How to prevent running injuries PART 3

Good running form, and strength and mobility exercises 

Good running form isn’t necessarily ‘perfect’ form – but it will reduce the likelihood of your clients sustaining injuries when running, writes physiotherapist Tim Keeley.

You can read Part 1 of this series here and Part 2 of this series here.

The first two instalments in this article series looked at the running cycle, common injuries and biomechanical faults, as well as the role of treadmill assessments in diagnosing running abnormalities. The aim of the running assessment, in conjunction with technique changes, education and exercises, is to address issues and achieve good running form in your clients. Here, we look at what is required to do this.

Good running form

Good running form doesn’t necessarily mean ‘perfect’ running form. It does, however, mean a running technique that will reduce the likelihood of sustaining injuries when running. Adopting a better running form doesn’t mean you won’t ever get injured, but it does mean you will probably experience fewer injuries over time.

1. Upright posture

Aim for an upright posture – or as upright as possible. This doesn’t mean absolutely vertical, because the angle of the torso is affected by the speed of running. The faster you run, the greater the forward lean, generally. The angle varies depending on the athlete, but is around 5-10°. What you don’t want, is to be bent forward at the hips.

2. Shorter stride length

An increase in cadence and a shorter stride length can result in ‘increased efficiency’ in the system, resulting in being less likely to compensate and break down. There is no ‘absolute’ when it comes to stride length, so using an audible cadence pedometer on a watch or phone may be helpful for improving your stride length. You will also be more likely to land mid-foot when you shorten your stride, making it a useful technique to use in individuals who are having problems as a result of heel striking – and who would therefore benefit from adopting a mid-foot strike.

3. Is mid-foot strike ideal?

There is not yet sufficient evidence to prove that mid-foot striking is optimal for either jogging or long distance running, in terms of injury prevention. However, it does appear to be better in terms of efficiency and speed, as well as creating less impact stress at the toes and the heels.

Olympic marathon runners tend to not land on their heels. This is, in part, because if they were to heel strike, they would get more loading response, leading to more injuries through the sheer volume of striking involved in their long training distances. The other reason is that the speed at which Olympic marathoners run (sub 3min/km) lends itself to a style which naturally results in mid-foot landing.

They are not sprinting like a 100m distance athlete (who will always land forefoot), but neither are they running in the style of a 5-6min/km pace runner. Sprinters who run forefoot will create more power, and although more demand is placed on the calves, they are running shorter distances. Problems may arise when forefoot strikers, like casual joggers, increase their distances to train for a marathon.

4. Active arms

Although the research may not yet be able to fully explain why, high performing athletes clearly find benefit in the use of active arm movement during running. The height of the arm swing is relative to how fast you are running. Using active arms can assist injury prevention by helping create a posterior cross sling effect, improving spinal stability for the lower back.

When you arm swing in the gait cycle, the pull back of the arm on one side, coupled with the push off with the leg on the opposite side, will mean the opposing lat and glute connect through the ‘thoraco-lumbar fascia’, creating a stability mechanism for the lumbar spine. It’s like someone taping you up in the back when you run. The more efficient you are with the connecting and strength of the glutes, and the movement of the arms, the more stable you will be. 

5. Trunk rotation

You are aiming to avoid too much trunk rotation when you run. Core stability training and anti-rotation exercises will assist in reducing excessive trunk rotation. In doing this you will be able to transmit more power production to the arms and legs, as well as be more efficient in the entire system.

6. Hips

Many people don’t get their knees high enough in the lifting or end part of the swing phase. With sprinting it is closer to 90 degrees at the hips, but less when jogging, due to speed. Athletic sprint drills, like A, B and C Step/Skips, are very effective in helping improve this hip movement, as it results in the foot landing underneath the hip.

Improvements in hip position happen over time, with identification of the cause of the tightness or weakness.

Other things to look out for in relation to the client’s hip movement are a pelvic drop on one side when they are in mid-stance position, and also the knees knocking together. There also needs to be adequate hip extension when they push through. Improvements in hip position happen over time, with identification of the cause of the tightness or weakness – and then addressing it with the right strength and mobility exercises, as well as continual neuromuscular programming so the corrected movement becomes automatic.

There is emerging evidence to support a focus on good running form in order to prevent injury. Currently, most of the advice, technique recommendations and education is coming from running coaches and non-peer reviewed articles, books, videos and social media, and based on the experiences of runners who are very efficient and suffer fewer injuries. Hopefully, more findings to back up this anecdotal evidence will emerge in the form of trials and systematic reviews.

Mobility and strengthening exercises

In instances where clients have specific injuries or problems, it is best to refer them for a running assessment, and to then work with the findings to tailor an exercise rehabilitation program specific to the client’s biomechanics, weaknesses and injury.

For most runners that we see, the focus is on core stability and strength work through the abdominal, lower back and gluteus, as opposed to leg strength or mobility. This is because the majority of injuries come from deficits or problems in pelvic and hip stability. The key is to not only do stretches to relieve pain or stiffness, but to use them as tools to help fix underlying problems, and therefore prevent pain and injury from occurring in the first place.

1. Calf and ankle mobility

Stretching out the calves and ankles will improve dorsiflexion range in the ankle. Performing 1-2 minute stretches off a step, or kneeling on the floor, are two great options. Doing this before a run will enable you to run a bit looser in the ankles and calves. This is especially important for people with previous ankle sprains and lower leg injuries.

2. Hip and thigh mobility

The stretch known as ‘World’s greatest stretch’ tackles groin, hamstring and hip flexors, as well as the hip flexion joint range – all in one. It mimics the running movement position, making it a very practical mobility exercise for runners and athletes. Equally as important are the gluteal and hip external rotation stretches and the quadriceps kneeling stretch for the front of the thigh, because runners’ glutes and quads can become very tight, especially when more hill training is being undertaken. All these stretches can be done without equipment, and are really good for maintenance of soft tissue movement in the hips and legs.

3. Lumbar spine mobility

McKenzie extensions help improve the flexibility into lumbar spine extension, as well as reduce disc pressure for people who sit a lot during the day. The quadratus lumborum (QL) stretch improves the mobility of the lower back muscles, which can become tight in those with a lack of core strength or people who spend much of their day standing.

4. Thoracic mobility

Rotation of the thoracic spine opens up the chest and pecs to reduce the rounded position at the mid back, as well as reduce tension in the front of the body to help with posture and arm swing.

5. Spinal stability and strength

These exercises become the focus of most injury prevention programs, as they address the weakness and stability issues that are causing the injuries in the first place. The bird dog works on the posterior cross slings and stability at the lower back, whereas the dead bug targets abdominals and the anterior cross sling. Both are very important in achieving good spinal stability when running.

The Paloff press is another of the anti-rotation exercises which provide an external load to one side, and is particularly helpful for people that have excessive rotation of the trunk when they run. The front plank and side plank are both abdominal and lower back endurance exercises. Front plank is more focused on the front part of the core, whereas the side plank works abdominals more laterally, while also targeting the big QL stabiliser muscles of the lower back.

6. Hip stability and strength

Hip external rotation strength is very important for hip stability and thus knee control. Clams are a low level exercise but excellent for glute activation and movement into external rotation. Once they are done well with instruction and specific cues, they can be loaded with bands for more strengthening. The one leg ball squat, meanwhile, is the best single leg weight bearing exercise for strengthening the gluteus medius. It works in the stance phase of the running cycle, which is very specific to the position the person is in when running: this mimicry of the actual activity it is helping to improve makes it an incredibly useful hip stability and strength exercise. Hip extension and flexion weaknesses can be addressed with single leg hip bridge and banded hip flexion. 

7. Knee control and strength

The three go-to exercises for knee control and strength for runners are the step down, single leg deadlift and the physio lunge. Again, like the hip exercises, these are very specific to the movement pattern that the runner is in, closely replicating the running action.

8. Calf and foot strength

Calf raises can be specific to the gastrocnemius muscle or the soleus muscle. Both the straight knee and the bent knee stretches are excellent for runners, improving tendon strength and general strength and conditioning. The arch lifts help those who have very low arches or ‘flat feet’ (including  runners who are a little older and starting to get some arch drop or mid foot collapse), as well as those susceptible to plantar fascia problems, tibialis tendon and shin splint injuries.

All these exercises are safe to do with and without injury, however some may be chosen over others depending on the type of problem or deficit the runner has. 

• Bio

Tim Keeley

Tim is the Principal Physiotherapist and Director at Physio Fitness, Bondi Junction in Sydney. With over 24 years experience in physiotherapy and the fitness industry, he is a rehabilitation expert, clinical educator and convention presenter. Tim specialises in sports, fitness and training injuries, corrective exercise rehabilitation programs and strengthening for lower back pain, shoulder injuries and ACL reconstruction surgery. To watch the full workshop presentation on running injuries, or to discuss referring your clients to Physio Fitness, visit physiofitness.com.au