Ask the MD — Becoming a Stronger Runner

Sprinting on the track.

Military​.com Fitness is starting a new section where we reach out to various medical and science professionals to get advice on fitness, injury prevention, injury rehabilitation, nutrition, and many other topics that will help our readers. Many emails ask our writing team about running faster, running injuries, and how to prevent them. I am pleased to introduce Dr. Michael Cassatt who is a former Navy corpsman and now a doctor of Sports Medicine. Dr Cassatt answers our “How to prevent running injuries” question with the following explanation: Injuries in runners are common. Injuries from the waist down can range from 1 in 4 runners, to 2 in 3 runners depending on training volume. Most of these injuries are preventable given a good training plan, quality running form, and a few specific exercises to help supporting muscle groups. There are a number of injuries that can occur from running including:

  • Hip– Hip flexor tendinopathy, impingement, and bursitis.
  • Knee– IT band syndrome, runners knee (Patellar tendinopathy), and meniscal tears.
  • Tibia– Shin splints, compartment syndrome, and stress fractures.
  • Foot and ankle– Achilles tendinopathy, peroneal tendinopathy, plantar fasciitis.

The good news is that by following the steps below, these injuries can be greatly reduced, or even eliminated.

Build volume for a lifetime of running. One of the most common mistakes made is attempting to build volume too quickly. The general rule is to build no more than 10% per week. Adding miles at 10% per week is probably fine at the lower end of mileage (0–15 miles per week), but as overall volume increases, the increases per week should slow. Ideally, there should be weeks with little to no increase in mileage after getting to 20–30 miles per week. Again, the goal is to build slow enough to allow muscles and tendons to adapt to this new strain, without incurring injury beyond the body’s ability to repair between workouts.

Slow it down. Building volume means focusing on volume. It is not the time to incorporate speed or intensity. Attempting to build volume at higher intensities greatly increases the risk of injury. This is where the concept of periodization comes in. Just like building a house, you have to focus on the foundation first. Volume is the foundation to build the muscle, tendon, and cardiovascular changes needed to support later training in intensity while limiting injury. During a volume building period, the majority of runs should be done at 2–3 minutes per mile slower than your best 1 mile time. They should feel too easy if done correctly, and you should be able to carry on a conversation while running.

Run more often. Attempting to compress all of your weekly volume into 2–3 runs is a recipe for injury. Trying taking the total mileage in a week and dividing it into 5–6 runs, alternating between an easy day and a higher volume day. Recovery from 2 4-​​mile runs is easier than 1 8-​​mile run, but still causes adaptation in the body’s muscles, tendons, and cardiovascular system. As long runs get longer, consider breaking them into a morning and afternoon run. The cumulative training effect will be similar while reducing the risk of injury.

Increase your cadence. Cadence is calculated by counting the number of steps for one foot in a minute and multiplying by 2. Elite level runners typically have cadences in excess of 180 steps per minute. Increased cadence has been shown to decrease injury rates by reducing ground forces through the lower leg. Increasing cadence promotes a mid-​​foot strike rather than contacting the ground with the heel first, also reducing the forces transmitted through the knee.

Stretch. Dynamic stretching before and static stretching after. Newer studies show decreases in strength when static stretching prior to exercise(The type of stretching we all grew up with– starting a stretch and then holding it for a period of time). A dynamic warm up prior to running involving controlled movement through a complete range of motion for each joint is better. After running, the usual stretching for 20–30 seconds per body part, without bouncing is acceptable. Maintaining flexible hamstring and calf muscles will help with injury prevention.

Hip Swing Front & Back
Front to back hip swing– Swing your hip in a comfortable arc from full flexion to full extension for 10 repetitions for each leg.
Hip Swing In & Out
Side to side hip swing– Swing your hip in a comfortable arc from across your body to completely away from your body for 10 repetitions each leg.

Keep a strong core and glutes. The core (abdominal and low back muscles) is the foundation for movement, and need to be strong to help control movement of the legs. The glutes, specifically the gluteus medius muscle, is responsible for controlling thigh rotation, tracking of the patella (kneecap), and knee control. A weak gluteus medius has been found to directly contribute to conditions such as IT band syndrome, patellar tendinopathy (runner’s knee), shin splints, achilles tendinopathy, and plantar fasciitis. This is particularly true for soldiers that run on uneven surfaces or in soft sand, As these muscles fatigue during the run, pronation of the foot increases, the angle of the knee changes, and stride length increases. All of which increase injury rate. The goal is to strengthen enough to function correctly throughout your entire run.

Front Plank
Front plank– Can be performed on forearms, hands, or for a greater challenge a Bosu ball.
Side Plank
Side plank– Can be performed on forearm, hand, and can be combined with hip abduction for gluteus medius strengthening.
Dirty Dog
Hip abduction from “all-​​fours” position — aka Dirty Dogs. Focusing on good form, try working up to three sets of 30, lifting the knee /​ leg out to the side 90 degrees.

Know when to back off. By reducing intensity, increasing frequency, slowly building volume, and increasing cadence, delayed onset muscle soreness should be greatly reduced or eliminated. Any pain that occurs during running, or immediately after is often a warning of injury. Continuing to run could substantially increase the injury, and prolong the time needed for recovery. Stop running when this type of pain occurs, take a reasonable rest period, and if it returns, seek help. Remember, you are training for a career, and hopefully for a lifetime of running. Take it slow, use common sense, and use these steps to help keep you healthy!

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