Running is one of the most accessible and beneficial exercises, not just for our cardiovascular health but also our mental health. In 2020, due to the Covid-19 pandemic closing many fitness centers, many people have shifted gears to incorporate more running into their routines. While running has a number of great benefits, it is important to recognize that there is more that goes into our training than just running. Running is a combination of mobility, strength, and endurance to consistently propel us for greater distances as we continue to set and achieve new goals and milestones within our own training. Whether we are racing against the competition or ourselves, we must set forth a strategically planned training regimen in order to prevent injuries. Many common running injuries include the following:

Patellofemoral Pain Syndrome (PFPS)

Commonly referred to as Runner’s knee, PFPS is one of the most common injuries to be diagnosed in the running community and typically presents as pain around the patella (knee cap). PFPS typically presents as pain at the end of activity that later progresses to pain during and even before activity. It is typically a result of increased stress on the knees during running and jumping activities. Commonly associated injuries include IT band syndrome, suprapatellar bursitis, and patellar tendinopathy.

Strains

Typically involve a forceful stretching or contraction of the muscle leading to pain in the muscle that is strained. For runners, this typically involves the hamstrings and the calf musculature. These types of injuries are typically observed in sprinters but do have their place in the likes of distance runners as well.

Shin splits

Commonly consists of throbbing pain along the tibial border (shin bone) that is brought on by activity and typically dissipates at rest. Typically associated with deficits in mobility, strength, or both at the ankle during running. Shin splints can present as lateral or medial tibia pain.

Tendinopathy/Tendonitis

Tendonopathy refers to the breakdown of a tendon, whereas tendonitis refers to the acute inflammation of a tendon. Both are observed in over-use injuries due to repetitive stress on a particular tendon. In runners, the most commonly observed include patellar, Achilles, and posterior tibialis.

Stress fractures

Caused by repetitive stress or recent increase in workload that typically affects the foot and ankle including the medial malleolus (distal tibia) and navicular bone (small carpal bone in the foot).

Where to begin?

Far too often, when I ask my runners how they prepare for training I am often met with a list of static stretches they incorporate to “loosen up.” While stretching is excellent for the human body I believe that it is more advantageous to incorporate a dynamic warm-up including mobility drills and a more active warm-up. This includes mobility drills and light exercises in order to “prime” and prepare our musculature for upcoming activity/exercise. This could include:

Standing Isometric Hip ABD

High Knees

Hamstring Scoops

Open gates/close gates

Strength Training

Now that we have touched on a quick warm-up to set us up for success with running and other activities, let's talk about the importance of strength. Running requires global strength throughout the body and most importantly in the lower extremities. Research from a recent study examining long-distance runners revealed that incorporating a strength training program into their training regiment did not only improve strength, it also improved running economy and vVO2 max, two performance indicators in high-level runners. This study incorporates both power training and plyometric/dynamic strengthening. Exercises utilized in this study included back squats, box jumps, and other plyo exercises targeting improving hip strength. Many injury prevention programs for runners tend to focus on hip strength as a primary target area, as many overuse injuries stem from weakness in the hip musculature. Some of the exercises include:

SL hip ABD:

Back squats:

Front squats:

What are we missing?

In many instances, as a PT we spend so much time looking at hip strength and motor control from an injury prevention standpoint, that we neglect other areas. I believe that, while hip strength tends to be a primary focus, we must start investing into other areas as well. This includes the gastroc–soleus complex, ankle inverter/everters, and foot extrinics/intrinsics. The role of many of these muscles is to absorb and dissipate forces while running. In other words, distribute the load throughout our legs to help take some of the stress off of our foot, ankle, knee, and hip, which can potentially lead to some of the injuries previously discussed.

Foot Strength

One area that I believe in particular that I believe has been neglected is the impact of foot intrinsics in this population. New studies suggest that intrinsic foot strengthening has an effect on foot morphology where increased muscle volume of the musculature helps improve vertical propulsion and potential force distribution during running. This is just another piece to the puzzle; however, we need to start to diversify our training protocols in order to incorporate a global approach to strength with runners in order to help them be the best athletes they can be; from novice runners to veterans. This will require us to continue to be creative and challenge our athletes with dynamic strengthening programs that incorporate all aspects of the musculature that pertains to their sport. Below are a few exercises that I believe use this philosophy:

Doming:

We can then combine exercises to incorporate core, hip, ankle, and foot strength in a functional manner. These exercises could be made even more challenging by changing the compliance of the surface with a foam pad.

Doming with SL balance:

Step up with counter-rotation

Moving forward

While running is one of the most accessible forms of exercise, we need to realize that it is a very complex and dynamic activity that is physically demanding on our bodies. We need to spend just as much time preparing our body for that increased stress in order to knock down barriers, achieve new goals, and most importantly; prevent injury so that we can keep pounding the pavement.

By Keith Walsh SPT

References

Beattie, K., Carson, B. P., Lyons, M., Rossiter, A., & Kenny, I. C. (2017). The effect of strength training on performance indicators in distance runners. The Journal of Strength & Conditioning Research, 31(1), 9-23.

Taddei, U. T., Matias, A. B., Ribeiro, F. I., Bus, S. A., & Sacco, I. C. (2020). Effects of a foot strengthening program on foot muscle morphology and running mechanics: a proof-of-concept, single-blind randomized controlled trial. Physical Therapy in Sport, 42, 107-115.

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