Running Technique and Injury Prevention

Whether you are interested in improving your speed, increasing the distance you run or reducing the risk of injury there is no shortage of information available to help you on your journey. However, which bits are relevant to you? How do you know if your glutes need strengthening, your ITB needs more stretching or if you just need to change your trainers? Then there is a whole host of other things to think about when buying a new trainer such as which brand, neutral or anti-pronation? If you have an injury should you run through it or take 6 weeks off? Should you see a physio, running coach or massage therapist? Are you struggling with injuries because you don’t stretch or warm-up enough? Is it your technique? Are you going to cause more damage or harm yourself? My head is spinning is yours?!

Seriously though, they are all really good questions and undoubtedly lots of the advice is good and may help, BUT which advice should you pay attention to and which can you ignore? In other words which is most relevant to you? When it comes to injury management or prevention one of the things we think about is whether your aches and strains are making you run differently and so affecting your technique OR is your running technique creating the problem in the first place?

Clear as mud hey?!

Ok, in my experience there is no one size fits all although there are definitely exercises that can be really useful for different runners regardless of their individual niggles, aches and pains, preferred running distance or terrain (I will come back to these exercises later). I would also strongly recommend you seek professional advice, preferably with someone who has experience of assessing and treating runners / sports injuries (check out their success stories) if you have an injury or any on-going niggles that are affecting your ability to run as much or as far as you would like.

 

So what physically needs to happen in your body to help you run?

Running involves movement in 2 different directions:

  1. Forwards and backwards – the arms and legs move backwards and forwards to keep you travelling forward and at the same time your hips, knees and ankles rotate to ‘lock’ the joint so when you land it is stable and you don’t fall! Then these joints ‘unlock’ to allow hip, knee and ankle to bend so that your leg can move forwards into position ready for you to land on again. The ‘locking/unlocking’ of these joints is a small movement within the joint capsule (the tissue that surrounds the joint) itself as opposed to a twisting / rotating movement such as counter-rotation (see below). As you land the knee, hip and foot should be facing forwards in line with each other to reduce the risk of injury at eny of these joints (see picture below – image on the left). This also gives a more stable support for our trunk/upper body.Lunge fwd pic

  2. Counter-rotation – this happens in the trunk and pelvis when you step forward on one leg the opposite arm also swings forward. This does 2 things:

a) Helps to spread the forces created as you land across the spine and reduces the stress placed on the hip, knee and ankle joints. This movement creates rotation in the spine which tightens the muscles and fascia (fibrous tissue that connects the opposite shoulder and pelvis to each other) on one side and stretches it on the opposite side. This creates or releases elastic energy and allows us to be able to fully use the forward propulsion created when the foot lands on the ground (the drive phase).

b) The swing of the opposite arm forwards keeps us balanced, a trunk (upper body) that tips from side to side as we run potentially increases the risk of getting injured or having back pain but also wastes energy which will slow you down! Achilles tendons can be placed under too much load if we lose rotation and cannot use the impulse created as the foot strikes the ground.

planes_of_movement_when_walking

Freely available movement in your joints!

You can see from the picture above you need to be able to bend and extend your hip joints. A loss of hip extension (so in this picture we are talking about the back leg) can reduce rotation at the pelvis and increase the load on the lower back which may lead to back pain. Something to think about if you are receiving treatment for back pain associated with running and its not improving as you would like, it may mean you need treatment or exercises to improve your hip mobility for your back pain to fully recover.

The feet play an important part in running (to be fair they are important in any weight-bearing activity!) in the stance (landing) phase in helping to:

  1. Absorb some of the forces as we land.
  2. To stay balanced and upright and also helps with the timing of the muscles controlling the hip and knee.
  3. Make sure these joints are in the right position for your to land on.

The soles of your feet you have specialist sensory (feeling) receptors that tell the rest of the leg about the ground you are running on so that your ankles, knees and hips can make the subtle adjustments required to stay injury free and upright! Through the different phases of landing you need the foot to be flexible as your weight rolls from the outside to the inside to then eventually pushing off through your toes.

 

What puts you at risk of injury?

To be honest there isn’t a definitive list but things such as:

  • Previous injury that either hasn’t fully resolved so it affects the way you run and puts additional stress on other parts of your body.
  • An injury such as a sprained ankle which may have healed but has affected your balance or ankle flexibility which can put you at a higher risk of it happening again
  • Over training so not building up your distance or how often you run gradually, not getting enough ‘rest days’ so either mixing your training up or just have a day off!
  • Poor balance, timing or co-ordination of the muscles and joints
  • A loss of mobility (stiffness) in any of the joints that form part of the running motion (which is a lot as most of the body is involved!)
  • A lack of flexibility or movement in the muscles or nerves (as these are physical structures that need to move) – this may be more noticeable if you are increasing your stride length to run faster
  • Pain pretty much anywhere can either lead to you either holding yourself more stiffly than you normally would or moving differently to compensate or avoid using/moving the painful bit
  • A lack of muscular endurance – so muscles get tired which affects your performance or technique
  • Poor running technique! Although there are individuals who run that don’t have good technique and may possibly never have any injuires – but in my experience poor running catches us out sooner or later! It may not be as obvious as a injury but persistent muscle tightness that doesn’t seem to ease with stretching or that pain that comes on after a certain distance or if you run up or down hills can be a sign that your running style may need looking at.

 

Top tips to help reduce the risk of running stresses, strains and injury!

1. How good is your balance?

Can you stand on one leg comfortably for at least 30 seconds with your toes nice and relaxed, your whole body in a straight line, from head to toes, that includes your hip and knee. Your weight should be balanced / spread over the whole of your foot – not all over the heel or toes or all on the inside or outside of the foot. Try feeling the sensation of your foot if you struggle with this then have a look in the mirror.
If you struggle then some practise is all you need! Remember to breathe! Your hips and shoulders should be level – if your hips and pelvis drop down like in the picture below then The Clam (below) is the exercise for you!

Trendelenberg pic

The Clam (strengthens the muscles that keep your hips and pelvis level when you stand on your leg – Gluteus Medius.

– Lie on your side so your upper body is in a straight line and head is supported
– Bend your hips and knees, feet are together
– Keeping your knees together, slowly lift the top knee off the bottom knee – NO rolling backwards!
– You can practise holding each lift 5 to 10 seconds, repeat 15 -20 times, rest for up to 60 seconds and repeat 2 more lots of 15 – 20

The clam exercise

2. How stable and supported are you when you land?

Can you do a lunge?

– In front of a mirror try a lunge (see picture below). Feet are hip width apart. Slide one leg backwards.
– Lift the heel of the back foot up
– Bend the back knee & drop the pelvis & the trunk vertically down towards the ground
– Keep the front foot flat.

Can you feel any knee, hip or ankle pain?

Then check:
– Does your front knee or foot roll inwards?
– Does your trunk stay upright? Do you lean forwards or backwards? Or does your trunk tips sideways?

Lunge fwd pic              Lunge

Can you correct any of the above if they are happening to you? If so have a go & practise until it happens naturally. Remember it’s meant to effortless!

 

3. How well do you lift your leg and bend your hip?

Stand in front of a mirror, feet together and arms out at shoulder level
– Lift one leg so that your knee comes up to hip height and then lower back to the starting position
– Do the same with the other leg
– Alternate between left and right leg – do about 5 on each

one-leg-balance

Can you stay upright and balanced or does one arm or your trunk tip to the side?
Do your feet come back together when you put your foot down?
Does your knee lift in a straight line?

If you answer ‘yes’ to any of the above keep practising until you can say ‘no’!

 

4. How flexible is your upper body?

– Sitting down, feet and knees hip width apart and feet flat on the floor
– Rest your hands on your thighs
– First find your sitting bones! Try rocking your pelvis back and forwards feeling yourself sitting on the fleshy part of your bottom then onto the bony part!

natural sitting position

– Then slide one hand down your thigh towards your knee and the other in the opposite direction towards your hip. Let your shoulders and trunk follow your hand so that you are gently rotating your trunk – no slumping! Keep your chest up!
– Head and eyes face forwards while your upper body moves

Knee-slide-2      Knee-slide-1

Can you do this keeping your shoulders level and while breathing!!

Do this continuously for 30-60 seconds and repeat 3-5 times

 

5. Are you just simply doing too much?

To be honest we are so unique as individuals this is not such a straight forward answer! As a general rule I would say varying the speed and distance of your runs can be very helpful, making sure you get enough recovery time in between training sessions. Recovery time doesn’t necessarily mean that you have to have a day of complete rest a change of training can be as effective and can help with your running speed and endurance in the long run. So maybe try some cycling, rowing or swimming on your ‘rest’ days.

I would always advise supplementing your running with weight or resistance training this doesn’t have to mean pumping iron in the gym! But can include classes that work on your own body weight as resistance such as circuits or body combat type classes. Finally, keeping as flexible as you can! Some of us are just stiffer than others (me included!) and have to work harder at staying more bendy! Static stretching of your muscles, certainly before you run, hasn’t been proven to reduce your risk of injury but regular stretching or taking yoga classes does help keep your joints more flexible and that will definitely help!

 

6. Are you having regular massage?

I think we all underestimate the benefits of regular massage treatment. I know for some it may be seen as a bit of a luxury (although that may depend on the type of massage…!). All joking aside a good massage from a therapist who has been properly trained is fantastic and cannot be understated. It can make all the difference to how you feel when running and help you recover between sessions much more quickly and so helping you run faster and further AND regular massage means your therapist can detect tightness in your muscles often before you get any symptoms which has 2 benefits: 1) they improve your muscles flexibility and reduce the risk of injury 2) refer you on to see a physio if its not responding for a more detailed look at you and your running technique – reducing the risk of injury and it becoming an chronic issue! Consider massage an investment in your body and in your whole wellbeing.

 

Jenny Manners MSc MCSP
Principal Physiotherapist @ Meadowhead Physiotherapy
JEMS Certified Practitioner (Joanne Elphinston Movement Systems)

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