Monday, September 12, 2016

Marathon Training Tip #10: Reduce Knee Injuries

Pain is a language.  Ignore it and you will more often than not pay the price.  Most running injuries are not traumatic, but present over time beginning with pain during the activity of running and progressing to pain during and after a run.  Acting at the first warning sign will shorten the recovery time and reduce any down time that might be necessary.  If you ignore pain more likely than not symptoms will worsen and more time will be lost from your training.  If pain worsens to the point that it is painful with normal daily activities or keeping you awake at night, you should seek a professional evaluation.

The knee is a complex joint and primary shock absorber for running.  Approximately 12 times body weight is absorbed with each stride.  Patella-femoral injuries, sometimes referred to as Runner's Knee occur if we land with our knees extended or do not have strong quadriceps and hamstrings along with a flexible Achilles tendon to absorb shock.  Landing toward the midfoot with a slightly flexed knee and performing strength training exercises can help minimize this injury.  Follow this link to learn a series of strength training exercises for runners using a simple piece of equipment:

Training Errors

Increasing the number of times you run per week and or number of miles per week is the biggest culprit.  When injury does occur it is best to modify your schedule and remember the ultimate goal is to be healthy come race day.  Missing a week of scheduled runs is preferable to pushing through and worsening the injury.  If you can keep the pain level below a 4 on a 1-10 scale during a run, 10 being terrible pain, it is usually safe to continue on a reduced frequency and duration schedule.  Increase non-impact activities to either help recover following runs or to substitute if pain is greater than 4 or present at rest.  Highly recommended is water running.  If a pool is not available then try the elliptical trainer or spin bike for low impact cardiovascular conditioning.

Biomechanical Faults

“Stay in your hinges.” The late Dr. Rob Roy McGregor, sports medicine pioneer coined that phrase and simply means to run with good alignment.  When alignment is off, the stress on the knee will be magnified with each stride.  If you have arches that collapse (excessive pronation) the inside of your lower leg and inside of your knee is susceptible.  If you tend toward valgus (knock knee) or varus (bow legged) you are susceptible for Iliotibial band (IT band) issues.  

Strengthening the outside of the hip is often overlooked, but is key in preventing and recovering from many knee injuries.  Here is a link with an exercise called Scooters used to strengthen the hip abductors:

Proper shoes as well as arch supports are important as well as correcting any muscle imbalances.

Use a common sense progression of 10% per week in your training, correct and condition the muscles that cross your knee joint, listen to your bodies signals and your knees will carry you many miles without a problem.

Watch the video for a few simple self-help techniques...

Blog post by Joe Carroll.

About Joe Carroll PT DPT SCS 

Joe is a Doctor of Physical Therapy and co-owns Cape Cod Rehab with his wife, Kathy. One of the first PT’s in the state to be certified as a Sports Clinical Specialist (SCS), Joe is also a Master Instructor in the Burdenko Method. He continues to run and support local road races every year and knows what it takes to help athletes get to the level they desire. Joe is a 5-time Boston Marathon finisher and ran his 7th marathon on April 18, 2016 at the Boston Marathon raising money for Boston Children’s Hospital.

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