Runners Knee by Eric Beard

Terrific post by Eric that reinforces everything I say about our runners now a days that injure their knees.

http://theericbeard.blogspot.com/2009/06/ill-take-runners-knee-patellofemoral.html

Training for Runners for Improved Performance & Injury Prevention - Part 4: The Plan

This piece is about setting your goal and developing your training plan. My wife has always trained for her races using Hal Higdon's programs. I like the way she approaches her races cause she plans everything well out in advance. She decides which race to run and how much time she needs to train.





Training for that race all depends on how experienced you are at running. Hal's 12 week training regimen for a 1/2 marathon begins with short runs at 2 or 3 miles and then progresses to the 13.1 race. If you have not run 2-3 miles on a regular basis or not at all then you need to have more time to train. My wife took the best approach by planning 24 weeks ahead of time. This way she began with a 5 k training program to help her prepare for the 1/2 marathon training program. The next thing she did was to plan out her week to see which days she would have available to perform her workouts/runs.

Hal Higdon's Program Runs Like This


Day 1-Stretch and Strengthen

Day 2-Run

Day 3-Run or Cross Train

Day 4-Run and Strength

Day 5-Rest

Day 6-Cross Train

Day 7-Long Run



This method seems to work on the running aspect and I am very pleased that Hal put in time to work on strength training.

My suggestions would be to make sure that you perform some other form of training on your cross training days other than running. This is time for you to work on your cardiovascular endurance without putting the wear and tear on your joints that long distance running does.


Ideas for cross training:

• Elliptical with a high stride or incline (don't use an elliptical that has no adjustment to the stride length, this will hurt your running form)


• Stairmaster or Stepmill (I love the step mill, does not let you cheat!)


• Kettlebell swings (you know I would throw this in here!)


• Walking on a treadmill (chose an incline over 5.0 and really work on good form!)


• Versaclimber (provides a terrific workout!)

You should try to Running intervals on at least one if not both of your shorter runs. This is a way to push your aerobic threshold without the wear and tear once again on the joints. This will help you to be able to push through when you hit your "wall" on your long runs.

Start by running at a level of 3-4 out of 10 on your exertion scall for 2 minutes, then perform 1 minute at a 7-8 out of 10. Keep with the 2/1 ratio until you feel yourself needing more of a challenge then go with a ratio of 1/1 and then move on to 1/2.


Please oh please make time for strength training! You will be surprised about the type of results you get when you perform at least 10-20 minutes of strength exercises 2-3 times a week while you are training and how much it will help your runs and also staying injury free. I will work on this more in the next section.


Here is the important point that most of you runners are going to hate. Your running form is more important to you than your time. So during your long runs if you hit your wall and your running form gets "sloppy" take time to walk and really work on recovering and working on your form. This will allow a little time to recover and allow your body to remember how to properly run. When people keep running during those sloppy moments is how bad habits develop. This will slow you down and set you up for injury.

If you have any questions or comments please let me know or send them to sghumanperformance@gmail.com

Training for Runners for Improved Performance & Injury Prevention- Part 2 - Self Assessment

The first thing you SHOULD do if you are going to train the RIGHT way towards your race is to perform a individual body assessment. This assessment is a way to try and determine if muscle imbalances are present within you body. Trust me those imbalances are there. Some are hidden deep within your body, some are more apparent. These imbalances may not be noticeable now but during your training those mild imbalances might pop up at any time and bite you right in the ass (sorry to be harsh, but that is what it feels like).

When I perform the Functional Movement Screen (FMS) it consists of seven total tests and usually takes me a total of 20-30 minutes to be able to determine what muscular imbalances exist and the best way to tackle them. EVERY runner should have a FMS performed once per year. This is the type of screen they run at Athletes Performance Institute for all of their athletes and many pro & college teams take all of their athletes through the screen at least once per year. (To learn more about it and to find FMS certified specialists in your area, check out www.functionalmovement.com)

I am going to explain to you an assessment you can perform on yourself to give you some idea of what muscle imbalances you might be dealing with.

SINGLE LEG STANCE

Stand in front of a mirror and place one foot straight ahead and pick the other leg up so you are flexing your hip, knee and ankle joint to a 90 degree angle.


Hold that pose for 60 seconds, then perform the exercise on the other side.

Note if you are having trouble anywhere. Can you hold the 90/90/90 position for the whole time without losing your balance? 

Were you able to hold the position with your waist line level and the hip, knee, and foot all in a straight line?

Most people have some problems arise in this position. 1-they cannot keep their balance, 2- their foot rotates outward towards their body, or 3- they cannot keep their thigh parallel to the floor.

How did you grade on one side compared to the other? Was one side fairly easy but the other side was completely difficult? If the answer is yes, then I am afraid you have a significant muscle imbalance present within your body. This imbalance needs to be cleared up before you start getting into heavy mileage.

LUNGE

Again in front of a mirror or better yet have someone video record you performing a stationary lunge. Keep both feet pointing straight ahead and take a large step out in front. Now in that position with good posture, drop the back knee to the floor and touch lightly and come back up. Perform about 6 reps each side if you can.

How did you do? Did you have trouble keeping your balance? Did either of your knees move in or out to help stabilize you? Did either of your feet turn outward in an attempt to provide you with more stability? This will be what happens when you are running, especially when you get tired or "hit your wall".

STRAIGHT LEG RAISE

lay down on your back in a doorway. Have the doorway line up directly middle the distance of your thigh muscle. Both toes pointing towards the ceiling.


Now place a rolled up towel underneath your knee joint on one leg

The leg that has the towel placed underneath your knee you are going to try and keep your foot, knee and hip all in a straight line and pressure onto the towel roll. With the other leg you are going to lift it as high as you can without bending your knee or losing a straight line with your foot, hip and knee

Were you able to get your heel on the up leg past the doorway without having to cheat on either leg? No? Then were you able to get your heel past your knee joint of the down leg?

How was one side compared to the other?

Next stand up and try and touch your toes without bending your knees. Was it easy or hard? Were you able to perform it?

Which one of these tests did you do the absolutely worst at? Better yet, was there one side that you rocked on and the other side was terrible? Then that is the movement you need to improve to make you a better/less injury prone runner.

Why are these movement important to running? Let me tell you.

SINGLE LEG STANCE-this movement mimics a runners actual running gait. The exercise helps to test stabilization on one leg while it is in a weight bearing position (closed chain), while the other leg is stabilizing in a non-weightbearing position. If you had trouble balancing on the down leg or have trouble keeping the up leg in proper alignment then the test is telling you that you will not be running with optimal technique and are subject to problems developing due to this imbalance. Now think about how many times you run... If each time you step you perform it wrong think how that adds up. Think of it this way. What would happen if you hit 10,000 golf shots incorrectly one right after the other? This is the same thing only with running.

LUNGE-the importance of the lunge is that your body is trying to use its stabilizers during the movement but now the exercise is more dynamic than the single leg stance assessment. Now your body also has to resist a rotational force put upon your body. This helps to tell if your muscles can dynamically stabilize while you are moving

STRAIGHT LEG RAISE- Many of you probably think that this is a test of how flexible your hamstrings are. It is to an extent. Actually your hamstrings don't usually get "tight" they just get overused alot. This is a great test to see how one leg can stabilize while the other is moving dynamically and stabilizing as well. Yes the hamstring needs to work correctly and be able to lengthen. But sometimes the hamstring is not the one to be blamed, at times it is a tight hip flexor on the opposite side.  This is why I have you try and touch your toes after performing the test.  If you were able to do so with not too much trouble then it is not the hamstring to blame.

If you are not all too sure which movement/assessment was the worst then start with the straight leg raise and move your way to the single leg stance and finally the lunge. Feel free to video record yourself and send it to me. Probably the best way to do this is sign up for a youtube account and upload the video and then send me the link to it.

Need more?  Feel free to contact me at mark.snow@vanderbilt.edu and ask about the Injury Prevention & Human Performance Program (IPHP).   There are also package options available that can either include a FMS screen and 30 minute corrective exercise session or you can also get 60 minute workout sessions as well. 

Not close enough to be screened?  You can again check the FMS directory at www.functionalmovment.com.  Other resouces include: the Atheltic Body in Balance by Gray Cook which includes a more specific self screen procedure (5 movements) or Core Performance for Endurance Athletes by Mark Verstegen. 

The active straight leg raise and lunge were taken from the Functional Movement Screen developed by Gray Cook and Lee Burton.  The Single Leg Stance test was taken from the Core Performance for Endurance Athletes by Mark Verstegen.

Training for Runners for Improved Performance & Injury Prevention-Part 1-Introduction

Intro

Back in 2006, my fiancee (and now wife) decided to compete in a 1/2 marathon to help her get in better shape for our wedding. She ran in the race, had a terrific time and I learned a lot about her determination. After the wedding, we decided to compete in a 1/2 marathon in 2007 for something that we could do together as a couple. It did help us to make our marriage and friendship stronger and there was nothing like the feeling that I got when we finished the race hand in hand. I never ever thought I (at 220 lbs) would be able to run and finish a 1/2 marathon.



But I paid a price for my achievement. I turned into the typical runner. I felt that I did not need, (nor did not have time for) flexibility, weight training, and alternate forms of training. I only had time to run. As I built up my tolerance for distance I felt great! Never ran more than 2 miles before and now was training with 6-8 miles on long days and felt great. Until one time I was running on the indoor track before the race and I felt it, "crack, crack, crack". My knee started to pop. I tried to ignore it (like most runners do) but then the pain began to enter. I developed IT band syndrome (runners knee). I had pushed myself to far and did not maintain the form and strength I needed to prevent injury and keep my performance. The next 2 months I battled with my knee pain using ultrasound, rehab, and the foam roller. I entered the 1/2 marathon with a knee brace on, taped as well and full of ibuprofen. I made it to mile 10 with no pain, but then I hit my wall and it felt like a knife was stabbing me in my knee with every step of my right foot. I finished the race, almost crying, if it were not for my wife coaching me the rest of the way I would most definitely have quit the race. Don't let this be you.



You might think that this instance will not happen to you. You have run in 1/2 and full marathons before and did not have any problems. All you need to train is to run, run and run some more. I promise you it will catch up to you sometime. Every runner hits their wall at some time and that is when you are risking your overall health by pushing through that pain.



Believe me I have experienced it, but more important I have seen it up close and personal. I met a man who ran all his life and just had a total knee replacement. He told me "if I had to do it all over again, I wouldn't. I would find something else to do other than run, because all of what I am going through right now is not worth anything I achieved when I ran." I have seen members of my gym who had to find other forms of exercise to perform cause there was just too much damage to their knees for them to be able to run anymore. And this fact just killed their spirits.



I also see the young ones who come into physical therapy with pain associated with running. Some are training for the 1/2 for the very first time and began having pain and symptoms. Some have trained for years and wonder why now they are having problems when they ran in 3 marathons last year. I tell them that they are the lucky ones. They don't have as much damage now that they would have if they kept it up for another 5-10 years when then the damage is irreversible. If they can correct their imbalances, recognize when their form gets sloppy, and get on a true training schedule then they are on the path to a better lifestyle that includes running.



There are so many runners here in Nashville, TN and I would say that a day does not go by that I am not working with, in some aspect, a runner who is recovering from some type of injury. It has gotten to the point that it inspired me to write this article. I am tired of seeing you runners who only make time to run and nothing else and end up paying a huge price. Think of this, spend a little time and money now to be happy or spend a lot of time and money later being miserable. Your choice.



Why am I doing this? What credentials do I have? What do I know that others don't? I understand muscle imbalance. I understand what poor posture, improper joint mobility, improper joint stability, and improper running mechanics can do to hinder running performance and lead to injury. Most important, I have gotten runners of all ages back to running pain free.



For example: I was very fortunate to rehabilitate a terrific gentleman in physical therapy 3 months ago who was suffering from a ton of damage under his kneecap and arthritis within his knee joint from years of running. Over time that we worked together he developed proper mobility and tissue quality. He understood the idea of improving stability in his joints (especially his hips) and he developed strength and the ability to use his stabilizing muscles at the right times to help protect his knees. He walked out of physical therapy able to walk and run pain free.



Why was he so successful?

1. He listened to everything I had to say, asked questions, and always told me what he was feeling during the exercises (good communication)


2. He committed completely to the program and used the time when he had knee pain to develop strength in other aspects of his body (checked his ego at the door)


3. He had his AHA moment (he found out how to key his muscles to work and make his knee pain disappear)-(very determined)


4. He did everything I asked him to do. He never tried to do new things or train more or run farther than I asked him to do (he trusted me)

Now on the last day of therapy I instructed him on some important points.

• Stick with the plan


• understand that he has irreversible knee damage and that he will have good days and bad days


• listen to his knee and know when he could run, how far he could run and when he needed to rest


• understand when he should cross train


• understand the importance of tissue quality and active rest


• understand the importance of interval training when running

In the next part I am going to teach all of you my plan for training for your running goals. This could be if you are training for a 5k, 10k, 1/2 or Full Marathon. Overall the important principles still apply. The other chapters will include:

• necessary equipment for success
• self assessment
• mobility & flexibility
• stability & strength
• reactive neuromuscular training
• running mechanics and "sloppy running"
• interval training
• cross training
• running/training schedules
• putting it all together

10 Exercises that you Can Stop Doing

Nice little article (for the most part) by AOL confirming what a lot of the experts are saying against. I don't necessarily agree with what they have to say about the squat completely.

Here is my opinion on the article and the 10 exercises.

• Leg Extensions: They spell disaster for your knees since it is an isolation exercise and puts a ton of torque on your knees. If you have knee pain-you should NOT do knee extensions and hamstring curls, this is just not the way our muscles were supposed to work. Only if you are a body builder and do nothing else but lift and pose. Just not very functional as well.


• Lat pulldowns and overhead lifts: I totally agree that you should not pull the bar behind your head due to the fact that it is just (once again stated) not natural. When you lift your spine should always be in a straight or "neutral" position. As for the overhead pressing I approach it like squats. Overhead pressing (military presses, kettlebell presses) and overhead pulls (pull ups, lat pulldowns) are only bad on the shoulders because you are doing them wrong. When pressing and pulling above your head you MUST make sure that your shoulder blades and packed back and down, also your ears must be in line with your shoulders.


• Cardio: I totally agree with this one. Vary your workout speeds burns way more calories in half the time. Try going with 2 minutes at a pace that you would consider a 5 out of 10 on your exertion scale (10 being all out gasping for air), then do 1 minute at 7/10, then 2 min back at 5/10 and repeat. Here is a good one for ya. 2min 5/10-1min 7/10, 2min 5/10-1min 8/10, 2min 5/10-1min 9/10 and repeat that cycle for 2-3 rounds.


• Sit ups: you definitely do not want to use those hip flexors to work instead of your abdominals. There are also ways to use tubing or weights to help you master the sit up. For those of you who have back problems there are much better exercises in which you stay away from spinal flexion all together (Like front, side and reverse planks for instance).


• Abduction/Adduction Machines: I do use the ab and adduction machines for some of my therapy patients to try and get those muscles tuned in a bit, I do make them brace their abdominals and tighten their glutes while they perform the exercise. Once they master the machine (2 weeks tops) then I get them moving onto band walks, lunges, and more standing band exercises instead of machines.


• I totally agree with side bends and twists. If you need to see some good abdominal exercises Nikki and I have some on youtube. One of them includes the thoracic rotation exercise.


• Squats: I love doing squats. The only reason you should not do them is if your knees are absolutely shredded. But again, its not the squat that causes pain, its how you do the squat (I quote Dan John out of the book "Enter the Kettlebell" by Pavel). The picture in the article is a true reason that people have pain. When people squat now a days they are what I call "quad dominant" and have glute amnesia. The first thing people do wrong is they bend their ankles and knees to lower and this puts a crapload of pressure on your knees. Think about reaching your butt back as if you were trying to sit in a chair, your shins should not move much if at all when squatting. Another issue is squatting below parallel, if you squat below parallel then you use your glutes to come back up instead of your quads, THIS IS WHAT WE WANT! Again, concentrate on pushing your knees out and pulling back and down with your hips into your squat. Hip hinges, bench squats, and face the wall squats are great in improving your squat technique. I will work on some instruction video to help with this.


• Toe touches: There are much better ways to improve your hamstring flexibility, hip hinges once again are a great way to improve your technique on these and not have to put yourself through all that spinal flexion business.


• Light weights: This is an absolute truth. If you use too light of a weight then you give your body the ultimate opportunity to use whatever muscles it wants to get the weight up. If you chose a weight that you can only perform 5-10 repetitions then you HAVE to use the right posture and technique (incorporating your stabilizers) to perform the lift correctly.

Quick Hint #2:Should you run to get into shape or should you get into shape to run?

This is a terrific question I heard on the fitcast (its a podcast I listen to every week).  Yes, some people are healthy enough to begin running as a means of burning off fat and do it and enjoy it.  BUT, the majority of people who would like to lose weight should take a different approach.  If they begin their workout routine with running then they may be setting themselves up for an injury.

My suggestion.  Get your nutrition into balance, get your head in the right place, and begin getting in shape in small steps and gradually work towards your ultimate goal of running in that half marathon.  (Consider hiring a personal trainer to help you achieve this goal) This way you when you are ready you will be running more efficiently than if you would have started with running.