running

Running - The Importance of Load and Capacity

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“It is estimated that 60% of all running injuries are due to training errors” - Hreljac, A; 2005.

 

This statement illustrates that when it comes to running, a huge factor in injury prevention is seen in setting up their technique and managing a person's volume of training. That is the total amount of training, not just running, in a program and may include frequency, duration, and intensity. This is referred to as the load of training.

 

“Have you ever felt like you can’t recover, or constantly feel tired?”

 

“How much training load is going through your body?”

 

When looking at training load, you need to appreciate that all training is, is creating a demand or stress. Your body has the ability to adapt to these training loads, which include muscles getting stronger, an increase in bone density, and tendons becoming more resilient. Load has 2 components that you need to take into account also: internal and external. Internal components are very dependent on the yourself, for example, factors like mood states, bloods (sex hormones, thyroid function, athlete monitoring systems), and rate of perceived exertion/RPE. External factors are influenced by creating physical, psychological or physiological demands like the training distance, frequency, time, speed and elevation.

 

As you could imagine by now there are a lot of factors to take into account, especially as a practitioner, when dealing with running and related injuries.

 

Most commonly people present with a disengagement in the training load and create overload. This is seen as pain or injury!

 

The 3 most common types of overload injuries in runners include:

  1. Medial tibial stress syndrome (shin splints).

  2. Achilles tendinopathy.

  3. Plantar fasciitis.

 

“But why do you feel like you are getting injured all the time even when your diet, sleep and other factors are managed, while others rarely see an injury?”

It all comes down to capacity and recovery.

Capacity is your ability to absorb load and adapt to it. Much like when going to the gym. You lift a certain weight for 4 weeks and the weight becomes easier. Your body has adapted to the load and increased its capacity to lift more. Much is the same with running.

When looking at someone's training load it's important I see areas of increased volume with areas of decreased volume. Your recovery should be illustrated in your training schedule as well as incorporated into periodization.

What is periodisation you ask?

It’s the systematic planning of training. It is made of building blocks with variable loads and recovery to overall increase your capacity and assist in your performance. It is known as a chronic training base, and is made up of layers of foundation building.

Now, if you’re the person who doesn’t have a coach and usually programs for yourself, listen up! This will be useful. The 10% rule. It allows you to add 10% to your weekly training load to steadily increase your capacity to load. Yes it is still dependent on yourself and any prior training base building you’ve established to have a starting point (chronic training load), but generally is a helpful guide to training volume.

Where do I as a practitioner come into effect? I am here to mitigate any loading errors you may develop, while still increasing your capacity to load. Essentially, you increase your training capacity while staying relatively pain and injury free.

Sounds pretty good doesn’t it?

Heel Pain In Most People, Is Probably Not Plantar Fasciitis

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Is heel pain a problem for you?

Has it been diagnosed as plantarfasciitis but not responding to any treatment?

Across our clinics we see many patients who present with heel pain after getting stuck into a new running program.

 

Trying to run, or even walk, with what feels like a little pebble in your shoe is quite debilitating!

At best it is definitely not comfortable.

 

If this sounds familiar, you will probably relate to following story we here all the time…

  • You’ve just set your goal. A half marathon for the first time!

  • People keep telling you which shoes to buy.. how to run.. how fast to run..

  • After downloading the most popular running app to help coach you through your distances you start training.

  • As at the start of any new fitness program your fitness improves. You feel good after each run! Secretly you start to enjoy the lung burn.

  • Something happens…

  • At the start of your next run, you notice a little ‘tug’ under your heel. It almost as if there is a pebble or something in your shoe. There’s nothing there, so why does it hurt a little? Probably nothing major.

  • Run it out right!?

  • You get to the end of your 5km for the day. Bit sore, but not too bad.

Until….

Waking up the next morning. Your heel is sore! Hobble around and it starts to free up and you’re looking forward to your next run. It’s there at the beginning again, but like last time it goes away.

3kms in, ‘Bang’

There it is again, but it’s worse than before. You need to stop and stretch! Something is definitely not right! This does not mean you have plantarfasciitis! Interestingly,

 

The majority of heel pain patients I help, present with symptoms of muscular overloading due to accumulative strain in impact type exercise. This is usually coupled with inefficient movement patterns and does not always support a diagnosis of plantarfasciitis.

 

I’ve noticed almost every case of heel pain in runners, will present with:

  1. Smaller calf size on the affected side

  2. Less strength endurance capability on affected side (single leg calf raise comparison)

  3. History of ankle sprains

  4. A recent change in load (hills/flats/sprints), equipment (type of shoes/orthotics), or technique (standing taller/toe strike vs heel strike etc)

 

Where we have had plenty of success in clinic is simply

  • Identifying the component letting you down

  • Strengthen it

  • Integrate it

  • Plyometrically and Directionally load it

  • Metabolically load it

 

Then you’re free!

 

If you still feel you have plantarfasciitis there is one other reason your not getting better….

 

The plantar fascia is tissue that helps you transfer force through the foot and up the achilles to be absorbed by your calf, hammie, quad and glutes. So if it starts to hurt, it’s because someone else up the chain is not pulling their weight.

 

In the end… whether it’s heel pain or plantarfasciitis, the solution does not lie with just hands on therapy. You need to:

 

  1. Get your movement checked and

  2. strengthen the area’s of weakness and assymettry.

Runner's Knee - Do You Have It?

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For me, there’s no better feeling than completing a solid early morning 5k. The fresh breeze and crisp morning sun gets the endorphins going, sets you up for the day.

We all know there are many benefits to running:

  • Reduced risk of lifestyle diseases

  • Improved heart health

  • Losing weight

  • Stress relief

  • And more…

Whilst not everybody shares my love of getting up at the crack of dawn to go for a run. It is one of the more popular activities when it comes to staying fit and healthy.

Problem is…

Not Everybody is Ready to Run

Did you know,

‘knees experience pressure equal to approximately
5 times the body’s weight when running’

 

It’s not surprising that I see so many knee problems from people who run for fun. Particularly patellofemoral pain syndrome. They just keep coming in!

One of the cases I saw last week is very typical.

If your knees hurt when you run this might just be you!

 

Like I try to… she runs 3-4 times per week for about an hour. Without fail, as soon as she hits 2k a dull ache creeps in under the right knee and doesn’t go away.

There’s nothing worse than finally getting into a rhythm and having to start walking because of your stupid knee.

Interestingly, she also complained of tightness in the front and inside of her hip which got worse after a run.

Like you would treat any kind of pain it’s a,

 

Simple 3 Step Process to Treat Knee Pain

 

  1. Assessing her running technique

  2. Use tests to confirm a diagnosis

  3. Treat and manage the problem!

What to Look For…

 

It didn’t take long to work out her knee caved in every time she landed on the right leg. Remember the 5x body weight pressure on the knee when you run?

This amplifies that pressure!

No wonder the knee always hurts…

You might not notice it yourself when you run, but look at the picture below. It just looks wrong when the knee caves in!

So What The Heck Causes the Knee to Cave?

 

It could be a few different factors. In this case…

An extremely weak right gluteus medius
(side of your butt or hip)

If anatomy of your bottom interests you, the medius is one of 3 gluteal muscles:

  1. Gluteus maximus

  2. Gluteus medius

  3. Gluteus minimus

The role of the gluteus medius is to:

  • Abduct the leg

  • Externally rotate the femur

  • Stabilise the hip and pelvis during single leg stance.

In simple terms, it’s is essential to keep the leg straight! If it’s weak or doesn’t work…

The body compensates by recruiting the hip flexors, quadriceps and adductors. Hence you may recall the sore hip after my patient went for a run!

This is PFPS or patellofemoral pain syndrome.

 

It affects a wide range of ages, beginning in early adolescence and creates greater risk of knee osteoarthritis if it isn’t dealt with on its first occasion.

So how do we fix this problem?

Come and see me or one of the team… That’s the obvious answer, but here’s a brief snapshot of how I approached this case of ‘runner’s knee’

Process For Treating PFPS

  • Release what is overactive through the use of soft tissue massage, dry needling or active release technique

  • Provide external support initially through taping to ensure the kneecap sits correctly

  • Activate/strengthen what is underactive through the means of strength exercises

  • Provide a targeted, individualised home exercise program to ensure ongoing strength improvements

  • Progress running distance as strength progresses!

 

I know first hand how frustrating this problem can be. Just like my patient I’ve had to overcome the debilitating nature of the pain and its effect on running.

 

Good news is… If you get it early, the rehab and progress is quicker than you might think. There’s a strong chance you will be back running pain free before you know it.

If you or someone close to you complains of the knees hurting, or they won’t run because it hurts we would love to help.

Just call the clinic and one of the team will be there to help you. It’s a condition we all treat regularly with good success.