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: http://mashpeefitness.blogspot.com/2016/08/cape-cod-rehabs-ccm-training-tip-6.html

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: http://mashpeefitness.blogspot.com/2014/11/5-burdenko-strength-exercises-for.html

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.

Marathon Training Tip #9: Other Recovery Techniques

Last year I completed my first 2 half marathons.  I was cruising through my first half back in June and I remember saying to myself at mile 10, “Wow, I can’t believe how great I feel!”  Then I got to mile 11 and my left calf started to cramp, shortly followed by my right calf.  No matter how much stretching I did on the course, I could not stop the cramping.  It wasn’t pretty but I finished the race, limping across the finish line.  I remember the pain being severe over the next few days at work but this didn’t stop me from registering for another half marathon in the fall. 

Moving forward with my training, I decided to try wearing compression sleeves over my calves.  There isn’t much evidence out there supporting that they’ll improve performance, but there is some evidence stating that they prevent muscle soreness post longer runs.  I wore these sleeves during my second half marathon last year and I got through the entire race without cramping and without excessive soreness afterwards either.  

When faced with an injury you always want to remember the acronym P.R.I.C.E.

P stands for protection from further injury

R stands for rest

I stands for ice

C stands for compression

E stands for elevation

Paula Radcliffe sporting compression
as she sets the World Record at the
2003 London Marathon!

During exercise muscles produce lactic acid.  Too much lactic acid causes muscle soreness and also makes muscles fatigue quicker leaving them susceptible to injury.   Wearing compression socks helps fight the effect of gravity and can help return blood to the heart quicker.  This allows the body to eliminate lactic acid more efficiently allowing our muscles to perform better over the course of a long run. In theory this sounds great!  My calves definitely felt the difference in a good way.  But do they actually work?  

There is a great article written by Andrea Bachand, MSc PT, BSc Kin who does an excellent job summarizing the current evidence on this topic.  Basically most studies do not correlate wearing compression socks to improved running performance or improvements in physiological performance such as HR, blood lactate levels, or VO2 max profiles.  However, one study from the International Journal of Sports Medicine by Bringard et al back in 2006 showed that wearing compression tights decreased running energy costs but only at very low speeds.[i]  So the compression socks/sleeves may provide a benefit for those like me who run at 9-10 minutes/mile or slower paces.  You can check out Andrea’s article here: http://www.run3d.co.uk/announcements/compression_socks.

Ice is always beneficial after an injury.  It is a natural anti-inflammatory.  Sometimes the body over compensates for an injury and swelling can become excessive.  Ice helps reduce swelling immediately after an injury.  However, when swelling is already present, that’s where combining ice with compression can help even more.

Game Ready is a company that provides Active Cold Compression Therapy.  A sleeve is wrapped around the injured body part which circulates ice water and inflates to aid in the healing process.  Cold therapy is effective because it slows the metabolic demand of cells, which limits the cells need for oxygen, preventing secondary tissue damage.  The unit then inflates adding compression to the desired body part.  This produces a pumping action, mimicking what our muscles do. This muscle pumping-like action helps eliminate swelling from the area, aiding in lymphatic drainage and improving blood flow. [ii]

Another company that provides dynamic compression is NormaTec and has become very popular among professional athletes.  NormaTec makes dynamic compression devices that use a Pulse Massage Pattern to help improve lymphatic drainage, thus improving blood flow.  There have been several studies published demonstrating the benefits of dynamic compression.  There are 3 components to NormaTec’s patented Pulse Massage Pattern. Pulsing is the first component.  This is more effective than static compression because it mimics the muscle pumping action of our arms and legs, “greatly enhancing the movement of fluid and metabolites out of the limbs after an intense workout.”[iii]  NormaTec also utilizes gradients to mimic the one way valves in our veins and lymph vessels.  These valves prevent fluid backflow.  NormaTec uses hold pressures in separate zones to keep fluids from being forced in the wrong direction, allowing the device to deliver maximum pressure in each zone.[iv]  NormaTec than utilizes a distal release pattern, releasing the hold pressures in lower (or distal) zones once they are no longer needed to prevent backflow.[v]  There are 7 levels of pressure.  I feel most comfortable at level 5.

Check out the video below to listen to Celtics Head Athletic Trainer, Ed Lacerte, explain the benefits of NormaTec![vi]  (I love Waltah!)

[vii]

I’ve been using the NormaTec sleeves as part of my recovery from a recent hamstring/calf injury.  It feels great after a 15-minute treatment and really helps accelerate the recovery process.

These are a just a few things that can help speed your recovery after a long run or help accelerate the healing process after an injury.  Let’s face it, us runners hate to take time off from running!

Blog post by Jon Carroll.

About Jon Carroll PT DPT OCS

Jon joins the Cape Cod Rehab Running Team with a few personal running accomplishments including finishing his first 2 half marathons in 2015.  A three sport athlete in high school, Jon took up running after completing his first Falmouth Road Race back in 2010 and hasn’t looked back.  A Physical Therapist and Orthopedic Clinical Specialist (OCS), Jon enjoys working with runners because he knows how good running feels and understands the frustration when runners have to take a break when injured.  Jon’s goal is to run a full marathon in the near future.  His motto: “Ultimate fitness is a marathon, not a sprint.”

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[i] www.run3d.co.uk/announcements/compression_socks

[ii] http://www.gameready.com

[iii] https://www.normatecrecovery.com/how-compression-works/how-and-science/default.aspx#sci

[iv] https://www.normatecrecovery.com/how-compression-works/how-and-science/default.aspx#sci

[v] https://www.normatecrecovery.com/

[vi] https://www.youtube.com/watch?v=OuQRMkAf7mY

[vii] https://www.normatecrecovery.com/

Marathon Training Tip #8: Aquatic Recovery

One of the most overlooked aspects of training is rest and recovery.  Often times complete rest for active people is very difficult.  There are many benefits to including active recovery sessions in your training.  One of the best places to perform an active recovery workout is in the water.  The water provides a non-weight bearing environment in that helps reduce stress on the joints, provide traction to your spine, promote circulation and reduce swelling to name a few.  The shallow water can provide some of the same benefits by reducing the amount of impact performing similar activities to running. At waist level in the water you are about 50% weight bearing.  Last but not least, exercise in the water is fun! 

Try these aquatic recovery exercises to improve your performance, reduce your risk of injury and add some variety to your training program.

Deep End Exercises

Wear a buoyancy belt. Perform waking exercises for 2-3 laps & hanging exercises 10-15 repetitions.

Forward Walking

Equipment: none

Action:  Step forward in a normal walking pattern. Alternate arms with each step while focusing on forward movement with proper alignment and posture. 

Walk + Stretch

Equipment: none

Action: Walk 3 steps then kick your leg forward, reaching for your foot with the opposite arm.  Walk 3 steps and repeat with the other arm and leg.  Keep torso straight and keep toes up.

Symmetrical Walking with Turns

Equipment: none

Action:  While walking forward turn palms out and push arms out to align with shoulders. Arms make a breast stroke motion. Bring arms to chest.  Return to start position.  Take 3 strokes forward, then turn 180 degrees and walk 3 strokes backwards, turn 180 degrees and repeat.

Splits + Spreads

Equipment: 2 long bars

Action:  Separate legs in open scissors kick position: one leg straight forward, another leg straight back.  Return to start position. Repeat with the other leg forward.  Return to start position.  Spread both legs apart to the sides, keeping toes up and legs straight.  Return to start position.

Tips:  Keep legs straight and attain full range of motion with each movement.  Feel the stretch while keeping toes up to.

Leg Stretch Series

Equipment: 2 long bars

Action: Bend one knee to a 90° position, keeping toes up. Extend leg straight in front of the body then back to the 90° position. Return to start position. Repeat with the other leg. Repeat the sequence changing leg extension of the knee to an internal position (kicking across the body) then an external position (kicking out).

Running Pendulum

Equipment: 2 long bars

Action:  Run moving to the side lying position using four running steps; pause.  Return to start position. Repeat moving to other side.

Shallow End Exercises

Perform walking exercises for 2-3 laps & stationary exercises 10-15 repetitions.

Weight Shift Catch

Action:  Shift weight to one leg and simultaneously catch and lift the knee with both arms and pull the knee to the chest, hold the balance. Return to start position. Repeat with the other leg.

Tips:  Maintain straight body alignment while pulling the knee up. Come up on the toes each time when pulling the knee up.

Catch + Pull

Action: Walk forward 3 steps and catch one foot with the opposite arm behind body, the other arm reaches straight above the head.  Return to starting position.  Walk forward 3 steps and repeat with the opposite hand and foot.  For an added challenge—before you catch the foot, bend the weight bearing knee down into a squat position and power up to your toes.

Leg Swing

Action: Walk forward 3 steps, stand on one leg while swinging the other leg forward, back, forward. Swing the arms so opposite hand and foot are in front.  Was forward 3 steps and repeat with the opposite side. Make sure to keep your body straight and sing the leg high back and forth.

Squat Hurdles

Action: Walk forward 3 steps then squat, arms straight forward at shoulder level. As you stand, mimic hurdle motion: one leg kicks straight out, touching the foot with your opposite hand. Other arm extends back.  Walk forward 3 steps and repeat with the opposite hand and foot.  Get the motion in rhythm, kicking knee is straight, weight bearing leg is on the ball of the foot.

Carioca

Action: Stand with arms out to side at shoulder level. Step side to side crossing one foot in front then in back (like the grapevine). Take wide steps, keeping your pelvis stable.

Blog post by Eric Chandler.

About Eric Chandler

Eric joins the Cape Cod Rehab Running Team with a background in Exercise Science. He is a Certified Strength & Conditioning Specialist (CSCS), certified in Part I & Part II of the Burdenko Method, a Certified Functional Movement Screen (FMS) Specialist, and has also been training in the TRX Suspension Training Method. Eric looks for his clients’ strengths and uses those strengths to help them get the most out of each session. A recreational runner, Eric has served on many of the CCR Flyers Cape Cod Marathon relay teams as has a goal of breaking 20 minutes in the 5k.

Marathon Training Tip #7: Give It A Rest

I’m sure you’ve been crushing your long runs, giving big efforts on your tempo runs and speed work, but maybe you’re starting to feel some tightness and soreness creeping in at times. What is the first step to preventing this from becoming an injury situation that keeps you from finishing your training and reaching your goals on race day? 

REST!

Why do you want to do this you might ask? Well for one reason, resting is when you get faster! All of your training is a stress to your body, this makes your tired, sore and decreases your ability to hold efforts in training. When you rest, the adaptations take place and you bounce back ready to go harder and stronger than before. Another benefit is that all that soreness from the great training you’re doing is going to decrease. You’re going to be more comfortable and that will translate to more productive workouts.

So, how do you incorporate rest into your training?

Professional triathlete Jesse Thomas shared some tips with Competitor Group:

Go way easier on your easy days.

Not every workout needs to be a personal best, your hard workouts should be HARD and your easy ones should be really, really, really easy. You’re training for a big effort on a single day, not a multi-day event like a cycling stage race.

Change the plan when your mind or body aren’t up to it.

If you have a long run or intense track session planned but the kids are sick, work went late and you skipped lunch, change the workout or push it to another day when the workout can be more productive for you.

Sleep More!

The single biggest difference between professional endurance athletes and amateurs is sleep. It’s hard to do; between family obligations, work, home maintenance and watching the Olympics every night, but if your motivation is dropping and the body is feeling sore, get some extra sleep. Even if it means skipping a workout here or there, remember the workouts are the stimulus for improvement, the actual improvement comes when we rest. Just a little bit adds up fast, one of my cycling friends once pointed out to me that just an extra 15 minutes of sleep a night is an extra hour and 45 minutes of sleep in a week.

When should you rest and how should you rest?

Blog post by Eric Wheeler.

About Eric Wheeler MSPT MPE CSCS

Eric joins the Cape Cod Rehab Running Team with an extensive list of athletic accomplishments including 2x Ironman finisher with a PR of 10:09:05. He earned a Boston Qualifying time for 2016 with a marathon PR of 3:06:27. A Physical Therapist and Certified Strength & Conditioning Specialist (CSCS), Eric enjoys helping injured runners get back on their feet.  It’s hard to believe Eric only started running in 2010 because everyone at Cape Cod Rehab was excited about the Falmouth Road Race! His motto: “Never judge your life because of one bad day. Judge it because of the BEST DAY.”

Marathon Training Tip #6: Strength Train

What do most runners do to train?  Run.

The majority of distance runners started running because they love to run.  There are many health benefits to running and it is also convenient to just walk out the door and run.  Often overlooked or ignored by runners is the importance of strength training. Complimenting your running program with strength training will improve your performance and also reduce your risk for injury.  

Here is a TRX series of exercises that will help strengthen your total body with exercises specifically selected to address weaknesses typically seen in runners.  They will help strengthen the core, upper body and lower body and should be performed 2-3x per week, with a day of rest in between.

Note: Do not perform any exercise that causes or increases pain.

Warm Up

Squat/Row to Heel Raise

Hold the TRX handles with arms bent and your feet shoulder width apart. Sit back into a squat keeping your heels on the ground and extend arms. Stand back up pushing through your heels and pulling with your arms. Once fully standing raise up on to your toes. 

2x15

  

The Workout

Power Pull

Hold the TRX handle in single handle position with one hand.  Keep elbow bent at the start and feet shoulder width apart.  Extend arm holding handle and drop back into a squat.  Reach back with your other arm towards the ground.  Return to the start position by pulling with your arm and driving up with your legs. 

2x10 each arm

Alternating Side Lunge

Hold the TRX handles and stand with your feet together.  Take a large step out the side keeping toes pointed straight ahead. Bend the knee that you took a step with pushing hips back and sitting into a side lunge position. Return to the start position and step to the other side.

2x10

Balance Lunge with Knee Drive

Hold the TRX handles and stand with your feet together.  Step back into a reverse lunge.  For a challenge: keep the back foot off the floor in a balanced position!  Stand up on your stance leg driving your knee forward into a march position.  Do all repetitions on one side then the other.

2x10 each

Bridge with Hamstring Curl Series

Lay on the floor with your heels in the TRX cradles (handles should be about 12” off the ground). Raise your hips into a bridge position.  Keeping hips level draw one knee in towards your body.  Extend leg out and repeat with the other leg. Repeat with both legs. Lower body back to the floor.

2x10

Watch Meaghan demonstrate all the TRX Strength Training for Runners exercises...

Bonus! Runner’s TRX Core Circuit

Complete the three exercises in a row without rest.  Try the circuit 3 times.

Mountain Climbers

Start in a push up position with your feet in the straps.  Maintain a flat back as you march knees towards your chest in an alternating pattern.  As the knee comes in towards your body your hips should rise slightly. 

10x

Three Position Crunch

Start in a push up position with your feet in the straps.  Maintain a flat back as pull both your knees towards your chest. Return to the start position and pull both knees in towards your right elbow, return to the start position and pull both knees towards your left elbow. Repeat the series of 3 movements 5x.

Pike

Start in a push up position with your feet in the straps.  Keep your legs straight and drive your hips towards the ceiling as you pull your feet towards your hands. 

10x

Blog post by Eric Chandler.

About Eric Chandler

Eric joins the Cape Cod Rehab Running Team with a background in Exercise Science. He is a Certified Strength & Conditioning Specialist (CSCS), certified in Part I & Part II of the Burdenko Method, a Certified Functional Movement Screen (FMS) Specialist, and has also been training in the TRX Suspension Training Method. Eric looks for his clients’ strengths and uses those strengths to help them get the most out of each session. A recreational runner, Eric has served on many of the CCR Flyers Cape Cod Marathon relay teams as has a goal of breaking 20 minutes in the 5k.