Creating An Unbreakable Athlete - Part 2 - Load Management

Creating An Unbreakable Athlete Part 2 (Monitoring and Adapting).

This is part two of a three part series about building an ‘unbreakable athlete’.

The three parts consist of:

• Identifying the Peak Demands of Your Sport and Building Capacity

• Monitoring and Adapting your Training

• Recovery

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As mentioned in Part 1, there is no one ‘right’ way to train for everyone.

This blog is an attempt to set out some basic principles you can use as a guide and then you can mold it with your own unique flavour.

The important thing is to listen to your body and if something’s 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.

As always, this blog contains very general information and should be used in conjunction with a coach or health care professional.

Also, as most sports have running as their base, we are once again focusing on how to build your capacity for running, as it is the foundation for everything else.

A small warning, half way through this blog we go down some deep rabbit holes in terms of monitoring the numbers.

If you happen to be a numbers person you will appreciate it, but if not, just skip that section and think about the overall principles instead.

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Building Capacity - How Hard Is It, Really?

Getting fitter and stronger involves a very simple equation:

Stress + Rest = Adaptation

On the face of it, as you build up your training, progress should be fairly linear, right?

For example, let’s say your training for your first marathon.

You start off with 5km runs which are very manageable, build up to 10km which your body enjoys and then 15km is a bit of stretch. When you get into the 20km+ long runs - all of a sudden something goes wrong…a niggle.

All of a sudden your perfectly laid out training plan is looking a little shaky.

You need time off, but that means while you rest your injury, your fitness is going backwards.

Instead of picture graph A below, your training turns into graph B (thanks to Adam Meakins for the graph).

The goal of this blog is to help make your climb as smooth as possible - no doubt there will still be ups and downs. This makes life interesting and reaching your goals even more satisfying.

But if we can avoid the dramatic boom-bust cycle in your training, I think you would enjoy the process much more.

As Matt Fitzgerald writes in his book RUN: The Mind-Body Method of Running by Feel, developing confidence in your body through sensible and effective training, leads to an upward spiral of enjoyment, satisfaction and ultimately improved performance.

Monitor Training Loads

“If you can’t measure it you can’t manage it”

There are many variables in how you apply a load and how you measure it.

So in the blog we’re going to take a look at the bigger picture of training loads, as well as zooming down to the daily battle of improving fitness.

The first step to avoiding the boom and bust cycle is becoming aware of your training load.

You can test the seriousness of an athlete by the presence of the wearable technology they use, with beginners relying on feel or an app.

With increased interest in progressing your training, the next step is investing in a GPS Running Watch.

With a GPS watch you can collect data such as:

• Distance

• Time

• Current Pace

• Average Pace

• Splits

• Cadence

• Heart Rate

• Estimated VO2 Max

Without a GPS watch, the research shows athletes are traditionally quite poor at measuring their training load.

For example, a recent paper shows athletes with bone stress injuries, tended to under-report their training volume.

We learnt from blog post 1 that many of us, especially beginners, under-appreciate the demands that running places on our body, and subsequently go onto cause damage and injury.

You can’t blame the activity

Often, when injury happens, we can be quick to blame the activity itself - believing it is dangerous and best to avoid it.

This can lead to a downward spiral of reduced fitness and lowered tissue resilience, further increasing the risk of injury.

No doubt this is how running probably got a bad rap and why your ill-informed relative continues to insist that running is wrecking your knees (it isn’t).

Instead of worrying about local tissue damage and pathology (aside from accidents), we can simply modify the load we are placing on ourselves, as this arguably has a greater influence on recovery more than any other factor.

As humans, we have bodies that are more like gardens that, given the right conditions, flourish and thrive, and once or twice per year give off the fruits and rewards of our labour.

Unlike a car, that tends to wear out with use - we are adaptable and actually thrive when given the right amount of positive challenge / stimuli.

Taking this view, we can see our injuries and niggles in through a wider lens.

If we understand how the various training loads affects us, we are less likely to be worried when the aches and pains strike.

We’ll talk more about that later.

For now, a quick story…

Getting your training recipe right

Admittedly, I am terrible at baking.

A few years ago I found this delicious cookie recipe.

I used to make it for our hikes and when I pulled them out on our breaks and got a Masterchef worthy applause from friends and family.

But then something odd happened…they started testing terrible!

Maybe because I have 2 kids now and I’m rushing around a bit more, so when I go to throw the ingredients in, I’m a bit more haphazard.

After a few more tries, they continued to taste even worse.

I finally had a good chat with my wife about why they tasted so bad, and I realized I had been adding waaaayyy to much bi-carb soda.

For some odd reason, instead of the half teaspoon that the recipe called for, I had got into the habit of grabbing the box and pouring some in, without measuring it…obviously way too much, so the cookies came out tasting weird and bitter.

In my head, I knew when baking it was important to measure things (my wife is a big stickler for that)…but subconsciously I was like,

“A little bit is good, so more must be better right?”

So I had wrecked the cookies by accidentally adding too much of one element and the balance of flavours was completely off and impossible to enjoy.

I think running can be like cooking.

You have all your ingredients and if you focus on getting the balance right - you will have a successful time achieving your goals and your enjoyment will sky rocket.

On the other hand, get the balance wrong, and your body will soon tell you.

When you look at experienced chefs - they are continously tasting their cooking - and modifying and adapting as they go to produce the best result.

But we need a way of measuring, otherwise there will a tendency to stuff things up, just like I did with the cookies.

The great thing about training is you can mix in the ingredients as you like, put it in the oven, and see what comes out on race day.

There are so many options and variables that everyone has their own unique blend.

But once you find a good recipe you stick to it.

Won’t looking at my numbers take away the fun of running?

I know there are some purists out there who resist the notion of monitoring their training.

I completely understand and I think there is a real risk of getting distracted/addicted to your watch and losing the connection to how you’re feeling and enjoying being in the moment with what’s going on around you.

But if you are always injured, or not achieving the goals you set out to achieve, then to me, that is worthy of further investigation of your training habits.

Running by intuition can play an important role in a balanced program (see below) - but sometimes it can be completely off.

The best example is someone who’s results have plateaued, and their intuition tells them they simply need to push themselves harder and harder in training. They may even feel like they are mentally weak.

In reality, they be simply over-trained and exhausted due to an un-monitored and overly demanding training program.

Imagine if you were to buy a lamborghini - that is incredibly powerful - but it didn’t come with a speedometer. The risk of speeding and getting yourself a ticket would be fairly high.

Investing a small amount of energy into monitoring your training ultimately should lead to less injuries - which means more time and enjoyment from the sport.

And you should be able to run happily as long as you want to into old-age.

Finding your optimal training

The graph below shows the relationship between training load and optimal performance.

The ideal training stimulus ‘sweet spot’ is the zone between improving fitness and building physical capacity, while at the same time limiting the negative consequences of training (ie, injury, illness, fatigue and overtraining).

Both under-training and over-training will lead to poor performance.

As you progress your training, your body will have the ability to absorb greater training loads.

Finding that sweet spot can be a little tricky, so how could monitoring our training load help us?

10% Rule

For many years athletes have used the 10% rule to guide their training - that is to never increase training load more than 10% on a week to week basis.

This has worked well for many athletes as a general guide, especially during the mid-phase of a training program.

But for athletes just starting out the 10% rule would probably be too slow of a build-up and athletes who are already at their peak it would be too much of an increase.

See the bigger picture of your training load

Another strategy, popularized by sports scientist Tim Gabbett is to use a ratio that compares your short term training (typically measured over a week) with your base fitness (typically measured as the average weekly load over the past month).

This is know as the acute:chronic load ratio.

For example if you run an average of 50km per week over the past month and the next week in your training cycle, you cover another 50km, the ratio would be:

Acute 50km (most recent week) : Chronic 50km (average over the past 4 weeks) —> 50 divided by 50 = 1

A score of 1 means your fitness will remain pretty stable, with a very low chance of injury (see graph below).

If you increase your subsequent week to 60km - the ratio would be:

Acute 60km : Chronic 50km —> 60 divided by 50 = 1.3

Tim Gabbett’s extensive work has suggested that a ratio of 0.8 - 1.3 is generally sustainable and is the ‘sweet spot’ for optimal training (see graph below).

But as your ratio gets up 1.5 or higher, your risk of injury increases.

Spikes in training loads are necessary to improve fitness, but spikes that are too great can lead to an increased risk of injury (see pic below).

Excessive spikes in training load normally relate to a sudden increase in volume or intensity.

Often this can happen after a period of reduced activity e.g. coming back from an injury or at the start of pre-season after a holiday.

It can also be related to sudden decrease in your bodies capacity relative to your training loads e.g. high emotional / environmental stress, poor quality sleep, nutritional / digestive issues, serious illness, poor recovery strategies) that increase the chances of an injury developing.

We know that not every time you spike your training load you will get injured, as some athletes are more robust than others. This ratio just gives us a general guide about the increased possibility of injury. Being aware of when your training load is high, you have the advantage of really doubling down on your recovery (sleep, nutrition and maintaining tissue quality) to help absorb to higher demands of training.

We will go into more detail later about some of the factors that influence your likelihood of getting injured, and how you can modify your training to avoid time on the sideline.

Benefit of the acute:chronic ratio

The acute:chronic workload ratio is considered a ‘best practice’ approach to monitor athlete workloads. As stated above, an acute: chronic workload ratio of ≥1.5 has been associated with large increases in injury risk.

The benefit of keeping an eye on the acute:chronic ratio is that is really emphasizes keeping your consistent base training volume relatively stable.

This means you can afford to spike your training loads in order to improve fitness, without increasing the risk of injury.

It’s a rather technical way of monitoring your load and ensuring a safe transition to higher physical capacity.

To become an unbreakable athlete, it definitely helps if you’re not in a rush.

Veteran marathoners and experienced coaches advise it may take 5-10 years to really realize your full potential as a runner / athlete, and building this chronic capacity is what they are alluding to.

How to find your chronic ratio

If you have a Garmin GPS watch, a simple and quick way of monitoring this acute: chronic ratio is to view your ‘Activities’ and check your 4 week average (see Figure below).

On the bottom left hand corner you will see your average distance over the past 4 weeks.

One of the most important metrics you can track (Bottom left hand corner) - Average Weekly Km over the past 4 weeks. This is know as your Chronic Load and is a measure of your general fitness. A good idea to check this number before your plan you upcoming training week.

To be sure you’re not over-training and increasing the risk of injury - your upcoming training weekly should be between 0.8 and 1.3.

Spikes of 1.5 or more may be tolerated, but do increase your injury risk and you’d need to really put a lot of effort into recovery.

Getting more specific with monitoring load

Another important point - obviously measuring distance covered alone doesn’t tell the full story about your training loads.

A 50km week of intense threshold training is very different to 50km of easy jogging.

If you follow the 80:20 principle (80% of your training easy, 20% hard) as proposed by Matt Fitzgerald, then using your Garmin’s distance would give you a good general guide about how much load you are getting each week.

The other option, more specific way is to use a Rate of Perceived Exertion Scale (RPE) and combine it with your training minutes.
So for every training session, you rate it on a scale of 0-10, where 10 is the hardest.

Then you would multiply the minutes trained with your RPE score to get the more accurate training load number.

E.g. you did a hard run at 60 mins

60 mins x 8 RPE = 400 units of load in that training session.

Using the acute:chronic training ratio over the course of weeks and months here would be highly specific, but obviously quite time consuming for the average runner and probably more for those wanting to take things more seriously.

There are some spreadsheets available online, also using Strava’s premium monitoring can give some good data that helps track your intensity and workload.

Coming back from injury / illness / time off running

We know from the research - the biggest risk for an injury is a past injury - meaning the way we return to our chosen sport is often not ideal.

Arguably the reason many athletes suffer injury after injury, could well be the way we manage their load upon return.

For example, let’s say you’ve averaged 50km per week over the past 4 weeks, and your training is going great in the build up to your next race.

Your chronic load is 50km, meaning a spike in load up 1.3 x 50 would be probably be OK.

That means your following week’s training, you have some extra time and want to build some volume, so you can (everything else being equal) build up to 65km in the week.

On the other hand, let’s say you come down with the flu, or happen to sustain an injury meaning you have 2 full weeks off running.

The last 4 weeks all of a sudden looks a little different:

Chronic Load Calculation:

50 + 50 + 0 + 0 = 100

100 divided by 4 weeks = Chronic Load of 25

So that crucial first week after your break - you may be anxious to get back to running and you return your standard 50km week (or even try and make up for lost time by doing a 65km week).

Acute to Chronic Load Calculation:

50 divided by 25 = 2 - which puts you at a dramatically higher risk of further injury.

Once again, going by the acute:chronic load calculator - increases of up to x 1.3 are generally safe.

In this example, the runner would have been wise to limit their first week back to a much more manageable 25km- 32.5km.

Just to confuse you a little more, injuries don’t peak until 3-6 weeks after training errors take place, so keeping accurate training data becomes even more vital.

Take home message

The key message here is the higher your consistent monthly average, the more you license you have to spike your load safely, in preparation for your specific upcoming event.

If you regularly miss days or weeks of training and you try and make up for it with higher intensity sessions, you may be setting yourself up for a frustrating boom-bust cycle of injury - where you have high physical fitness, but your body is continually breaking down, from one injury to the next.

Before you plan your training week, have a quick check of your average weekly load over the past 4 weeks, and make your decisions from there.

This approach will test your patience and it requires some faith in the science, as well as your body’s ability to adapt.

The slower, more considered return to running will pay dividends weeks and months later when you have made a successful return to training and running.

Training Guidelines

If we look at top world class runners, they schedule 2-3 hard sessions maximum per week where they are really pushing themselves.

The rest of their training (80%) is spent at easy intensities, focusing on building their volume and efficiency.

Other training tips include:

• Consistency in training trumps short-term intensity

• Allow a proper warm-up and cool down. Your warm-up may involve some foam rolling and gluteal / core engager exercises (especially if you sit a lot of the day) to prepare your body for optimal performance

• Schedule a rest day at least once per week, or 2-3 days per week if your a beginner

• Never do two very hard training days back to back (unless you are very experienced)

• Take a recovery week every third or fourth week to consolidate the training you’ve done and keep you fresh and motivated for the next training cycle

• Build your low intensity base volume early in the season and then focus on speed work later

• Saves the long hill runs for later in your training program, but you can include short hill sprints (e.g. 10 x 10 secs) early in your program to help build leg strength

Increasing Training Loads - What To Look Out For

As you start increasing your training load, certain tissues have a tendency to become overloaded.

The following graph gives an excellent visual of the common issues many runners face.

Photo Credit: Rich Wily Running Symposium La Trobe 2018

If you are doing a lot of ‘speed work’ - your calf, plantar fascia and achilles is at high risk. Tendon soreness/pain can often take 24 - 72 hours after sessions to fully come on, so that is something to be aware of as you plan your week.

If you are doing more higher volume work - your knee, tibia and lower limb stress injuries are more prevalent.

If you have a history of certain injuries, it may be worthwhile avoiding excess speed or volume work in the short-term until you have built up a better base foundation.

Signs of over-training:

Sometimes we can push our training too far and I think most athletes have had the feeling that comes from over-training.

It’s normal to be fatigued and sore, but there are some other signs that can point towards over-training such as:

• Lack of enjoyment in training and racing

• Un-explainable under-performance

• Persistent, extreme fatigue

• Increased sense of effort in training

• Sleep disorders

• Fluctuating mood

Listening can be hard

It can be hard for runners to listen to their bodies as pain killing hormones such as endorphins can mask the damage.

Ignoring and going into denial early on and turn small niggles into serious injuries.

Sometimes you need to hit rock bottom i.e. you can’t run or train at all due to pain and weakness, before you change your approach.

Monitoring Tissue Quality

The state of your musculo-skeletal system is generally a pretty good predictor of the state of your body’s readiness to perform.

Improving body awareness through things like massage, foam rolling, stretching, yoga and stretching can give you an early sign that your tissues may not be handling the loads of your training.

As a Physio, I spent a lot of my time ‘panel beating’ tight muscles and get a sense of whether a tissue is abnormally tight. If appropriate we can perform a series of treatments, over time noticing the tissues moving towards a better state of equilibrium.

More importantly, I can give feedback to the client about extra self-care they may need to focus on, teaching people more about potential ‘blind spots’ they have e.g. hidden tight spots, under-active muscle firing or an inefficient movement pattern that could increase injury risk and limit performance.

If you are ‘tight everywhere’ which many athletes complain of - it’s most likely a training overload situation and no amount of foam rolling or needling will help until you address the underlying cause - so the reason for this blog series.

Injuries

Warning signs that you have an injury may include:

• intense pain > 5/10

• night pain

• excess swelling and inflammation

• pain that gets worse with exercise or 24-48 hours following exercise

The most important way to avoid injuries is to not train through pain.

If you are feeling pain from an injury, it is wise to take 3 days off running, then have 2-3 days of low intensity running to see how it responds.

Getting into to see your local Physio early on can also be a big help in getting the best treatment and plan in place.

Intuitive - Running by Feel

As you become more experienced as an athlete, you learn to trust what your body is telling you on a day to day basis and make adjustments to your program.

Listening to your body over time will help you to define your optimal training formula in terms of the volume and intensity of your training.

I’m a big believer that getting out there and running more is the best teacher. Intuition is a great guide - and your body is always talking to you and giving you hints and tips about what it needs.

The other thing to keep in mind is that when you’re feeling good - it can often be hard to know when to call it quits on a session as there is a temptation to push that little bit extra in the hope of gaining that extra bit of fitness.

Bradley Croker, co-host of the Inside Running Podcast summed it up perfectly, when he was reflecting on his own pattern of injury -

“When you’re feeling good, rather than increasing load by 10%, you should probably decrease load by 10%”.

Feeling good means you may well be at the peak of a training cycle and rather than pushing on even harder, an easy week absorbing your training and enjoying the benefits of improved fitness may be what you really need.

As small wins accumulate, you gradually gain more confidence in your body.

Every run is a battle between current capacity vs load

We’ve zoomed out and looked at weekly/monthly training practices that can be optimised, leading to safely building your physical capacity and protect you against injury.

But that is only half of the equation…

The second half of the blog will focus on zooming in and seeing what happens every time you perform a training run or competition at the micro-level.

As a rehab community, we’ve had a big focus on the load and talking about training practices, but not as much focus on the readiness, or capacity of our bodies to match that load.

Essentially every training session is a battle between your current capacity (which can fluctuate daily) and the load you’re applying.

In an ideal world you would structure your training so there are only incremental differences in the demands of training and your current capacity.

A process that stimulates continual positive adaptations in your fitness (see graph below).

Key point: your physical capacity can vary significantly day by day

We can apply the same load on two different days - and have two significantly different results.

There are a number of important modifying factors that decrease your physical capacity in the short-term.

These factors may include things such as:

• Inadequate fueling (dehydration or lack of carbohydrates / glucose)

• Digestive issues

• Injury

• Soft tissue issues e.g. excessive tightness or neuro-muscular inefficiencies

• Inadequate recovery from previous session

• Static stretching right before a run

• Poor sleep

• Decreased motivation

• High stress levels

• Long work hours

• Excess sitting

• Other lifestyle factors e.g. excessive alcohol consumption

• Inappropriate equipment e.g. worn shoes

• Caffeine (lack of)

• Viral illness

• Altitude

Non-modifiable factors:

• weather e.g. high humidity, wind e.t.c

• age

• gender

• pregnancy

• serious illness / accidents

The more of these modifiable factors you have in a given training session or competition - the bigger the gap or mismatch between your capacity and demand, thus the greater risk for developing an injury.

Key point:

Significant spikes in training load can be a result of a mis-match in current capacity vs training load (e.g. too much training, or a body that has dropped in capacity).

These modifiable factors may be present on a particular day, or they might lurk in the background over months/years.

For example being nutritionally deficient in calcium or vitamin D can pre-dispose you to stress fractures, which develop over months.

Becoming aware of these modifiable factors (and there are plenty more that haven’t been listed) is huge step to avoiding over-training and injury.

Ultimately it means you can set realistic expectations and work towards them.

Getting the most out of your training sessions

Managing your modifiable factors can be a way to manipulate your training to make it easier or more challenging.

As you gain more experience, you can start to play around with the variables to cause positive stress to your system.

Obviously on race day, you’re looking for your physical capacity to be 100% to give your best performance.

Sometimes it doesn’t always work out like you had hoped.

An example: My Melbourne Half-Marathon disaster.

The best example I can give you came last year at the Melbourne Half Marathon in October.

I was going for a PB in the half-marathon and thought I had done enough in my training build-up to warrant giving it a good crack.

But I was to be brought down to earth quite dramatically!

These are some of the factors that lead me to a dramatically lower capacity on the day of the half-marathon:

• we did a road trip from Adelaide over 2 days, arriving the evening before the half marathon and then spent another 1 hour in the car driving to the race the following morning - so my hip flexors were incredibly tight

• had a 2 month old son who was awake during the night, which meant very little sleep

• nutrition in the lead up to the race was very average - being on the road and eating a lot of crap

• alcohol consumption - we were staying with my father in law - so just to be social a few beers were consumed the night before the run

• de-hydrated - it was an unusually hot and windy day in Melbourne

• late to the start line - so a little stressed and missed out on running with my pace group, so battling to catch them in the first 5km and running way above my goal pace

This culminating in getting to the 10k mark completely spent - and I was forced to walk and shuffle to the finish line completely burn out and no where close to a PB.

You’re a different runner every time you run

Running coach Greg McMillan states you’re “a different runner every time you run” and you need to appreciate the subtleties of your what you’re feeling every day (he talks about this in depth on Tina Muir’s Running for Real Podcast).

When you’re not feeling great, forcing bad workouts rob you of confidence and increase your chance of injury.

Taking charge of your own training by modifying and adapting your training means you can string some solid weeks of training together - putting you on the fast track to performance and becoming un-breakable.

Many elite athletes follow these principles - for example Kara Groucher stated that if only two out of every three scheduled training sessions go ahead as planned, that is a really good result.

She and her coach are happy to improvise if she isn’t feeling great or still recovering from her previous workout, possibly scrapping the session altogether.

So never be afraid to modify and adapt your training until you a state of readiness.

This internal awareness / intuition and being open to adapting your training on a daily basis is where the game can be won and lost.

It involves a process of constant decision making and listening to your body.

All scheduled workouts should be considered provisional, until you get a feel of what your capacity is on the day.

Brad Hudson and Matt Fitzgerald summed it up perfectly in their book, Run Faster - From the 5k to the Marathon:

“The art of coaching, or self-coaching, is fundamentally a matter of taking a systematic approach to training that makes better performance more or less inevitable, if not entirely predictable.

It begins with the premise that you cannot predict the future - or specifically how your body will respond to training.

Therefore every workout is treated as an experiment.

You then allow the results of these experiments to guide you toward a future of running faster.

Training patterns that seem to hold you back are eliminated, while those that seem to push you forward are kept and possibly increased or intensified.

Sooner or later this approach is bound to lead you to new personal best performances”.

How to adapt your training

If you’re aren’t feeling great, you don’t have to fully take a day off training. Here are some other options:

• have an easy restorative run instead of doing a session

• cross train with a swim, walk or hike in nature instead of run

• double down on nutrition, massage, sleep

• yoga class - especially restorative

• pilates class to get your deep core stabilisers switching on

But having a good pain threshold and learning to push through is a good thing, right?

Well, as always - it depends.

Sometimes having the ability to dig deep in spite of less than ideal conditions can be very helpful.

In fact training to be ‘anti-fragile’ means getting out there and chasing challenging situations that make your stronger and more resilient.

Intelligently and judiciously using these modifiable factors in training can make training tougher to (hopefully) make race day easier.

Hard training and suffering is important - but being smart about how often and when you push yourself into the red zone is the key.

Conclusion

I know it’s been a long read - so great job for getting this far…I hope it’s been useful for you.

A big thanks to legends Tim Gabbett and Michael Nitschke who inspired this blog.

Please share with your friends who you think might find it helpful.

Stay tuned for next months final chapter, Recovery.

Part 1 - Building A Resilient Athlete

Part 3 - Recovery - click here

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.

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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...

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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?

Take the free quiz 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…

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

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.

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

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.

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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.

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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

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