Resistance Training For Runners

Resistance Training For Runners

Guest Blog By Sam Hicks (Distance running coach and Personal trainer and owner 4 Runners)

Doing weights was once viewed as an activity carried out by gym junkies and Olympic weight lifters.

These days it’s become not only ‘in’ with the cool kids but highly recommended by medical professionals for the general population.

In distance running circles back in the good old days of marathoning it’s understandable to realise that lifting weights wasn’t highly popular among the elites.

And why would you as long distance runner, or any endurance athlete for that matter?

After all when it comes to specificity in training logic would say if you want to improve at running, just run more.

In addition doesn’t lifting weights give us bigger muscles which will end up becoming aerobically more expensive?  

But as training research advances and evolves more and more elite and recreational distance runners are including specific resistance programs into their training.

The main reason is injury prevention.

This means more consistent uninterrupted training that is likely to produce improved performance in race times.

We can break the benefits of resistance training down even further:

Improved musculo-skeletal health and strength

Strengthening of the running muscles and improved bone health.

Improved running economy

More strength can mean less ground contact time and enhanced “pop” from each foot strike.

Hormonal change (maximise anabolic response)

When the majority of your training time is spent completing extended periods aerobic exercise the body can enter catabolism “destructive metabolism”.

This can have detrimental effects on your overall health.

To reduce periods of extended catabolic states, an appropriate resistance training programme can be prescribed.

Combined with a healthy balanced diet will more than likely induce anabolism “constructive metabolism”.

So never fear stacking on excessive muscle mass from a couple of strength session per week.

Hypertrophy (enlarging of tissue) should only occur after specifically programmed sessions where this is the desired outcome.

But in the right dose, its likely strength gains will occur without excessive gains in lean mass.

Some examples of how strength training has helped runners…

Sir Mo Farahs (Multiple Olympic Gold medalist) ex coach Alberto Salazar running strength information:

https://www.flotrack.org/articles/5034678-to-make-it-to-the-next-level-strength-training-is-a-must

Steve Moneghettis Biography Page 255 “In the long run” describes his weekly mileage daily breakdown plus his body weight strength circuit including push ups , sit ups , dips, chin ups ,leg raises etc.

If you’re unsure of how to structure resistance exercise into your program contact myself or another trusted  athletics Australia distance running coach , strength and conditioning coach or personal trainer that you trust to help with your running goals.

Sam Hicks is owner for 4 Running, an Adelaide based Running Coach and Personal Trainer.

4runners was founded by Sam Hicks in 2015.

As a level 2-advanced distance running coach and personal trainer, Sam himself is proof the systems that he use work.

“The methods I use are simple to understand, but not all are easy to execute”

Training for a distance running event can be overwhelming, leaving it hard to know where to begin.

4runners has been developed to remove the stress of knowing what to do in your program and when to do it.

Sam coaches long distance runners of all age groups, abilities using online correspondence to track your progress week by week. He tailors all the programs himself and monitors how the athlete responds to them.

Whether you’re a young novice 1500m track runner or a veteran marathoner, 4runners will cater for the individual.

“These systems are not new, flash or easy. They’ve been around since the 50’s. I’ve got so much confidence in them as I’ve experienced the results they produce.”

For more information, please contact Sam via this link.

Creating An Unbreakable Athlete - Part 1

This blog post was inspired by world leading sports scientist Tim Gabbett who recently posed the question,

Is it possible to develop an unbreakable athlete?

Tim elaborated on this on a recent podcast you can check out here.

---

My hope for this blog is that you may find something that resonates with you.

A (perhaps missing) piece that you can make part of your own unique and ever changing journey towards the holy grail of becoming an unbreakable athlete.

And if you think this article doesn't apply to you, in the words of Bill Bowerman,

"If you have a body you are an athlete".

The same principles apply for anyone who wants to break free of ongoing niggles and pain.

Be warned though, this blog is a long read, so get yourself a nice cuppa and get comfortable...

---

After studying the field of Physiotherapy for nearly 20 years now, I can say there’s no doubt that effective training is a blend of art and science.

There are a lot of opinions out there and it can be hard to figure out the right plan of attack.

In this blog I’ve tried to bring together the thoughts and opinions of world leading coaches, sport scientists and Physios and match it up with evidence based practice to help you achieve your goals.

We’ll try and put together a holistic and systematic approach that will develop a robust and resilient athlete, providing the foundation for planned training and competition.

I’ll also talk personally about some of the mistakes I’ve learned along the way.

Staying injury free

“The way to peak performance isn’t the secret, the secret is learning how to get to that point without getting injured along the way”

- Nick Willis dual Olympic medallist.

There is no one magical ‘correct’ way to train for everyone.

We all have our individual strengths, weaknesses, history and specific goals.

While we need to accept our approach will never be 100% perfect, we can always get better at it over the months and years.

Injuries are the number one factor limiting performance for athletes and the main obstacle holding you back from achieving your goals.

As well as reducing fitness dramatically, time off through injuries may also lead to weight gain and decreased physical capability, leading to a higher risk of future injury, sometimes leading to a downward spiral (See figure 1).

Ongoing injuries and time off training leads to an under-loading situation, and a perception of having a ‘vulnerable’ body that might break down at any stage.

Figure 1

Becoming An Unbreakable Athlete

On the other hand, if you can stay healthy for an extended period of time and put together some consistent weeks / months / years of training, improvement is virtually guaranteed.

Injury prevention needs to be a priority in your training plan with specific strategies in place (see below), otherwise you will break down sooner or later, especially as age catches up with you.

Really listening to your body and gaining self-knowledge about how you’re responding to your training and making appropriate adjustments to your schedule is what can make the difference between becoming an unbreakable athlete and ending up burnt out and not achieving your goals.

Addressing niggles / minor injuries early on and using a growth mindset can propel you towards becoming a resilient and robust athlete (see figure 2).

Figure 2

The ultimate cause of overuse injury

They say exercise is medicine and I agree with that.

But, you need to get the dose right. Too much or too little will lead to issues.

Research shows errors in load management are responsible for up to 75-80% of over-use injuries.

The perfect storm is when inadequate preparation (low physical capacity) meets with excessive training intensity and load (Figure 3).

Figure 3 Always keep this picture in mind !

Errors in load management can happen due to:

• sudden excessive spikes in training load

• over-training over time with insufficient recovery/adaptation

This is a recipe for disaster!

When your capacity is considerably lower than the demand placed upon it, your body remains in a constant state of stress and overload.

Injury is often a case of the straw that breaks the camels back, with signs and symptoms not heeded weeks or months beforehand.

There is a delicate balance between training and recovery and this can be difficult to achieve, especially if you are fueled by initial success and endorphin highs from challenging training sessions.

Unfortunately, in pursuit of gaining the competitive edge and high levels of internal motivation, injuries are very common.

Valuable time, energy and resources are then re-directed towards rehabilitating injured structures that can sometimes take weeks / months to heal properly.

As most older athletes can relate to, we can get stuck in a cycle of injury, pain and de-conditioning that can zap motivation quickly.

Sometimes it’s hard to see a way out when you’re stuck in the zone of stress.

Personally…

For me as a runner, I’ve experienced just about every injury and made all the mistakes about increasing training loads too quickly.

So I can very well understand your frustrations about your body.

You can go from practitioner to practitioner looking for a magic cure.

But until we can zoom out and see the bigger picture of why we’re getting injured, (grasping the capacity vs demand concept), we may never truly get over our niggling injuries.

As a Physio, I enjoy helping people with diagnosing and treating injuries.

But my real passion is to empower people to build their physical capacity to a point where they can create a ‘buffer zone’ where they can achieve their goals without risk or worry of becoming injured.

To see someone get out of chronic rehab and get back to their best, and restore their confidence in their bodies is hugely satisfying.

That is one of the reasons I created the KIN Foundation training system that helps build the fundamental movement skills as a crucial stepping stone to more lofty physical goals.

Key Point

A key point to be made here, is that it’s not the high demand and load that is generally the problem.

It’s how you go about preparing your body to handle that load.

Technically, you can build your capacity for any sort of demand, as long as you are well prepared for it.

An ultra marathoner who is well prepared for a 100km run may well have a lower risk of injury than a park runner doing their first 5km in 3 years.

I’m convinced it is possible to build an unbreakable athlete.

Let’s go into more detail…

5 Steps To Becoming An Unbreakable Athlete

1. Preparation

The first step in becoming an un-breakable athlete is to determine current physical capacity and know exactly where you’re heading.

If you’re a runner, you could do a 3km or 5km time trial that will determine your base aerobic capacity.

To assess your current musculo-skeletal capacity you could use the help of a Physio or Exercise Physiologist who would be able to guide through some testing.

With the help of a coach or physio, you can then use the feedback from your performance to structure a plan towards achieving your goal.

For example if you scored poorly on the aerobic test and felt out of breath really quickly - you’ll need to work on your cardio-respiratory fitness.

If you felt cramps or twinges in certain body parts - building specific structural capacity is what may be required.

Working closely with a Physio early on who can help you put together an indivdualised program can pay seriously big dividends later in your training program and avoid a lot of the issues of having things break down.

Preparing for the worst case scenario

A key part of becoming an unbreakable athlete is to identify the worst case demands on your body during competition.

For example, if you’re a runner with an upcoming race later in the year, you can break down the demands into more detail:

• what is the exact distance?

• what is the elevation profile - how many hills?

• what sort of pace or time goal are you aiming for?

• weather condition - hot, cold or windy?

• what time of day will it start?

• will it be crowded with people - are you used to running in big groups?

• what time will the race start?

• what is the transport like before the start?

• what sort of nutrition and hydration is available on the course

To ensure your preparation is adequate, ‘begin with the end in mind’ and then start to train your body to be able to handle those specific loads.

Identifying the demands of running

To get more specific in terms of identifying the demands of running, I would say many people under-estimate the forces that are a placed on the body when you run.

Often there’s an assumption that running is a pretty natural form of exercise and that our bodies can easily handle it.

But when we look more closely, the figures can be a little disturbing.

The research shows, on average during the landing phase of the running cycle, we must absorb approximately three times body weight of force.

If we do a quick calculation - let’s say you weigh 70kg and go for a 10 km run (approximately 10,000 steps).

10,000 steps x 70kg x 3 times body weight = 2,100,000 kg of force

That is over 2 million kilograms of force your body needs to absorb, just for a 10km run.

You can see why many runners end up with a few niggles!

Running as a foundation for most sports

We know from the research that fatigue leads to higher injury rates and poor decision making capabilities.

We know of many world class golfers, tennis players and surfers who use running as their base foundation to improve their game and be able to compete with the best in the world.

If you play football, soccer or other sports - the demands will be specific to your position and your coach can give you more guidance as to training required.

In addition to running fitness, you may need to include strength, agility training and sport specific skills.

Keep in mind most AFL footballers and soccer players run around 10-15km in a game, so they need a huge aerobic foundation to be successful.

Most AFL clubs employ running coaches and exercise scientists to help prepare their athletes to compete at the highest level.

This blog post has a focus on running as it’s the foundation for most sports.

In fact running a half marathon (21km) can be one of the best barometers of your musculo-skeletal foundation.

2. Increase Capacity

The process of building your physical capacity to meet the demands of training and competition is known as load management.

On the face of it, preventing injuries should be pretty simple.

Just gradually increase capacity at a sensible rate until you meet (or even better exceed) the expected demands.

And sometimes this plan works smoothly, especially when you are young and robust.

Figure 4 below shows a fairly straightforward progression with the goal known as the ceiling and your current capacity as the floor.

Figure 4. Picture Credit: Tim Gabbett Training Injury Prevention Paradox Seminar

Things get more complex when you are attempting to build capacity and have some risk factors, such as:

• history of injuries

• low tissue capacity

• poor general base fitness

• inadequate nutritional support

• lifestyle factors such as sitting or standing all day at work

• mental / emotional stress

• poor sleep

• poor digestion

• over-weight

• older age

Your physical capacity may well have bottomed out and we call this being in the basement (Figure 5).

Figure 5. Picture Credit: Tim Gabbett Training Injury Prevention Paradox Seminar

You may be in the basement if you’ve:

• had a long term injury and been unable to train

• been inactive for many years and spent a lot of time sitting at work

• recently been pregnant

• had a flare-up of a chronic illness or recently had surgery

• been on extended holiday

Getting from the basement to the ceiling is obviously going to be a longer, more difficult journey than if you started at the floor.

The other factor we have to consider is how much time you have to reach your goal.

The longer you have, the less likely you will be to spike your training loads and increase the risk of overload and causing injury.

Also it’s good to keep in mind that our body systems respond at different rates to training. For example cardio-respiratory fitness improves much faster than the muscuol-skeletal system (bones, muscles, tendons e.t.c) that may take months or years to fully develop.

Starting from the basement

If your current capacity is very low, it may be necessary to start with walking as your main form of aerobic exercise.

Walking is a seriously under-rated activity for athletes and especially runners.

If your goal is to eventually run a half marathon or marathon, walking has many benefits, particularly if you're coming back from an injury.

Here's 4 key benefits walking has for the runner:

✔️ Increases blood flow to aid recovery

✔️ Encourages gradual loading of tissues and creates a bridge to safely achieve higher loads of running

✔️ Helps maintain a healthy body weight

✔️ Mental benefits of staying active and achieving small wins & avoiding complete rest (that can dramatically drop your physical capacity)

If you can build your walking capacity to 30-40km per week, you will have an excellent foundation for layering in some running safely down the track.

Getting the foundation right

As you’re building capacity, there are three main variables in your training:

• volume

• frequency

• intensity

If you imagine a sound mixing board with all the various levels you can adjust.

Obviously it would be unwise to increase all the channels at the same time.

For runners it’s fairly well accepted that your first priority is building your low-intensity volume and then layering in your speed and race specific training towards the end of your training cycle.

Some recent research from the Journal of Strength and Conditioning Research has suggested that world-class long-distance running performances are best predicted by volume of easy runs (and deliberate practice of short-interval and tempo runs).

This novel study shows that there is a crucial role for long, easy runs that contribute to greater volumes of running, allowing for improved cardio-vascular efficiency (building a better engine) and optimal physiological functioning.

Arthur Lydiard the legendary New Zealand running coach strongly advised building this low-intensity aerobic base over a period of at least 3 months, (or 4-5 months if you’re starting out) and then building your race specific work later (see Figure 6).

Figure 6

Without the aerobic base, the more intense anaerobic training falls over and results become unpredictable.

The dramatic increase of injuries seen in team sports such as the AFL I believe can be traced back to players not getting significant component of endurance-based work in the pre-season.

Their bodies are put under enormous pressure with sprinting and high intensity drills placing extreme demands on them right from the early stages of their preparation.

Building Your Optimal Running Volume

Figure 6 below gives you some guidance on your ideal weekly mileage to aim for (in kilometers), depending on your experience level and your running goals.

Figure 6.

Building higher volume initially will mean you’ll need to keep your intensity on the lower side.

To figure out what pace you should be doing your easy runs, we created an online calculator that can help you:

Running Calculator

You can enter your most recent 3km or 5km time and see the pace range you should be aiming at for your easy runs.

It also gives you an accurate idea of your training zones for specific goals which is super handy.

Knowing and respecting your individual ‘easy’ zone pace (zone 1 and 2) is probably the single most important factor for a beginner runner to learn (see Figure 7).

Matt Fitzgerald has done a great job of explaining the finer points of getting your training intensity ratio right with his book 80:20 Running: Run Stronger and Race Faster By Training Slower.

Figure 7

Volume First, Speed Second

Here’s where Tim Gabbett’s training paradox comes into place.

Traditional thinking would suggest the more volume and training you do, the higher the ‘wear and tear’ on your body and the greater risk of injury.

This school of thought believes that training is important, but you’ve got to limit yourself, so you will be OK for competition.

However, the research is pretty clear that wrapping yourself in cotton wool from a training perspective leaves you unprepared to meet the demands of your sport, and opens your risk to developing an injury.

So hard and appropriate training is important - but you obviously can’t go out and give 110% in every training session.

Capacity must be built slowly by gradually expose yourself to higher demands.

Benefits of building low-intensity running volume base first

• increase capillary density and mitochondria in muscles

• improved running technique and efficiency - every stride is practice and improving your neuro-muscular efficiency

• improves muscle strength and endurance

• increases blood flow and circulation, leading to healthier tissues and aiding recovery

• improves mind - body connection (can become aware of weak links early in the training cycle and strengthen them with a specific plan)

• improves aerobic capacity, setting the foundation for the rest of the training to build upon

• helps burn fat and maintain appropriate weight

Picture Credit: Hansons Marathon Method Book

Tips for building base mileage

• think about getting more time on feet than achieving a certain pace

• pace should be relaxed and easy - it should pass the ‘talk test’

• keep your cadence relatively high, while maintaining a gentle pace (takes some practice)

• insert walking breaks whenever you feel like you need it

• keep your feet fresh by rotating between 2-3 of running shoes

• get onto the trails where you can take some pressure off your joints and enjoy being out in nature

• listen to running podcasts…highly recommend the Inside Running Podcast

Discovering your weak links

Most of us have some weak links in our body that we may never know until we start to increase demand.

As you’re progressing in training, the harder sessions will ‘test’ your physical capacity and movement foundation.

The benefit of building your low-intensity volume in the initial few months of training is that it can expose weak links in your body, without risking huge strain on your body.

Because there is no pressure to be fast and progress too quickly, in this phase you can take your time to properly address the issue.

Figure 8

The bigger the upcoming performance, the deeper your foundation has to run to support the demands (See below Figure 8).

Identifying your weak links can sometimes be really easy - it’s the area of your body that is overloaded and painful.

But there is often also a deeper root cause of why a certain tissue is getting overloaded.

That is where a good Physio can help you do some detective work and identify the more subtle biomechanical issues that may be contributing.

These issues may be things like:

• weak or inefficient core muscles

• inactive glutes

• stiff ankles from past injury

• tight hip flexors

• poor body awareness

Won’t all this easy running make me slow?

For many years I followed more of a high threshold training approach, believing that training at the pace you want to race at would stimulate the most beneficial training gains.

As a younger athlete with good recovery powers, this seemed to work well.

I did throw in some occasional slower runs, but to be honest I felt guilty doing them because it felt like going slow was completely counter-productive and my body would become soft.

As I have gotten older though, things changed. Harder training sessions took more of a toll and recovery was not as good as it was when I was young.

The old ego was not allowing me to get the proper training that I needed.

It wasn’t until I had a good discussion with running coach / podiatrist Michael Nitschke and he showed me this graph of the training intensity ratios of elite runners.

This was a really good wake up call.

The 80/20 principle of training came into full realization.

Once I fully accepted this principle, a weight was really lifted off my shoulders.

Suddenly I had the green light to run easy, and not feel guilty!

I distinctly remember my first conscious effort to run along at an easy pace.

It was really hard to slow down and be disciplined.

But after about 10 minutes I got over that and then started thinking - this so much fun!

Running suddenly turned into a pleasurable activity, when I wasn’t picking up the pace and burning out with fatigue on every run.

Admittedly the results of this approach to took a little longer to appear.

The ego and running pace takes a short-term hit.

But 6-12 months later, a solid foundation had built up from which faster running will come.

Invest in your training and reap the dividends

To use an analogy, running is like how you manage your money.

Easy running / building up high volume is like building your savings.

Every time you can go out for a jog without pushing into your red zone / high intensity, you’re building up your account.

Every minute your working hard above your threshold you’re spending money.

If you spend more than you save, you’ll go into debt pretty quickly and the bank will call you up and demand you start paying back what you owe.

Injuries are like going into debt.

If you can be disciplined and sensible, investing your savings over time (building your low-intensity volume) over many months and years, you’ll get to really enjoying spending the dividends on race day.

“The less effort, the faster and more powerful you will be” - Lao-tze

Efficient vs Effective Training - The tortoise and the hare

In terms of producing short-term results, there’s no doubt doing threshold runs and pushing your intensity gets you fit and ensures rapid progression towards your goal.

In terms of time invested vs results, this is a highly efficient way to train.

But because each week is full of hard training, it means there is a limit to how much capacity you can generate as you need to allow for rest and recovery.

Your improvement will be quick in the beginning but will begin to plateau fairly quickly.

As your fitness reaches as a plateau, improvements can be smaller, and because of this the temptation is to push even harder in training, naturally leading to an increased injury risk.

On the other hand, effective training, as proposed by Lydiard, recommends more of a pyramid training approach, with the emphasis on increasing total capacity (achieving higher volume mileage) in the beginning of a training cycle.

By starting off slowly and gradually building up can possibly yield better results in the long-term.

The story of the tortoise and could be analagous to the training styles.

As stated above, there is no one ‘right’ way to train for everyone and the research is still lacking.

The important thing is to listen to your body and if somethings working well that stick with it.

But if you’re having ongoing niggles or have plataued in your training, you may need to re-assess your training approach.

Part 2 - Load Management - click here

Part 3 - Recovery - click here

Pain on Inside of Knee? Get To Know Your VMO

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

Is The Resilient Knee Program right for you?

Start a conversation with our new Chat Bot HERE

Get to your know your VMO

If you’ve ever had a nagging pain on the inside of your knee or a knee that seems to buckle or give way, there is a fair chance you’ve had some dysfunction in the VMO muscle.

VMO dysfunction is very common in runners, hikers, cyclists, athletes involved in jumping sports and after any knee injury.

In this short blog, we’ll find out more about how issues develop in the VMO and what you can do to help.

WHAT IS THE VMO MUSCLE?

VMO stands for Vastus Medialis Oblique and this is part of the quads, running along the inside of the thigh, with the bulk of the muscle sitting directly above the inside of the knee.

FUNCTION:

The role of the VMO is to assist with extending your knee and arguably the most responsible muscle for knee stability, as it helps control the alignment of the knee-cap.

When the VMO isn’t functionally optimally, the knee cap tends to shift slightly out of place during movements such as squats and lunges, causing pain and inflammation behind the knee-cap.

SYMPTOMS:

When the quads get overloaded (suddenly or over time), tightness in the muscle fibres (called trigger points) can refer a toothache-like pain deep in the knee joint (see Figure 1 below).

This pain from the overloaded VMO muscle can often be confused with joint pain such osteo-arthritis or a meniscus tear, as the location and type of pain are often similar.

Figure 1

The initial knee pain then may disappear after a few weeks, only to be replaced by a sudden weakness in the knee (a condition called “buckling knee”) that causes a person to unexpectedly fall while walking.

HOW THE VMO BECOMES OVERLOADED:

The VMO can be activated as a protective response to knee injury such as to the ligaments, meniscus or post-surgery.

The VMO is also commonly overloaded with repeated use in the following situations:

• suddenly increasing your volume of running or cycling (running places around 6 x body weight through the quads)

• a new (or sudden increase) in an exercise program involving repetitive squats, lunges, leg extensions or wall sits

• jumping sports e.g. basketball

• cycling - poor bike fit

• walking downhill or stairs

• being over-zealous in rehabbing the VMO - too much strengthening too soon

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your VMO issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building capacity in the quads, glutes and core is critical to prevent a relapse.

TRIGGER POINT DRY NEEDLING:

Tightness and contraction of the VMO responds very well to dry needling, which can de-activate the trigger points (knots in the muscle).

The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms. 

Treatment of the VMO is generally very responsive to treatment, provided the contributing factors are addressed.

SELF-CARE TIPS:

• apply heat to the VMO muscle 10 minutes each day to increase blood flow and reduce tension

• if you’re a runner or hiker, avoid the hills (in the short-term)

• ensure your shoes are not overly worn

• when running - avoid over-striding, ensure proper warm up and cool down and take walking breaks frequently to avoid overloading the VMO

• avoid prolonged kneeling on the floor e.g. gardening, washing floors - use a low bench or stool to sit on instead

• foam roll the VMO daily for a few minutes (see below). It’s also a good idea to roll out the adductors which are also commonly tight
  

Foam Roller for the VMO:

Foam rolling the inner quad and adductor - fun times!

Let’s get you back to doing what you love…

Online Physio plans are available for anyone who wants to be guided back to good health, under the supervision of an experienced Physio.

If you’d like to get your knee on the fast track straight away, please use the button below to schedule an appointment online:

Download the The Healthy Knees E-Book - now on special !!

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

---

Building A Resilient Knee For Running

Building A Resilient Knee For Running

Important Note: This blog post is very general in nature. Some or all of the advice may not be appropriate for you. Please check with your Physiotherapist for specific advice on your condition.

---

If you’re fairly new to running - and tell your friends and family you’re planning or running a marathon or half-marathon, very often you get this well intentioned question:

While we can easily shake off the comment at the time, it’s often not until a few months down the track, when your training volume starts to increase, you may in fact start getting some twinges in the knee, that the comment can come back to haunt you.

An element of doubt can sit in the back of your mind, making you question:

“Is running actually harming my knees”?

“Were they right after all”?

So what does the research say?

There’s a common view in the community that running isn’t good for your knees, and may cause early wear and tear and possibly lead to arthritis.

So what does the research actually show?

A very high quality study recently came out that followed over 100,000 people to see how their lifestyle and exercise habits related to their risk of developing knee arthritis.

The study showed that recreational runners had a risk of developing knee arthritis that was around 3.5%, compared with non-runners whose risk was 10.2%.

Knee arthritis risk: Runners vs Non-Runners

In other words the non-runners had a three times greater chance of developing knee arthritis that runners.

Amazing.

Rather then their joints ‘wearing out’, runners had increased muscle bulk around the knee, providing a protective effect on the joint.

This study allows you to be confident that recreational running will not harm, and may actually improve, your hip or knee joint health.

Biggest Risk Factor

So if running doesn’t cause arthritis in the knee, then what is the biggest risk factor?

If we look at the research again - the biggest risk factor for knee arthritis was being over weight.

So in terms of knee arthritis, the risk of being inactive and becoming overweight is much greater than being active and running regularly.

Knee pain and running

So… we know running doesn’t cause arthritis - (it actually might prevent it).

However, the knee is still a very common area of pain and injury for runners (in fact 50% of all running injuries are in the knee).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

Patello-femoral Syndrome

The most common running related injury is what we call Patello-femoral Syndrome (also known as Runner’s Knee).

Patellofemoral pain (PFP) is a condition where pain is felt on the front of the knee, either around or behind the patella.

It is caused by an increased load and force going through the knee-cap that, resulting in inflammation and swelling around the knee.

The main symptom of Patello-Femoral Syndrome is pain with loading and a general vague ache in the front of the knee.

The pain generally gets worse with:

• running especially downhill

• climbing stairs

• kneeling and deep squatting

• sitting with knee bent up for prolonged periods e.g. sitting on a plane or movie theatre

Key Point:

A key point here is that knee pain from running is most likely related to inflammation around the knee cap rather than any structural joint damage.

The confusing thing is that the aching pain from patello-femoral syndrome can mimic the pain you may feel in the early stages of knee arthritis.

No doubt this can be a little disconcerting.

But you definitely don’t need to freak out about developing knee arthritis.

2 choices:

When you develop knee pain as a runner - you have 2 options:

1. Keep running and push through the pain barrier.

   Sometimes this can help and the pain goes away. But sometimes the pain doesn’t get better and things just get worse. Runners traditionally have very good pain thresholds - but the jury is still out if this is a good thing or not!

2. Stop running altogether.

   As runners, we know when you stop running, you tend to lose your fitness really quickly. Your capacity decreases rapidly and your muscles become de-conditioned and so just resting doesn’t really solve anything. When you get back to running, the pain and inflammation is just as bad as before.

Thankfully there is a 3rd option - and the rest of this post will be talking about five very practical strategies you can use to help reduce your knee pain and get back to running.

5 Strategies to help with knee pain and get you back to running

Before we start, we need to get on the same page.

Unfortunately there are no quick fixes.

There are multiple factors (20-30!) that may all play a role in why you’ve developed knee pain.

Without doubt, the best results come with a personalised assessment with a Physio who has a special interest in running.

This will help identify the main issues and get you on the fast track to healing.

On average, it takes 8 - 12 weeks to reduce knee pain and get back to running properly again.

Getting healthy again will test your patience, and it is very often a case of 2 steps forward 1 step back.

1. Reduce Inflammation

If we go back to the original cause of the patello-femoral pain in the knee - it is inflammation that develops under the knee cap.

If you have knee pain, it means you have inflammation.

So the first and most important step is to reduce the inflammation in the knee.

The best way to do this is to use a good quality ice pack on your knee for 15 mins x 2 day (every day for 2 weeks).

The ice packs we sell in the clinic are the Sideline Ice and Wrap ($39)…they are a great option.

Using the velcro strap means you can get a solid compressive effect and still keep moving about, without having to stay seated the whole time.

Often the knee starts to feel better quite quickly when you decrease the inflammation, but it’s important to keep icing for 2 weeks so you completely break the inflammatory cycle.

If you start to feel better and then return to exercise too quickly, you will start the inflammatory process over again.

Another good option when you have knee pain is getting into a pool or standing in the cold water down at the beach. The buoyancy of the water can have a positive impact on decompressing the knee.

We don’t tend to use anti-inflammatory medication, unless the pain and inflammation is severe.

2. Reduce Load

Generally, activities with more knee bending increases stress to the Patella-femoral joint.

So to reduce irritating your knee further, you will need to:

• reduce heavy weights especially lunges and squats

• avoid stairs

• avoid kneeling

• avoid sitting with your knee bent up for prolonged periods

Sometimes you also need to avoid a quad stretch as this can also irritate the knee joint

Reducing Load When Running

If at all possible, we like to keep you running in the short-term, with a few alterations.

Some common modifications include:

• avoid downhill running and keeping to flat ground as much as possible

• reduce speed and include some more walking breaks (especially when you feel knee pain)

• do shorter, more frequent runs rather than longer runs

If running is still too sore you may need to take a complete break for 1-2 weeks.

In this time, you can generally keep walking and getting in the pool can be helpful too.

Some people like to get on the bike, which can be a good option to maintain your cardio-vascular fitness. However you need to be wary of developing muscles imbalances that cycling can often accelerate - most commonly increased hip flexor tightness and under-active gluteals.

3. Increase Tissue Capacity

If we look at which muscles are loaded when we run, the soleus muscle in your calf (takes up to x 8 body weight) and the quads (up to x 6 body weight).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

They already work a lot so it probably doesn’t make a lot of sense to increase the strength of them, especially if you are running a lot and doing hills regularly.

But the accessory muscles such as the hamstrings, gastrocnemius, and the glutes have all got potential to improve their capacity and help off-load the knee.

Some common exercises you could include would be calf raises, bridges, clams, crab walks and hamstring curls on the ball.

Getting a Physio to develop a personalised program for you will provide many benefits in the long term and keep your knees from getting overloaded and inflamed.

4. Create Neuro-muscular balance

Many people think of the knee as a simple hinge joint.

While the joint does act like a hinge, there are around 20+ muscles that attach and need to be balanced around the knee.

If you are a musician - anyone who plays the guitar - you know that every time you play, you spend a couple of minutes ‘tuning’ up, before you play.

If your strings aren’t fine tuned properly then obviously your going to sound terrible!

The muscles are like the strings of the guitar, and tend to get overloaded and tight with running, leading to increased loads on the knee-cap.

Keeping your muscles in tune could include things like:

• foam rolling

• stretching

• deep tissue massage

If your muscles are having a bit of trouble releasing, then the next step would be to try dry needling.

Trigger point dry needling has the ability to reach deeper into the muscle, getting a more effective release.

You can find out more about dry needling here.

5. Modify Running Gait

There is some solid evidence showing that making some small modifications to your running gait can take pressure off your knee.

Returning to running after a knee injury can be a little scary.

We find sometimes people can be a bit over-cautious and defensive and this leads to a very upright posture, almost running within yourself.

Counter-intuitively, this upright posture tends to increase the force on the knee…so switching to a forwards lean is a simple solution.

Some studies have shown that incorporating a forwards lean can improve your running efficiency by up to 30%, as you tap into the power of gravity.

It’s important to lean forwards from your ankle, rather than bending from your waist, that could lead to pressure on your lower back.

Over-striding

A common thing with knee pain in running is over-striding.

This can lead to increase peak forces going through the knee.

The solution is to modify your cadence (how many steps you take per minute).

Generally, increasing your cadence 5-10% can significantly decrease the peak load of force going through your leg.

For example, if you’re at 165 steps per minute - increasing to 175 - 180 may do the trick.

Many GPS watches track your cadence in real-time, or you could use a metronome app on your phone to help keep your rhythm.

Side note: Running with a faster cadence doesn’t mean you have to run at a faster speed. There is an art to learning to shorten your stride, but still run at a comfortable pace - it can take some practice.

Return to Running

Just a few final tips about returning to running from a knee injury:

• for the first 3-4 weeks, choose a flat surface to run on and gradually layer in the hills as your pain allows

• before you run - do a quick tune-up - foam rolling, gluteal engagement exercises

• try taping the knee. About 50% of the time, using a rigid tape can make a huge difference in stabilising the knee cap. The other half of the time it doesn’t make much difference, so it is worth trying out - and your Physio can show you how

• shoes - a new pair never goes astray after an injury and will help take the full shock absorption with less pressure on the knee

Pain as you return to running

As you return to running, your knee may still be twingy.

The following scale is useful to keep in mind and rates your pain level from 0 (no pain) and 10 (worst pain you could imagine).

Of course, ideally the pain would be 0, and that’s great if that’s the case.

In reality, you may still have some twinges and soreness as you’re getting back into it.

This is really common and is often more related to the knee getting used to the loads again, rather than more damage.

We rate a 0-5 pain score as an acceptable level.

You can still run, but just be mindful, if your pain increases to a 6 or greater, then you need to stop and walk / rest.

Take note of your pain levels at the time of exercise, and also the 24 hour response.

Pain that lasts until the next day means you’ve probably done too much, so next time reduce the amount so your body can handle it and gradually build up from there.

---

What about if you already injured your knee - is running still OK?

That is a great question, and it is very hard to say without a personalised assessment.

If you have previously torn a ligament or meniscus in your knee - some doctors would suggest you avoid running forever.

However, if we go back our research showing the biggest risk factor of knee arthritis is being over-weight, there is a case to be said for gradually re-introducing running (if it’s something you enjoy), as a means of maintaining effective weight control and creating a supportive muscular foundation for the joint.

Following the five strategies outlined above would most likely be a great help, but again please consult with a Physio to get a tailored plan set up for you.

Avoiding surgery

Some recent research has demonstrated that 65 per cent of people with knee arthritis and meniscus tears can avoid surgery by following a physiotherapy program (Katz et al. 2013).

The protocol involved an individualized physiotherapy treatment plan with a progressive home exercise program. 

The three-stage structured program was designed to:

• decrease inflammation

• improve range of motion

• optimise muscle strength

• improve aerobic conditioning (e.g., with the use of a bicycle, elliptical machine, or treadmill)

• proprioception and balance re-training

Conclusion

Running is safe - it definitely doesn’t cause arthritis and may even protect your knees.


Knee pain is common however and the most common cause is knee cap pain.

Listen to your body - respect it - get in touch with Physio who can guide you back to running safely.

Rather than pushing through the pain or stopping alltogether, try the 5 Strategies:

• decrease inflammation using an ice pack

• temporarily decrease load

• increase tissue capacity with some simple strengthening exercises

• create muscle balance

• modify your running gait

If you have any other questions about knee pain and running, I’d love to help you out.

You can send me email to dan@kinfolkwellness.com.au

If you’d like to get started on your journey back to running pain-free again, simply click on the link below to schedule an appointment.

Dan O'Grady is an experienced Running Physio in Adelaide who has worked with runners from around the world including ultra-marathoners and weekend warriors.

• Dan worked with Robert De Castella's Indigenous Marathon Project at the 2013 New York City Marathon.

• A keen runner himself, Dan ran the New York City marathon in 2015 & 2017 and is currently preparing to break his 5k PB before he turns 40!

• For running advice & inspiration, follow our Instagram

---

The Pilates ‘spectrum’

The Pilates ‘spectrum’

Guest Blog Post Written by Melissa Anderson Owner; Körpermotus Pilates (123 Unley Rd, Unley)

We have heard it often - ‘Pilates was too easy; just seemed like I was just stretching’ or ‘I was in a group class, it moved too fast and I felt like I couldn’t keep up’.

Hopefully I can explain why that might be the case, so you can continue with your Pilates classes!

The Pilates Method consists of a spectrum of movements and equipment to cater for all clients, and wherever you reside, we promise that being patient (as hard as what that can be) it’s worth it!

I’ll be explaining the different types of classes (such as mat and reformer Pilates classes) to help with a better understanding.

What do you mean by ‘spectrum?’

Due to the overall method, the movements and the variations that the Pilates method contains, Pilates is able to cater for a range of pathologies and goals.

With this in mind, the goal is to match (or at least get as close to matching) your expectations with the requirements of your body.

The Spectrum:

At one end of the spectrum would be those who are:

• injured

• just come out of surgery

• new to Pilates or

• mid-late stage pregnancy

Ideally, you would work with the likes of a Diploma-qualified (or equivalent) Pilates instructor (note: seek classes that are individually programmed or request private sessions rather than general classes) or a Pilates-trained physio, chiro or other allied-health professional would be conducting the session.

It’s not to say that these sessions won’t be challenging; it’s more about the suitability to the current pathological status to ensure an injury-free future or management plan.

This may require what could be seen as ‘boring’ exercises, but we ask that you keep asking questions if you feel like you’re not sure of the ‘why’s’, as these exercises tend to be the ones you may need the most.

You should be able to find classes and privates like these at dedicated equipment Pilates studios and physio/chiro/allied health clinics.

For those who have moved a lot and/or are only limited to ‘niggles’ here and there, small and large Pilates classes (of any kind) are financially viable, usually at times around work and have a great mix of challenges and mobility work.

In an ideal world, a few smaller classes or at least an introduction will help to break down your own personal understanding of better breathing, pelvic and spine alignment and head and shoulder posture.

Sounds fussy, but constant consideration of these components (as well as a few other things!) are the underlying focus of Pilates.

Please also note that Pilates isn’t a gym workout replacement – this isn’t to say that you won’t feel worked, but your expectations from Pilates shouldn’t be to sweat and frequent fatigue.

If you are wanting that feeling, I’d recommend adding Pilates as an accompaniment to other HIIT/strength classes to ensure your goals are met across the week.

These group classes can be found at a Pilates studio, a physio practice, a Pilates franchise studio and a gym.

These classes can be of the mat, reformer, chair or equipment variety depending on the studio/clinic.

I recommend to still search for Pilates-qualified instructors (rather than a quick weekend course) and to assess if a smaller (5-10) or larger (10-12+) class size is better suited to get the most value out of the method.

When it comes to different class ‘types’, finding suitability may come down to your current injury or level of confidence rather than a mat or equipment class.

That’s not to say you can’t attend one or the other; the studio in your area will be able to further explain their approach and what would be best suited initially.

Types of Pilates Classes:

Mat classes:

These classes can be smaller or larger in size depending on the studio or the gym and primarily consist of exercises on the mat with small equipment and props for added challenge or support.

It’s common to see pre and post-natal mat classes as well as age and level specific classes.

It’s common to see these classes at gyms, but please be mindful that these classes may not be ‘Pilates’ per se; if it’s just full of abdominal exercises then you’re not getting the full Pilates experience!

Clinical/studio/equipment classes:

These classes are commonly held as a 1:1 up to a 5:1 client/instructor ratio depending on the studio.

The Pilates equipment allows for more challenge, support and mobility whilst also allowing us to get more specific with your injury or your goal.

Some equipment moves on a fixed line, where others move around; so when it comes to building up shoulder strength after a rotator cuff injury for example, we can challenge and support accordingly.

The equipment consists of, but is not limited to:

• reformers

• trapeze tables (or Cadillac)

• chairs

• baby barrels

• ladder barrels.

Due to the nature of these classes, they are usually individually programmed rather than everyone doing the same movements at once.

Reformer classes:

When you hear someone say ‘I do reformer Pilates’, this is it – but there isn’t really such thing as ‘reformer Pilates’ in the sense that it’s another method, it’s just that the reformer is so versatile in its offerings that it makes for a great class.

I do recommend sticking to small class sizes to ensure you’re receiving appropriate instruction and cueing to get the most out of your class.

Depending on the studio you may see beginner and intermediate classes, however some studios also cater for all within the one class and ensure the spring setup is suitable.

I recommend contacting the studio you’re interested in to confirm.

Joseph Pilates once said:

“Concentrate on the correct movement each time you exercise, lest you do them improperly and thus lose all vital benefits.”

So with that in mind, I hope that the explanation of the ‘spectrum’ of Pilates and the types of classes offered has enabled you to find the most suited and valuable class type for your current situation, and that you feel more informed to make decisions down the track if that changes.

Alternatively you can visit www.korpermotuspilates.com.au as we are always happy to have new faces at the studio!

Happy Pilates-ing!

Melissa Anderson

Owner; Körpermotus Pilates – Cross-pollinating movement forms to create better humans

Level 1/123 Unley Rd, Unley SA 5061