I’ve been a competitive athlete all my life. I started playing basketball in the fourth grade and played competitively through two years of junior college before transferring to UW Madison. I thought about attempting to walk-on at the UW, but came to the frank realization that I just wasn’t that good and I should probably concentrate on my studies. I was so competitive during high school that I played my junior and senior years with stress fractures in both feet. I was supposed to sit out 4 to 6 weeks, but just couldn’t mentally handle sitting on the sidelines. I sat out one game and couldn’t handle it; I lied to my coach about being cleared to play, taped up my feet and hit the floor. The pain and frustration of not playing was far worse than any the physical pain. This mindset, this need to be active is common in many competitive athletes. It’s this quality in athletes that drive us to be constantly at our best, it pushes us through the tough times and helps us excel during the good. But this quality will also cause us to abuse our bodies well beyond what we should. This can be seen across the sporting world, but is especially apparent in distance running where overuse injuries are common. During any distance run, every runner comes to a point where they feel discomfort, and have to decide whether to stop or to push through the pain. More often than not we push through the pain.
I’ve learned the hard way how overuse injuries can sideline a competitor for weeks and months at a time. I started running a little over a year ago to train for the Walt Disney World Marathon, and being the competitor that I am, I thought I could do more than I could. I pushed myself too hard, too fast. About six months before the marathon, I pushed myself on the long run and injured my knee. After a couple week of pain that prevented me from any kind of running, I decided to go to the doctor who referred me to a physical therapist, who then referred me to my running evaluator, Scott. Scott was a lifelong runner who showed me the ins and outs of injury prevention while running. He videotaped me running on a treadmill and then we played it back frame by frame showing my form and where it needed improvement. He then gave me techniques and advice on how to improve and we hit the treadmill to practice. If it wasn’t for him I probably never would’ve completed my first marathon. A lot of running stores, physical therapists and sports medicine experts offer this service and I encourage every new runner to have it done. Here is some of what Scott told me, and what I’ve learned along the way to prevent injuries and run pain free.
Start from the ground up – Pay attention to the surface you run on. Always running on the left side of the road facing traffic is good from a safety standpoint, but the constant slant of the pavement where your right foot is always higher than your left will limit the healthy pronation of your left foot and encourage overpronation of your right. Repeating this 180 strides a minute, mile after mile, week after week, can lead to injury. Find a flat trail to run on, especially if you are returning from injury or feel one coming on. Also, it may not be as nice as running outdoors, but treadmills provide a nice flat surface for runners recovering from injury or marathoners trying to increase distance.
Proper shoes – Each foot is going to hit the ground about 90 times per minute, which is over 5000 impacts over a 30 minute run. Your shoes are the only thing cushioning your body you against each blow. Having properly fitted shoes is essential for running injury free. To find the right shoe for you, go to your local specialty running store. They are a treasure trove of information and helpfulness. They will spend the time to measure your feet and then watch and analyze you run to get you fitted with the proper shoe. Many will even let you road test so that you to find out which pair is right for you. In general, you don’t get this kind of service or knowledge at the large chains stores. Once you have the right shoe, how do you know when to replace them? There are a lot of opinions, but as a general rule they should be replaced every 300 to 500 miles.
Cadence and stride – In essence, cadence is how often your feet touch the ground and stride is the distance of each step. Typically speaking, the slower your cadence, the longer you will be in the air, and the harder you will land with each step, which over time may result in injury. To measure my cadence, I count the number of steps I take with both feet over 30 seconds and then double it. Not only does it keep my feet turning over at a proper rate, it also gives me something to do on the long runs. The magic number for cadence seems to be 180 steps per minute. This should give you a short enough stride so that you are light on your feet while not forcing you to take baby steps. This was one of the keys to getting me to run injury free. I was using too long of a stride and heel striking when my foot hit the ground, which is a big running no-no that I will discuss in the next section. In theory, your stride should end and your foot should land directly below your center of gravity, not too far ahead, this technique allows the runner for greater efficiency while preventing injury.
Foot strike – Foot strike refers to what part of the foot hits the ground first. There’s been a lot of debate whether heel, mid-foot, or forefoot striking is the best approach to endurance running. The mid and forefoot strike allows for greater shock absorption and thus can prevent injury, as compared to the heel strike. When I did my running analysis, I was running with the heel strike. When running with the heel strike each step on the treadmill produced a loud thud as my foot hit the ground. As soon as I was coached to run on my forefoot, there was a noticeable sound difference and I could feel less impact in my knees. It was awkward at first, it felt like I was running on my tip-toes, but I got used to it. To me, this with the single greatest change in my running technique that allows me to run without injury.
R.I.C.E – RICE stands for rest, ice, compression, and elevation. These four things are the best immediate treatment for joint pain and muscle aches. Of the four, the most important component is rest. You need to give your body time to mend before taxing it again. You don’t have to be totally inactive, but just take it easy on the affected area until you are pain free. Ice is used to reduce the inflammatory response and pain of an injured area. Typical recommendations are to alternate ice and no ice for 10 to 15 minutes for a 24 to 48 hour period immediately following the injury. Remember, too much ice is a bad thing as it reduces blood flow and prevents the body from flushing toxins from the affected area. Compression is used to reduce swelling that result from the inflammatory process. This is typically done with an Ace bandage wrap. Elevation is also used to control swelling. It is most effective when the injured area is raised above the level of the heart which helps your body return blood. Ice tends to be the best friend of an injured runner but don’t underestimate or forget the other components of RICE.
Listen to your body – This is probably the simplest and sometimes most difficult piece of advice to follow. On a long run there will typically be some sort of discomfort; choosing which pain you can run through and which is causing harm is a difficult task the master. At the first sign of an atypical pain or a discomfort that worsens throughout your run and forces you to alter your gait, you should begin to take it easy. Give yourself a rest day or two substituting walking for running or alternate with some other form of a cross training. When you get back to running take it easy, start off at a pace slower than your normal training and gradually work yourself back up. For competitors this can be a maddening process, but the price of giving yourself a few rest days is far better than having to sit out a week or a month with a severe injury.
Strength training your core and hips – Over the course of a long run, as you tire, weak core muscles allow for sloppy form which can lead to injuries. You change your gait without realizing by not having the strength to hold good form. When you strengthen your hips and core you increase your leg stability all the way down to the ankle. The goal is not bulging muscles but good solid strength to keep your pelvis and joints in proper position. A 2007 study found that of 284 patient that complained of leg pain, 93% of them had weak hip muscles. After completing a strength program 90% of these people were pain-free within six weeks. For recommendations on a hip work out visit www.runnersworld.com/injury-treatment/all-hips
Build mileage gradually – It is said that you should increase long runs by a maximum of 10%, meaning if your last long run was 10 miles the following should only be increased to 11 miles with adequate rest time in between. Newer runners, or runners coming back from injury, should keep this number closer to 5%. Your body needs time to adapt, typically two to three weeks between long runs. Pushing yourself too far too fast is an easy mistake for any competitor to make.
Limit race and speed workouts – There is a correlation between injuries and the frequency of race efforts while running. For runners trying to improve their time, regular speed training is great, but this kind of training is not recommended for average runners. For typical runners trying to quicken their pace a weekly, or biweekly, speed workout is good, but be wise about it and listen to your body. Give yourself plenty of recovery time. A good general rule is one rest day per each mile at race speeds. So a 3.1 mile run, at race pace, should be followed by three rest days.
Stretching and warm-up – This is a highly contested issue. You can find arguments for stretching before a run, after, or even not at all. I will give you my thoughts from research and what I’ve been told, but just be aware that there is a lot of differing opinions. Through research I have found stretching before a run will decrease power, force output, and speed (i.e. it’ll actually make you slower). A dynamic warm-up, focusing on muscles you tend to use during your workout, will improve performance and give you the most benefits for your time. A proper warm-up gets the blood flowing and prepares the muscles for the workout ahead. On the flipside, it cool-down is just as important, build in a five minute walk after each run to let the blood return from the legs to your core. As far as stretching, my preference is to do it after a workout while my muscles are still warm, it seems to reduce cramping and keep me flexible.
If you have any questions comments or concerns: please feel free to contact me; my email is RaceDisney@yahoo.com, follow me on twitter @racedisney or visit my webpage www.raceDisney.com. I love hearing from fellow runners and hope to chat with you soon.
QOTD: What is your best injury prevention tip?