Injured runner looking for answers? You’re in the right place, welcome!
I would guess that at the moment you’re getting a little frustrated with your lack of progress. You miss running and the sense of freedom it brings. There certainly is something very liberating about putting on your trainers and getting out there, even in winter.
Like most things, it’s only now that you can’t do it, you realise how much you love it.
You may be a little concerned that you’re putting on weight as a result of not being able to run. On a deeper level you’re perhaps worried that your body might not be able to tolerate running anymore and that your running days could be over for good. These thoughts have got you in a bit of a funk.
Am I doing something wrong?
Is this an inevitable part of the ageing process?
Should I take up bowling?
You have most likely tried physiotherapy and as a result have been foam rolling your IT band to destruction and working on your ‘weak glutes’ for what seems like an eternity.
This hasn’t worked too well so now you’re seeking the advice of specialists who will have diagnosed a whole host of problems including but not limited to; a leg length discrepancy, ‘over pronating feet’, weak things and tight things, dominant muscles and submissive ones, things that need injecting and other things that might need cutting, joints that need a ‘clean out’ and of course the ubiquitous ‘tight hamstrings’ as a result of sitting at a desk all day.
What an injury represents.
First of all I can assure you that this is not part of the ageing process. Your arm is the same age as the leg that hurts and hopefully that feels just fine right? Great.
You have not done anything wrong, you’ve been failed by the well meaning advice you’ve been given thus far. You will be able to run again but first you need to think about what this injury represents.
Any injury, be it ITB friction syndrome, runner’s knee, plantar faciitis, hip impingement, achillies tendon issues, shin splints, or anything else you may have been diagnosed with, is caused by a mismatch between what you are asking your tissues to tolerate and what they are currently able to handle.
Understanding this is the first step to getting better because it will also explain why everything you have tried so far hasn’t worked.
Think about it, how does applying massage, stretching, foam rolling, trigger pointing, chiropractic adjustments, orthotics, cryotherapy, corticosteroid injections, arthroscopy get you stronger? They don’t. None of these interventions will do anything for your ability to tolerate force. In most cases they will actually make you weaker.
Why the exercises you’ve been doing haven’t worked.
Think back through all the assessments you’ve had. Has anyone actually tested which muscles were weak? They may have asked you to stand on one leg, or perform a single leg squat (which you were no doubt rubbish at on your injured side) but these are assessments of multiple muscles crossing multiple joints. They can’t be used to accurately diagnose specific muscle weakness. Just as driving your car can’t be used as a diagnostic tool to assess where that strange noise is coming from.
No doubt you’ve spoken to other runners who have also suffered injury. Do you find it a little strange that you’re all working on the same muscles despite having different injuries and very different histories?
Is it possible that of the 650 muscles you possess, only your glutes, one particular division of your quadriceps (vastus medialis oblique) and the magic core stability muscle (transverse abdominus) are contributing to your lack of progress?
I can tell you now that there is no magic muscle and that the exercises you’ve been doing for certain muscles will have most likely strengthened them but there are plenty more that are weak and contributing to your situation.
So how do you get stronger?
Over 15 years of working in this area has taught me how not to do it and why most exercise rehab programmes for runners don’t work.
It’s important to realise that just as the single leg balance and squat is an assessment of multiple muscles that control multiple joints, employing this as an exercise, as many rehab programmes for runners do, will not get weak muscles stronger. You will simply strengthen what is already strong and your central nervous system (CNS) will work around your weaknesses.
To illustrate the point, one particular client of mine was instructed to perform a single leg squat post knee surgery and told that once he could do that with 80 kilograms on his back he would be able to run free of pain. At that point he couldn’t bend his knee without pain. You can read about his experience here.
This is rather like attempting to run a marathon every day in the hope that this will improve your ability to run a marathon. You will simply overload yourself and become injured. Everybody knows that marathon training must be broken down into smaller parts. It’s not necessary to run the full distance, just as it’s not necessary to be able to single leg squat with 80 kgs to be able to run without pain.
What does work and why.
In order to successfully rehabilitate your running injury we must first assess the individual parts that contribute to the motion. This will tell us exactly where your weaknesses are. Just as a car mechanic will perform diagnostics on each part of your car to discover where the problem is, we must first isolate the muscles involved in running and test them to find out exactly which ones are contributing to your situation.
Once these weaknesses have been located, they will require 1) specific work to get them contracting again effectively and 2) specific exercises to strengthen them.
1) If a muscle has been exposed to a force that exceeds it’s tolerance your CNS will respond by inhibiting it. This means it’s unable to contract on demand. There’s typically an increase in this effect when pain and injury are present.
Just by performing a motion that the target muscle should be involved in doesn’t mean it is. We must first ensure that it’s actually contracting before we begin to strengthen it.
2) As I’ve previously mentioned compound movements involving multiple joints such as the single leg squat will not strengthen isolated muscle weakness. Your CNS recognises the capability of weak muscles and will simply bypass them if the load is too great. In order to accurately target the weak muscles you must give it no other option.
This requires single joint exercises where possible. For example, if you have weakness in the quadriceps the knee extension machine is a great option. Amazingly you can squat with very little quadricep involvement and it will be very difficult to tell the difference.
What you can do today to get stronger.
Gluteus medius isometric.
Try this simple exercise to improve the function of your gluteus medius, a muscle that sits on the side of your pelvis. It has an influence on the stability of your pelvis during running and weakness in this area is thought to contribute to many running injuries.
Gentle isometrics are a great way to improve a muscles ability to contract. Isometric just means a muscle contraction without lengthening or shortening of either the muscle itself or the joint it acts upon. I use them a lot with my clients to activate muscles that I find to be unresponsive when tested.
Lay on your back with your legs together. Squeeze your thigh muscles on one leg and keep the knee pointing to the ceiling (no hip rotation). Slowly slide the leg directly out to your side as far as it will go. Check how much range you have and bring it back to the centre. Repeat with the other leg.
Is one side more limited than the other?
Work on the limited side first. Repeat the leg slide out to the side but this time have an immovable object block you at the end of your range. A table leg just above the ankle works well or a partner if you have one handy.
Again ensure that your knee is pointing directly to the ceiling (no hip rotation). Squeeze your thigh muscles tight to keep the knee locked and very gently push directly out to the side into the object or partner as if trying to take the working leg further away from the other.
The effort should be no more than 10% of your maximum, very gentle in other words, and your attention should be focused on the lateral aspect of the hip where the gluteus medius muscle resides. After holding this for 6 seconds return the leg to the centre.
Repeat this process a further 6 times. If you find the exercise difficult don’t take the working leg out so far and try again.
With each isometric you should notice a small increase in how far you’re able to take your leg to the side. This means your gluteus medius muscle is now contracting more effectively. Nice work.
Bear in mind that all we have done is improve the communication between your CNS and the target muscle. The muscle is now contracting better and will be able to generate more force as a result.
You’re also a bit stronger than you were a few minutes ago and on the path towards injury free running. Fantastic.
Book a free Discovery Session to find out exactly what else is limiting your progress.