Adequate musculoskeletal strength is of equal importance in the prophylaxis of running injuries. Strong ligaments, tendons and muscles improve running technique and lead to a consistent gait pattern.  

“How your knee turns in, your hip drops and your foot pronates changes with each step. But with strength, these movements are the same each time, so your mind and body know what to expect“

Reed Ferber, Ph.D., director, Running Injury Clinic University of Calgary

If one muscle is weakened in the kinetic chain then other muscles become over-worked resulting in compensatory injuries. Combining running with strengthening exercises such as Double leg Squats, Lunges, Heel Raises, Clams, Swiss Ball Shoulder Bridges, Hip Extensions and Lateral Jumps plays a very important role in injury prevention. It is important that you have the correct technique when doing any of the above exercises so if you are unsure about technique ensure you speak with a gym instructor or personal trainer, or alternatively, feel free to contact us and we will be happy to advise you.

Warming up muscles, joints, ligaments and tendons is vital in preventing injury as the warm up gently prepares the body for activity. Muscles that have been adequately prepared have improved blood supply which the muscle needs when undergoing aerobic activity.  It also promotes elastin activation within the muscle to facilitate large amplitude movements. Warm up times and activities vary greatly, but a brisk walk or skipping for approximately 5 minutes can be sufficient so long as the desired effect of elevating the heart rate and warming the body is achieved.  

One should always stretch prior to running and adhere to the following guidelines:

• Hold Time: Work up to holding each stretch for 20 seconds or more.
• Set Count: Three to five sets of holding a stretch, per leg.
• Breathing:  Slowly inhale through your nose and exhale out your mouth during each stretch.

Calf Stretch: With your arms extended and your back straight, place both palms on a sturdy surface, preferably a wall. Put the calf you want to stretch behind you, being sure to keep your heel pressed to the floor and the leg extended without bending the knee. The other leg is in a lunged forward position in between the wall and the extended leg. Keeping your heel down and your hips straight, slowly bend your elbows and lean towards the wall.

Hamstring Stretch: stand tall with your left foot a few inches in front of your right foot and your left toes lifted (pulled up towards your face). Bend your right knee slightly and pull your abdominals gently inward. Lean forward from your hips, and rest both palms on top of your right thigh for balance and support.

Quadriceps Stretch:  Stand and touch a wall or stationary object for balance. Grasp the top of the ankle or forefoot of the leg to be stretched.  Straighten the hip by moving the knee backwards.

Running Surface

Ideally, a running surface should have good shock absorption and a healthy mix of up and down hill gradients. In reality most of us spend our time running the same road circuit day after day. Unfortunately given that roads are cambered to deal with surface water, runners will commonly present for physiotherapy with myofascial (muscle) adaptive changes. Therefore it is important to change your route frequently and also experiment with different surfaces such as grass, running tracks and AstroTurf which have excellent shock absorbance.

Avoid Overtraining

Listen to your body at all times during and after training. Runners are often the worst offenders when it comes to “running through the pain”. Remember that pain is a sign that the body is not comfortable with a certain activity and therefore should not be ignored.  In the case of runners it is often due to micro muscle tears with can result in “DOMS” Delayed Onset of Muscle Soreness.  Typically, symptoms present between 24-72hrs post run. It is a sign that the muscle has undergone micro trauma following eccentric exercise and it is important to rest and consume plenty of fluids during this period. Research suggests resting for approximately 3 days and on the 4th day reducing your running mileage to 50% of the previous run and reducing your pace to approximately a 9 min mile to facilitate the resolution of DOMS and to reduce the risk of injury. For those who find 3 days of rest too much, substituting running with swimming, static bike cycling or Pilates after 48hrs can help maintain levels of flexibility and minimise the risk of deconditioning.

This area can be a minefield given the abundance of running shoes which are now available, from Five Finger shoes to Double Shock Absorption anti-pronator shoes and every variation in-between. However, there are some fundamental principles one should be aware of when purchasing running shoes. Firstly, shoes need to be changed approximately every 300-400 miles so look at your budget and the average number of miles you run per week. Secondly, every foot has a unique arch profile and this should dictate whether you require a shoe with a pronator or supinator component. This should be assessed by someone familiar with foot biomechanics. Rear foot stability and running surface are also factors which will determine if dual cushioning or simply gel cushioning is sufficient for you.

Advising someone on the shoes which is best appropriate for them without looking at foot biomechanics is very difficult and is not to be advised.  However if you take the above guidelines into consideration it should help in the decision making process. Unfortunately if you continue to experience pain despite changing your shoes, you may require a more in depth assessment of the foot biomechanics.

Runners Knee: A condition which is characterised by anterior knee pain. Several factors can be present when anterior knee pain develops but the most common reason is Patello- Femoral joint mal-tracking. This can occur due to altered foot biomechanics resulting in internal rotation of the tibia. Reduced Hip stability and Gluteus Medius (one of the buttock muscles) inhibition cause overuse of the ITB and subsequent lateral tracking of the patella. Swelling can develop within the knee complex also as the posterior surface of the patella comes into contact with the anterior distal femur.

Any acute injury and acute swelling should be treated with rest, Ice, compression and elevation (RICE regime). Addressing muscle imbalance, joint proprioception and foot biomechanics are key to ensuring this does not become an ongoing issue.

Shin Splints: A pain which occurs along the inside or front of the shin bone. People with flat feet (pronated) tend to develop this injury more frequently. The onset of symptoms often coincides with long distance running or running on a more inclined gradient. Treatment should include rest, ice and elevation, stretches to the anterior lower leg muscle groups and a phased return to flat surface running.

Achilles Tendonitis: An Inflammatory pathology of the largest weight-bearing tendon in the body. Achilles tendinitis is characterised by pain during full weight bearing activities and stiffness in the posterior ankle in the morning. Factors which contribute to the development of this condition include tight calf muscles, abnormal foot biomechanics and overuse injury. Treatment for this problem should include rest, Calf Stretches and contrast therapy to the area (ice for 10 minutes followed by heat for 10 mins). Kinesiology taping techniques, foam rolling and insoles/orthotics if indicated on biomechanical assessment may also be required to fully resolve this pathology.

Muscle pull: A small tear in muscle, also called a muscle strain, often caused by over-stretching. If you sustain a pulled or strained muscle, a popping sensation may be felt when the muscle tears. Acute treatment includes the application of the RICE principles.

Some of the more common muscle strains in running affect these muscles groups:

• Hamstrings
• Quadriceps
• Groin
• Calf

The important points to note are that one should never run through pain or ignore an injury as this will only lead to compensatory movements and secondary injuries. If pain does not ease with rest, stretching and ice over a five day period, we would recommend consulting with or attending a Chartered Physiotherapist for further guidance. Any Injury which is treated in the acute or sub-acute time frame generally has a better prognosis and a quicker response to treatment facilitating a speedy return to running.

Foam Rolling

Foam rolling is a form of self myofascial release that targets tense and overworked muscles. It is similar to myofascial release, a common technique used in massage, otherwise known as deep-tissue massage. Over the last decade there has been a large shift towards injury prevention and myofascial flexibility. This has led to the rise in popularity of the “Foam Roller”. Studies have found that massage and soft tissue mobilisations help the body to repair following micro-trauma (such as running). But as having a massage after every run is not realistic, the foam roller is a cost effective way to improve myofascial flexibility. It is an excellent adjunct to any runners training routine and is highly recommended for those running more than or up to 10k per week. It is very successful in the treatment of ITB Syndrome (as part of a full treatment program).