Written by Molly Frankinburger PT, DPT, OCS, CSOMPT, CSCS
Running can provide many benefits, aside from a good mile time. It is a great mode of exercise to stay fit and healthy, especially during a pandemic when access to gym equipment is limited. All you need is a quality pair of sneakers to enjoy running outdoors. Running can also benefit our mental health by decreasing stress and improving sleep.
However, beginning a running program can be a challenge to the body. Our muscles, bones, ligaments and tendons adapt to the stresses placed upon them, but when the load is greater than the body’s ability to adapt, injury occurs. There are many risk factors associated with running related injuries such as, increased speed, mileage, change of terrain, and improper footwear. A history or prior injury is the strongest risk factor for injury followed by insufficient rest between bouts of exercise. Proper pre- and post-exercise activities may reduce injury risk, such as a progressive warm up followed by activation exercises. Mobility exercises should also be included into a runner’s weekly routine, but not necessarily around workouts.
Below is an example of a dynamic warm-up to perform prior to exercise:
50m for each exercise
Walking Kicks with Contralateral Toe Touch (Toy Soldier)
Knee Hugs with Heel Raise
Front, Back and Side Skips
Activation exercises are equally important following a dynamic warm-up in order to prime your muscles prior to running. These include simple exercise focusing on gluteal muscle contraction:
3×10 for each exercise
Glute Bridge Marching
Bird-dog with Knee to Elbow Touch
Mini-loop Resistance Band Squats
Mini-loop Resistance Band Sidestepping
All runners will likely experience an injury at some point in their training. This leads to the question, “Why did I get injured?” This can be a frustrating time for athletes as they try to figure out what went wrong. Below are general guidelines for common running-related injuries and how to treat them.
Tendonopathies – Hamstring, Achilles, Patellar. A low level pain that increases with running and returns to baseline within hours. General principle for healing is progressive loading and symptom management. You may need to stop running and cross train depending on the severity of the injury. Reintroduce force in the tendon gradually by starting with isometrics, then isotonics, and progressing to plyometric loading with minimal pain during exercise.
Low back pain – Typically runners will present with non-specific low back pain due to poor form and alignment issues. Management includes advising the athlete to staying active while training the abdominal, lower back, and gluteal muscles for endurance as these muscles likely fatigue during running and contribute to compensatory patterns.
Patellofemoral pain – The most common cause of anterior knee pain in runners. It’s described as a sharp pain in the front of the knee that increases with running, descending stairs, squatting, and after prolonged sitting. Treatment will focus on strengthening the hip abductors, external rotators, and quadriceps to control lower extremity alignment during the loading response of running.
Iliotibial Band Syndrome – This is the second most common injury in runners caused by repeated tissue strain deep to the lateral portion of the knee. Treatment is similar to patellofemoral syndrome by correcting dynamic knee valgus. Risk factors include excessive pronation, hip muscle weakness, limited running experience, and recent increases in running volume.
Plantar Fasciitis – This is the third most common injury in runners caused by collagen degradation and overuse. Symptoms include stabbing pain near the heel of the foot, and typically worse in the morning. Over-pronation is also a risk factor for this injury and treatment includes strengthening the foot intrinsic muscles to control foot posture and gait retraining.
Returning to running
In order to consider returning to running after an injury, daily activities should be pain free. Plyometric activity should result in a pain score of 2/10 or less and subside within an hour. Resuming running can be divided into four phases. Phase one is walking for 30 minutes. Phase two is plyometric activity such as one and two-legged hops. Phase three is walk/jog intervals based on symptoms. And phase four is increasing the running time once you are able to complete 30 minutes of intervals. Progress no more than 10% per week and take the symptoms into consideration, if pain returns drop back to the previous phase. There should be no stiffness the following day.
With that being said, take it slow; start easing into outdoor runs gradually and be sure to warm up beforehand as your body won’t be used to the sudden increase in exercise. It’s important to stay hydrated, wear comfortable clothing, and be aware of your surroundings in order to stay safe and avoid potential injury.
If you’re experiencing any pain or discomfort during or after your runs, be sure to contact a Physical Therapist for a consultation. To schedule an appointment with a Professional physical therapist, visit us at https://www.professionalpt.com/physical-therapy-clinics/.