“If you’re too fit for your legs eventually they will fail”.

Sometimes you read a sentence that resonates so strongly with you it literally stops you in your tracks. Ok, so the actual sentence was:

“If the physiological capacity of the body exceeds the bio-mechanical capacity then continued physiological training without focus on the biomechanical deficiencies will eventually lead to plateau or breakdown” (Joanne Elphinston, 2008)

Importance of physical prep

As an elite athlete I did more than my fair share of strength and conditioning exercises. However, my running was still interrupted at key points by injury. Looking back I can’t help but wonder what I might’ve achieved if I’d really fully understood this concept then. Better late than never. I’ve now been running injury free for the last two years. This is largely as a result of physical preparation becoming a more integral part of my own training.

Unfortunately the original sentence is not quite short and snappy enough to make a good mantra so now as a coach I have taken the liberty of paraphrasing.

Based on the anecdotal evidence of my own running career and the many runners I know, I would argue that, more than any other event group, this concept is poorly understood by the endurance community. Endurance runners love running. Given the choice between a run or some strength and conditioning work most of us opt for the run.

Good intentions require action

We profess to know the importance of strengthening work but still consistently fail to put it into practice. The relationship between knocking vital seconds off our PB seems more closely related to running extra miles than it does to strengthening our core, glutes or calves (to name a few key muscle groups).

What’s more, as a coach I would venture to say that coaches must share some of the blame. Many coaches, like myself, start as athletes. The institutional endurance culture is still skewed towards the running training with strengthening work the junior partner or after thought, and too often non-existent. Ultimately to the detriment of performance of athletes.

Studies show that the vast majority of endurance injuries are over-use injuries. Even when athletes are stuck in a cycle of injury and training, many coaches still fail to prioritise the long-term commitment to physical preparation in their training plans. They may follow rehab exercises from the physio but often these are dropped as soon as the athlete is back running.

 

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All too often we ignore our glutes and, instead of being pistons of power driving us forward, they hang around in the back seat of the car doing nothing like a pair of passengers eating a McDonalds from the service station….. If I’ve got any hope of staying ahead of the 14 year old big child I’m going to have to bring out the big guns…. or more accurately, the big glutes! I need every help I can to run stronger and faster so it’s probably worth focusing on one of the strongest muscles we have. Not only strengthening but engaging your glutes is key. And that requires a strong core and good pelvis position as well or they literally won’t work. So on top of my new weekly intervals running session to improve my pace I’m also working on core, glutes and leg strength throughout the week. A programme of strengthening exercises that develop functional stability – strength and control throughout the required range of movement – to make sure all of my effort is going into running as fast as I can because I need every bit of help I can get! Yesterday’s 30 min steady run followed by some backward lunges to high knee. #runfast #runstrong #runstronger #runfaster #run5k #runningcoach #5k #intervals #steadyrun #strengthandconditioning #stronglegs #lunges #highknees #runningmotivation #runningmum #runspiration #runnersofinstagram #runner

A post shared by Jo Wilkinson (@runningjo10k) on Jun 7, 2019 at 5:31am PDT

Performance gains

Physical preparation benefits performance by more than just injury prevention. Running is about bio-mechanical force being applied through the body to propel it along in the most efficient manner. We can isolate this from the focus on energy systems and physiology which dominates endurance training.

The average sprinter takes 50 steps in 100ms. The average (male) marathon runner takes 55,000 steps that’s over 1000 times as many. Sprinters usually do a minimum of 2-3 strengthening sessions in the gym and 2-3 sessions on technique per week.

Sprinting is a power-strength event but that doesn’t mean that we can’t learn some important lessons. The understanding of basic bio-mechanics, forces, loads and movement patterns within running is as relevant to endurance as to sprinting. If we can improve the efficiency and power of each step, by even a tiny amount, it can add up to significant improvements in marathon times.

Cultural change

British Athletics are trying to address this by emphasising the importance of physical preparation in their coaching courses and qualifications. We need a change of culture within endurance groups and clubs to embed this as every day accepted practice.

As a coach my aim is to emphasise the importance of physical preparation to each and every runner, each and every week. So that is where my new mantra comes in. Tomorrow instead of running an extra mile or doing another rep, stop, do some strengthening exercises instead and repeat after me

“If you’re too fit for your legs eventually they will fail
If you’re too fit for your legs eventually they will fail
If you’re too fit for your legs eventually they will fail……”

Jo is a former GB marathon runner and now fully qualified British Athletics coach. To find out more about her coaching or see what running she’s still doing you can visit her website  or follow her on Instagram, Twitter or Facebook.

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After my last blog I asked readers what they would like to see in my next piece of writing. One reoccurring topic that came up was “How do you mentally deal with injury”.

I received several messages from runners at all levels asking for advice and talking about their mental health struggles during difficult times. This is something most athletes experience at some point in their career and is something I have had my fair share of experience with. 

We often read about success stories of coming back from injury, but there seems to be a lack of information on the injury/illness phase. Recovery often focuses on physical rehab, but it is also important to include the psychological aspect to get through these difficult periods.

When help is needed the most

Injury or illness periods are a time when we all need the extra help, coping mechanisms and support to get through. After writing my dissertation on the barrier’s athletes face on getting mental health help and as someone who has experienced long periods out through both injury and illness, I hope to offer some advice to help others through the inevitable barrier every athlete will face at some point in their career. 

As an overview of my own experience, a few that have stood out was my first stint of illness during my second year at university where I spent a year or so fighting through and getting over glandular fever.

My second stint was during my fourth year when in the doctor’s words I had a “career ending” injury which took me a good two years, if not longer to get back to fitness. My most recent injuries came at the worst time- one week prior to London Marathon and then came a horse kick four days before Dublin Marathon. 

Injuries and illnesses are devastating to athletes and even more devastating when they come at the end of a long training block, just before a race. The injury itself is often apparent resulting in all treatment and rehab to be focused on the physical aspect. But what about the psychological aspect that just took as big a knock (if not bigger) as the actual injury itself?

Feeling the weight of injury

When things go wrong it can be easy to get weighed down with negativity and even become irrational. It is easy to give up on your goals and completely lose sight of why you have just spent the past few months pushing your body through gruelling workouts. It’s times like this when we need to realise these feelings are normal and there are ways to treat them just like there are ways to treat the physical injuries. 

I think the first step to take is to realise is although these feelings might seem extreme, they are in fact are normal.

If you don’t experience any feelings then you probably aren’t as committed to your goals as you should be. Each athlete may react differently but there are several traits that are common responses for a lot of athletes which include anger, depression, low self-esteem, fear, anxiety, isolation and even denial. Injuries seem unfair and on the surface it’s impossible to see past the negatives, however it is important we find positive strategies to cope with the set-backs.

It is also important we learn from each injury just as we would learn from each race or training session. 

Coping Mechanisms

Something I struggled with during my first two stints (glandular fever and my knee injury) was not knowing what was wrong. I knew something was wrong but doctors couldn’t tell me what. All my test results came back normal which in one sense was good but this caused great frustration as I knew something was wrong.

The frustration then turned into low self-esteem and a lose of sight on my goals. It got to the point where I even tried telling myself I was just being weak and it was just in my head.

I tried to run in denial and get through the pain which then lead to me telling myself I wasn’t strong enough to cope with the demands of an elite athlete as the more I went on the harder things got. The biggest take I got from both these experiences is- you know your body better than anyone else!

Test results and health professionals can be wrong sometimes. If you can’t get answers continue to search for the answers until something makes sense. Feeling pain or feeling unwell is not a weakness, giving up is a weakness, so don’t give up- somewhere or someone will have an answer. 

Set smaller, achievable goals along the way

Another struggle I faced, was post-surgery when everything seemed impossible and all my previous goals seemed unrealistic. I had the goal of running the commonwealth standard yet I couldn’t even walk! This is when the use of short-term goals is important to help focus on the current situation.

However small a goal may seem it can keep you motivated.

Once I could walk, a goal I had post knee surgery was to be able to push the pedal on a stationary bike in the complete circular motion- this took me weeks of sitting on a bike pushing the pedal down then repeating. When I finally had the mobility to push the pedal all the way around, I was so happy that the feeling of accomplishment is still so clear in my mind several years on that achieving what seems like an insignificant goal has stayed with me. 

Use cross-training to help overcome the challenges

Prior to running Newport Marathon, just when training was starting to come together, I picked up another knee injury. After the normal irrational reactions, I was able to maintain my focus through cross training. If you can’t run but can-do different forms of exercise to maintain your fitness this can act as a great psychological relief as well as give you all the physical benefits that come with it. 

When I got injured one week out from London, I experienced the feeling of denial. I had trained for months; I had just got over the flu so to then get injured as well was too much for me to accept.

A marathon is perhaps the worst race to try and deny an injury as trust me 26.2 miles will show you there is no way to hide from an injury or illness. The disappointment of my performance at London left me in a far greater emotional state than what accepting the injury and withdrawing from the race would’ve left me.

Listen to your body

The biggest lesson I learnt from this was always listen to your body. You are better off accepting an injury and dealing with it right away rather than acting in denial, prolonging recovery and dealing with the mental knock from a bad race on top of the original negative emotions that already came with the injury. 

Something else that I have also found a major help when dealing with injuries is surrounding yourself with the right people. You know you have a good coach if he or she will support you through injury unlike several coaches who just write their athletes off during injury. Injuries can be isolating as you are taken away from something that you normally do every day.

If you have a coach or teammates who don’t want to know you when you are injured this will only elevate the feeling of isolation further. Isolation then leads to further negative feelings, turning injuries into a vicious psychological cycle. It is so important to surround yourself with positive people and people who believe in you. 

Injuries can make you a better athlete

Prior to injuries I took running for granted and definitely took my running goals for granted. Injuries have made me resilient and have made me value every day I can run. Therefore making every day count.

The big injuries have made me level headed and have helped me to overcome other barriers and smaller injuries. For example, before Dublin marathon when I got kicked by a horse 4 days prior to race day I was able to stay level headed and keep a positive mindset despite the undesirable circumstances.

Without the other injury barrier’s, I have had to overcome I think my reaction to the kick would’ve been far different and impacted on my performance and perhaps I would’ve never have broken the Welsh record. 

Also remember how far you’ve come

When something is hard, I think to myself, I’ve overcome an injury that doctors said would end my running career, if I can do that I can definitely get through a minor injury, hard work out or hard race!

Rewinding back to when I was struggling with glandular fever and then when I had my first knee injury, whilst Olympics was always my dream it never seemed realistic. But now Olympics is a realistic goal, to look back and remember the months I was bed bound and the months I couldn’t walk it seems unrealistic to think that was actually me.

Injuries and setbacks have really taught me anything is possible if you truly want it and if you have the right mind-set and work hard for it. 

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As a runner who isn’t often injured, finding myself with a niggle in my glute the last few days has been an interesting time. At first it was just a niggle that I ran through. Our annual training camp made this a necessary action.

When the pain got worse with activity, I knew something needed to be done. Cross training was the first thought, as well as full on rest. The best thing to do is get some expert advice.

Having seen a physiotherapist and an osteopath, we figured I was a bit wonky in the hips and this had eventually inflamed my piriformus. I had stretches to do, self massage as an option, but rest was necessary. Time off my favourite hobby, what on earth was I to do with myself?

All the extra time and energy suddenly on your hands can be a problem. But with a bit of sense it can be used to help with your injury and even to come back stronger. What should you be doing with your time off running?

Is true rest best?

Often an injury will need rest, but true rest is sometimes hard to come by. In our busy lives many will be on our feet at work, commuting, walking the dog, throwing the kids around and a whole host of other things that are more important than out and out rest.

A runner’s injury might stop them running, but actually still leave you fitter and more able than most. Telling your boss you need to rest, when you’re still more active than everyone else might not make sense to them. A doctor can say you’re fit and healthy, even if you can’t run all the miles you want. It makes it hard to prioritise recovery.

Compared to the general population you’re probably still in fine shape. Not all injuries need complete rest and a physio can often advise on whether cross training or inactivity is the best course of action. Appropriate loading is a term used, don’t make things worse.

If you do need full rest then think about allocating the time you might be out running to a period of proper rest. If you might normally have a 45-60 min run then replace that with time reading a book or having a nap.

We often undervalue rest, but actually putting it into your plan for the days when injured is a logical thing to do.

Photo: Natalie White

Cross training

We’ve got your back covered when it comes to cross training in these articles. First we asked whether cross-training could be key to your success, then looked at the different types of cross training on the market. There’s even the mental benefits in there too.

But before jumping on your bike, have a think about whether your injury could be aggravated by the activity. Different types of cross training might be suitable for your injury and a good physio can give you advice on whether swimming, cross country skiing or trampolining might be better for your active recovery.

Personally I tried a bit of biking, being careful not to get too excited at the intermediate sprints and avoiding too many hills. Towards the end of the hour it still started to feel like rest might have been better, so a few more days of full rest before I jump back on the carbon stead.

Wider activités

Everything you do doesn’t have to be about improving your fitness. Something highlighted in David Epstein’s new book “Range” is the importance of having interests and outlets outside of your specialised subject.

Having a creative outlet, such as relaxing with a musical instrument, taking a woodwork class or getting into your photography could really help provide a different eye for your running.

In a world where many believe we need to specialise more and more, having a wider world view can be key in seeing a novel way to success. Problem solving, something any ultra runner has to do in any race, as well as any endurance athlete really, is helped by a bigger range of experience.

Becoming totally focused on your running might stop you seeing the bigger picture and in the long run, that’s not going to be good for your physical and mental health. Take the time out injured to improve your range, even just studying a different sport could be beneficial.

Strengthening the weakness

Time on the injury bench can also be a good time to address other weaknesses. These needn’t be solely physical weakness, but other areas of performance too.

On a basic level it might just be doing some core strengthening that will help you come back stronger after your time off (as long as it’s not aggravating your injury) or looking at your lifestyle or work space to find a way to prevent your injury from reoccuring, be it dietary improvements or changing your desk to a standing one.

Using your time off to read into topics such as mental skills or race fuelling can be useful too. There’s plenty of online course at places like FutureLearn and just on Youtube. Coming back stronger isn’t just about muscles, but your knowledge too.

Plan for the future

It can certainly be frustrating to be on the sidelines. Even now I’m still hoping to be back in time for a 5000m race next week, but it will take some sort of miracle for that to be a good idea (although I’m an external optimist).

Instead of bemoaning missing events, sessions and losing training time, focus on future goals and how you’re going to achieve them. Make plans so the future is brighter than ever.

Goal setting is a useful exercise whether you’re running strong or taking some down time. Making SMART goals can be a productive distraction for your mind when you want to go out running.

Failing that, getting the right kit for your next adventure is also effective, for a short term hit, but before going on a spree of retail therapy, look at ReRun Clothing and the message they are trying to send.

Stay involved

Just because you’re not running doesn’t mean you can’t be part of the running community. Take the time to volunteer at your local club or as part of the weekend parkrun.

Volunteering isn’t only a great way to give back to your community, keep your running mind happy and help others, it’s also a good way to keep learning for your own running.

Just be careful not to get carried away in all the excitement and go running around anyway! Same for those first runs back as well. Don’t start sprinting the second you can go back outside, take those first few runs nice and easy.

If you really want to spend some cash, then get a new tattoo. Always mixes well with time off to let the new ink heal.

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The post What the hell are you supposed to do when you’re injured? appeared first on Fast Running.

A week rarely goes by where I don’t get someone telling me they have shin splints. It is one of the most common injury related phrases heard in the running world, so you would think it is fairly well understood, but often this isn’t the case.

This isn’t just something I see in those new to running either. I see it across the board. From people just starting out at parkrun all the way through to the elites. So what actually is shin splints?

The term ‘shin splints’ isn’t so much a diagnosis, rather a part of one of four conditions affecting the medial shin area, most commonly. Shin pain can be broken down into four general categories; muscular, bony, neural and vascular.

Often muscular shin pain can be caused by strain or excessive tightness to a number of muscles occupying the medial shin area. Their attachment to the bone via a structure called the periosteum can become irritated and inflamed (periostitis). If these structures continue to be overworked and overloaded bony stress injuries can occur (reaction/fracture).

There are also several other conditions which can manifest themselves as lower leg/shin pain. None of which should be overlooked. These include types of compartment syndrome and nerve related issues such as nerve entrapments in the lower leg, or referred neural issues from the lower back. To make our lives more difficult you can have combinations of these.

Muscular

First we will focus on the most common, the muscular type injury.

Differentiating between these conditions can often be difficult, no less because they often co-exist. However, there are subtle distinctions in the presentation and behaviour of each. This helps to guide the treatment and rehab.

The most common type of shin pain I see is caused by excessive tightness or strain to the muscles occupying the medial shin area. Namely the tibialis posterior and soles muscles. As well as occasionally several other muscles in the area responsible for flexing of the toes. You can also develop inflammation to these muscles points of attachment to the bone via a structure called the periosteum (periostitis).

Tibialis posterior/soleus pain is felt as a dull pain or real tightness typically along the distal 1/3 of the inner shin, into the soft tissues behind the bone. A soft tissue problem generally won’t be painful at rest. But will be most sore at the beginning of a run and will often get easier as you get moving. 

Bony

You then have the bony type injuries, the two words that put fear into ever runners minds… stress fracture (or reaction).

To briefly explain the process, our bones are constantly being remodelled to adapt to the stresses and loads placed upon them. If the level of stress being placed through them is greater than the rate at which the structures adapt, an area of bone weakness will develop.

When the excessive stress continues the bone may fracture microscopically – this is when you experience pain. Ignore the pain and continue to stress the area then it can develop into a larger crack. Eventually, a stress fracture will happen.

Similar to the muscular type pain the most common location for stress reaction/fracture is the lower part of the inner shin. There will be a specific point of tenderness on the bone and in contrast to the muscular type injury this will be felt over a much smaller area – maybe 1-2cm. Another give away is the behaviour of the pain.

With a stress reaction, the issue will worsen as you run and will feel worse after, and you may even experience a deep ache, or throbbing type pain at rest or at night in the more developed (stress fracture) types.

‘Medial Tibial Stress Syndrome’

Where things can get confusing is the involvement of the periosteum (periostitis) – which is often understood to be part of a process called ‘Medial Tibial Stress Syndrome’ (MTSS) the term now more commonly used in place of ‘shin splints’.

Due to the rich nerve supply of the periosteum the bone will be exquisitely tender to touch, however, this will generally be felt over a larger area. There will not be the one to two centimetre focal point of tenderness as in a stress fracture. Some view this as a part of the stress reaction/fracture pathway, while others view it separately.

The Causes of shin pain

Shin pain of bone, muscle or inflammation of the periosteum often have similar causes. As a physiotherapist the aim is to figure out what factor(s) have contributed to an excessive amount of stress being placed through the medial shin.

The simple things should not be overlooked. “Too much too soon” or footwear that should have been changed months ago. But also things like changes in running surface, e.g. more running on concrete, running on a camber, more track running. All such things will impact the way we run and the stresses and strains placed through the body, especially the medial shin.

There are however some common biomechanical issues that can cause medial shin pain. The most common is over-pronation, the rolling in of the foot. This pattern of over-pronation can happen higher up the chain as well, with excessive internal rotation of the leg as whole.

This lack of control on impact places a torsional (twisting) stress through the inner part of the shin as the foot collapses and the knee drifts inwards. It’s overloading the inner shin muscles – namely the tibialis posterior – which coincidently controls pronation. Weakness in this muscle, along with the lateral glutes (you’ll hear this a lot) will often leave you with this pattern of movement.

Self testing

There are a few simple tests you can do yourself, which may be revealing….

Standing in front a mirror or recording on your phone, perform a few single leg knee bends. Watch what happens to the foot and knee. Then do the same but hopping this time, what happens.

What you are looking for is the foot to maintain a strong arch, the knee to travel over the middle of the foot and also for the pelvis to remain level.

It is then worth looking at the strength of these specific muscles…

Tibialis posterior

With the outward force being applied by the tester, the foot should hold strong. If the tester is able to easily move the foot it simply isn’t strong enough. When we run we put somewhere around there to four times our body weight through the legs. If you cannot resist a friend pushing your ankle out, imagine what is happening when you run?

 Glute strength 

The more lateral gluteal muscles are of particular importance. They are holding the knee over the middle of the foot on impact. Side-lying, lifting the test leg up and backwards (behind the line of the body), you should hold strong to a downward applied force. There must be no rocking back of the pelvis/trunk or bringing forwards of the leg – these are all cheating mechanisms to overcome the weak lateral gluteal muscles.

As well as having the strength in these muscles we also need to have adequate flexibility, particularly through the calf, foot and ankle to allow for load absorption on impact.

If there is a restriction in ankle range, either due to calf tightness or ankle stiffness the foot will often over-pronate, or externally rotation (turn outwards) to overcome the lack of range. This will cause a much greater torsional stress through the medial shin.

If you have been working on these areas and you still feel you aren’t getting anywhere it is worth looking at several other areas. I would recommend routine assessment by any qualified physiotherapist you may visit. Restrictions through the hip, issues in the sacroiliac joint (SIJ) and lower back can all also be contributing factors.

Treatment

The often co-existing and overlapping nature of medial shin pain is what makes it so difficult to treat. It’s why people so often find themselves suffering with it time and time again. Even when doing what they think (or have been told by Dr Google) are the right things.

If there is any concern that you may have sustained more of a bony type injury my advice would be to get it properly checked out. Despite the fact I have just written heavily about the issue,  do not solely rely on the internet for help.

Once the underlying cause of your shin pain has been determined, the rehabilitation can take a number of routes.

Bony

If the issue is bony in nature (i.e. stress reaction or fracture) you will require rest, somewhere between four-eight weeks depending on the severity of the injury. More detail of stress fracture management and rehabilitation will be discussed in later pieces.

Muscular

If the issue is muscular in nature, or irritation to the periosteum, you still need to be sensible. Symptoms are often ignored in the early stages. It might just be that the pain is felt as an occasional tightness and soon disappears once you get running. But the sooner you take action the better.

If these early signs are ignored and the feeling of tightness becomes more consistent you will likely require some rest. This is simply overloading the tissues and a more serious injury will develop if ignored.

In order to address the issue, treatment will be focussed on correcting all the weaknesses, areas of tightness, and biomechanical faults that have been identified.

Tibialis posterior strength

The tibialis posterior muscle is largely responsible for controlling pronation of the foot on impact, so it is essential this muscle is strong.

I would aim for three sets of around 15 repetitions. Alternatively, you can perform the same exercise in the gym using a pulley machine. 

Lateral glute strength

When running the lateral glute muscles are responsible for controlling the internal rotation of the hip on impact. Weakness here will often leave you with the movement pattern shown above.

There are many many ways of building strength through these muscles, but the more functional you can make it to running, the better.

Standing on the affected leg, with the opposite leg against the wall. Keeping the foot pointing forwards, slightly bend the standing knee and turn it out over the foot so that you can see several toes inside the knee, as you look down.

Push the leg into the wall and hold strong through the standing leg. Initially, I would aim to hold for at least 30 seconds, but quickly working up to two-three minutes.

Progressing on

Once the initial strength through these muscles has been well developed you should then look at building to more running specific exercises. These can include single leg control drills such as hops, bounds, lunges etc. It is this initial strength, coupled with the running specific drills that, over time, will transfer into your running. This then reduces the chances of developing such injuries.

It is also worth assessing the range through the calf muscle as tightness here will force the ankle into a more overpronated position on impact, as the knee moves over the foot, again stressing the medial shin area.

In terms of self treatments, it is worthwhile getting fingers and thumbs through the inner, muscular part of the shin. Just a few minutes, every day or so, to free off any of the tightness can help.

The strengthening exercises will take a few weeks to show initial improvement. Thus some deep tissue work is a good place to start in the meantime.

RELATED: The causes of Achilles pain by Matt Bergin

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk.

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The post Runner’s shin pain: What, why and how to treat appeared first on Fast Running.

After the first article addressed identifying and treating an Achilles injury, this time we look at the causes of this type of injury.

There are a number of common causes that can predispose one to developing an Achilles injury, and it often requires looking deeper than just the normal ‘too much too soon’.

Biomechanical faults, lower limb weakness, poor muscle flexibility or joint range, limb control, as well as training and footwear errors can all impact the way you run. Change the loads being placed through the Achilles and over time you have the potential to cause tissue damage.

If you are experiencing Achilles pain then start by looking at the possible causes below.

The most common causes

1) Strength

For any runner you should be able to achieve around 3 sets of 25 single leg heel raises, with weight (up to 20kg). If you are only able to complete 10 before you feel fatigue more strain may be placed upon the Achilles tendon than it can manage. Specific to the Achilles tendon, eccentric heel raises should be completed.

Eccentric Heel Raises are shown in my first article.

For a mid-tendon Achilles issue that is a few weeks old, begin the eccentric heel raises. Rise up on two feet, and lower down on one. Initially perform 3 sets of 15 reps, 2 times daily and then working up to 3 sets of 25 reps as able, plus working up to some resistance (up to 20kg).

For the more acute issues, rest, ice, load management, plus some isometric strengthening are your best options until things settle.

It is also worthwhile looking at the strength of several other areas, which have a stabilising and movement control role during running:

2) Foot invertor strength – tibialis posterior

3) Gluteal strength – especially gluteus medius

4) Movement control – assesses both pelvic control (especially glute) and ankle control also

5) Flexibility

This can either be from stiffness in the ankle joint itself, or from tightness in the calf muscle. You can test the calf length yourself. With the help from a friend, keeping the knee straight the ankle should be able to passively bend up 20 degrees past 90.

6) Excessive pronation

Does your foot collapse in as you run?

This could be a result of weakness in the tibialis posterior muscle, which should be strengthened (as per picture of ankle inversion strength above)

7) Training errors

Injury to the Achilles tendon can often occur as a result of a rapid increase in training volume. You should aim to increase training volume by 10-15% over time.

You may also have just incorporated a lot of hill training into your schedule, or have started running on a surface harder that you are used to, for example concrete. Even a track that is harder than you are used to could have an impact.

8) Footwear

Do I need new or more supportive running shoes? What about orthotics due to a long history of flat feet?

These are all questions you will have on your mind and, as runners; our footwear is our most vital piece of equipment. I advise footwear to be changed every 500 miles and plenty of training apps allow you to count the miles in each pair of shoes.

We must also consider the terrain we run on. Minimalist or barefoot running is becoming increasingly popular, and we are seeing more and more foot issues as a result. Wearing these shoes is not always a bad thing, but it must be done with caution and introduced over time. It’s no good suddenly doing all your runs in minimalist shoes on concrete, you will get hurt.

Remember everyone is different

Everything discussed in these Achilles articles is a guide. Everyone’s Achilles issue is different and everyone will respond differently to the exercises and progress at different rates. So it is vital that you listen to your body. If things settle sooner, then you can accelerate things, and progress the rehab accordingly, and similarly if you feel soreness don’t be afraid to take a day or too longer.

If you wish to have more individual guidance then please consult a chartered Physiotherapist with specialist knowledge of Achilles issues. Here, the lower back and pelvis can also carefully be assessed, as many imbalances stem from issues in the spine and pelvic girdle

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk

In his next article, Bergin will take a closer look at the causes of an Achilles injury.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post The causes of Achilles pain appeared first on Fast Running.

If you’re reading this, there’s a good chance you’ve had a run-in with the dreaded Achilles tendon pain, and you’re wondering ‘is it finally time to have a few days rest’.

You wake up every morning tentative to take those first few steps out of bed. You know the pain and stiffness is ready to greet you. The first 10 minutes of your run is a hobble until finally, it eases out and you feel you can run normally. Then you wake up the next morning, and it all begins again…

Background

The Achilles tendon is the strongest tendon in the body, but one of the most problematic for runners and also one of the most difficult to treat.

Its role is to absorb shock and, through elastic recoil, allow us to push off through our toes. During this movement, the Achilles is subjected to around three to four times our body weight. It’s hardly surprising it’s such a common injury!

Our bodies are constantly building and breaking down tissue. This balancing act is guided by the stresses and loads we place on them. This constant dynamism is what allows our tissues to adapt to the demands placed upon them.

Unlike with muscle the Achilles tendon has very little blood flow of its own, so relies on the supply that exists in the sheath surrounding the tendon.

If we place too much load through a tendon, without adequate recovery tissue breakdown begins to exceed production and we are left with a painful Achilles tendon. The addition of poor biomechanics further overloading the area can exacerbate this even further.

Treating an Achilles injury

In order to effectively treat an Achilles issue, you must look at two aspects.

1) The tendon itself. It needs time to heal. If the problem has become chronic (six weeks plus) it needs to be prompted to heal through a number of techniques.

2) The underpinning cause(s) of the injury. Typically a combination of poor biomechanics, strength deficits, and reduced flexibility. These must all be addressed in patient and activity specific ways. One must allow the tendon to adapt to the demands that will be asked of it.

Symptoms

1) The onset of pain is rarely sudden, but a stiffness that builds. This can be especially in the mornings and at the beginning of a run.

2) If the stiffness eases throughout the morning (less than 10 minutes) and eases as you get into training, then it can be trained on at a level that does not make things worse.

3) If the pain is sharp there is likely to be significant tissue damage and running will cause more problems. Please stop.

4) If the tightness and stiffness does not lessen when running and gets worse throughout the day, you are asking too much of an already damaged tendon. You need to reduce the frequency, duration and intensity of your training.

Some patients complain that their Achilles swells or seems constantly swollen. If the Achilles blows up with swelling after a run please reduce the amount you are doing. You are continuing to damage an already damaged tendon.

If it appears swollen, but it is a thick, solid type swelling that does not fluctuate then this is more likely the result of scar tissue and thickening of the tendon sheath. If the pain is not worsening you can still run on it.

Where does it hurt?

The exact location of your Achilles pain will help guide you to the type of rehabilitation exercises you should undertake. Tendons are inherently tender to poke, so compare with the other leg to see if you have found the right part, there may be an area of lumpiness or it may feel like it’s creaking.

Mid-tendon

This is felt a few inches above the heel, often more to the inside of the tendon. If it is only a few days old and particularly tender, please rest and ice until symptoms have eased.

If the issue is a few weeks old begin loading the tendon through eccentric heel raises. This is where you rise up on two feet on the edge of a step and lower fully down on the affected leg in a controlled manner. Three sets of 15 reps, two times daily then building up to around 20kg as able.

Insertional

This is felt within an inch of the heel bone. When the foot is pulled up the heel bone is pushed into the Achilles. Do NOT pursue eccentric exercises with the heel below the toes as this will potentially irritate things further.

If a few weeks old you may do the eccentric lowers but on the flat.

Retrocalcaneal Bursa

The retrocalcaneal bursa, which is a fluid-filled sack, sits between the Achilles insertion (as above) and the heel bone, and is there to reduce friction. However, it can often become irritated in someone with an insertional Achilles issue.

– With the bursa, the pain will be felt more to the sides of the heel.
– If you suspect a bursa, stick with ice and rest to start with as often any heel raises will irritate it.

Haglund’s Deformity

This is an extra bit of bone that sits on the outer edge of your heel bone. They can be in response to loading or just genetics.

Some people can have no Achilles problems even with a Haglund’s deformity, however, having one predisposes you to Achilles issues as the bone compresses into the tendon more than a ‘normal’ heel would. For these please seek advice and do not continue exercising while in pain.

What can I do about it?

The history of your Achilles issue will help determine what type of rehabilitation exercises and treatments you should undertake. Is it an acute problem that has developed in the last few days? Or are you suffering from an Achilles that has been giving you issues for weeks, if not months now?

In an acute Achilles issue, the first step is to address the pain.

Running through this might not be the answer. You are obviously operating at a level which the Achilles simply cannot cope with. Tissue breakdown is exceeding tissue generation.

We must reduce the loads being placed through the tendon. This is done by reducing the volume/intensity of runs, avoiding hills, harsher running surfaces, and anything else that aggravated your Achilles which may be specific to you. If you do this early, your tendon may settle in as little as one week.

A general guide in helping to decide whether you need to stop entirely is your level of pain the following day(s) after running. Tendons often ease throughout the course of a run so may feel quite good during your run, however, the following morning, or even up to 48 hours after, is a more realistic time to judge things.

Other treatments to help an acute Achilles issue

– Anti-inflammatory medication – ibuprofen is often recommended for acute tendon issues. Please consult your GP or pharmacist first.
– Ice – 10-15 minutes several times throughout the day.
– Foam rolling – avoiding the tendon itself, massaging or rolling the calf muscle can help to reduce strain on the Achilles.
– Isometric calf raises (should be pain-free).

In standing slowly push up onto your toes on both feet, use support if required. Hold this position for 5-10 seconds, and then slowly lower again. Work up to 10 reps. If you have no problems and find this easy progress to rising up on two feet, transfer the weight onto one leg and then hold. Then slowly lower on two.

Weeks or months of pain

If you have been struggling with your Achilles for a few weeks now, or you’ve had issues for a few months with intermittent flare-ups the approach will be slightly different.

You may find that your Achilles is visibly thicker than the other one or there may be palpable ‘nodules’ and areas of thickening within the tendon. These changes will often not resolve but it does not mean the tendon cannot function well.

As with an acute tendon issue, the load being placed through the Achilles must first be addressed.

If you continue to run on an already weakened tendon it may soon lead to severe degeneration or worst case, tendon rupture. Again be guided by the pain and symptoms (stiffness/creaking etc.) you are experiencing the following morning.

Specific to the Achilles tendon, we can enhance the tissues ability to handle load through an eccentric loading program, which have been shown to produce great results.

Over the edge of a step (mid-tendon) rise up on two feet and slowly lower down on one, coming past the level of the step.

You should aim to initially complete 3 sets of 15 reps, two to three times daily. Work up to 25 reps and building in weight (up to 25kg) using either a Smith Machine in the gym or by popping on a backpack and filling with household objects.

Mobilization

The Achilles needs to be elastic and not stiff, as often happens in a damaged tendon. So mobilization of the whole tendon is essential. All it takes is two minutes several times a day.

As discussed above the Achilles tendon is surrounded by a sheath. This can become stuck down to the tendon, even after the tendon has repaired, and this is often the ‘creaking’ feeling you may experience in the mornings.

Freeing this up can be very beneficial, but can be a little painful during. Pinch the sides of the tendon, and move the foot up and down. This slides the tendon within the sheath and helps loosen these adhesions. Two minutes, a couple times a day.

These exercises will take around two to three weeks to have an initial effect and then a further two to three weeks to get really good. So stick with it!

About the expert

Matt Bergin is an international middle-distance runner for Ireland and physiotherapist at leading UK practice Witty, Pask and Buckingham, specialising in running injuries. You can find out more at www.wpbphysio.co.uk

In his next article, Bergin will take a closer look at the causes of an Achilles injury.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post How to identify and treat an Achilles injury appeared first on Fast Running.

Whilst Rosa may be a little different from most of us reading – she’s German for starter – the lessons that can be learned from any full time athlete’s recovery from major surgery can be valuable to all runners.

The injury

The story starts in Italy. On a normal training run at altitude, just as many of us do, Rosa was chasing a marmot. A quick slip into a hole on the ground and something snapped…

Rosa: “I was just chasing this little hairy marmot and suddenly I was in so much pain. My right front leg had stuck in a hole and I had twisted round. It was so painful I yelped, but as I was with a group we continued on. That was my first mistake.

Fast Running: Ouch. Did the doctors diagnose the issue straight away?

Rosa: No, not initially. We went to several different vets before we got the right diagnosis. It’s the same for any runner, you need to see a specialist. Your bog standard vet isn’t used to dealing with the highly tuned body of an athlete. I could still run, but nowhere near my normal speed. The problem is, my damaged ability was still acceptable for someone my age.

FR: So what actually happened?

Rosa: On the third visit to a specialist we got an answer. It was a tear in the ligaments and cartilage in my right front foot. They were completely gone.

They actually got me into surgery that day. Dr. Fabrice Bernard is an expert in his field and had spoke to my local vet. They knew running was my life and wanted to help me.

All the ligaments and cartilage were removed. Now it was replaced with a metal splint and pins. They even took bone from my shoulder to fill in the gaps and help everything fuse back together.

FR: So how was recovery?

Rosa: Well the first day was quite funny.I was coming down from the ketamine they gave me and I couldn’t even eat a croissant without it falling out of my mouth. It probably helped keep me still for a day or so though.

As with any runner I just wanted to go running again. Luckily I have some good friends around to keep me sensible. Robbie and Natalie made sure I didn’t just go straight out, there was no jumping around in the house either.

So many of us just ignore the rehabilitation we’re supposed to follow and good friends help you stick to the plan. I wasn’t allowed to run for three months.

FR: Three months of no running? That must have been difficult!

Rosa: Well, yes and no. You can get caught up worrying about the past and the future, but I’m very much someone who deals with the here and now. Every day I could walk a little further on the leg was a good day. You have to just be happy with where you’re at.

Too many people focus on what they could do before an injury. They remember past times, how easy it is to jump over fences or how close you get to catching a marmot. But all that really matters is making the most out of what you can do in the present.

That first run back felt like I was on a lead. Nat’s helped me from going wild. We’ve all done it. Everything feels great and all the other muscles are rested so you fly off on those first few runs. Then you end up causing more damage. Once again having good friends around will help, they will understand.

I put on a bit of weight during the off time too, but it soon dropped off. I had to eat a few less croissants, but getting the mileage steadily built up, adding some sprints to the postman and back, that really helped.

FR: Were there any low points?

Rosa: Not really. There was the odd moment where I realised I couldn’t do something that would have been easy in the past. Trying to jump over a log on the trail I couldn’t bend my leg to get over. I tried a couple of times without realising that it just wasn’t possible.

I felt sad for a second or two because I couldn’t keep up. Yet again it was friends who helped out. Robbie carried me over the log and I was off again. I actually sprinted off up the hill just to prove how fast I still am.

Downhill is a lot harder now, the shock absorption is gone from that leg. It’s really painful on road or hard trail, but fine uphill. You just have to play to your strengths though. I race uphill only now and take the downhill at a walk mainly. If it’s more technical I can get ahead of the group and rest too.

FR: What’s next?

Rosa: I’m getting a little older now (Rosa is nine and a half) but I still have plenty of trails to explore. It’s become less about racing others, although I still burn everyone off uphill. You just change the focus of your running a little. There is so much to enjoy about our sport and so much to see.

I’d like to do a Bob Graham Round or at least see a fair bit of the course. In the past I would have struggled because of all the sheep distracting me, but I’m a bit older now I can keep focused. I might help Nats run a quick time.

FR: Last question. Any advice for others returning from injury?

Rosa: Plenty. Just focus on the moment. There’s a lot of catshit online about mindfulness but I really think it works now. If you get too concerned with how fast you were in the past or how you won’t be that quick in the future it can get you down.

Focus on being the best runner you can be on this very day, on the run you are currently on. It works for races too. Don’t worry about the miles gone past or ahead, focus on the mile you are running.

I rest more now too. Don’t get me wrong, I rested loads before, but it’s important to listen to your body. Some days when the gang are at the door ready to go, if I’m not feeling it I’ll say no. In the past I would have jumped at any opportunity to go running but now I’m more sensible.

Oh, and stretch. I stretch every time I get up, like a dog does. Just a couple stretches, but always before and after a run.

I no longer chase marmots anymore, even though the desire is there. Pond skaters and tadpoles are a lot safer, plus you’re in water cooling the leg off too. Still do the things you love, but maybe change them a little.

If you want to follow Rosa on her adventure she is on Instagram and posts daily.

RELATED: Dewi Griffiths on returning from injury 

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Trail Dog: Lessons on the journey back from injury appeared first on Fast Running.

When Dewi Griffiths stormed to an astonishing 2:09:49 marathon debut in Frankfurt last winter, his performance reignited the perpetually heated discussions about the state of modern British endurance running compared to its ‘heyday’.

However, injury was set to cruelly strike the Swansea Harrier down just weeks later at the end of 2017, bringing to an abrupt halt his most successful year yet.

Griffith’s sub-2:10 clocking was the 15th fastest ever marathon time for a British man, and the second fastest in 12 years – second only to a certain Mo Farah, who himself has only managed to run 88 seconds quicker, so far.

That incredible run followed on from PBs in every distance from 3000m up to the half marathon, but it was all to come to a sudden and painful end just a month later.

The tear

Griffiths – whose surname literally and appropriately, considering his steely determination and bossing of his domestic competition, means ‘strong grip’ and ‘chief’ – agonisingly had to drop out of the European cross country championships in Samorin, Slovakia, last December, where he tore his hamstring after leading the race for the first 4km.

Those injury woes were to continue, although Griffiths started 2018 off with an impressive comeback at the Armagh International 5k in February, posting a 14:07 result to finish a creditable 11th.

Alas, he was forced to DNF once again at the Welsh National Cross Country Championships nine days later, with what was to be later diagnosed as a stress fracture in his hip, ending his goal of winning his seventh senior title.

Determined not to let this latest setback curtail his running dreams, the farming athlete juggled helping out on his family’s 300 acre livestock farm in Llanfynydd with a rehab programme designed to get him back running, little by little.

The comeback

After five months out from racing, the 26 year-old – who turns 27 this week – made an eye-catching comeback in July, taking the win at the hugely competitive British 10k (running 29:41 for victory on the streets of London), before posting a 14:45 parkrun at Swansea Bay.

His latest 10k race came at the Barry Island 10k, where he fought off top competition from Matt Clowes and Josh Griffiths to win in 29:41.

How has the Swansea man made such a remarkable comeback after sustaining such a potentially serious injury? By taking the long term, little by little approach, says the Welshman.

He explains where he is now with his running: “Although I was given the go ahead to crack on with running in early June, I didn’t want to (and was advised not to) rush things and do too much too soon.

“I’m currently running six days a week, and hitting up to 70 miles of volume a week. Included in that are two sessions (typically running up to around 8km in volume in intervals) and a longer run of 90 minutes.

“My focus is on the long game – the next six months, 12 months, 24 months, the rest of my career – and focusing on being a better overall athlete and not chasing form too much in the short term and jeopardising everything.

“During a quick chat with Jonesy (Steve Jones) back in the spring, one comment stuck with me, which was: ‘You don’t want to be in the same position in 12 months’ time’. He is very much on the same page as the guidance I’m getting from Sport Wales.”

What did Griffith’s rehab programme look like from the end of February to June?

He explains: “Following expert advice, I was aiming to go from being diagnosed with a stress in the ilium (hip) to hopefully be in a position where I’d be pain and injury free and back running most days – in 12 weeks. After this point, me and my coach would take the lead in my training again.

“As you’d imagine, I had to be able to complete everything pain-free before being able to move onto the next stage and so on. Taking an extra week if needed to make sure things have healed properly before progressing isn’t the worst thing in life, and could save further complications down the line.

“The start of any programme of this nature is rest. Due to having a stress fracture, I was advised to increase my calcium (by eating and drinking more calcium-rich food and drink like milk and yoghurt) and Vitamin K (weeds such as broccoli, spinach and kale!). Both help with bone strength.

“Luckily, due to being able to walk pain-free, I didn’t need crutches, but anything of real impact was off limits for eight weeks at best.”

Starting cross training

He continues: “After two weeks of rest I was allowed to start swimming or cycling on a static bike, as long as I was pain free doing so. My swimming isn’t great and I probably wouldn’t back myself to make it from one end of the swimming pool to another without help, so cycling was the only option for me.

“It was nice to feel like I can do something again even if it was on a bike and low intensity.”

Strength and conditioning

“Once I’d got to week three, I started doing some bodyweight strength and conditioning, he says. “Again, I could only progress if everything was pain free. At the start, it was about maintaining some muscle mass while starting to engage and move the injured and supporting area. By this I mean doing stuff like single leg calf raises to help maintain calf muscles and doing double leg hip bridges to start to engage the hip area.

“Over the ensuing weeks, the programme evolved and the intensity of the S&C sessions increased, so I was physically ready to run before I attempt to run. In simple terms if I couldn’t do sets of single leg squats pain free then I was never going to be able to run pain-free.”

Week seven was a landmark week for Griffiths, he started to run again – on an Alter G machine.

“On the Monday, I ran my first steps on the Alter G, and through the week I was able to progress, so that come Friday I was up to 90% body weight and the next stage was running outside,” he explains. “I also completed several max tests during this week which would shape my S&C programme moving forward.

“This essentially focussed on the main areas, such as core strength, glutes, hamstring and calves, testing both left and right legs separately and comparing results, looking for weaknesses and imbalances.”

After showing great patience he finally started to run outdoors.

“Week eight began with my first easy 30 minute run outside,” he says. “Initially, it was one day on, one day off from running, and over the following weeks I progressed from running two days on, one day off, three days on, one day off, and so on.

“The key thing here is to progress only one of the three variables at a time (duration/pace/surface). The non-running days I could get back on the bike and cross-train to increase volume if I wanted to and then phase back out as running levels increased again. Fortunately, with no complications so far, I’d completed the 12 week plan as expected.”

The importance of physio and massage support in the rehab process

Griffiths is clear about the importance of regular physio and massage in his comeback from injury: “The key time for this for me was the introduction back to the running phase. Regardless of the work I’d put in during my lay off, the injury side would always be on the weak side to start with, and so my right side would be working harder and get tighter faster than it should.

So it was imperative to the success of the rehab that during the three weeks where I’d go from running my first steps on the Alter G to running outside again, was being able to see the physio five to six times during that period, just to make sure I’d be starting my runs ‘loose’ and moving correctly. Once I was up and running and with no issues, I was back to seeing the physio every week or so for maintenance.”

What did Griffiths do to specifically improve strength and mobility around his hip area?

He explains: “The main and most important things I’ve done are probably the single leg work, such as the elevated split squat, bridges, and the band work.

“I’ve discovered my right glutes don’t fire properly (this was probably a contributing factor to the injury), so after finding this out, I’m now trying to teach my body to start using them instead of relying on surrounding muscles.

“It’s a long-term thing and won’t change over night, but with time it’ll hopefully make me a better athlete, a more efficient runner and ultimately a faster runner – that’s the hope!”

Griffiths is keen to acknowledge the wealth of support he’s had from the governing athletics bodies to help him regain his enviable speed and strength.

“I’ve been fortunate to have great support from both British and Welsh Athletics during my time out, as well as from Sport Wales,” he explains. “I need to express a huge gratitude to everyone who has helped me get back on my feet. Hopefully, I’ll repay them with a special performance one day.

“The nice thing from my own and my coach’s point of view is it’s been a long-term approach and looking at the big picture, with my best interests at heart, rather than a quick patch up and get me back running as quick as possible and run the risk of breaking down again.”

Griffiths is keen to share more about his injury comeback experience, and offer up advice to other runners going through the rehab process themselves.

We will share the Welsh star’s words of advice later on this week, so keep an eye out for top tips from one of Britain’s greatest ever endurance runners to help you make your own successful return to fitness.

Are you a fan of Fast Running? Then please support us and become a patreon. For as little as the price of a monthly magazine you can support Fast Running – and it only takes a minute. Thank you.

The post Dewi Griffiths reveals how he’s fought back from injury appeared first on Fast Running.

This yoga practice will help runners stabilise joints and release IT band stiffness.

Perform this 30-minute practice twice a week to cultivate balance and find ease.

The post IT Band Relief with this Yoga Routine appeared first on Fast Running.