Injury Prevention 101

We all know that runners have a higher risk of injury than non-runners, just as do athletes of any other sport. Obviously this is true, as simply being more active means you are on your feet more often with a greater availability to trip over an object and fall, step on uneven surface and roll an ankle, or just overuse weak body parts. In my opinion this risk is better than being inactive and risking developing heart disease, diabetes, and other health issues that come from lack of exercise. Besides being cautious to avoid tripping and bumping into something, runners, and all other endurance athletes, should follow other steps to decrease their injury risk on a daily basis.

SLEEP & Rest

The first and most important method to help prevent injury is to make sure you are getting enough sleep. You may feel like your 4 or 5 hours of sleep every night is just fine to keep you going, but sleep does much more than help us get through our day. Most, if not all, of the muscle damage repair and growth occurs during sleep. Human growth hormone is released during certain stages of sleep that increase blood flow to our muscles so that they can repair from our workouts. Another stage of sleep, REM, is responsible for relaxing our muscles and reducing symptoms of chronic pain. Runners should aim for at least 7 hours of sleep each night, but research shows 9 or more hours gives the most benefit to competitive athletes.

Strength Training

A well-rounded exercise plan is always best when it comes to lowering your risk of overuse injuries. You’ve probably read that triathletes, even those who participate in Iron Man competitions, have a lower risk of injury than marathoners. That’s because triathletes train with a balanced mix of running, cycling, and swimming. As a distance runner, if all you are doing is running, then you are inching your way closer and closer to an injury every day. The best formula for runners is to incorporate a mix of running, weight lifting, and other cross training cardio exercises. Lack of time may be the reason most runners skip strength training, but you can highly benefit from a quick 20 to 30 minute session a few days per week. This should be a priority if your goal is to improve your performance and not get injured.

Pack on the Miles GRADUALLY

One of the quickest ways to get injured as a runner is to increase weekly mileage by a substantial amount—even if you’re feeling great. The rule of thumb is to never increase by more than 10% each week. This may even be too much for some runners. A safe method is to increase by a handful of miles each week for 3 to 4 weeks and then have one week as “recovery” where you drop your mileage by 20% to let your body rest. After this recovery week, you can safely start back from where you left off.

Rotate Your Shoes

Since the feet carry your entire body weight during all activities, it is beneficial to give this part of the body a break. One way to do this is to switch your shoes throughout the week. Most brands make running shoes for different types of workouts. Save your well-cushioned shoes for long runs and recovery runs, and your lighter pairs for speed and track sessions. The style of each shoe is different which means your foot muscles will work differently in each pair. Everything that happens down in the feet has an effect on the rest of the body—so shoe rotation lets different muscles all over the body work and rest all at different times. 

Focus on Good Form

The constant pounding on the ground from running has an impact on the entire body. The ideal running form is one that lessens this impact and keeps all parts in sync and balanced. It is beneficial to add strides once or twice a week to focus on this. Run 5 sets of 20 to 30 seconds at a hard pace where you practice holding an upright posture with relaxed shoulders, taking quick steps, landing on the mid-foot, and a having a slightly forward lean—all aspects of proper form. Once you master good running mechanics, you will lower your risk of overusing any part of your body.

Stretch & Foam Roll

Just like weak muscles are prone to overuse injuries, tight muscles are more prone to tearing—which is an injury that can put you out for months! Runners can get tight all over, but hamstrings and calves/Achilles are the common areas that get torn. My advice is to make it a habit to stretch after EVERY SINGLE RUN for 10 minutes. A few sets of 20 second holds for the glutes, hamstrings, quads, and calves is enough. Foam rolling can be more tedious but is useful to tackle much deeper muscular tightness. It may also help improve range of motion that is limited by chronic muscle inflammation.

These steps may seem like a large load added onto your regular running routine, but they are necessary if you want to run for years without worrying about easily getting injured. These components will also help you become a more efficient and faster runner over time, so it’s a win-win if you ask me!

Sources

How Sleep Adds Muscle. The National Sleep Foundation. www.sleep.org. Nov 15, 2019.

Balance Training: A Key to Injury-Free Running

Most runners are primarily focused on improving their endurance and speed during their training cycles. Strength and flexibility are usually a secondary focus, especially if the runner has had a history of an injury and has been educated on the importance of these components. Balance training, on the other hand, seems to be of less importance to runners. In general, balance declines as we get older—by up to 75% by the time we are 75 years old. This is why older people are prone to falls, which is currently the leading cause of injury and death in the geriatric population. Balance is fundamentally the skill of keeping the body aligned and upright by reacting to changes in our center of mass at all times. Taking this definition into consideration, it seems balance should also be a primary focus during training, since after all, running is basically a one-legged balancing act.

Balance is (Almost) Everything

Most people will think of running as an activity involving a push-off phase, forward propulsion, and a landing. These are all most definitely parts of the running cycle, but about 50% of running is an action of falling forward. Thankfully, we developed the ability at an early age to stabilize ourselves against falling while running. This natural reaction gets harder to control as we run longer and faster, since the muscles in charge of this action get fatigued. And if running straight with no disruptions gets harder to control when we are tired, then the task of maintaining our balance is that much more difficult when having to make a sharp turn, stepping over uneven surface, or having to make a sudden stop to avoid a collision with a person or object. Improving our body’s balance directly will not only improve running form and posture, but it will also decrease injury risk and pain.

How to Train Balance

Balance is controlled by proprioceptors in our muscles and joints, which are basically tiny sensory nerves that can anticipate changes in our body’s center of mass. When we step on a pebble that causes a loss of balance, the proprioceptors fire this sensation to our muscles, so that they can react as quickly as possible to stabilize our joints and avoid a fall. For the case of running, the main proprioceptors to focus on when working on balance training are the ones located in the feet, ankles, and hips. It is always best to start working from the ground up as the feet and ankles are the first to sense any position changes from running on uneven surface, for example.

Exercise (and Run) Barefoot

One theory of why Kenyans are one of the fastest and most efficient runners is because they grew up walking and running barefoot on uneven terrain, therefore constantly strengthening their proprioceptors and intrinsic foot muscles that control balance. This enables these runners to devote the majority of their energy to forward propulsion while running. Unlike the Kenyans, most of us have grown up running in some good-looking shoes with excellent support and cushioning. On top of that, we opt for road running when training for a marathon. This means we leave our proprioceptors pretty quiet during our entire run. The only time those nerve receptors are active is when there is a sudden change in our position that we are not prepared for.

Strengthen Balance Muscles

A part of every runner’s strengthening program should include core, hip, ankle, and foot exercises. Most of us occasionally incorporate upper leg strengthening, which is important, but often forget to directly strengthen the joints and muscles below. The foot and ankle joint are probably one of the most important body parts for runners, as they carry the entire weight of the body at all times. The feet absorb the initial impact of striking the ground, which makes them extremely vulnerable to injury.

Easy exercises to work the ankle stabilizers can be done with resistance bands, strengthening the four main movements of the joint. For the intrinsic muscles of the feet, towel curls are an effective strengthening exercise. Place a small towel on the floor and try to pick it up with your toes for 10 to 15 repetitions at a time.

Simple exercises for strengthening the hip stabilizers can also be done with resistance bands such as clamshells, bridges, standing legs lifts, and lateral squat walks. All of these moves can be done without the bands, along with bodyweight squats, step-ups, lunges, and heel raises. Isolating one leg at a time is also useful, especially if you have experienced a one-sided injury or low back pain in the past. Incorporating a handful of these moves before or after runs is the easiest way to make sure to get them in.

Uneven Surface Training

One of the most effective ways to challenge your balance muscles and proprioceptors further is to perform lower and upper body exercises standing on a wobble board, balance disc, foam mat, or other unstable surface. This will help work the ankle and hip stabilizers, intrinsic foot muscles, and the entire core all at once. As mentioned above, most runners training for marathons limit their runs to the road. Trail running is a beneficial way to strengthen the proprioceptors as you constantly challenge the joints and muscles with the varying terrain.

Keep in mind the reasoning for emphasizing balance training along with your regular marathon preparation. Good balance will help relax the body more while running, leading to better posture and less tension when fatigued. This means less energy wasted and more to use for the push-off phase and increasing speed. Keeping these specific muscle groups and proprioceptors strong will ultimately make you a better runner by allowing your legs to effortlessly move faster, while lowering your chances of injury and pain.

Sources

Scott Mullen, MD, Jon Cotton, MD, Megan Bechtold, DPT, and E. Bruce Toby, MD, Barefoot Running: The Effects of an 8-Week Barefoot Training Program, Journal, Nov 4, 2019.

Anna Brachman, Anna Kamieniarz, Justyna Michalska, Michał Pawłowski, Kajetan J. Słomka, and Grzegorz Juras, Balance Training Programs in Athletes – a Systematic Review, Journal, Nov 4, 2019.