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Who's Really to Blame for that Pain?

You run or walk 10, 20, 30, sometimes 100 miles a week. Suddenly a pain appears in your knee, apparently from nowhere and catches your attention; maybe even stops you in your tracks. You look down at your legs as if to ask them “what’s the deal here?” You have an injury and it’s time to treat it. Perhaps you put some ice on your knee, maybe even wear a brace or ace wrap on your knee for awhile. However, if all you do is focus on the knee, you may well be missing the perpetrator in this crime. Go ahead, soothe the victim – use the ice, the massage, and the foam roller if you like; but don’t forget to do your detective work and find out who the real perpetrator is.

Success in running and walking is the result of a combination of several factors, including attention to training details as well as a balance of adequate strength and flexibility and a generous dose of biomechanical influences. If any of these factors aren’t in place, there’s an increase in the risk of injury. If two or more of the factors aren’t in place, the risk for injury goes up. Taking the time to do a little detective work can speed your recovery along.

Here are a few places to look for your perpetrator:

Lack of adequate flexibility – Although stretching in general has gotten a lot of mixed press lately (some studies fail to show any benefit from pre-exercise flexibility exercises), there is ample evidence that muscle imbalances can result in overuse injuries. The very nature of the repetitive action of walking or running tends to work muscles in patterns that contribute to a tendency to lose flexibility over time in certain key muscles. The muscle groups I most often find tight among athletes I work with are the calves, hamstrings, hip flexors and sometimes the quads. Though stretching prior to activity has not been shown to be associated with a reduction in injury frequency, stretching on a regular basis at times other than just prior to exercise has been shown in some studies to be associated with a reduced risk of injury. Stretch gently, slowly and consistently (daily).

Lack of adequate strength – Many athletes I work with are so focused on their running and walking that they allow little (if any) time for strength training. You don’t have to be a weightlifter or “gym rat” to overcome the muscle imbalances that occur with your single-minded focus on running or walking. All you need to do is realize that there are other supportive muscles that may not be getting the stimulus they need to keep up with their more-utilized neighbors. Simple exercises like squats, lunges, ball exercises or multi-directional balance-and-reach exercises can be done anywhere and require little to no equipment. Key areas I most often identify as weak in athletes I work with include the lateral hip muscles, lower back, and abdominals. Strength work should be “endurance focused” (think high reps) and can usually be performed 2-3 times per week with good results. Some athletes find that Pilates classes or some Yoga classes enable them to explore core strengthening options they might not otherwise have known about.

Lack of adequate biomechanical support – This is where the rubber meets the road. Your shoes (or shoe and orthotic combination) play a key role in directing the chain of events that occur when your foot hits the ground. Ground reaction forces (impact) aren’t the issue so much as the timing and degree of motion that takes place after your foot hits the ground. Manufacturers of shoes have created a wide variety of shoes from the really squishy to the really stiff, in order to deal with the myriad of foot types that are out there. Those with really flexible feet (can be high arches or low – the issue is flexibility not arch height) generally benefit from a shoe that offers a bit more support (stability or motion control). Those with really stiff feet generally respond well to a shoe with a bit more cushioning. If the shoe you are wearing is not allowing your foot to pronate to the right degree at the right time, you’ll be at risk for an injury. On the other hand, if the shoe you wear is allowing your foot to pronate too far or at the wrong time, you’ll also be at risk for injury. Now to make it a little more complex; if your muscle flexibility in your calves isn’t adequate – then you may not tolerate the shoes that your feet actually need. In other words, muscle flexibility and biomechanics of the foot and leg are intricately related and even though your foot may benefit from a shoe with a bit more control, if you’re tight in your calves you may not be able to tolerate the control the shoe offers.

Training errors – Whole volumes have been written on this subject, so I’ll keep this brief. Train smart. Building tissue strength takes time and just because your cardiovascular system is adapted to a distance (you’re not out of breath) doesn’t mean your musculoskeletal system is. Building mileage or speed gradually may be a simple concept, but far too many runners and walkers overlook this and think they can “skip” stages along the way. Physiology wins that argument most of the time. A few general rules can help keep you out of harms way: build mileage by no more than 10% per week, keep specific speed work intervals to no more than 10% of weekly mileage, don’t run the same distance every day and don’t go out the door at target race pace. Utilize hill training judiciously (it’s very effective but start gradually) and don’t forget that REST is a key part of training.

By doing your detective work and keeping a good record of your training you should be able to identify the perpetrators in your particular crime. Soothe the aching body part – but don’t blame it for your pain. By treating the CAUSE, you’ll be much more successful in your rehabilitation and in your training. 

To your success on race day! - Coach Janet Hamilton, MA, RCEP, CSCS


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