by Liam Oliver, Physiotherapist
Returning to running after injury
Do I need to strength train?
strength training is often overlooked as a key part of a runner’s training. It is especially important after an injury due to the decreased capacity of the injured area as a result of time off running and the injury itself. Strength training minimises any imbalances and weaknesses as well as increasing the body’s capacity to deal with the demands of the task thrown at it. It not only minimises injury but also enhances performance.
Research on the ability of strength training to reduce injuries is strong. Here is a summary of some of the key evidence:
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Individuals with kneecap pain were shown to have 26% less hip abduction strength and 36% less hip external rotation strength than healthy individuals. (1)
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Hip abductor weakness was a significant factor in the development of ITB friction syndrome. (2)
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strength training reduced sports injuries to less than ⅓ and overuse injuries could almost be halved (3)
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In a study of 24 patients with ITB, hip abductor weakness was identified in the affected leg of the symptomatic patients. Rehabilitation exercises led to a 51% and 35% strength gain in abduction in men and women, respectively. This also led to resolution of symptoms in 22 of 24 cases in only 6 wk. (4)
What can I do before running to help condition my body?
The forces that the body must absorb when running are multiple times your bodyweight. Whilst strength training can help prepare the body for this, it is often not enough. A structured walking program and plyometric training can help prime the body for the forces it will endure in running. Plyometric training was shown to reduce the risk of injury in marathon runners when compared to core training and no training (5).
Example walking and plyometric program:
How can I be sure I am ready to run?
Returning to running after injury should not occur unless you have gone through a series of assessments with your physio. Completing these assessments towards the end of your rehab will give you and the physio confidence that you are ready to run. These assessments should test your strength, endurance, power and balance. Just remember, if you are not testing you are guessing! Some of the commonly used assessments have been detailed below:
How do I build up my running without re-injuring myself?
Once you have returned to running, the next challenge is to get yourself back to a full training capacity. Building up too quickly can lead to overuse injuries. This means it is important to be educated on how to safely increase your running load. Here are a few tips:
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Start by tracking the duration or distance - this can be done by recording the time or kilometres that you run for.
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If you are managing this well, start tracking the intensity of your running - an easy way to do this is to record the RPE of a session. See this link here for more information.
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Have some days off between running - On these days, go for a walk, or do a strength training session.
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Repeat the previous session before increasing your running load - repeating a session gives your body time to adapt.
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Don’t increase everything, every week. This means, you shouldn’t try to increase both your PACE and your DISTANCE at the same time. You’ll likely end up disappointed, either because you’re incredibly tired, or because of injury. Early on, focus on building up some distance. Then, once you’re consistently running at least 3-5km (depending on your goals), add in some pace in a shorter run (for example, a 3km run but faster than normal.)
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Have a deload week. This means, instead of increasing the difficulty of your sessions every week for ever, try 3 weeks of building up your run, then 1 week of cutting your running distance in half, but keeping the pace (intensity) the same. This allows you to recover mentally and physically, and you’ll experience what is called ‘super compensation’. This means the following week when you start to build your runs again will feel amazing!
Whilst you are increasing your running load, you will need to monitor any pain or soreness that might be early signs of a potential injury. The following information can be useful in determining how to interpret this pain or soreness:
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it should not affect how you run
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it should not get progressively worse
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it should not exceed a 3/10 during or after a run (note that some tissues have a latent response to exercise, such as tendons)
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the pain should not last more than 24 hours
Most runners are great at consulting a physiotherapist when their injury first occurs, helping them receive a diagnosis and start their journey to recovery. However many runner’s aren’t aware of the different elements that need to be considered when attempting to return to running after injury (strength training, walking/plyometrics, assessments and load management). This is where a physiotherapist can continue to assist you to navigate you through these important stages of rehab.
To book in with one of our expert running physiotherapists today, click here.
References:
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Davis, I et al (2003). Hip strength in females with and without patellofemoral pain. Journal of Orthopaedic & Sports Physical Therapy, 2003 Volume:33 Issue:11 Pages:671–676 DOI:10.2519/jospt.2003.33.11.671
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Mucha, M. D., Caldwell, W., Schlueter, E. L., Walters, C., & Hassen, A. (2016). Hip abductor strength and lower extremity running related injury in distance runners: A systematic review. Journal of science and medicine in sport.
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Lauersen, J. B., Bertelsen, D. M., & Andersen, L. B. (2014). The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British journal of sports medicine, 48(11), 871-877.
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Fields, K. B., Sykes, J. C., Walker, K. M., & Jackson, J. C. (2010). Prevention of running injuries. Current sports medicine reports, 9(3), 176-182.
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Lundstrom, C. J., Russell, H. C., O’Donnell, K. J., & Ingraham, S. J. (2019). Core and plyometric training for recreational marathon runners: effects on training variables, injury, and muscle damage. Sport Sciences for Health, 15(1), 167-174.
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