Running: Slow and Steady Wins the Race

Running: Slow and Steady Wins the Race

Richard Johnston is a musculoskeletal physiotherapist and completed a PhD which investigated training load and injury associations within an endurance athlete population. He is also an avid long-distance runner and currently trains with Hunter athletics club.

Combining his passion for running and his expertise, he has some top tips for anyone looking to run long and strong as you train for your next event.

1. BUILD SLOWLY & GRADUALLY

Running remains one of the most popular forms of physical activity globally and its health-enhancing effects have been well documented. Pain and injury are common among marathon runners, especially for novice runners. To reduce and control this risk, it is important that the training volume and intensity is progressed in a gradual manner.

This is especially true for individuals with a low baseline fitness level or who are unaccustomed to running. It is important to remember that pain and injury can be delayed. That is, you might not experience symptoms for up to four to six weeks following an increase in training loads.

Building up slowly to being able to run moderate to high training volumes consistently in the long term might reduce the risk of sustaining an injury. The route taken is more important than the destination!

2. MAKE ROOM FOR EASY RUNS

For the more competitive runner, an appropriate distribution of easy and hard runs is also something to consider. Speed sessions (intervals, fartlek, tempo runs etc.) need to be balanced with easy runs. For many elite distance runners, as much as 80 percent of their training runs are “easy” with the remaining 20 percent completed at high intensity.

The easy runs allow sufficient recovery to both tolerate and execute the more demanding sessions. The most common mistake is running too quickly on the easy days leading to diminished performance and a higher risk of injury.

3. PRIORITISE SLEEP & RECOVERY

The demanding nature of training for a marathon imposes stress on the body, therefore Sufficient recovery is essential to maximise the benefits of training, to improve performance, to reduce the risk of injury and to prevent overtraining. Additional stressors such as everyday life stress, a demanding work schedule, anxiety and poor sleep habits further add to the physiological stress of marathon training.

It is therefore important to recognise such factors as the emerging evidence suggests that such stressors can interfere with the adaptations to training and increase the risk for injury. Sleep is a fundamental process required to optimise recovery, as adequate sleep is linked to a reduced risk of injury, improved performance and improved mental health. Nutrition, relaxation techniques such as mindfulness and stress management techniques can further aid recovery.

4. RUNNING INJURIES

Running related injuries can be multifactorial and it is important to identify potential injury drivers,  therefore, you should work alongside a physiotherapist who can assess and determine injury contributors. Physiotherapist assessment will identify areas in your biomechanics and strength that can be targeted to reduce running-related injury risk.

5. GET STRONG!

A common belief among the distance running community is that strength training will slow you down due to an increase in muscle bulk. However, scientific evidence has shown that strength training can lead to improved running economy and performance. When strength training is added to a well-designed running training program, any increase in muscle bulk can be avoided.

It is important that the training is gradual and progressive and should be tailored to the individual depending on their performance goals, injury history and general health. Strength training is an important part of injury rehabilitation and prevention programs. It helps to build capacity to tolerate the demands of running.

In summary, progress your training gradually, ensure your easy runs are easy enough, work on optimising your sleep routine and consider adding strength training to your routine.

Common Adolescent Injuries

Common Adolescent Injuries

Adolescent – A High-Risk Period for Injury

Adolescence is generally a very active time of life, children are often involved in numerous sporting and recreational activities. As children begin to develop into adults, it is no secret that the body can be prone to injury.

It is important to note that the nature of injuries to adolescents is often different from adults, and hence, must be treated differently. Common sites of pain and dysfunction include:

  • Heel pain (Sever’s disease)
  • Knee pain (Patello-femoral pain/knee cap pain)
  • Shoulder pain or instability
  • Posture-related pain and symptoms

Heel Pain – Sever’s disease

Sever’s disease is a common condition in youths in which the Achilles tendon pulls on the growth plate that is located in the heel. It is common in children who participate in sports with lots of jumping and running. Adolescents may report an increasing pain in their heel that may progressively worsen with activity.

The condition often coincides with a growth spurt in which bones; muscles and tendons are growing, but not always in sync. The change in structure and an increase in load is often the cause of the condition.

Sever’s disease can be successfully managed with physiotherapy, including footwear modification, exercise, taping and manual therapy. Activity modification may be necessary depending on the individual’s load. 

Knee Pain – Patello-Femoral Joint Pain (PFJP)

Knee pain is frequently reported amongst growing children. Most commonly, patellofemoral pain syndrome, or knee cap pain. Adolescents may present with pain that worsens with activity, sitting for a prolonged period of time, and using stairs.

The growing body will often present with an imbalance in musculature and a lack of control through the hips and pelvis.

PFJ pain is often a combination of tight and overactive lateral quadriceps, and weak and underactive gluteal, inside quadriceps and calf muscles.

  • This imbalance/lack of control leads to your patella (knee cap) not tracking straight up and down, and rather may move to the outer side of the knee, irritating the joint surface or surrounding structures.

PFJP can be treated with a combination of manual therapy, home-based strengthening and stretching program, and occasionally taping.

Shoulder Pain / Instability

There are a number of sports and activities that can increase the risk of shoulder pain and instability in adolescents. The risk of shoulder injury is increased for those who participate in throwing sports, contact sports, swimming and sports involving complex upper body supporting manoeuvres (gymnastics, aerobics).

Dislocation of the shoulder is common in the adolescent population, however uncommon in the younger child. Falling onto an outstretched arm, or a blow to an arm that is reaching upwards and backwards can cause a shoulder dislocation. Management of this requires comprehensive discussion with both your physiotherapist and an orthopaedic specialist.

Adolescents may suffer from shoulder pain from impingement, a common shoulder issue in adults. Impingement often arises from repetitive movements of the shoulder that may not be controlled by weak muscles around the shoulder and can cause damage to the shoulder joint. This can occur in throwing sports, and in swimmers.

Shoulder pain and instability is most successfully managed by a home or gym-based exercise program supervised by your physiotherapist, focusing on strengthening the muscles of the shoulder blade and shoulder to provide as much muscular support as possible.

Posture Related Pain

In adolescents, pain and dysfunction from posture are a frequent presence in the clinic. Children spend a great deal of time sitting, either in front of the computer or desk, at home or at school. It is common for them to present with pain or discomfort in their neck or back as a result of these positions.

Posture-related pain might present as diffuse or aching pain through the neck shoulders or mid back. Adolescents will often report these symptoms after spending prolonged periods studying or using the computer or device.

Treatment involves initially addressing these sustained positions and making practical adjustments – using a desk instead of a table, adjusting chair or moving mouse/keyboard.

Physiotherapy may involve manual therapy to treat symptoms, as well as an exercise and stretching program. Quite often structures of the chest may feel or appear overactive, and structures of the back may be underactive. An exercise and strengthening program can address this issue, in combination with necessary activity modification.

Ankle Sprains

Ankle Sprains

The causes of ankle pain or injuries and the exercises to identify the cause.

Ankle sprains are one of the most common injuries for the active, as well as the general population. This is exemplified with approximately 70% of people incurring an ankle injury during their lifetime.

There are three grades of injury classification of ankle sprain injury which can be assessed by your physio. With grade 1 ankle sprains being considered as mild with an expected full recovery within 2-3 weeks, to grade 3 injuries which are considered to be a complete rupture of the injured ligament, which would need special input and advice from your physio and or surgeon depending on the indications.

Chronic ankle instability is a real concern when dealing with ankle injuries as when left untreated which can have further implications for sporting goals or even daily tasks as climbing stairs or walking on uneven surfaces. The main focus of rehabilitation of ankle injuries is strength, balance and mobility.

To identify if you have either stiff or unstable ankles and therefore increased the risk of incurring an ankle injury you can ask yourself the following questions:

  • Have I rolled my ankle previously?
  • Do I participate in activities that involve a change of directions (eg. soccer, basketball and volleyball) or uneven surfaces (hiking, gardening)?

Some easy tests you can do to identify if you have stiff or unstable ankles are:

Knee to wall test

  • Step one: in bare feet have a leg with which ankle you are testing close to a wall with toes pointing forward
  • Step two: lunge forward whilst maintaining heel of lunging knee on the ground (back leg can be anywhere)
  • Step three: Find the furthest point away from the wall that you are still able to touch your knee to the wall without lifting heel.
  • Step four: Measure that distance and compare to the other side.

Single leg balance

  • Stand on one leg with eyes open and with bare feet.
  • Maintain balance without touching other foot down or using hands for balance for 30 seconds.

Indications from the knee to wall test are that if there is a large discrepancy (more than >2cm) between the distance away from the wall each foot is that you may have a stiff ankle. If one or more of your ankles aren’t able to be ~10cm away from the wall then you likely have stiff ankles and this could be impacting your daily life.

If you aren’t able to stand on one leg for 30 seconds then this could indicate instability of the ankle joint.

Come and get an assessment of your ankle if you feel that you are experiencing difficulties with your ankle and/or these symptoms.