Preventing running injuries

Preventing running injuries

As November begins, the marathon season comes to a close this weekend with the New York City Marathon. While some people will cross the finish line after months of training, many others will have quit before they started due to a variety of injuries.

The most common problems runners face are overuse injuries. Jeff Rothstein, an exercise physiologist and Director of Sports Enhancement at the PT Center for Sports Medicine (a Physiquality network physical therapy clinic in Akron, OH), says that “some of the most commonly seen injuries among runners are plantar fasciitis, Achilles tendonitis, shin splints, and runner’s knee,” all stemming from overuse. He recommends the following exercises to avoid such injuries:

  • Strengthening the muscles of the foot and calf. Performing 3 sets of 12-15 reps of calf raises, in addition to some single leg balance activities, is a great start. Helps to prevent: plantar fasciitis and Achilles tendonitis.
  • Strengthening the tibialis anterior (front of the shin). Doing heel walks will strengthen this muscle and help to prevent overuse and inflammation. To perform, stand on your heels with your toes as high as possible and walk for 30 seconds. Rest and repeat 3 times. Helps to prevent: shin splints.
  • Strengthening the IT band. Side leg raises work this fibrous tissue well. Lie on the opposite side of the affected leg, straighten the knee, and slowly raise and lower the affected leg. Perform 3 sets of 12-15 reps. Helps to prevent: runner’s knee, or painful inflammation of the IT band.

Strength training is essential for runners.Marsha Berger Grant, a physical therapist and managing director for Apex Physical Therapy, a Physiquality network physical therapy clinic in Chalfont, PA, notes that “the probability of injury occurring may have more to do with what you may not be doing then actually just the running itself. Strength training is essential and often overlooked among runners.”

This is seconded by Chris Nawrocki, a physical therapist and COO at The Center for Physical Rehabilitation, a Physiquality network physical therapy clinic in Grand Rapids, MI. Chris suggests strengthening throughout the core, gluteus maximus (buttocks area) and gluteus medius (pelvic area). He also points out that because the nature of running is a straight line activity, frontal (side to side) and transverse plane (rotational) exercises are important in an exercise program. Exercises like clamshells, bridges, lunges with upper body rotation, squats with an elastic band around the knees, and planks work on these areas. Moving from these strengthening exercises into more functional, weight-bearing positions, and gradually progressing to plyometrics and single leg balance positions, are important for carryover to running.

This is also why Chris encourages cross-training. Adding other sports, like swimming or cycling, on a runner’s off days will help strengthen muscles unused in running and give running muscles a rest. And, especially if you’re just starting to run, don’t do too much too fast. Build your running distance gradually; Chris says to add no more than 10-15% of your distance per week.

Test your balance before going out for a run.All of our PTs stressed the importance of balance for runners. Peter Kluba, physical therapist and owner of Global Physical Therapy (a Physiquality network member with 2 locations in Michigan), suggested this test for checking your balance before running:

Stand tall and still on one leg, with the leg bent at 90 degrees at the knee and hip. Keep your arms at your sides. Hold for at least 30 seconds without wobbling or swinging, even a little.

Once you’ve mastered that, try holding the balance longer, extending your leg, or holding the balance on a BOSU (seen at left) or a wobble board.

Besides strengthening and balance, stretching is also key to preventing injury. Jeff says, “As a strength coach, the vast majority of runners I see have terrible flexibility in their hamstrings and in the muscles surrounding the hips. This can lead to a less efficient gait and make the athlete more prone to fatigue and subsequent injury.” He recommends focusing on the hamstrings, glutes, groin, IT band and hip flexors. Marsha also points out that the way one stretches is just as important. She notes that “dynamic stretching, where you actually move through the stretch, is shown to be more beneficial than traditional static stretching.”

Physiquality also has partnered with several companies that offer products beneficial to runners:

  • Archmolds insoles offer additional arch support customized for your foot. The heat-shaped inserts can even be shaped inside your favorite running shoes, and since the insoles can be replaced more cheaply than your shoes, will help you go longer before replacing your kicks.
  • Use the Indo Board to develop balance, coordination and increased leg strength while enhancing your core fitness. Keeping the board from touching the ground for extended rides is both the goal and the challenge.
  • Many of Medi-Dyne‘s products can be used to help runners stretch and strengthen, but one in particular stands out. The ProStretch Plus is designed to stretch the calves, feet, heels and toes. Stretching these muscles results in improved flexibility and range of motion, helping to avoid plantar fasciitis and pain.
  • Massage tools from Pressure Positive are a great way to reduce aches and pains after long runs. The Tiger Tail Rolling Muscle Massager allows for easier self-massage of such leg muscles/tissue as the calves, IT band and glutes, while the Original Backnobber II® allows you to work on the otherwise unreachable trigger points in your back.

One last note before you lace up: Pain is your body telling you to rest. According to Marsha, if your pain continues after a week or two of rest, it’s time to see a physical therapist. (You can find a PT in your neighborhood by searching here.) The physical therapist will be able to evaluate you and will most likely show you some exercises to strengthen your weaknesses and get you back to running.

Marsha Berger Grant, PT, DPT, OCS, is a physical therapist and the managing director of the Chalfont location for Apex Physical Therapy, a Physiquality network physical therapy clinic with locations throughout Pennsylvania. A certified orthopedic specialist, Marsha is an avid runner.

Peter (Piotr) Kluba, PT, DPT, is a physical therapist and the owner of Global Physical Therapy, a Physiquality network member with 2 locations in Michigan. He is also a board member of PTPN, the nation’s premier network of rehabilitation therapists in independent practice, and the parent company of Physiquality.

Chris Nawrocki, PT, MS, MDT, OCS, is a physical therapist and COO at The Center for Physical Rehabilitation, a Physiquality network physical therapy clinic with four locations throughout Grand Rapids, MI.

Jeff Rothstein, EP, MS, CSCS, is an exercise physiologist and Director of Sports Enhancement at the PT Center for Sports Medicine, a Physiquality network physical therapy clinic, in Akron, OH.


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For further reading, look through our selection of articles on running and marathons, in addition to the below links:

Reynolds, Gretchen. Are we built to run barefoot? New York Times, June 8, 2011.

Alderman, Leslie. For running shoes, it’s fit first and price last. New York Times, October 22, 2010.

Erickson, Jeff. Overuse injuries in runners. Pressure Positive, July 28, 2009.

Branley, Alison. Don’t do it; pricey running shoes not worth it, study says. Sydney Morning Herald, March 12, 2009.

Excel Physical Therapy. Excel video library.
Note: Excel PT has an extensive section on exercises for runners at the bottom right.

Kirk, Anthony Baron. Knee pain exercises and stretches. eHow: Health.

Ten tips on avoiding running injuries. Physiquality.

Plyometrics training. StrengthCoach.com



The material and information contained on this Web site is for information only and is not intended to serve as medical advice or consultation.

Consult your personal physician before beginning any exercise program or self-treatment.