Running Injury Prevention

Running is a great way to improve aerobic fitness and cardiovascular health. Running not only burns calories, but can contribute to one’s mental and physical health. However, a large percentage of individuals who run are exposed to a wide range of running-related injuries, most of which are due to overuse. Up to 80% of the injuries occur in the lower extremities with the knee found to be the most commonly injured body part (Callahan, 2018). Patellofemoral pain, medial tibial stress syndrome (shin splints), achilles tendinopathy, iliotibial band syndrome, plantar fasciitis, and stress fractures are the most common diagnoses. 

RISK FACTORS
In the majority of cases, pain may arise in the lower extremities due to intrinsic factors such as being overweight, having weak core and leg muscles or with changes in foot type such as having flat feet. Extrinsic factors such as poor footwear, not stretching, or an unbalanced diet may contribute to running-related injuries. The main risk factor to running-related injuries was due to having a previous injury in the last 12 months. It is important for your physiotherapist or coach to be aware of all previous injuries that you may have sustained.

TREATMENT
Acute treatment includes stretching the posterior structures, massage, ice, activity reduction, taping, corticosteroid injection, or orthotics. Long-term treatment includes strengthening the intrinsic foot, ankle and hip. New footwear, night splints, or surgery may be indicated if conservative treatments are unsuccessful. Consult your physiotherapist or coach for the appropriate treatment. 

RETURN TO RUNNING CHECKLIST
Ensure there are no signs or symptoms of inflammation and you have gained the full ability to weight bear through your legs and feet. You should be able to hop in multiple directions on each leg and should be able to walk at a speed of at least 5.6 km/h (or 3.5 mph). Toe dexterity, or precise control of the toes, should be present in each foot and you should be able to balance in a wobble-free manner for more than 30 seconds. 

Below are some key exercises to stretch and strengthen muscles essential to improving running performance and reducing the risk of running-related injuries:

CORE ACTIVATION
A) Wall Squat

The exercise shown above can help with the retraining of the core stability, hip, leg and ankle muscles.

  1. Wrap a closed loop resistance band around the thighs just above the knees. 
  2. Position yourself so that your low back is fully leaning up against the big ball on the wall. Keep your posture nice and tall but don’t arch your low back when leaning upright against the big ball. 
  3. Engage you inner core stabilizers by contracting your pelvic floor muscles and pulling your transverse abdominal muscles below your belly button inwards, hugging your spine. Remember to keep breathing. 
  4. Leaning your weight on the ball slide downwards doing a wall squat while you maintain static isometric pressure against the resistance bands. Keep your knees over your ankles and in alignment with your second toes. 
  5. Hold the wall squat for 10 seconds. Repeat this for ten repetitions doing three sets daily.

B) Psoas March

The exercise shown above helps increase hip flexor and core strength.

  1. Being by lying flat on a mat so there is no arching of the lower back. Place your hands just below the belly button to cue engagement of the core muscles.
  2. Bring both knees up to approximately 90 degrees and wrap a band around your feet.
  3. Hold one knee stationary while pressing down the opposite leg. Then bring the extended leg back to the starting position.
  4. Repeat with the other leg while maintaining core activation and controlled breathing.
  5. Complete three sets of five repetitions on each side. Progress to sets of 10 repetitions for more difficulty.

MUSCLE STRENGTHENING & STRETCHING
A) Bridging Hamstring Curls

The exercise shown above helps strengthen the hamstrings, glutes, and core stability muscles to help protect the ligaments of the knee. 

  1. Lie on the ground with the stability ball under your heels with your legs straight and your toes pointing up. 
  2. Engage your inner core muscles below the belly button. Then extend your hips by squeezing your butt and lifting it off the ground. 
  3. Bring the ball in towards you by flexing your knees and hold for a second and then straighten your legs back to the start position while keeping your butt up and hips extended. 
  4. Keep your inner core engaged the entire time. 
  5. Start by doing 3 sets of 10 repetitions and then progressing it to 3 sets of 15 to 20 repetition 4 times per week. 

B) Step-Ups

The exercise shown above helps strengthen the hip, quad, and core muscles to prevent leg injuries.

  1. Start with a tall posture and your inner core engaged below the belly button. 
  2. Bring the opposite arm up while using your glute muscles to fully extend the hip up as you step with one foot onto a step box.
  3. Keep your thigh strong by preventing the knee from buckling inwards, as well as keep your knee over the heel so it doesn’t go over your toes. 
  4. Do 3 sets of 10 on each side. 

C) Wall Plank Resisted Knee Highs

The exercise shown above helps reduce anterior hip pain and weakness that may contribute to running-related injuries.

  1. Place a closed loop light resistance band around your feet. Slightly flatten the lower back and keep the inner core muscles engaged below your belly button to stabilize your posture. 
  2. Going into a plank position on the wall, bring one knee in a straight line up towards your chest and then slowly lower it back down with control. 
  3. Repeat this on the other side while alternating each knee to chest doing a total of 10 repetitions for each side. Perform a total of 3 sets, 10 repetitions for each side. 
  4. A progression of this exercise is to perform the knee lift twice as fast but still lowering the leg and foot back down with control while you keep your core muscles engaged and maintain core stability control throughout all repetitions and sets.

D) Lateral Quad Stretch

The exercise shown above is particularly helpful if the Iliotibial Band is tight due to stiffness in the lateral quadriceps muscle. Overuse knee pain can be caused by excessive running. 

  1. Start by lying on your good side with the tight Iliotibial Band or “IT-Band” facing up. Keep your inner core muscles below the belly button engaged while keeping your low back flat. 
  2. Bring the bottom knee towards your chest and with your left hand, reach down and back for your other leg above the ankle. 
  3. Pull the heel back towards the bum while keeping the core engaged and the low back flat. 
  4. Keeping the top knee and ankle parallel and level with the floor, lift your bottom heel onto the top part of your knee. 
  5. Next, guide your lower leg down toward the floor with your heel while keeping the top leg, knee and ankle parallel and level to the floor. 
  6. As the top leg is lowered down, have the top knee and thigh pointed downwards so it’s in alignment with your whole spine. Hold this stretch for 30 seconds and repeat 3 sets 2 times daily.

References:
https://www.uptodate.com/contents/overview-of-running-injuries-of-the-lower-extremity