Running Prehab

Good Morning and happy Sunday! Congratulations to Jake Floriea for winning the giveaway!

Here is what I will cover today:

Runner Injuries

One of the worst feelings while training for a race is the onset of pain while running. There are three specific injuries that can occur during your running journey that I want to talk about: IT Band Syndrome (knee), Patellar Tendonitis (knee), and Hip Flexor Strain.

IT Band Syndrome

The Iliotibial Band (IT Band) is a long piece of fibrous tissue made of thick collagen that runs down the outside portion of your leg from your hip to your knee as pictured above. This piece of our anatomy is strong and able to absorb shock.

The importance of this band is that it helps your leg with stabilization in activities such as running or cutting to change direction due to its lack of elasticity like most muscles.

IT Band Syndrome is one of the most common injuries in runners that have pain on the lateral outside portion of their knee. In fact, this often occurs in new runners/ walkers. Unfortunately, this is considered an overuse injury and your body isn’t used to this new activity, which can cause some irritation. But luckily there are things we can do to fix this issue once we know what it is. IT band syndrome can present with these symptoms:

• burning on the outside of the knee

• feeling unstable in the knee

• pain that increases with walking or running, then decreasing with stopping the activity

• sharp pain on the outside of the knee, particularly when your heel hits the ground

• snapping or clicking at the knee

A misconception is that we can stretch this band with foam rolling and stretching to elongate it and relieve pain. But as stated above, the IT band is a thick piece of collagen, it doesn’t have much ability to elongate. What foam rolling actually does is reduce your perception of the pain. Similar to bumping your arm and rubbing it or the phrase “rub some dirt on it”.

Now, as far as reducing your symptoms without having to say the worse phrase a runner hears, “You need to stop running” try this:

1. First, try foam rolling, not to stretch but to give your brain some soothing input to reduce the perception of pain.

2. Next, switch your runs to treadmill runs, this is less impactful on your joints than concrete or asphalt. As well as reduce your mileage, speed, reducing hills, or increasing your cadence. Start with reducing the mileage and speed, then reduce hills, and lastly work towards increasing your cadence.

3. Now if your pain is starting to subside, Good! We can move into the next phase which is strengthening the muscles in the leg. But, if the pain is not subsiding down to at least a 3/10, I would have to advise you to stop running for a week or two depending on how significant your pain is.

4. For strengthening, you will need to focus on the quadriceps, hamstrings, glutes, and the abductor (very important) muscles. Heres an exercise for each!

   1. Quads - Reverse Nordic

   2. Hamstrings - Nordic

   3. Glutes - Single Leg RDL

   4. Abductors - Banded Clam Shell

If you would feel more comfortable with getting a training program for your next race, you can apply here for a consult!

Patellar Tendonitis

Patellar tendonitis, also known as Runners knee, is a common injury that can lead to pain in front of the knee . As you can see in the picture above, the patellar tendon is right below the knee cap and connects to the tibia (shin bone). This is exactly where the pain exist.

With Patellar Tendonitis in runners, this tendon usually gets irritated from the either new activity or the overload of an activity. The pain increases with increase of load on the knee extensors. Which means, when using your quadricep muscles to straighten your leg, the pain flares up.

This is one of the most frustrating injuries to deal with. And unfortunately, runners, the best plan of action here is to reduce your mileage immediately. Your tendon is a little upset with you and wants a break from running. Your next best step is to pick up some weights and do some loading of the muscle and tendon to make it stronger.

In fact, if you just completely rest, this could cause more pain once you start back up again. Also, I’m sure your mind won’t let you just sit and do nothing, especially if your in the middle of training for a race.

Most likely, you will still experience a little bit of pain with weight lifting (less than 4/10) and it should not increase as you go through this progression but that is normal. These are the steps I would recommend in your strengthening program:

1. Isometric Exercises – This would be an exercise like a wall squat where your leg is not bending or straightening but you are still loading the muscles. Another would be sitting at the edge of a table with your legs hanging off and someone applying resistance at your shin pushing your leg back. You would resist this movement.

2. Isotonic Exercises – Eventually moving into your regular exercises like squatting, lunging etc. Slowly progress the weight for these exercises because this can be a big jump from isometric exercise.

3. Eccentric Exercise – this is your money maker to help strengthen the tendon as well as prevent further injury to the tendon. Eccentric exercises are the slow loading point before the contraction. For example, lowering slowly for 3 seconds on your squat (eccentric phase), then coming up (concentric phase). Another exercise is slowly and controlled lowering on a step down.

4. Throughout this strength progression I would also recommend doing abductor strengthening to help take so much pressure off your knee. Think of it like this, your muscles in your body work as a team when running, and often times, your knee picks up the slack from your abductor muscles not putting in work. So strengthening this group of muscles can help reduce the load your knee takes when running

5. Jump roping as long as it causes no pain. The reason I like jump roping is to give your ankles the amount of foot taps you need throughout your training since your not running at the moment. This well help still prepare your ankles and calves for the upcoming race.

Hip Flexor Strain

Next, and moving up the ladder is a hip flexor strain. Your hip flexor consist of three muscles, Iliopsoas, Psoas Major, and Psoas Minor. These muscles do exactly what they say, flex the hip by bringing the leg up closer to the body.

Sometimes these muscles can get over stretched or due to repetitive flexion with a new activity (running) can flare up. This type of injury will cause some tenderness to the touch, pain with flexing the hip with resistance or in some cases without resistance, and with stretching the hip flexors.

To treat this, we can use the acronym POLICE.

• Protect

• Optimal Loading

• Ice

• Elevation

RICE (Rest Ice Compression Elevation) has actually not been recommended anymore for about 20 years.

POLICE is a way of active treatment by protecting the strain with reducing the amount of activity, properly loading with exercises to strengthen the muscle and tendon, icing to reduce the pain, and if swelling and inflammation is present, elevating the leg. Additionally, if you are in training, you can try running on an elliptical. This machine shortens your stride so you may experience no pain with it compared to just running outside or on a treadmill. If you have no pain on the elliptical, it is good to continue.

We’ve learned that the right amount of activity can improve injuries like these to recover faster and recover better than just resting.

Prevention

If you are new to running, or taking on a large amount of mileage, you can take a step in prehab to prevent these injuries from even occurring.

First, make sure to properly increase mileage. The rule of Thumb is to increase no more than 10% each week. Only increase one thing when it comes to intensity (speed or miles).

Strength train, especially your hip abductors. These are often weak in many people and can lead to multiple types of lower body injuries. Remember, your body works as a team and often times the abductors are slacking causing other parts of your body to pick up the slack (knee).

If you would like a 12 week training program for your next race, you can apply here for a consult!

If you have more questions about these injuries, or you are experiencing any of these, don’t hesitate to reach out to me!

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