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A General Guide to Running Injuries and What a Good Therapist Can Do About it

In the line of work that I do, I am very fortunate to be able to see all sorts of people with all sorts of physical ailments, ranging from ankle sprains, lower back pain and cervical whiplash patients. Though all of these patients each bring a set of challenges, there is something totally different when I see someone who is a runner. Since I have been one myself for over 20 years, and lots of that time spent injured, I know how hard it is to miss time to an injury and not get out on the trail or on the roads. And though I certainly don’t claim to know everything about the subject of running injuries and mechanics and such, I certainly know enough to help most of my runners get back to full capacity. Here are a few “take home” tips that I think that if each injured runner actually listened to and followed, that we wouldn’t see the high rate of running injuries that we see, which has been estimated to be as much as 82% of all runners!

  1. Pay attention to what got you injured. This may sound elementary, and some people have no idea what got them into my office, but usually it’s due to a “Training Error”. This is a term that basically means too much too soon and ramping up speed, distance, or both at a rate your body is unable to handle.

  2. Back off the running for a little while. This one means to focus more on your imbalances, weakness, tightness, etc. instead of plugging along on the same old run. Physical therapy can give you all the things to work on to get better, but I see people continue to run the same distance and pace, wondering why they aren’t getting any better. DUH! Now, if the running truly is not hurting while running or after, or isn’t getting worse as you run longer, then fine. However, there is an element of addiction in running (and other endurance sports) that is unlike anything I’ve seen for other injuries. These people need their fix, and no matter how much I tell them to slow down or cut back, they keep coming back for more to the very thing that keeps them injured. The key is to replace the old habits with new ones that get you stronger and more aligned as a runner, so you will be able to run for the months and years ahead. Isn’t that worth a brief decrease in mileage in the short term?

  3. Get your hips and butt working for you. I would say that about 90% of the runners I see have weakness and/or tightness in the hips (usually it’s and). This compromises your ability to stand on one leg as you transfer your weight forward during gait. There is a great article about this in the April 2014 issue of Running Times magazine. I have an awesome routine that I give to patients that will get those butt muscles firing, as well as get all major muscle groups lengthened such as hip flexors, gluteals, adductors, quads, hamstrings.

  4. Do your core work. I don’t care if it’s Pilates, Yoga, planks, P90X or whatever, this is a crucial part of stability in gait. If you are weak here, then you set yourself up for a whole host of problems, even in the knee or ankle. We need to start thinking of ourselves as athletes, not just sedentary people who run. My runners get a healthy serving of core stability exercises that start from the most basic “neutral spine” positions to more dynamic stability movements on the ball, foam roller, or other unstable surfaces.

  5. Get better at standing on one foot. I heard once from an online running coach that all runners should be able to stand on one leg for at least 3 minutes. Try it. It’s hard to do if your feet and hips are not strong. Also, it’s amazing how bad people’s awareness of their bodies are, especially the injured ones. Practicing single leg balance for at least 2 minutes while brushing your teeth is a great way to improve body awareness and alignment for running.

  6. Go to the Video. This doesn’t have to be complicated, and since having a video camera is so common, it’s very easy to capture. All you need is about 30 seconds (or less) of running at normal pace viewed from the side and from the back. Usually without much training in biomechanics, you are able to see things about your stride that don’t look quite right. By working on the exercises and body focuses that we work on in therapy, you can then recheck your form again in a month or so to see if you notice a difference. Of course, we also do some basic video analysis in the clinic using an iPad so you can see what we see in your stride and what needs work. A good article about this was written in the Jan/Feb 2011 issue of Running Times.

  7. Feel the Chi: For virtually all my runners, I recommend they at least look at or buy the Chi Running book by Danny Dreyer, due to its simple approach to running stride that is less about force and more about flow. The basics include posture focuses such as leveling your pelvis, then leaning yourself forward while picking your feet quickly off the ground, not pressing. The stride rate, or number of strides per minute is usually more than you’re used to, but it helps take pressure off the muscles and joints, since you are using gravity to pull you into a controlled fall forward. There is a TON more to it than that, but then can help you go a long way with much less effort. Chi Running also has an App on iPhone that you can use to get your mind around this new concept.

  8. ASTYM/Graston/GuaSha: This might really be necessary for the chronic tendonitis patients we see, which actually is now classified officially as a tendonosis, describing an actual break down in connective tissue strength and elasticity due to repetitive loading and inflammation cycles. ASTYM uses special instruments to help stimulate growth factors in chronically inflamed and scarred down tissues, helping to remodel new tissue growth that will be stronger once healed. What’s great about ASTYM to runners is that it is important to exercise regularly to load the tissue, because this helps your body to stimulate a new stronger tendon or muscle.

  9. Work out your tissue yourself. ASTYM and Graston are rough, but very effective, and so can massage, if you can go regularly (and afford it) . Another thing you can and should do is to get familiar with a foam roller, and use it frequently. In general, the more sensitive an area is, such as your calf or butt muscle, the more you need to massage it.

  10. Persistence, Persistence, Persistence!!!! I really get annoyed when people come back after a week or two, or even the 2nd visit, and wonder why they aren’t any better. Hold on a minute: usually this has been a problem that’s been brewing for quite a while, so a couple quick exercises aren’t going to just snap you right into perfect running form and no more injuries. There are important things that must be done, and it takes up to 6000 repetitions of any movement for it to get ingrained as a habit without conscious focus. Keep that in mind that you need to not only get your muscles stronger and more flexible as well as more balanced in the right places, but you are more importantly training your nervous system to work correctly by feeling the optimal way for us to put one foot in front of the other. This is like running to the horizon—you never will get to the ideal, but you keep working at it by tuning into your body. Your body will be glad you put the effort in to gain new healthy habits to keep you running for a long time.

Trent Corey PT, DPT

Xtra Mile Physical Therapy


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