Northern Ireland Running

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'Top Tips' for runners by Apex Clinic (Belfast):

As runners, we are always looking to improve or get the best out of our running and training sessions.  There are so many factors and small things that can affect our performance, be that in training or racing.  In this sub-section of the 'Physio Room', our Physiotherapy partners Apex Clinic will provide some useful tips for runners.  We will add to the 'Top Tips' on a regular basis...

Avoid aggravating runner's knee pain...

Runner's knee pain, felt at the front of the knee or more medically known as patellofemoral pain is very common in runners.  Whilst many of us love our leggings and compressed clothing for running, those with patellofemoral problems should NOT wear tight leggings or compressive clothes around the knee, as this causes compression of the under surface of the knee cap (patella) which will aggravate the pain of runner's knee. 

Therefore, loose clothes or shorts are best! Also avoid using compressive bandages around the knee, such as tubigrip as it might feel good at the time, but will always make your knee pain worse.

Remember when it comes to patellofemoral pain, loose clothing is best!

Should you run with a cold?

There isn’t any evidence that running with mild or moderate cold like symptoms ie congestive symptoms such as a runny nose, stuffiness and sneezing is going to make it any worse.  So if you come down with a mild to moderate cold you are okay to continue running.  If you're suffering from a bad cold we recommend reducing the distance and frequency of running.  

Symptoms below the neck, such as a chest cold, chest infection, achey muscles and/or fever, require a definite time off running and exercise to avoid escalating it into a more serious condition.  

Getting back to training after a holiday:

If you have to take a break from running while enjoying some much needed time away on holiday, be careful to give it some thought on how to return to running on your return.

If you miss one week of training, you can jump back into your training regime as long as you were consistent with your training schedule for at least 4-6 weeks before your holiday.  Don't ever try to cram in the runs that you've missed, as this will significantly increase the risk of injury.  

If you miss between 10 days to 2 weeks of training, you should return to running gradually, taking it a bit slower and slightly reducing your mileage over an approximate 2 week period.  It will take this long to be ready to train at your previous intensity and volume.  

Enjoy your holidays from the team at Apex Clinic!

Stretch those calves to prevent numerous injuries:

In a recent survey of injured runners in the UK, it was found that calf pulls were the second most common complaint.  Having tight calves is one of the main factors which can predispose to pulling a calf muscle.  Tight calves can also increase the risk of shinsplints, stress fractures, compartment syndrome and achilles problems.

Apex Clinic recommends that all regular runners should stretch their calves preventatively, once daily on 6 days per week.  The calf muscles consist of the gastroc and soleus muscles.  Standing on a step and stretching both calves together is usually the most time effective way of stretching them:

1) For the gastroc muscle- stand on a step with both knees straight and lower both heels as far as possible.  Hold this position for 20 seconds.  Repeat the stretch 3 times with approximately 10-20 seconds between each stretch.

2) For the soleus muscle- stand on a step with both knees bent to approximately 45 degrees.  Lower both heels as far as possible.  Hold this position for 20 seconds.  Repeat the stretch 3 times as above. 

Happy Stretching!

Consider sports massage before the big event:

Now that the marathon and half marathon season is upon on, why not consider the benefits of having a sports massage to help keep your muscles supple and flexible before the big race. 

Massage helps break up and clear scar tissue within your muscles preventing muscle strain. The most beneficial time to have a sports massage is 3-4 days before your race, helping to set you up for your run. You should feel the difference.  

Good Luck for the Marathon Season Ahead!

Take action to prevent runner's knee starting:

Patellofemoral pain, also known as Runner's knee is a very common injury among runners, with 1 in 4 of the athletic population being affected. Don’t let it be you.  A simple exercise to strengthen the inside knee muscle and therefore help to prevent it starting is as follows-

Stand on one leg on a step with a 10 degree outward turn of your foot.  Slowly bend the knee as though stepping off a step, such that the foot of the non-loaded leg is lowered towards the step below.  Just before the foot of the unloaded leg touches the step below, come up again slowly by straightening the knee of the loaded leg.  This exercise is called a Step Down.  Repeat this 20 times, 2-3 sets once daily on each leg to help prevent this painful condition occurring.

Don't let the cold weather disrupt your training:
If the cold weather is proving tough for your running training, why not try using a cross-trainer!  If you swing your arms as if you’re running (not holding onto the handles), it’s a very similar action to running with no impact through your joints.  Keep your forefoot on the footplate throughout the session, allowing your heels to raise up and down with each stride.  The best part is that your training can continue indoors.

For a warm up do 5-10 minutes at half speed. If you want to mimic running on flat ground- keep the manual setting on, if wanting to mimic hill training - add in some resistance.

Don't run under the influence this festive season:

Over this festive season, it’s important to know that alcohol can remain in the bloodstream for several days. If you have a lingering hangover it’s best not to run/exercise as it can increase your risk of muscle injuries, further dehydrate you and reduce your endurance during training.

Wishing you all an injury-free New Year from the team at Apex Clinic, Belfast!

Warm up for an extra few minutes in this cold weather:

Take some extra time to do a thorough warm-up in these cold weather conditions. When muscles, tendons and ligaments are cold, they are less elastic which can make them more prone to inflammation or injury.  A warm-up can be completed indoors, and should include 5-10 minutes of an aerobic warm up which raises your heart rate, core temperature and blood flow to your muscles.  

An aerobic warm up may include gentle jogging on the spot or gently kicking your heels to your bottom on the spot.  It should be followed by dynamic stretches to prepare the muscles for action.

So remember, time spent to warm up your muscles should help prevent an injury.

It’s important to have the correct arm swing when running:

To make your running more effortless and energizing, pay attention to your arm swing. Your arms help determine your stride so you will be able to run faster, longer, or with less perceived effort if your arm swing is correct. If you move your arms more quickly and with power, your legs will also move more quickly and powerfully.

Your arms should move like a pendulum, moving smoothly backwards and forwards, with your upper arms tucked closely to your body.  Your elbows should be held at a 90 degree angle, with your wrists and hands relaxed.  Make the emphasis of your arm swing a backward push of your elbows, instead of a forward pull.  Your arms will naturally swing forwards on their own.  Resist the urge to lift your shoulders.

Allow your body to dictate the pace:
Too many runners fall into the trap of deciding their pace before they set off.  If you've had a hard week at work and you've not had enough sleep then you might not be able to complete a fast run and that's ok, your running schedule isn't set in stone - if today needs to be slow and steady run, then that's ok you can move your fast run to later in the week.     

Rest Vs training:

Recovery means allowing your body to rest, repair and refuel, in order to let our body adapt to the training workload. The following steps help to ensure you allow your body enough rest to prevent injury. 

1) take a complete rest day at least once a week

2) vary your training pace over the week, avoiding two consecutive days of hard training

3) have a day if light training every 2-3 weeks 

4) eat enough proteins and carbohydrates to help repair muscle damage and growth 

Cool down, is it important? 

The answer is YES! Cool downs can prevent your body from being sore and can prevent injuries by reducing the lactic acid build up caused by anaerobic exercise. 

This should generally take 10-15 minutes and involve a few shuttle runs of jogging, getting progressively slower until you are waking, followed by static stretching of the muscles especially the quads, hamstrings, calves and hip flexors. 

Each static stretch should be held for 20 seconds with between 3-5 reps.

Don’t forget your breathing!

Breathing technique is an important part of running that should not be overlooked. The right breathing pattern helps your body deliver oxygen more efficiently, can improve endurance and pacing making your run more comfortable. Synchronise breathing in and out through the mouth in time with your stride.

For moderate pace; breathe in for three steps and out for three steps (3-3 pattern).  For faster pace; breathe in for two steps and out for two (2-2 pattern) or in for two steps and out for one step (2-1 pattern).

When to change your running trainers?

Ensuring you have proper running trainers can reduce the risk of picking up injuries like shin splints or plantar fasciitis. Most running trainers typically last 400-500 miles, minimalist trainers or racing flats typically last 200-400 miles. 

Old shoes can be the cause of new aches and pains beginning to arise so monitor the wear and tear of your trainers. Check your soles regularly.

Is your arm position right?

Runners typically tense their upper bodies when running leading to fatigue, reduced performance, poor breathing technique and even injury.

Check your technique when running by ensuring your shoulders is relaxed with shoulder blades together slightly, arms by your sides with elbows at a 90 degree angle to your body with your wrists and hands relaxed.

Don’t forget to stretch your hip flexors:

Tight hip flexors (the muscle at the front of your hip) are a common complaint in distance runners due to the increased workload and repetitive use of the muscle group. Tight hip flexors can lead to injury and can have an effect on your running posture.

Stretch your hip flexors:

Get into a lunge position, with your front knee bent. Let your back knee go to rest on the floor and then lean forward into the stretch, stretching the hip flexor of the back leg. Keep your back straight.  Hold for 30 seconds, 3-5 reps. Twice daily.

Keep hydrated:

During exercise you sweat which can lead to dehydration. Dehydration reduces the blood volume in our bodies which means the heart has to work harder to deliver oxygen to the working muscles. Keeping hydrated helps fight muscle fatigue and prolongs endurance.

In general we need 2-3 litres of liquid a day. During a run you should drink little and often.

When to return to running following an injury?

This requires a gradual approach to prevent prolonged pain or re-injury.  Steps to a graded return:

1.      Can you walk for 30 mins pain-free before starting to run

2.      Reduce mileage to 50% of mileage prior to injury

3.      Allow a rest day between each run

4.      Change one thing at a time i.e distance or speed

5.      Avoid hills and speed work until you’re back running at 75-80% of your mileage prior to injury

6.      Progress gradually when comfortable to do so and pain-free

'Embrace Variety'...

Try not to stick to the same route. A new route and change of surface will give your body a rest from the road and the same repetitive forces, improve ankle proprioception (stability) and keeps it interesting!

Feeling unwell, should you run?

If you have the cold (congestive symptoms) reducing the distance and frequency of running is advised.

If you have acute flu symptoms (achey with/without fever) you should not run. This will compromise your immune system and potentially escalate symptoms to a more serious condition as exercise increases the core body temperature even further facilitating greater viral spread and significantly increasing the time needed for your body to recover.

Stress Fractures - a Bone Density Check is Recommended...

For anyone who has suffered a new or recent stress fracture we strongly advise that they have their bone density checked, as a low bone density can predispose to stress fractures.  

A bone density test is called a Dexa Bone Scan and can be organised by requesting it through your GP.  Whilst a low bone density is more common in woman, it also occurs in men.  So don't miss it!

A Reason to Build up Your Quads:

As you run your body absorbs 2.5 times your body weight from every heel strike.  To reduce the pressure and impact coming up through your joints and bones, build up your quads muscles by adding squats to your exercise program.  

Sink down until your thighs are parallel to the floor, or just below this.  We recommend 3 sets of 10 reps, 3-4 times weekly. 

More Top Tips for Hill Running:

If preparing for the Mourne Skyline Mountain-Trail Race next weekend or simply enjoying hill running, here are a few top tips to reduce the risk of lower back injury, particularly disc injury:

* Never run uphill during the first 2 hours after getting up in the morning... get up earlier if it's a planned morning uphill run.

* Before starting the run, if you've just driven to the venue then walk briskly for 10 minutes on the flat and then do 20 bend backs, with your hands on your hips, pushing your belly button out. Now you're ready to start your warm up.

* When running uphill, hit the ground with the front of your foot rather than your heel and shorten your stride length.

Happy hill running!

NOTE:  Apex Clinic will be on hand at the Mourne Skyline MTR finish line, providing massage for the finishers.  

Don't forget nutrition for injury prevention:

Top Tip for Runners, by Apex Clinic:

With the Belfast City and Waterside Half Marathon's coming up don’t forget nutrition for injury prevention...

Within the first two hours after you run the most important nutrient to consume for tissue repair is protein, however according to research consuming protein with carbohydrate is even better as carbs activate muscle protein synthesis as well as restocking depleted muscle glycogen stores. For all you veggies out there Quorn is an excellent source of protein.

Running With Mild Knee Swelling - You could Do More Damage:

Running With Mild Knee Swelling - You could Do More Damage:

Continuing to run in the presence of any knee swelling is likely to lead to more knee damage. Research has shown that even a teaspoon (5 mls) of swelling in the knee is enough to switch off some of the knee stabilising muscles (namely VMO). This in turn will predispose to getting runner's knee (or anterior knee pain) and will also make the knee more susceptible to further injury because of the reduced muscle reaction times of the muscles around the knee.

In the presence of any knee swelling, cross training (if it's mild) plus aqua-jogging is a great way to maintain running fitness whilst allowing the knee swelling to clear.

Improve your running posture:

Improve your running posture:

A helpful mental tip to improve your running posture is to imagine that you have a string attached to the top of the back your head which is pulling straight upwards, making your spine straighter and moving your chest bone upwards. 

Improving your posture while running can help prevent injuries!

Improve your biomechanics:

Improve your biomechanics :

While running try to keep your knee moving in a forward plane over your second toe.  This will activate the posterior fibres of your glute med (butt muscles) which are important in maintaining good biomechanics and help reduce lower limb injury particularly for those who have a tendency to run with slightly knock knees.

Plantar Fasciitis Prevention:

Plantar Fasciitis Prevention:

Particularly common among runners, plantar fasciitis is inflammation of the plantar fascia which is caused by increased stress or pull on the plantar fascia structure. Tight calves and an inflexible achilles tendon can result in overstressing the plantar fascia, weakening the attachment of the fascia to the heel bone

To help prevent plantar fasciitis make sure you do your 2 calf stretches (one with your knee straight & one with your knee bent) and this will also stretch your achilles tendon. This is even more important if you are a heel striker as this can predispose to this injury more than mid-foot strikers.

Backwards Running:  Introduce it to your warm-up!

Introduce Backwards Running to your training schedule:

Runners tend to have over-active hamstrings & under-active glutes (buttock muscles) which predisposes to injury.  Running backwards is great for activating the glutes and helps to improve the imbalance between the two muscle groups and because you are recruiting more muscle groups it is more tiring! So you work harder.

We suggest introducing it into your warm-up routine, preferably on a grass strip of about 50 metres long. Run backwards and then jog forward to your starting point. Repeat approximately 15 times. 

Cross training can help stave off running injuries:

Cross training can help stave off running injuries:

With the dark evenings and frosty days now's the time to incorporate cross training into your running/fitness program. Cross training is when runners train by doing another kind of fitness workout such as, using the cross trainer, ski machines, stationary bike, swimming, aqua jogging, fitness classes or strength training. 

Cross training gives your running muscles a chance to recover while strengthening under used muscle groups which helps prevent or stave off injuries by correcting muscular imbalances and reducing the impact coming up through your feet. Your body will thank you for it!

Are your hamstrings flexible enough for running:

Another TOP TIP from Apex Clinic:

Are your hamstrings flexible enough for running?  

For running, the recommended minimum hamstring flexibility is a leg raise of 65 degrees from the horizontal...... or else recurrent hamstring, calf or buttock pain may become an on going problem.  So if your hamstring flexibility is letting you down start hamstring stretches twice daily.

Protect your back whilst running uphill:

Protect your back when running uphill:

When running uphill the low back is loaded considerably more than when running on the flat.  A secret tip to reduce this load on the lower back when running uphill is to take much shorter strides.  

This reduces the amount of forward bend (flexion of the trunk) which in turn reduces the load on the low back.  This can make the difference between being able to run up hills and not and applies to those with or without back problems.

Don't run through pain:

Apex Clinic provide more good advice:

This is perhaps the oldest and most-widely-repeated advice for avoiding running injuries, and still the best: If you don't run through pain, you can nip injuries in the bud. Most running injuries don't erupt from nowhere and blindside you. 

They produce signals, aches, soreness, persistent pain, but it's up to you to take appropriate action and get an experienced physio to take a look. Pay more attention to pain and get to the root of what's causing it rather than trying to push through it.

Don't always run on the same side of the road:

Another TOP TIP from our friends at Apex Clinic: 

Remember, footpaths and roads are generally cambered. If you always stick to one side this will give you a functional leg length discrepency, since one foot hits the road lower on the slope than your other foot. You're also placing one foot on a slant that tends to limit healthy pronation (flattening of the arch of your foot) and your other foot in a position that encourages overpronation. 

Running in an unbalanced way mile after mile, week after week may have a significant impact on running injuries. Think about varying the side of the road you run on or changing direction.

It's important to have the correct shoe for your insole:

Choosing the correct running shoe to use with your insoles:
If running with corrective insoles (orthoses) in your runners, make sure you're using a "neutral" running shoe and not an "anti-pronation" shoe. 

The insoles/orthoses will be doing the corrective work to improve your foot biomechanics, and therefore a neutral shoe type is recommended here.

Planned rest will help you stay injury free:

Rest up to stay injury free:

The biggest threat to injury-free running comes from the, "too much without rest" approach to training! 

Muscles and joints need time to recover and repair between training sessions.  Apex Clinic recommends building into your running regime a minimum of 1 rest day in every 7.  On that rest day relaxed cross-training or rest alone is advised. 

Keep to the 10% rule of building weekly mileage on your long runs by no more than 10%. Good things come to those who wait, or at least rest!

Aqua Jogging - Why not give it a go?

Aqua Jogging - It’s worth trying:

Why not swap one or two of your weekly land based running sessions with aqua jogging for the same length of time in a pool. 

Aqua jogging enables you to get a fantastic cardiovascular workout without the impact, giving your body & joints a nice rest from the pavement.  All you need is an aqua jogging belt & a pool which is deep enough, so your feet don’t touch the bottom.  Remember to keep an upright running stance in the water throughout, moving your arms and legs as they would on land.

Local swimming pools have set times for aqua jogging sessions so why not give it a go!

How to prevent ankle sprains:

How to Prevent Recurrent Ankle Sprains

Following an ankle sprain (of the lateral ligament) the KEY factor in helping to prevent it becoming a recurrent ankle sprain is retraining the ankle balance (proprioception) on the injured side.

This is done by different exercises performed twice daily, whilst standing on the injured ankle alone.  For example, clap your hands in front of you, behind you and above your head initially with your eyes open then progressing to the same exercise with your eyes closed. 

Many folks believe that strengthening the ankle is the most important thing to prevent recurrence, but whilst it's important, balance retraining is the key ingredient.  Happy running!

Want to get more out of your Hill sessions?

Top Tip for Runners:  Hills...

For runners who enjoy hills, try to avoid running up steep hills for the first 2 hours after getting up in the morning...

This is because the pressure within the discs in the spine (the intradiscal pressure) is higher for the first 2 hours after getting up, making the discs more prone to injury, especially the lower back discs during uphill running.

Enjoy running uphill any other time!

More 'Top Tips' will be added on a regular basis...

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