Injury Prevention for Runners

Recently I got an opportunity to attend a workshop on “Injury Prevention for runners”. The workshop was conducted by Dr. Gladson Johnson.  The workshop was very insightful and informative  for the runners. I have captured the relevant learning from the workshop for the benefit of the fellow runners:

1.       Who am I?

This is most important question. One should understand and appreciate “who is he/she”. You can either be a recreational athlete or a professional athlete. This segregation is done based on the maximum time you spent on the activity. We all would be categorized as recreational athletes as we spent smallest part of our day on this activity vis a vis professional athlete who spent maximum part of their day on this activity.

You can have a role model in life, but do not think that you can mirror him in all aspects. Do not follow the professional athlete as they prepare at a different level and their goal is very different from a recreational athlete.

2.       How long?

Amongst living creatures human being has the best adaptability. Human being can live in any climatic condition from extreme cold to hot climates and adapts very fast. Whenever one starts something new, he/she has to give time for getting adapted to same. If one uses his body without adaptability, it is called abuse. When one gives enough time and puts lot of work on the activity one is pursuing he/she gets adapted, the same is sustainable too and it is called use. In running parlance, running in isolation is abuse and running with a proper regime of conditioning and strength building leading to adaptability is use of the body. Give proper time to your body to adapt. Appreciate your own body, do not compare with others, for sure with practice you will perform better for yourself and get your PBs. If you are a runner, the suggested thresholds for various levels in terms of time/duration is:

a)      First 18 months – 10 kms

b)      Post 18 months – Start with 21 kms

c)       Post 36 months – Start with 42 kms

     When you are doing 10km distance, you can stretch to 14-15 kms in your practice run, and when you are doing 21 kms, you can stretch to 25-30 kms during your practice run. This would minimize the chances of injury and you will be comfortable covering your 10km and 21 km distance during official event.

   For an injury free running, time spent on running should be 30% and time spent on conditioning should be 70%.

One does not get expertise in any activity, unless you practice the same for 10 years.

Pain is called a pain and hence if you see a pattern in your pain, you should consult a doctor.

In running, you do lot of action based on feel. Do not go with the feel factor, rather go with logical flow. You may feel that you can do a half marathon after a 10km run or a full marathon after a Half Marathon but in reality if you have not practiced enough, you may complete the distance but with calling for injuries.

3.       What is running?

Running is an aerobic system of work-out. Any aerobic system of work-out maximizes the use of heart and lungs. Swimming and cycling are also an aerobic system of work-out with swimming being the easiest with low impact and cycling having semi-impact. Running is a full impact form of work-out. Swimming and cycling aids in recovery and does not necessarily helps as cross training. Both are form of endurance training only and does not help in strength building.

If as a runner, you only run and do not work on conditioning and flexibility, you get endurance in return which is just one-third of your investment in running. Endurance sport, you lose the strength and flexibility in the body. To get better return from running, one has to continuously work on building strength through conditioning and flexibility workout for the body. Thus to get 100% return from your investment, along-with running one need to focus on the strength and flexibility training/workout.

Striking a balance between running and conditioning is very important. Any endurance sport has high level of repetition. When you are running, you keep swinging your arms, moving your legs back and forth repetitively. For building endurance one should focus on repetition but for building strength once should focus on full muscle movement and the essence is in the time you can hold the position.

It is suggested that beginners should spend 2 days on running and 4 days of conditioning and next level runners should spend 3 days on running and 3 days on conditioning. Flexibility building should be part of daily routine. One should do one activity in a day and take one day in a week as complete break and should not over-do by including morning and evening schedule for running and conditioning.

Suggested Strength and flexibility training are:

a)      Yoga (do not focus on repetition, rather focus on form and time), flexibility is a by-product of Yoga. For example, time spent on each pose of Surya Namaskar helps in strengthening and flexibility, however faster repetition of the poses ends up building endurance. Power Yoga does not help in strength building, it ends up an endurance activity;

b)      Pilates – this is good for strengthening, it is westernized form of yoga;

c)       Cross Fit – this is good form of strengthening, Namma Crossfit across Bangalore is catching up;

d)      Gym – this is good for runners, only if we do not use cardio. When in gym runners should focus on weights. Weights help in building the strength;

Plyometric exercises are for agility and cannot be considered as good for strengthening. This again helps in building the endurance. High Intensity Impact training (HIIT) is again an endurance building activity, but may vary based on the design of the program. Cross Fit acts as a dynamic stretching only.

For injury free running, any runners’ calendar has to follow a micro and macro cycle i.e. a year should be split into micro and macro cycle. Keep high intensity during the macro cycle and reduce the intensity during the micro cycle. It can be in combination of 9 months and 3 months for runners running for 5 years, else it can be 6 months and 6 months or if it works it can be in intervals of 3 months alternating between macro and micro. A runner should build his calendar and plan the events to participate before-hand. The concept of micro and macro cycles helps immensely in recovery and thus lesser probability of injury.

Runners have to understand the importance of weight vs health criteria. There are runners who just neglect the health as they focus on running to control weight. Runners’ who are very weight conscious, tend to continue running even though they are injured or highly fatigued. By doing do they compromise on their health side.

As runners’ do not ever under-estimate fatigue. Do not go by the feel factor i.e. even after 20km run on the previous day, you feel fresh next day and may feel that you can run another 20km, this may not be a right approach and it may lead to injuries due to not recovering well. You feel so because you have adapted to the calendar/routine you have designed for yourself but this is another avenue where you are inviting injuries.

Sleep is very important, whatever you do during the day, all dissipation happens through sleep. When you sleep, you should have a sound sleep i.e. you should not know what is happening around. A minimum six hour sleep is a must for body to recover, in case you sleep less than six hours, you need to work on increasing the same. Restless sleep is not good, you may be boasting yourself to be alert sleeper, but it does not help the body. As part of routine you may get up every morning for the work-out, but at the same time for better performance you should sleep well.  

4.       Impact:

Body weight has nothing to do with impact. When you run, the impact is double of your weight. Impact can be controlled with right technique. The following techniques are essential for less impactful and efficient running:

A: Arm Swing: Beat the drum. Do not carry any weights with you, keep yourself light while running. A bottle in one hand or a mobile phone or a belt on the waist for keeping the hydration should be avoided. All these would impact while running. For hydration, either buy or keep it at a proximity in the loop in which you are running. Swinging the arm at 90 degrees is the right form of running. For sustained arm swing, you must strengthen your shoulders.

B: Breathing: Breathe through nose and not through mouth. 10 times breathing through mouth is equal to one time through nose. Breathing through nose help in regulating your heart rate. One breathe out of mouth completely exhausts you thus taking more effort during the activity. Most of the runners use mouth for breathing. You need to start breathing through nose, start with 2:2 steps, and increase to 4:4 steps till it reaches 25:25 steps.

C: Core Control: Build your core and use the core to drive your body during running. Build strength in your abdomen. This will help you stand tall till the finish of the run, irrespective of the distance. As a test on how strong is your core, put your fingers deep on the stomach and feel the core and you will yourself realize the work you need to put on strengthening the core. As you see in martial arts, before the act they shout loudly, why? To activate the core and show the impact.

If you follow above, A, B and C, the result would be in D and E i.e. Direction and Efficiency.

Running like any other sport requires right technique. If you have been running, when you work on changing the technique your mileage will drop by two-thirds which will be very demotivating. Do not get dishearten, it is essential that you re-boot yourself and start afresh. In long run this will be immensely helpful and you can be a recreational athlete for life. Focus on technique over distance.

5.       Pre and Post Run:

Pre-run, it is very much essential that you warm-up. Warm-up is essential to bring the heart rate to a right level for you to start the run. If you start running without warm-up the heart rate increases very fast and when your body has not yet adapted. Run or any activity without warm-up is an invite for injury.

Following are suggested as part of warm-up:

a.       Spot jogging for 1 min (with increasing speed)                      

 

b.      Spot Skipping for 1 min

c.       Full Squats – 20 reps

                                  

d.      Alternate site bending – 20 reps

              

e.      Alternate front and back bending – 20 reps

   

f.        Wide squats – 20 reps

       

Post run, cool down or warm down is also of immense importance. Cool-down or warm down should be completed within 45 mins of the finish of your run. Cool-down or warm down is nothing but stretching all your muscles. For cool down and warm-down, the following are the suggested stretches:

a.       Kneel sit on toes

         

b.      Kneel Sitting

                                             

c.       Long Lunge Stance                                            

 

d.      Wide Stance forward bend

e.      Fork stance forward bend 

 

f.        Shoulder Ankle kiss

                                                 

g.       Sumo Pose

   

h.      Half kneeling “Q” stretch

                   

i.         Interlocking elbows side bend                                      

j.        Rotator cuff stretch

                                             

k.       Head side bends

                                                                  

l.         Back bending

6.       Conditioning for strength building

As stated above, conditioning is the heart of running strong, running consistently and running injury fee. Conditioning has to be done diligently on the non-running days. The following are suggested for basic conditioning:

a.       Pushups 

     

b.      Stiff Leg Lunges

     

c.       Hand Bridges

                           

   

d.      Stiff Arm forward bend

      

  

e.      Side Press with side hand plank

    

f.        Front Plank to Hand plank

                           

 

g.       Hip Thrust

          

h.      Wind Shield Wiper

                    

i.         Pull-ups

j.        Single leg calf raises

k.       Upper Back extensions

 

l.         Reverse Plank Dips

For effective results, all these need to be performed in 12 rep * 3 sets * 3 days per week. Each rep should be 2 + 2 seconds. 2 seconds while going down and 2 seconds while coming up. Breathe in while going down and breathe out while coming up. Breathe through nose and not through mouth.

7.       Others:

a)      Shoes: Select the shoes which are (1) Light Weight; (2) Bend from the mid-foot; and (3) Moderate cushioning. Shoes should be changed based on wear and tear. Wear and tear can be identified looking at the soul of the shoes. When you buy new shoes, get adapted to the same before using in the event. Another important aspect is the tying of the laces. We tend to just tie the lace from the end and start running. Rather it will be immensely helpful if you do and undo the shoe laces from the start till the end every time you wear shoes.

b)      Chaffing: This can be avoided by applying Vaseline or putting a tape. This is the result of friction of the soft tissues.

c)       Foam Rolling: Foam rolling is a new way of recovery. Foam rolling should be done after 72 hours of the long-run/event. It can be made a part of calendar for once a week activity. Use a soft foam roller to start with.

d)      Cramping: Do not stretch immediately on getting the cramp. Lower the pace/intensity for some-time and then if you feel comfortable stretch light for recovery.

     A big thank you to Dr. Gladson Johnson for sharing these insights and helping with practice of the above during the workshop. I hope you will find this useful for injury free running. I personally have taken the above insights and have started implementing in my daily schedule of work-outs as I prepare for the next milestone I have set for myself in running. 

Notes taken in the workshop held in Bangalore on 10th October 2015