Four ways to prevent your next running injury. Part 4.

Studies suggest if you’re a runner, you will likely get one of the following injuries (1).

1. Medial tibial stress syndrome (shin splints)
2. Achilles tendinopathy (pain, swelling, and impaired function of the achilles tendon)
3. Plantar fasciitis (pain under the foot)
4. Patellofemoral syndrome (pain in the front of and around knee cap).

This is a four part series to help you prevent these common running injuries. Note, these are prevention strategies not rehab strategies. If you already have one of the following injuries work with a specialist to rehab the injury correctly before returning to full training. Part 4. Patellofemoral syndrome. ‘Runners Knee’ or ‘Jumpers knee’ are common names for patellofemoral syndrome (PFS). It is characterised by an aching pain in the knee cap area and is usually worsened when loading a flexed knee joint or keeping it in a flexed position for long periods of time (2). Thinking outside the box Pain in the knee would usually make you think there is a problem at the knee, which to a certain extent is true with PFS, however, the knee lies victim to the ankle and the hip and pure knee strengthening isn’t the magic key to fixing PFS. A study by Ferber, Kendal and Farr (3) found runners with PFS were 28% weaker when performing maximal hip abduction compared to runners without PFS. Hip abductors prevent the hips from internally rotating, which if happens, causes a knee valgus. A knee valgus is when the knee cap falls inside the line of where the femoral head attaches to the hip. This causes internal stress to the knee and results in pain. So stronger hip abductors prevents knee valgus and therefore reduces internal stress and pain… Studies have also found quadricep strength plays a role in PFS, and comparisons between a quadricep strengthening program with a hip strengthening program have been measured (4),(5). Long term, both strengthening programs help to reduce PFS, however, short term results seem to show that patients performing the hip strength program have reduced pain faster than those on a quadricep strengthening program (3),(4),(5). A study looking at short term hip strength on PFS (3) lasted just three weeks and found a 30% increase in maximal hip abduction strength in patients with PFS. Traditionally, three weeks is not seen as long enough to cause a muscular strength increase, so it is likely the strength increase comes in a neuromuscular form. ’Switch your glutes on’ making more sense now? Further to this evidence, the studies that found the hip strengthening protocols to reduce PFS pain also reported the pain reduction at 3 weeks, compared to the quadriceps group which came at 6 weeks (4), (5). ’Switch your glutes on’ So this term isn’t wrong, and coaches shouting it out every 2 mins aren’t wrong albeit annoying… Neuromuscular strength is the strength of the connection between brain and muscle. So the more we know what we want the muscle to do and feel like the stronger our neuromuscular part of the muscle is. Understanding what a switched on glute feels like could mean many different things to different people. Below are two exercises that will help you feel what a switched on glute, particularly glute medius (key to hip abduction) is and I urge you to try and feel this when running. Your glutes should be rock solid and tensed upon landing when running, this will help prevent knee valgus and hopefully PFS! Side plank with leg raise - Click through for a video tutorial. This exercise is a great place to start a pre run warm up. To make it easier, just lie on your side on the floor and rest your head on your arm. Keep your other hand on your hip to feel the muscle working (tensing). Single leg medial rotation - Click through for a video tutorial. Do this right before or just after you’ve got your run shoes on. The standing leg glute should be really tensed and feeling the same as when you did the leg raise (this is what a ’switched on glute’ feels like). Also notice you are actively trying to avoid knee valgus. To make it easier perform the movement with your bent knee against a wall for balance and to push against something. I hope part four of this series has helped! I talk about some key strength training principles for runners over at the famous Mile High Endurance Podcast with host Rich Soars. To strengthen your hips and everything else you need to strengthen as a runner you need Run Strong! A strength training program for runners that fits in alongside any run program for any distance. Also make sure to read part 1, 2 and 3 of this series and if you have any questions reach out to me on email tw@innerfight.com or Instagram @tomwalkerfitness Thanks for reading! #RunStrong By; Tom Walker, Endurance Coach (1) Gill LH. Plantar fasciitis: diagnosis and conservative manage- ment. J Am Acad Orthop Surg 1997;5:109e17. (2) Evidence based management of acute musculoskeletal pain. Australian Acute Musculoskeletal Pain Guidelines Group Web site. 2014  https://www.nhmrc.gov.au/guidelines/publications/cp94-cp95. (3) Ferber R, Kendall KD, Farr L. Changes in knee biomechanics after a hip-abductor strengthening protocol for runners with patellofemoral pain syndrome. J Athl Train. 2011;46(2):142–149. doi:10.4085/1062-6050-46.2.142 (4) Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train. 2015;50(4):366–377. doi:10.4085/1062-6050-49.3.70 (5) Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011;41(8):560–570.