Tips for Training Safely
Oh the joy of running! Sometimes we love it too much. Training your body to run is hard and rewarding work, and for many of us, sometimes it goes wrong. If there is a weak link anywhere in your “chain”, it will come out with running.
To me, running is no different than weight training. You don’t walk into a weight room the first time and expect to bench press hundreds of pounds. Similarly, many beginners run too fast, too far or too often, and this all adds weight to the bar.
Environmental factors will also add weight to the bar. Wind, hills, temperature and running surface can making running more or less challenging. Accounting for these elements can help minimize injuries. Perhaps you can run 8 miles at 8 minute pace when it is 55 degrees with no wind, but you have to work much harder when it is 95 degrees or 20 mph winds.
Being flexible with your goals and understanding your body will make running more enjoyable and may minimize injury. Here is a list of common injuries and some tips to avoid them.
Tendinopathy (Patellar, Achilles, Hamstring)
Commonly referred to as tendinitis, this injury may cause swelling or pain. “Itis” means inflammation and usually begins by running too far or fast, or straining a muscle. “Pathy” means suffering or disease. Runners often compensate for pain, which may cause other problems. Over time tendons can weaken and change in structure with this compensation causing tendinopathy.
The best medicine for tendinitis is strengthening. Research supports first alleviating inflammation and then strengthening the muscles and tendons involved. For example, place toes on a step edge, rise up 1-2 seconds and then lower 3-5 seconds until your heels are below the step, slow and controlled. This puts more tension through the tendon as the muscle lengthens rather than just as it shortens, ultimately increasing tendon strength and helping repair the micro trauma. Doing three sets of 15 reps, five to six days per week x 12-16 weeks is what it usually takes to get things back in order.
Iliotibial Band Syndrome
The Iliotibial Band is a long tendon that runs from your hip to just below your knee. It is a thick fibrous structure that attaches several of your hip muscles (tensor fasciae latae, gluteus medius and gluteus maximus) to your lateral lower leg. At certain angles of knee flexion, this band can rub over an outcropping of bone that is part of your thigh or femur bone. This happens most commonly with running and biking with your knee in about 30 degrees of flexion. This repetitive trauma can cause inflammation and injury to this structure.
This pain can also happen higher over the outside of your hip as the tract runs over another outcropping of bone at this joint. These injuries are usually accompanied with decreased hip flexibility and weakness, which can cause changes to gait with walking and running.
A good way to stay ahead of this injury is stretching and core strengthening that involves the hip. Rest, ice and other anti-inflammatory measures also help.
Patellofemoral Pain Syndrome
This one comes down to how your knee cap or patella tracks. Weakness in certain parts of the thigh muscle or inflexibility at the hip can cause the knee cap to shift to one side and bump against the femur bone, causing irritation, pain and swelling. The strength of your hip muscle can contribute to poor form with your gait, especially at the end of a long run. Quadricep strengthening, hip flexibility, and core and hip strengthening all help keep this condition at bay.
A sharp pull, pop or burning sensation that happens in your posterior thigh or lower buttocks could be a hamstring strain. The higher the grade of strain, the more damage there is to the muscle and the longer the recovery process. If you experience difficulty walking, significant bruising or swelling, this is a sign of a more severe strain or even rupture and may be something to have checked out.
Overtraining is an easy way to develop this injury. Pushing too hard, too long or too often will cause breakdown. Be sure your hill work or speed work is done at your body’s ability to help prevent this injury.
Hamstring injuries are best treated with core work, hip strengthening, balance training and gradual return to agility with slow progression of the forces on the muscle. Simply stretching your hamstring and hitting the leg curl machine are not enough to get this one to go away.
Medial Tibial Stress Syndrome
This is also known as shin splints. Tenderness and sharp pain along the shin bone are tell-tale signs. It most commonly occurs when a runner increases mileage too fast or has poor running form. Many high school cross country and track athletes feel the wrath of their lack of off-season training when they begin a new season.
The easiest way to avoid this is to slowly increase your mileage and spend time working your core, hip and overall leg strength with cross training.
Running, when done in the proper amount, will lead to an increase in bone density, as well as tendon and muscles strength. Done in the wrong amount or when your body is compromised due to nutrition or other health problems can lead to faster break down of bone and an imbalance in the bone remodeling process, which may lead to a stress fracture.
A stress fracture is a very small hairline crack in the bone. It commonly happens for runners in the tibia (shin), 5th metatarsal (lateral foot) or femoral neck (hip). Sharp pain, difficulty weight bearing, pain even at rest and significant tenderness over these areas are signs. Rest, crutches, boots and limited weight bearing are some early treatments. Left untreated, it can lead to a significant bone break.
To avoid this injury, be sure your training has a slow and steady progression. A general rule is increasing mileage no more than 10 to 20 percent per week and being sure your body is getting the fuel it needs to rebuild bone and muscle. Lastly, listen to your body and take rest when your body is asking for it.
Sharp pain in your heel with initial standing, especially with getting out of bed in the morning is the hallmark of this condition. Plantar fasciitis (PF) is usually a combination of overtraining and body type. It is most common in someone who has either a very high or low arch.
Most cases have significant restriction in their calf muscles and trigger points. Having poor footwear, doing too many miles for your body’s current fitness level, or not matching the proper shoes to your foot type all make a difference.
Another factor can be your stride or how your foot hits and pushes off the ground. A running assessment can be helpful. Video gait analysis breaks down exactly what is happening with your form and gives clues as to where you might need more strength, better flexibility or a change in your cadence or form.
Treatment for PF is rest, taping and flexibility, and may include myofascial release or dry needling. To avoid PF, include calf flexibility as your cool down, make sure to keep track of the mileage on your shoe, and when you first buy shoes, check with a local running store to be sure you have the right size and fit for your foot.
Injuries are no fun and often sideline runners. Training smartly and listening to your body can help avoid them and keep you running.
JP Larson is a Physical Therapist for ThedaCare Orthopedic Care.