Tag: running injury

Last year at this time, I was primarily gym-ridden. After roughly five months on snow, my fitness was high but my tolerance for the impact and specific demands of running were low. Throwing better judgement to the wind, I gave in to the allure of warm days, rapidly drying trails, and beloved road loops around town, and paid the price.  

Despite running between zero and ten miles total between December and the end of February, I took off for my first run of the season: 4.5 miles. That first week totalled 20 miles in four runs. Much lower than summer totals, but far greater than the sum of the months prior.

Two weeks later, I did a 90 minute trail run with roughly 1,200 feet of climbing and descending. What started as the sensation that a tendon on the lateral side of my right knee was snagging with each leg swing quickly turned into a sharp stabbing pain. I hobbled my way home and by that afternoon, I couldn’t walk downstairs without sidestepping or even make it down the gentle slope of my front yard. Sound familiar?

This experience is not uncommon. When snow conditions deteriorate in the spring but weather is perhaps not yet conducive to cycling or rollerskiing, our options for aerobic exercise that provides the same satisfaction as the kilometers we logged all winter are limited. The best available early season option is often running, so we lace up our cobwebbed sneakers, and fight the temptation to jump back in too quickly. 

While some may tolerate a rapid transition, there are a myriad of running related injuries that could easily crop up. Last year at this time, FasterSkier featured recommendations from Dr. Ross McKinnon, DPT, to address the topic of a healthy transition to running. His advice included a slow increase in running volume, working on running mechanics, beginning with soft surfaces, and making sure your shoes are up to the task. 

To add on, we reached out to DPT candidate, Olympian, and former APU Teammate Jess Yeaton for additional information to support a healthy return to running. 

Seconding Dr. McKinnon’s first recommendation, Yeaton began with the importance of committing to a gradual return.

“I think the absolute biggest thing is taking a slow progression back and not increasing your weekly mileage too much, as well as adding in exercises that target strengthening glute med.”

The gluteus medius muscle, or glute med, is a fan shaped muscle on the outside of the hip which connects the iliac crest to the top of the femur. The glute med plays a vital role in single leg stability, in particular, in maintaining level positioning of the hips and proper alignment of the leg during each stride. After all, running is essentially a repetitive high-impact single leg motion, so stability at the hips and through the core are key.

By strengthening the glute med, runners can reduce “hip drop” and prevent the knee from caving inward with each stride. These phenomena reduce the body’s natural mechanisms for absorbing the impacts of running. They put abnormal strain on various ligaments, tendons, and joints down the chain, leading to IT Band Syndrome, knee and low back pain, and more. 

“Examples of [exercises to strengthen the glute med] would be things like donkey kicks, fire hydrants, bridging up with both legs and then holding with one leg,” Yeaton explained. “I actually had to do a community project working with a running group here in Albuquerque for school and made a video with some of these exercises, which is available on YouTube.”

In the video, Yeaton demonstrates forward and lateral walks with an exercise band looped above the knees. Maintaining tension in the band activates and strengthens the glute med, promoting better stability in single leg movements, such as running — or skiing!

Yeaton also contributed to an article on single-leg stability geared toward better balance on skis this fall, which can be found here. 

In the gym, you could try single leg deadlifts with a kettlebell or free weight to build stability. To execute this move correctly, it is important to keep the hips level to the floor and avoid the tendency to rotate away from the standing leg. While keeping a flat back, focus on hinging  from the hip and staying within the range of motion that your hamstring flexibility allows rather than reaching the weight toward the floor, which often leads to rounding at the low back. In addition to challenging your single leg balance, you should feel this in the glute and hamstring of the standing leg. 

Another option for enhanced glute med strength is to try a split squat with the rear leg elevated, also known as a Bulgarian split squat. With one foot resting on a box, stair, or bench, complete a single leg squat, creating a 90-degree bend in the knee of the standing leg. The knee of the elevated leg should drop straight down toward the ground, while the other knee stays stacked over the ankle and in line with the foot. 

By pushing your heel into the ground as you come out of the squat, you can keep the action in your glute muscle, rather than letting the quadriceps muscles on the front of the upper leg take over. Again, the positioning of the hips is important; here they should stay squared forward throughout the movement. 

Yeaton also noted that she commonly sees skiers develop calf and achilles related injuries from jumping back into running too quickly and recommended variations of calf raises and heel drops to combat these issues. 

“Another one you could add is doing calf raises with a ball between your ankles, which puts you in a supinated position (meaning the foot is rotated slightly inward), which helps target tibialis posterior. I’ve noticed this muscle is a BIG problem for a lot of skiers.”

The tibialis posterior lies underneath the gastrocnemius, more commonly known as the calf muscle. Running the full length of the lower leg, the tibialis posterior begins behind the knee and connects to the arch of the foot. It helps to flex the foot and reduce pronation, where the arch collapses and the ankle tracks inward. This is commonly seen in runners.

To perform the exercise, hold a soft ball, such as a tennis ball, between the heels of your feet. Slowly rise onto your toes while maintaining the positioning of the ball, hold briefly at the top, then return slowly to standing. 

“For achilles strength, you can do heel drop exercises on the stairs. Push up into a calf raise on both feet, then lower down slowly on one foot. The eccentric, or the slow, controlled lowering part is what’s important.”

Returning to the concept of a gradual increase in running volume, Yeaton recommends actually calculating how quickly you are ramping up. Yeaton recommends the 10% rule — meaning volume should increase by no more than 10% per week. She referenced a 2014 study titled “Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury”, which followed roughly 900 runners for one year, tracking mileage increase and injuries. The research showed that athletes who increase by 30% or more were at a higher risk for injury, whereas those who increased by 10% or less were the least likely to incur a running-related injury. 

“I think this is crazy when skiers put a number to it, because that really isn’t much of an increase… from what I’ve seen, what most athletes consider taking it slow and easing back in is really a pretty significant progression.”

Obviously, there are caveats — if you start with one three mile run, you’ll probably be okay running more than 3.3 miles total the next week. If you ran 12 miles over four runs last week, you probably shouldn’t run 13 in one go the following week. However, paying attention to frequency, distance, and intensity of your runs as you progress can play a vital role in keeping your body happy.

Anecdotally, running 5-7 miles once per week through this winter has made a big difference in my ability to progress this spring. 

So there you have it. Work on hip stability and core strength (bonus: this will help your skiing too!), incorporate calf raises and heel drops, and keep an objective eye on your progression. Have fun and stay healthy!