The runner’s guide to rehab 101
It’s Tuesday in early October, and you have been expecting that email from the Virgin London Marathon telling you whether your ballot place has been accepted. You hear a ‘ping’ on your smart-phone, which indicates that you have received an email… you open it with anticipation, and result, you have been entered into the Marathon… Or, if you haven’t found your place, you persevere anyway and contact your desired charity to represent, raise money for, and guarantee a place.
The realisation soon shortly kicks in of now putting in hard work to prepare yourself to run, be as fit as you can be, and possibly get a personal best on last year’s Marathon time.
Nowadays we are used to getting apps on our phones that show us how to train and the best methods of training. Whilst these apps are great, it is important to select the right programme for your ability and ensure that it has tapering weeks and a form of cross-training. Cross-training involves another form of aerobic exercise. This can include swimming, cycling, rowing or using the x-trainer. Other sporting activities such as football, rugby, tennis, and basketball are not recommended as this can increase your training loads. However, a mixture of different cross-training methods on different weeks between 30-60 minutes is generally best.
When initially starting out with any new training programme, or increasing the volume or intensity of your current training, it is important to consider previous injuries and muscle weaknesses around the body. These can definitely have a part to play in future injuries and compensations if not addressed correctly. When running we put a load 6-9 times our body weight through our legs, and so there is always that risk of injury if we do not adequately prepare our bodies to train with sudden increases in high-load. Tim Gabbett, a physio expert explains, “it’s not the load that breaks an individual down, but rather the load they aren’t prepared for.” Training error and over-training accounts for 60-80% of overall running-related injuries.
In an ideal world, with every race we undertake you would want to start fresh, pain-free, with no aches, and certainly no soreness from any previous runs. Unfortunately, in reality this is some-what different. Therefore, we definitely need to make sure that your body is able to become resilient over 26.2 miles, as a minor injury can suddenly start to snowball and impact on your running when you least want it to, or at best just be annoying, preventing you from enjoying your run.
Here are some of the most common injuries and how to combat them:
Inflammation and microtears of the thick band of tissue (known as your plantarfascia) that runs across the bottom of your foot connecting the heel to your toes. Pain is typically found near the base of the heel.
There is a high risk of plantarfascitis when rapidly increasing your mileage. Weak and tight calves, core muscles, hip flexors, glutes, hamstrings and low back pain can contribute to this. Poor foot biomechanics- having very high or low arches can stretch the plantarfascia from the heel bone. Over-pronating (foot rolls inwards) over-supinating (foot rolls outwards) feet when running can also cause this.
- Reduce your impact but keep your aerobic fitness by using the x-training, swimming, or cycling.
- Stretch and strengthen your calves, hip flexors, glutes, hamstrings and core muscles.
- Roll your foot over a frozen water bottle.
- Have your running gait assessed and analysed by physiotherapists to see if you require any orthotic devices or corrective trainers.
- Tibial stress-syndrome
This is often confused with “shinsplints”. It involves an ache around the shin-bone due to overactive muscles when running causing muscle tears.
New runners and returning runners after an extended period of time off are often affected. Again a sign of overtraining and rapidly increasing intensity.
- Check your running shoes are appropriate for you by gait analysis.
- Stretching and strengthening the calves, and stretching out the shin by sitting back in a knelt position can be helpful. Deep tissue massages either-side of the shin may also help.
- Kinaesio-taping the shin and calves, and icing for pain can also help.
- Stress Fractures
These include ‘shin splints’ which can affect the tibia (shin bone), metatarsals (feet), or calcaneus (heels). They develop overtime with consistent overload in training, and stress on the bone when very little rest is undertaken and the athlete over trains. Pain is typically centred around any of the above-mentioned sites with difficulty sometimes on weight-bearing.
Rapidly increasing your frequency, intensity, and duration of training sessions without much rest causes your bones to undergo stress. Our cells constantly breakdown and rebuild with every bone and tissue in our body, if we don’t give our bodies adequate rest, then those cells cannot repair quick enough. Stress fractures are more common in females due to nutritional deficits and with any reduction in oestrogen levels.
- Weight-bearing exercises like running are actually a protective factor as long as you adhere to gradual increases in training.
- Prehab is best to avoid such injuries, as you may be out of action for between 8-16 weeks. Therefore, make sure your training programme has tapering weeks and cross-training sessions in between.
- Avoid all impact exercises, but running in the pool/ cycling may be better options.
- Post injury, rest and gradual loading are best, but it is still worth seeking medical advice regarding this issue.
- Assess your intake of calories/ nutrients.
- (ITBS) Iliotibial band syndrome
The IT band is found on the outside of the thigh, running from your hip to the knee. Symptoms involve pain on the outside of the thigh, hip and knee. It is brought on by the overuse of certain hip abductors causing the IT band to tighten which may cause friction on structures it attaches to.
If your glutes, hip abductors, and hip flexors are weak and tight, it can affect the position and movements of your hip, stressing the IT band. Pain can be further exacerbated if training with IT band syndrome. Overpronation and leg length discrepancies may also have an effect.
Strengthen the hip abductors with lateral side steps, side leg lifts, and one-legged squats. Use a foam roller before and after you run: Rest the outside of your thigh on top of the roller, and roll your IT band from your knee to your hip. Hiking and bicycling can aggravate ITBS. Instead, swim, pool-run, and use an elliptical trainer.
- Shorten your stride length when running to reduce IT band stress.
- Strengthen both glutes, and hip abductors with exercises that engage these muscles such as: lateral side steps, lateral squats, clamshells, Bulgarian squats, and step-ups.
- Stretch the glutes and hip abductors by placing one foot in-front of the other in a staggered stance and leaning one arm over the body. Alternatively do the yoga pigeon pose stretches.
- Foam roll the Tensor Fascia Latae muscle by resting the outside of your hip on the foam roller and rolling the top 6 inches of your thigh from your pelvis.
- Foam roll the glutes by sitting on the foam roller with one leg crossed over and rolling over the glutes.
- DO NOT foam roller your IT band as the band is full of sensitive nerve endings which can be quite irritable.
- Beware; step climbing, hiking, and cycling can aggravate the IT band.
- Patellofemoral pain syndrome (PFPS)
Better known as runner’s knee, it is an irritation of the cartilage behind the patella (kneecap).
This usually occurs with muscle tightness (often due to weakness-relative to the demand of the activity) of hip flexors, hamstrings, and calves. We put a force approximately 6-9 times our body weight through our legs, and so need to ensure that leg muscles are sufficiently strong enough. Overtraining with little rest may also cause fatigue and therefore weakness. Poor biomechanics- overpronation (inward rotation) at the ankle joint may also lead to PFPS. Patella maltracking (excessive and poor movement of the kneecap caused by muscle tightness of hip flexors and the IT band) may also lead to PFPS.
- Strengthen and stretch hip flexors, hamstrings, glutes, and calves.
- Avoid running downhill, as this may exacerbate pain, however, uphill running may help.
- Icing the knee post-run may also help in the acute injury phase.
- Heat may also help reduce tightness of muscles after the intialacute phase.
- Hamstring/ Adductor strains
Hamstrings (the muscles at the back of our thighs, which help us drive uphill) can be strained in 2 different ways. Firstly, by overstretching (such as over-striding), which is mainly common in sports like tennis and football. Secondly, they can be strained by rapid stop-start running movements, as the muscles work hard to slow us down (more common in running).
Adductors (groin muscles) help stabilize the leg and again can be strained just like the hamstrings with stop-start running motions.
A sudden, sharp, strong pain and possibly even a snap or pop sound while running can be heard or felt with both injuries.
Hamstring tightness from weakness can lead to muscle imbalances. Muscle imbalances between quads, glutes and hamstrings may be a serious riskfactor. The quads: hamstring strength ratio should be roughly a 60:40 ratio in terms of muscle strength. Adductor tightness, and hip flexor tightness from weakness may lead to adductor injury. Glute muscles are another hip stabilizer, and if they are weak or underactive, it may cause the adductors to overwork.
- The hamstrings can be tight most probably because they are weak already. Single leg hamstring bridges, nordics and single leg deadlifts, may be useful in assessing and strengthening the hamstrings.
- Isometric adductor exercises and single leg lunges/ squats.
- Foam rolling the hamstrings may alleviate tightness pre-run.
- Active release techniques (ART) and deep tissue massages will also help release tightness.
- Achilles Tendonitis
The Achilles tendon connects the 2 main calf muscles to the heel. Under high loads and stress, the tendon can become irritable and inflamed.
Runners who rapidly increase training loads (especially hills and speedwork) can develop an injury. Tight and weak calves are another strong risk factor.
- Strengthen calves with Gastrocnemius and Soleus (calf muscles) heel raises with a straight and bent knee to 45 degrees respectively.
- Calf stretches- Gastrocnemius/ Soleus stretches.
- Active release techniques (ART) and deep tissue massages will also help release tightness.
- Kinaesio-tape may also help improve blood flow around the calves and alleviate tightness.