Chronic injuries like piriformis syndrome, achilles tendinitis, Knee pain & ITB friction syndrome, plantar fasciitis, are all common running injuries that could easily be prevented if a well designed strength training program was implemented. Having been a very keen distance runner for a long time myself, I am very aware of all the injuries associated, and experienced first hand many of the most annoying and painful injuries in my time. For what seems like a fairly gentle sport, I have had more injuries from running than playing football. Having said that all these injuries I am referring to occurred before I discovered how to actually prevent them. All of my best times as a distance runner were not until I was 35 years of age, when I was finally running pain free and really taking my running to new levels. I am now 47 years of age and can still get out and hit a 20 minute 5km within a few weeks of training and always without pain! So what is the secret? Well it was not from running more, in fact my best times were when I was running less! The secret was using strength training and working on my running technique. I found the perfect combination of strength training, stability training, postural retraining, movement skills and more efficient running technique that allowed me to reach my potential. If I had of known this many years earlier who knows what I would have been able to achieve. I have since used the same methods for assessing hundreds of runners and sporting athletes to overcome some of the most annoying and chronic injuries preventing them from enjoying their running or sport. In this article, I am going to show you these secrets and also what I have found to be the common traits so you can prevent them from stopping you in your tracks.
Is Strength Training Useful To Runners?
Many runners fear that strength training will make them "big" by producing huge gains in muscle mass, creating a ‘dead weight’ to be lugged around during running.
This is true if you do weight training like most people do in the gym which is based on body-building principles. The body-building technique will definitely make you stronger, and bigger, but it will not help you run faster, and it definitely will not prevent injury. If anything it will create injury! This type of strength training is to be avoided, but what about other forms of strength training will they make you big and bulky too? It is near impossible for distance runners to get "big" as they need to devote a huge commitment of time and energy to the weights room which is far more than most runners are willing to do. So that hits that myth right out of the park.
What runners also fail to understand that unless you are a sprinter you are actually eating your own muscle tissue from running too often. This is called the catabolic process. You are in fact becoming weaker in the legs as opposed to stronger! When you appreciate that up to 3 times your body-weight is being placed on your hip joint during the running action you realize how important a strength program can be.
Okay so it is clear you need to strengthen your legs.
Does that mean just start doing some heavy squats in the gym and a few step ups and you will be right? No you need a plan. A simple program like this will add some strength and power to your legs, but a key problem is that it may contribute to some muscle imbalances becoming greater. Meaning it will cause problems rather than solve them!
Where do you start? There are nearly an infinite number of strength exercises and almost as many workout programs. How do you select the exercises and program which are perfect for you? How do you coordinate your strength program with your running routine? You need a starting point, and that means you need an assessment.
And you need to base your program on functional movement patterns.
Why You Need An Assessment To Define Your Weaknesses & Muscular Imbalance
Below is a great video to watch of how we use a Single Leg Squat to pinpoint any weakness and a video giving you some ideas relating to improving your gait pattern.
Understand however you need to assess all movements and not just this one, but this gives you a great insight into how important strength training will be for improving performance and preventing injury.
Unfortunately there is not a single set of strength exercises which is best for all runners, which magazines like Runners World will tell you, there is only a few key exercises for YOU. That is because we all have unique strengths and weaknesses based on previous injuries, posture, occupation, genetics etc.
It would be impossible to narrow this list to a handful of exercises. For each of your weaknesses, there are a handful of key stretches, stability exercises and strength-training exercises that will make you stronger. Your job is to identify your weaknesses and find the best ways to strengthen them. A detailed assessment will help you pinpoint these weak links? If you are consistently injured in one part of your body, that area is unnecessarily weak and needs to be strengthened. Just remember your body will continue to compensate and break down various joints if you ignore these weaknesses and continue to train and run.
Now even though we have established that the exercises we need to use will vary significantly from person to person. The causes are nearly always the same! They are:
- Poor posture
- Poor running technique
- Poor pelvic control
- Weak glutes
- Stiff ankles
- Poor foot stability
Arguably the two biggest factors are foot stability and glute strength.
In a single leg stance your glutes are needed to control the alignment of the leg and prevent excessive pronation. Excessive pronation is the common theme to every injury I listed at the start and the foot and hip play a big part in creating this problem. When you look at the running action it really is a series of single leg squats. Meaning if you have a problem with a single leg squat, then you will have a problem with running! Guaranteed!
Strong Glutes Equals A Strong Runner!
The posterior chain muscles of the glutes and hamstrings provide the major torque-producing capacity of the body during the activity of walking and running. From hip extension in walking, to powerful hip extension in sprinting, the Posterior Chain are the key muscles in use. It makes sense to really look after them if you are a keen runner.
Take a look at the picture below to see what happens when you lose control of the hip or the foot.
The gluteus medius is a hip extensor, abductor, and external rotator while it also stabilizes the pelvis in the frontal plane. There is three distinct heads of the gluteus medius muscle that perform a unique role as the body moves:
- The posterior fibres - These fibres contract at early stance phase to lock the ball into the hip socket. The posterior fibres therefore essentially perform a stabilising or compressing function for the hip joint.
- The middle/anterior fibres - These run in a vertical direction, help to initiate hip abduction, this is where the clam comes in which is then completed by a hip flexor muscle known as the TFL. The glutes work in tandem with TFL in stabilising the pelvis on the femur, to prevent the other side dropping down.
- The anterior fibres - These allow the femur to internally rotate in relation to the hip joint at mid-to-end stance phase. This is essential for pelvic rotation, so that the opposite side leg can swing forward during gait. The anterior fibres perform this role with TFL.
How do you strengthen your glutes?
Well it takes a lot more than just doing some clamshell exercises or hip extensions on the floor. The Single Leg Squat is the BEST leg exercise you can do if you are a runner! It is absolutely critical you become the master of this exercise if you want to be a great runner and have no pain. For running is a series of single leg squats at high speeds! However, you will need to gradually build up to doing this movement and will need to start with easy exercises before progressing to the more complex single leg movements.
Shortly I will provide you with some good video examples, but I suggest to grab a copy of the free checklist below that will take you through the process of building strong glutes.
Now to help you out I am going to give you a brief overview at our rehabilitation and injury prevention programs for some of the most common running injuries.
Plantar Fasciitis & Achilles Injuries
These are both very annoying injury and very painful. It often starts out as a mild ache and one that most people ignore in the beginning before it becomes much more chronic, which can seriously derail your training efforts and affect daily living.
Anyone who has had that real burning feeling in their heel or underneath their foot knows all about this injury and how painful it can be. This injury affects the heel and underside of the foot. And it is characterized by inflammation, or structural breakdown of the foot's plantar fascia. Pain is worst first thing in the morning when you get out of bed and try to put your foot on the ground.
Typical treatments usually involve remedial massage, trigger point balls and lastly orthotics to correct the pronation of the foot. However the breakdown of controlling the internal rotation of the femur by the hip, because of weak glutes and abdominal muscles we have found to be a much more significant contributor.
Also do not underestimate the role of poor breathing mechanics and overall posture. The forward lean of being a mouth breather trying to get more air is another common cause to this problem. Poor footwear, tight ankles and tight hips are all factors that need to be considered in designing the overall program. And last but not least assessing your running technique is critical. Quite often I find people with this condition over stride and are massive heel strikers.
Great articles to read with more information on each of these injuries is provided in the links below
Piriformis Syndrome
A much more severe injury with this condition leaving people almost disabled and unable to stand!
Common causes of this condition trace back to sitting too long, genetic weakness within the hips, poor posture and movement skills, that includes running technique that all become exacerbated once running training begins. A more detailed article on this is here "Piriformis Syndrome - What A Real Pain In The Butt".
The function of the piriformis muscle is to assist the glutes to externally rotate the hip when it is extended, and abduct the hip when it is flexed. The problem occurs when the Piriformis begins to overwork due to lazy and weak glutes. Because the glutes are not controlling the "rolling in" of the hip the piriformis and other hip muscles, try to take up the workload.
When it overworks it becomes short and tight, and starts to compress the large sciatic nerve due to it's location which is right next to the sciatic nerve. This leaves a deep aching pain in the butt or a radiating sharp nerve pain that extends along the back of the legs near the hamstrings. It feels like hamstring tightness but it is only nerve irritation. Sometimes this can even lead to numbness and tingling into the calf and toes.
Some great video ideas of how to combat this problem are shown below.
Our detailed program, with over 60 minutes of video and 70 pages of exercises and instructions will give you the best information on how to treat this condition. To find out more go to Quickstart Piriformis Video Toolkit. If you are a runner who suffers from this now, this will be the best money you ever spend and can save you a lot of time, money and unnecessary pain by implementing these methods which we have provided hundreds of people all around the world long lasting results.
Click here or on the image below to get yourself a copy of the Ebook or the video.
Patella-femoral Knee Pain
If I was to conduct a survey with 100 runners asking how many were dealing with knee pain at the moment, there would be a good chance about 85% of them would begin to tell me about their niggling problem that wont seem to go away, or how it hurts going downhill, but seems okay on flat ground.
Unfortunately, for some people this niggling problem can grow into a much larger more sinister problem that can lead to chronic pain! Surgery should always be a last resort after every other more simple less invasive methods are tried. Because as you will find, just like the other two injuries Knee Pain actually has not much to do with the knee!
This is because unlike the ankle and the hip, the knee joint itself cannot perform any other movement than flexion. It is basically like a hinge on a door and can only flex forwards and backwards, it has very minimal rotation movement. It basically gets caught in the crossfire of the ankle and the hip who are meant to be controlling all of the sideways movement. The knee cannot control what happens if the hip or ankle are too stiff or weak and do not keep the entire leg aligned.
This is why people with knee pain find the lateral movements most painful and difficult to do. And why runners find downhill so much more painful because the quadriceps are trying to "brake" to stop you falling flat on your face but the excessive forces on your leg must also be controlled by the glutes to stop you over pronating. To see detailed article on knee pain read this article "Weak VMO & Knee Pain". Once again we see the role of the glutes and the abdominal muscles combining to create perfect leg alignment in a single leg stance.
Excessive pronation will cause the compensatory movements from the hip in order to prevent the knee getting pulled into sideways movement, which it cannot do. In many ways this injury is so much easier to work with compared to the previous two injuries but unfortunately many people make the mistake of trying to work with all the muscles around the knee such as the VMO.
Trying to strengthen the quads and even isolate the VMO is what most people are told to do. Strengthening the VMO without first incorporating the glutes or integrating the posterior chain of muscles is a complete waste of time and why so many rehab programs for the knee never work. For many people the whole reason they have knee pain in the first place is due to Quad Dominance and a weakness in the entire posterior chain! Your solution is to learn how to release the tight muscles around the hip and encourage the lazy glute muscles to fire.
The videos below will provide you with a ton of ideas of how to combat this problem.
As with our Piriformis Syndrome video we also released a Knee Pain video and PDF report that you can find out more by going to our online shop and download instantly by clicking here or on the image below. We provide latest techniques, over 60 exercises, stretches and mobilizations plus a 6 month program to get you back into action. An absolute must if you currently have knee pain and want to be able to run pain free!
ITB Friction Syndrome
The iliotibial band is a thick band of fascia that begins at the pelvis and runs down the outside part of the thigh, and crosses the knee to attach into the top part of the tibia or shinbone. It forms from the hip flexor muscle known as tensor fascia latae (TFL) and the gluteal muscles where it stretches across to the knee. The main function of the ITB is to help stabilise the outside part of the knee through its range of motion.
It also is one of the hip abductor muscles that helps to moving the hip away from the mid-line. The iliotibial band also helps with both knee flexion and extension. Notice I underlined the word helps both times and this is important to remember for this muscle is designed to assist much larger and more powerful muscles such as the glutes to perform their role of hip abduction and stabilisation of the hip and knee. It is not powerful or capable of performing this role on its own but due to compensation and muscle imbalance this is exactly what it does.
Due to the location of this muscle and the precarious positions it ends up in is how this injury is created. It is located behind the femoral epicondyle, which is a small bony protruding part of the femur (thighbone) at the knee joint. Whenever you flex and extend your knee the IT band moves across this condyle. To help make it move smoothly across this bony prominence there is a sac or bursa under the band, however with increased friction from repeatedly rubbing the ITB due to poor movement eventually leads to pain which is felt along the outside part of the knee.
Unfortunately it is very common for many people to ignored the symptoms of this injury in the early stages and continue to train until the inflammation increases to a point where scarring can develop in the bursa. This significantly decreases knee range of motion resulting in more pain and eventual end to all type of training.
The video below provides you with a great explanation of this injury and some of the exercises I would use to treat it which are very similar to the patella tracking problem seen prior to this.
I also suggest to read the detailed article as it has a ton of additional information and exercise examples to help you.
Running Technique
An article on running injuries would not be complete without looking at your running technique. I highly suggest finding a good running coach who knows the Pose Method. Here is a link to another good video about pose running - POSE RUNNING VIDEO
I changed my running technique about 10 years ago to this method and along with the strengthening and stability work mentioned already this made me not just injury free but very efficient. As time went on and I got better and better at this technique my times just kept coming down and down even from not running all that often and the fact I was getting older!
My best times by the way are: 5km - 18:51, 10km - 39:31, 15km - 1:02:30, 21km - 1:27:31. All of these were set in 2010 when I was 37 years of age! I am by no means a world class athlete but no chump either!
Anyway looking at the running technique. The main emphasis with pose running is that you are trying to land on the mid foot! Many people are taught to land with a heel strike and most of us will do that automatically, which is not only very inefficient but very quad and hip dominating.
What the pose method tries to do is use the hamstring muscles to withdraw the foot from the ground, relying on gravity to propel the runner forward.
The bad news with this technique is extremely that it is really hard to master. It took me a good year to get just the slightest idea of it and I had to use a lot of the drills to help get it into my head, not to over stride or land on my heel. A good runner should have a very high leg turnover not a long, extended stride length which is what I used to do. In pose running, the key is to maximise your effort in removing your support foot from the ground; good training is essential to ensure that you don’t over-stride or create excessive vertical oscillation.
The runner should fall forwards, changing support from one leg to the other by pulling the foot from the ground, allowing minimum effort and producing minimum braking to this body movement. The idea is to maximize the use of gravity to pull the runner forward.
Without a doubt the best running method for injury prevention I have seen in all my years as a trainer and keen runner. To find out more about this google Pose running or go to Rehab Trainer for heaps of information and case studies. Below is two videos we use to teach beginners the basic concept of this.
Conclusion
To achieve your potential as a runner or simply just to enjoy your run without that niggling pain you must adopt a well designed strength training program. Following someone else's program or a one size fits all workout from a Runners World magazine will not do much good for you, and as we have shown you could make it worse. You need to apply a simple assessment method of defining tight muscles that need to be stretched, followed up with stability and strength exercises for muscles that are weak. Your focus will inevitably lead you to work on your glute strength in a standing position with many single leg squats and various lunge or single leg methods. If you can apply this to your training you will never look back and be able to complete every run without fear of re injury and more importantly have fun!
For more ideas and information on specific topics I may not have covered in detail be sure to check out our INDEX PAGE on the website that has over 300 of our best articles. These are all sorted into categories for quick reference so you can find what you are after more easily. You can also subscribe to our FREE fortnightly newsletter by clicking here.
If you do need specific help with your exercise program please feel free to reach out to me for help and we can set you up with your individualised program.
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 15 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specialises in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References:
- Functional Anatomy of the Pelvis and the Sacroiliac Joint - By John Gibbons
- Sporting Ankles - By Peak Performance
- Muscle testing & function - By Kendall, McCreary, Provance, Rogers, Romani
- The Vital Glutes - By John Gibbons
- Movement - By Gray Cook
- Corrective Exercise Solutions - by Evan Osar
- Back Pain Mechanic - by Dr Stuart McGill
- Diagnosis & Treatment Of Movement Impairment Syndromes - By Shirley Sahrman
- Low Back Disorders - by Dr Stuart McGill
- Ultimate Back Fitness & Performance - by Dr Stuart McGill
- Core Stability - by Peak Performance
- Athletic Body in Balance - by Gray Cook
- Anatomy Trains - by Thomas Meyers
- Motor Learning and Performance - By Richard A Schmidt and Timothy D Lee
- Assessment & Treatment Of Muscle Imbalance - By Vladimir Janda
- How To Eat, Move & Be Healthy by Paul Chek
- Scientific Core Conditioning Correspondence Course - By Paul Chek
- Advanced Program Design - By Paul Chek
- Twist Conditioning Sports Strength - By Peter Twist
- Twist Conditioning Sports Movement - By Peter Twist