can be progressed by lifting arms and legs from the floor alternately.
✓ Twists using medicine balls or cables in a controlled motion can be used to strengthen the core dynamically.
The Best Running Shoes
I am often asked about different types of running shoes by clients looking to get back to running – whether there are one type that are superior to another, or whether it is worth spending extra money to get the insoles tailored to your foot.
Richards et al., (2009) reviewed various trials and systematic reviews that investigated the effects of running shoes on injury rate, performance and overall health. They found that no trial thus far has actually proven that one type of shoe is superior to another.
For that reason, until solid evidence emerges from the literature, I will continue to tell clients that the best shoe to wear whilst running is the one that is most comfortable!
Take Home Messages
✓ Plan well ahead of your event so you don’t rush through a training regime.
✓ Only manipulate one running variable (distance, intensity, frequency) at a time by 10% maximum.
✓ Train the muscles around your hips and pay special attention to your hamstrings also.
✓ Train the core statically and dynamically to significantly improve your running performance.
✓ Comfortable shoes seem to be better than expensive prescription shoes.
✓ Stay hydrated at all times during training and events!