Injury Prevention

In a perfect world, every step while running would be pain free. Unfortunately, the reality is that many runners are dealing with minor (or maybe not so minor) pain or discomfort - a tight hamstring, a twingy knee, a tender foot. Often these issues are not cause for a break from training, but they are annoying and can let us know that if we keep going the way we are we might sustain a more significant injury.

You can think of these running pains in terms of a spectrum. On one end of the spectrum there are the more serious injuries that require a break from running to recover - such as shin splints, a stress fracture, or a muscle strain. On the other end, when you’re in the best health, you might have mild aches that bother you one day and are gone the next. However, many runners get stuck in the middle - not quite injured, but not 100% healthy. The difference between moving from the middle zone to either the injured zone or to the healthy zone comes down to whether you take a little time off now or a lot of time off later. You can reduce your risk of injury if you back off at the first sign of an issue. Try decreasing your mileage, reducing the intensity of your runs, cross-training, starting a treatment program, and developing a long-term injury prevention strategy. This article will lay out what a long-term injury prevention strategy looks like, as well as what to do if you are feeling the beginnings of a common running injury coming on or are dealing with a significant injury.

Long Term Injury Prevention

Proper Warm-Up

Having an individualized warm up is an important part of preventing injuries. When you perform a warm up you are increasing your heart rate and the blood flow to your muscles, improving your mind to body connection with the muscles you will be using during your workout (which gives you more awareness of your body in space), and improving range of motion. All of these factors help to prevent you from sustaining an injury. Your warm up should consist of:

• A short jog
• Form work drills
• Stretching
• Build ups (aka strides)

Proper Equipment

Having the right fitting shoes that offer support for your feet and help improve your biomechanics is a must. I recommend working with a physical therapist who can perform a gait analysis to determine any functional or structural limitations that can be improved by prescribed exercises. Physical Therapists are also able to give you a prescription to take to a local running store that offers shoe fittings. The prescription will tell the person performing your fitting what kind of support your shoes should have. Often pain in your hips or knees can be caused by a muscle imbalance or lack of range of motion in your feet, which is why it is beneficial to see a Physical Therapist who can assess this and recommend exercises for you to do.

Cross-Training

Substituting a running workout for a cross training session (biking, water jogging, etc..) is a great way to reduce muscle and joint stress and help prevent injuries. Cross training is especially useful when the weather is not ideal for running outside, or at the first sign of discomfort or pain.

Strength Training

Strength training using weights or your body weight is very beneficial for your overall fitness as well as preventing injuries. Strength training increases muscle, bone, ligament, and tendon strength. The more force your muscles, bones, ligaments, and tendons can sustain the less likely you are to become injured. It is recommended to work with a personal trainer or physical therapist to learn proper form for strength training exercises so that you do not injure yourself while strength training.

Proper Nutrition and Hydration

Making sure you are eating a healthy diet and getting enough water is vital to injury prevention. Your body needs nutrients to make it stronger, improve your immune system, and help you perform better overall. Check out our recent articles about hydration and fueling if you want to learn more! It is highly recommended that you work with a certified nutrition professional who can help you create an optimal diet to help you reach your running goals, as well as to improve your overall health and fitness.

Preventative Medical Care Team

• Creating a network of medical professionals in your area to have as resources for injuries that come up is invaluable.
• Working with a Physical Therapist to identify any muscle imbalances, functional and/or structural limitations, decreased range of motion, mobility and/or stability in your muscles and joints and to correct those deficiencies will help you to prevent injuries, as well as improve your overall fitness level, and as a result, improve your running performance.
• Working with a Registered Dietitian or Certified Sports Nutritionist is a great way to ensure you are eating a balanced, anti-inflammatory diet, and address any medical conditions you might have.
• A Massage Therapist is able to help tight muscles relax

Even if you were to take all the steps listed above to prevent an injury, there is still a good chance that at some point you will sustain an injury or maybe you are rehabbing one now. Below are three common running injuries, how they are caused, what the symptoms are, how to treat and hopefully prevent them when you start to feel them coming on.

Preventing & Treating Common Running Injuries

Shin Splints

Shin splints (medial tibial stress syndrome) is inflammation and micro-tearing of the muscles, tendons, and bone tissue around your tibia (lower leg bone).

• Symptoms
  
• Pain from shin splints is usually felt along the inner border of the tibia, where muscles attach to the bone. In some cases shins splints can present fluid filled pockets on the front of your shin from the micro-tearing of the muscle away from the bone.
• Causes
  
• Shin splints are an overuse injury and often the result of increasing physical activity too quickly. They are usually associated with running but can come on from any vigorous sports activity.
• Prevention
• Wear a Proper Fitting Athletic Shoe
• To find a pair of shoes that are right for you, it is recommended to see a Physical Therapist for a gait analysis. A physical therapist is able to write a recommendation that you can take to a running store (like fleet feet) and give to the employee fitting you for shoes. Be aware of physical therapists who try and push orthotics on you, orthotics are not always necessary and often what the orthotics are correcting for can be corrected by specific exercises. However, in some cases orthotics are necessary.
• Slowly Build Your Fitness
• Increase the duration, intensity, and frequency of your training program gradually.
• Cross Train
• Supplement your running workouts with lower impact sports like biking or swimming.
• Treatment
• Rest
• Back off from physical activity until your shins are feeling better (this can take several weeks). Not slowing down when you have shin splints can lead to a stress fracture. It is better to take the time to heal rather than push through pain, often pushing through pain will lead to a worse injury that requires a longer recovery time.

• Ice
• Use cold packs for 15-20 minutes at a time, several times a day. Do not apply ice directly to your skin, use a towel or pillow case between you and the ice pack to prevent burns.
• Compression
• Compression socks or sleeves can help prevent additional swelling.
• Stretching
• Stretching your lower leg muscles may help your shins feel better.
• Strengthening Exercises
• Single leg calf raises
• Toe scrunches
• Monster walks
• Seek Out A Professional
• If your symptoms persist make an appointment with your doctor.
• Return to Exercise
• Shin splints can be resolved with rest and the treatment described above. Before returning to exercise, you should be pain free for at least 2 weeks. Remember that when you start running again you will need to decrease the volume and intensity of the running you are doing. Make sure to warm up and stretch before you run. If you begin to feel the same pain stop exercising immediately. Try using an ice pack for a day or two before returning to running again at a lower level of intensity. Increase training even more slowly than the first time.

Runner’s Knee

Patellofemoral pain syndrome (PFPS) is an irritation of the cartilage on the underside of the patella (kneecap). About 40% of running injuries are knee injuries, and about 13 percent of runners suffered knee pain in the last year, according to 4500 respondents to a runnersworld.com poll.

• Symptoms
  
• Pain is usually worsened during or after a longer run and with prolonged sitting, squatting, stairs, and kneeling, and it is possible to have pain with quad stretching.
• Cause
  
• Possibly caused by incorrect tracking of the kneecap (kneecap pulled off line due to muscle imbalance and/or overpronation in your feet, and/or tight lateral connective tissue).
• Anyone who has biomechanical factors that put extra load on the knee are at risk for PFPS. Risk factors include overpronation (inward foot rolling) and weak quads, hips, or glutes.
• Prevention
  
• Stride
• Shortening your stride length and landing with your knee slightly bent can help take some of the load off your knee joint.
• Count the number of steps you take per minute and increase that by 5 to 10 percent per minute.
• Strengthen
• Keep your knee tracking correctly by strengthening the muscles around your knees - quads, hamstrings, and glutes. It is important to strengthen the muscles in your feet as well - often pain in your knees or hips can be due to a muscle imbalance in your feet.
• Exercises:
• Lateral steps
• Squats
• Step ups
• Balancing exercises
• Lunges
• Clamshells
• Foot Yoga
• Toe Scrunches
• Treatment
  
• Can you run through it?
• Yes but take extra days to rest and reducing your mileage is very important for reducing your risk of making PFPS worse. Avoid running downhill as that can exacerbate your symptoms.
• Cross Train
• Biking, swimming, or using an elliptical can help speed up your recovery time by strengthening your quads.
• Strengthening Exercises
• Same as those listed above (in prevention).

Plantar Fasciitis

Unsurprisingly about 15% of running injuries are foot related injuries. Each step we take, our feet absorb a force several times our body weight. Plantar fasciitis is the most common foot complaint among runners. Plantar fasciitis is when the tendons and ligaments that run from your heels to your toes have small tears and inflammation.

• Symptoms
  
• Dull ache or bruise along your arch or on the bottom of your heel.
• Pain is often worst in the morning when you first get out of bed.
• Long bouts of standing can make pain worse.
• Cause
  
• Runners with very high or very low arches are at risk. Both of these foot types cause the plantar fascia to be stretched away from the heel bone.
• Extreme pronation (foot rolls inward excessively).
• Extreme supination (foot rolls outward excessively).
• Increasing your mileage too quickly.
• Tight hip flexors, weak core muscles, and a history of lower back pain can contribute.
• Prevention
  
• Supportive Shoes
• Wearing shoes that are supportive and work for your individual biomechanics can help reduce the stress not only in your shins but throughout your whole body when you run. Make sure your shoes fit your foot type by getting an analysis at a running shoe store or from a podiatrist or physical therapist.
• Strengthen
• Core exercises - 2x/week
• Planks
• Dead bugs
• Russian twists
• Foot/ lower leg exercises
• Single leg calf raises
• Toe scrunches
• Balancing exercises
• Use a bosu and practice balancing on one foot at a time, then try a single leg RDL standing on the bosu
• Stretch and massage several times a day. When you wake up in the morning hang your feet over the side of the bed and do some ankle rolls in each direction.
• Treatment
  
• Can you run through it?
• In the case of plantar fasciitis, it is best to take a break from running because running through it can delay healing or make things worse. Recovery time can range from 3 months to a year, 6 months is typical.
• In chronic cases a break from running is best.
• Cross Train
• Water running or swimming are the best alternatives to running when healing from plantar fasciitis to keep pressure off your feet.
• Biking or using an elliptical can help maintain your fitness level but should only be done if you do not have any pain.
• Rehab It
• Rolling your foot over a tennis ball, or frozen water bottle for 5 minutes at a time, 5 times a day can help.
• Stretching Exercises
• Sit with one leg crossed over the other so that your right ankle rests on your left knee. Grab the end of your right foot at the toes and gently pull back.
• Tight calves can play a factor, use a foam roller to loosen them up, or perform a traditional calf stretch.
• Strengthening Exercises
• Dead bugs
• Planks
• Russian twists
• Lateral steps
• Squats
• Lunges
• Clamshells
• Foot Yoga
• Toe Scrunches
• Return to Exercise/ How to Proceed
• Stop if you have ongoing, persistent arch pain and tenderness even after you warm up.
• Be cautious when you step out of bed, get up after sitting for a long period of time, or during the first few minutes of a run.
• Return to running when you are pain free all day, even when you first get out of bed, and when walking barefoot on hard surfaces does not cause any pain.

If you notice that you are feeling the beginnings of an injury it is best if you decrease the amount and intensity of the running you are doing and take the necessary precautions so that it does not get worse. If you have had pain for more than a week or two and it does not seem to be getting better, visit your doctor or a physical therapist who can evaluate you. Remember that the prevention and treatments in this article are recommendations and not a doctor’s prescription, if something causes more pain stop what you are doing and talk with your doctor.

~Sierra, The Tunnel Marathons Trainer
trainer@tunnelmarathon.com

Source: Runner's World