By Shannon VanAntwerp- PT, DPT, FAAOMPT
Tuesday August 29th, 2017
Impact Physical Therapy- Lakeview
Marathon season is upon us. For those of you training we have collected a few exercises to help you prevent injuries leading up to your longest training runs and the race. Leading up to the marathon we commonly see a pattern of injuries as the mileage starts adding up. Patellofemoral pain, achilles tendinopathy, plantar fasciitis are a few of the most common injuries.
The Gait Cycle
While running the our body goes through the gait cycle which is the interval from the strike of one foot to the following strike of the same foot on the next step. The Gait Cycle can be broken down into two phases, the Stance Phase (weight‐bearing) and the Swing Phase (non‐weight‐bearing). During the stance phase, the stance leg absorbs 3 times the body weight of the runner. During a marathon, the body absorbs 3 times its body weight every step for 26.2 miles. When assessing runners, we commonly see what is called a valgus position, where the knee collapses medially, during stance phase of the running gait pattern. This is usually indicative of hip weakness. The valgus position of the knee can easily cause knee pain, but can also lead to break down in the ankle and foot as well.
The following exercises will help to increase hip strength, keep your hips loose, and decrease the likelihood of tendinopathy in the foot.
Foam rolling your glutes and quads
When you foam roll, you’re trying to break up the “knots” in your quads and glutes. These “knots” are taut bands of muscle fibers that are constantly contracted. The contracted muscle fibers cannot further contract when they need to fire as a whole unit which makes the muscle a fraction weaker. After foam rolling, the taut bands should be looser which will restore some of the strength in those muscle groups. Foam rolling the hips is important for knee control during strike phase. Foam rolling the quads is important so that iliotibial band (IT band) stays loose. 5-10min total on quads and glutes
Foam roll- Quadriceps
Start by lying face down so that a foam roll is under the top of your affected thigh. Cross your other leg over the top of your affected leg as shown.
Next, using your arms propped on your elbows, roll forward and back across this area.
Foam roll – Glutes
Start by sitting on a foam roll and cross your affected leg on top of your other knee as shown. Lean slightly towards your affected side.
Next, using your arms and unaffected leg, roll forward and back across your buttock area.
Foam roll – Iliotibial band
Start on your side with a foam roll under your bottom thigh.
Next, using your arms and unaffected leg, roll up and down the foam roll along your lateral thigh.
Single leg eccentric squat
A lot of strengthening exercises focus on the concentric phase of strength, or the shortening phase. The easiest way to think about it is with a bicep curl. When you bring your hand to your shoulder during a bicep curl, the muscle shortens, this motion strengthens the muscle concentrically. When you lower your hand, the muscle is lengthening, and this strengthens the muscle eccentrically. For a runner, each step, the body is controlling itself from collapsing to the ground. As previously mentioned each step is controlling 3x body weight; therefore, it is important to strengthen the glutes, quads, hamstrings, and calves eccentrically. A single leg eccentric squat is the most functional type of exercise to translate to running. The focus of this exercise is to keep the hips level, try not to the hips drop to either side. Keep the knee in-line with the toes to prevent the medial knee collapse. Three sets of 10.
Most people think side planks are important for core strength, and they are, but they are also very helpful for strengthening the gluteus medius. A study from JOSPT measured EMG activity of glute med and glute max in 9 different core strengthening exercises. The study found that side planks measured the highest glute med activity compared with single leg bridge, lateral step up, and active hip abduction. Side planks are a good starting point for initiating hip strength to then translate to more functional movements.
While lying on your side, lift your body up on your elbow and feet. Try and maintain a straight spine.
If starting from your feet is too difficult, begin with a modified plank and bridging from your knees instead. 3 sets of 30” each side.
Eccentric heel raises
Eccentric strengthening is also beneficial to facilitate tendon remodeling. In the cases of achilles tendinopathies, a protocol of eccentric heel raises is commonly used. To prevent the onset of an achilles tendinitis, runners should focus on eccentric heel raises. Starting standing on the ground, push up onto the ball of the foot, lift one foot off of the ground and slowly lower with the other foot. When that becomes easy progress the range of motion with the heels hanging off of a stair or a half foam roller. Three sets of 15 reps.
Swiss ball eccentric hamstring curls
More eccentrics… Don’t forget the hamstrings. Using a swiss ball, lay on the ground with feet on the ball. Bridge the hips up, bring heels in towards the butt. Raise a leg, extend the ball away from the hips with one leg. Hamstrings will be on fire after this exercise. Three sets of 10 curls on each leg.
Perform these 7 exercises during your cross training days, and post easy runs during the week. If you continue to have problems, or want a quick run through on form feel free to stop by one of our clinic for a complimentary injury screening.