Strength training to help prevent running related injuries Corey Whipple, MS, AT Kettering Sports Medicine
• In the US alone up to 40 million people run regularly with more than 10 million running 100 days a year or more. 1 • Up to half of runners report an injury, mostly due to overuse. 1 • The incidence of lower extremity injuries in runners ranges from 19.4 to 79.3%.1 • Clinical studies show that over 60% of RRIs (running related injuries) could be attributed to training errors.2 • Despite the popularity of running and the prevalence of related injuries, few studies have successfully identified the individual factors most responsible, suggesting that many running injuries are multifactorial. A
history of prior injury is one of the few variables that has consistently been shown to increase the risk of incurring a subsequent running injury. Therefore, every injured runner seeking
medical attention should be questioned about prior injuries, including treatments. Incomplete rehabilitation and failure to address potential risk factors associated with a prior injury increases the likelihood of recurrence. Greater mileage is another factor that is consistently associated with increased injury risk.1
• 2008 GRONORUN (Groningen Novice Running) study looking at a standard 8 week training program vs an adapted graded 13 week training program for novice runners while training for a 4 miler.3 • 2010 GRONORUN 2 study looking at the effect of a 4week preconditioning program preceding a 9 week training program.2 Results still pending. • Initial GRONORUN RRIs outcome was 20.8% in graded program vs 20.3% in standard program.3 • Primary outcome measure was RRIs per 100 participants. • Both studies used the “10%” rule.
• 2010 15 year longitudinal study of 3233 HS cross county runners – initial injuries reported 69% in September & 25% in October (boys & girls similar).4 • 2012 cross country season study followed 421 runners analyzing summer workouts vs injury rate during the season. 253 participated in an 8 week or less training program including not frequently alternating short & long mileage days = more likely to result in 1st month injury.4 • 60% participated in summer training with 16% (67 runners) reporting an injury during the first month of season.4
• Dr. Robert Chapman, Associate Director of Sports Science and Medicine for USA Track and Field and faculty member at Indiana University states that - The athletes who are the most flexible and have the greatest range of motion usually will: • • • • •
--Develop fewer injuries --Recover quicker from quality workout sessions --Not be as sore as less flexible athletes after high intensity workouts --Improve their speed quicker than less flexible athletes --Be able to tolerate higher mileage without breaking down
• Recent studies have shown that static stretching during warm-ups actually impairs explosive and/or endurance performance.7 • Several studies have shown that dynamic stretching acutely improves explosive performance.7 • 2015 study in the Journal of Strength and Conditioning revealed that performing a dynamic stretching routine during warm-ups before running did effectively improve performance.7
• Purpose is to neurologically activate large muscle groups, particularly the glutes. • Being the largest muscle group, the glutes are usually the last to be activated which results in the smaller muscle groups (low back, hip flexors and hamstrings) to be over-utilized early on in the run. • This can lead to injury situations to the smaller muscle groups experiencing early fatigue, unnecessary pulling/strain, unable to absorb their normal load of pounding and stress later in the run = load transferred more to the bones = environment for stress related injuries. • Dr. Chapman believes that many injuries are a result of pounding/running on tight muscles. The kinetic chain (ground up approach) is effected – i.e. tight muscles in foot and ankle resulting in tight muscles up the kinetic chain (quads, hamstrings, hips & glutes) causing altered mechanics and potential injury.
• Goal is not to necessary add muscle mass but to9 • • • • •
Improve muscular strength Improve local muscular endurance Maintain current muscle mass “Pre-hab” for injury prevention Post-injury rehab
• General rule of thumb is 2-3 times a week can improve running economy, with 2 sessions being enough to achieve a sufficient increase in strength during a 12 week period (off-season/post competition lifting program)10 • However in order to achieve the improvement, the program must accomplish a minimal threshold of volume and frequency of explosive training.10 • For example, one study had runners lifting 2-3 sets of 4-10 RM with 2-3 minutes of rest between sets focusing on high volume low intensity10 • In season strength training (1 session per week) focused on low volume high intensity for maintenance10 • Running is catabolic = breaks down muscle while strength training is anabolic = builds muscle which means that it is hard to “bulk up”
• Stretch? Lift? Warm-up? Nothing, just run? Stay on the couch? • 2016 study in the Scandinavian Journal of Medicine & Science in Sports conducted a randomized controlled trial evaluating RRI’s in novice runners participating in resistance strength training vs. functional strength training vs. stretching control group.8 • Initial findings included – large dropout rate (129 to 68) requiring further studies; RRI’s reported ranged from 35-48% (stretchingresistance-functional); 56 RRI’s were reported - knee 46%, ankle 20%, and foot 11%; higher injury rate during first 8 weeks training session compared to 4 month maintenance period after training8 • Self reporting purpose of this study was to show need for future larger scale RCT evaluating strength training for the novice runner.8
5. Injury Free Running, Dr. Thomas Michaud
• Address the body as a whole • 75% of all RRIs are result of overtraining5 • Potential for injury dramatically increases when over 3540 miles per week5 • Identify the cause first that has attributed to the injury – strength, flexibility, coordination, bony alignment • The best predictor of future injury is prior injury5 • Our role is to find the cause and determine the best course of treatment and/or prevention for our athlete.
• Common practice is dynamic warm-up first and then stretch (no studies found to show otherwise) • Remember the purpose of the dynamic warm-up is to activate the large muscle groups, not necessary to promote proper running form and technique (address that with running drills) • The time ranges are anywhere between 8-15 minutes for the warm-up with stretching ranging from 10-15 minutes. • Most studies advocate the use of stretch bands and holding the static stretch for 1-2 seconds for 8-10 reps; taking the stretch to point of light irritation (don’t overstretch) go as far as your ROM allows; stretch after warm-ups and after run when muscles are warm and loose. 12
Walking knee lift (knee to chest), walking quad pull (heel to glute), walking unilateral pike, walk outs, walking high knee to step out (light snap in knee), walking straight leg (monster walk/zombie walk/toy solider), jogging high knee to step out, carioca, high knee skip with arms (height not length), jogging butt kicks, high knee side holds (step and cradle), hurdle unders, body weight squats, Spiderman lunge, side lunge with squat, leg swings,
• Fatigue causes form to deteriorate which leads to poor running economy (tired legs, arms, back and core) • Prevents gradual loss of strength and bone mineral content due to aging • Eccentric muscle contractions reduce risk of injury • Eliminates muscle imbalance between opposing muscles • Improves running economy (stronger legs, arms, back and core) = faster times over same distance due to decrease in oxygen consumption = increase in time to exhaustion • Produces neuromuscular adaptations that causes muscular activation to remain high • As a result of strength training, rapid force production when the foot is on the ground reduces ground contact time thereby ensuring a higher running speed.
• Primary explanation for improved performance is most likely adaptations within strength trained muscles including10… • • • •
1. Postponed activation of less efficient type II fibers 2. Improved neuromuscular efficiency 3. Conversion of fast twitch type II X fibers into more fatigue resistant type II A fibers 4. Improved musculotendinous stiffness (baseline muscle elasticity)
Ronnestad & Mujika
Acute Program Variable
Off-season
In-season
Volume
High volume to increase local muscular endurance. Meant to parallel the longer duration of running helping to build a stronger endurance base.
Lower volume allowing for higher intensities. High stress demands of intense endurance workouts & races require lower lifting volume to reduce risk of overtraining.
Intensity
Very low to ensure some degree of aerobic benefit but also needs to be low due to high volume
Higher to elicit a neurological response making muscles stronger and more powerful = enhance stride length = increase running efficiency/economy
Rest Periods
Short rest periods keep heart rate up adding to the endurance qualities
Longer rest periods required to “reload” muscles in order to exert high levels of force and power (plyometrics require longer rest period for the nervous system to adapt)
Choice
Exercises that hit all the major muscle groups, combining multi and single joint movements
Exercises are sport specific and explosive in nature
Adapted from Erickson, Travis. The Benefits of Strength Training for Endurance Athletes.
Upper
Lower
Core
DB bench press, DB incline bench press, DB row variations (upright, bentover), DB flyes, bicep curls, DB curl & press, tricep pullover, 2/3 way shoulder, DB shoulder press, shoulder shrugs, push-up variations, dips, chin-ups, pullups, TRX
Squats (front, back & split), MB squats, lunges (front, back & side), wall sits, leg press, PB leg curls, SB leg curls, deadlifts, Good Mornings, RDL’s, hang power clean, box jumps, vertical jumps, split squat jumps, PB leg squeeze, calf press/toe raises, step-ups (box variations – explosive, lateral & front – progress to adding MB), TRX
Plank variations (add MB, PB or dyna disk), Superman, hip-ups, MB bicycles (figure 8’s), Russian twist, MB pass (leg to hands), hyperextensions, crunches variations, leg raises, bridge variations, mtn.climbers, bird dog variations, pendulum, flutter kicks, reverse crunch/seated knee-ups, V-ups, weeble wobbles, toe touch crunch, TRX
* Use kettlebells or MB in place of DB for variety
• Work through full range of motion • Allow adequate time for recovery and physiological adaptation • Challenge your muscles • Progress to single arm/leg as technique and strength improve • Proper nutrition and rest are essential
• Include your runners/cross country athletes in the open weight room invite. • Introduce any strengthening programs in the off-season. • Create an off-season strengthening workout with your cross country coach. • Attend the spring cross country interest meeting to talk about the benefits of strength training for the runner. • Create an in-season strength training workout for their light workout days. • Look into purchasing stretch bands and/or foam rollers for the cross country program – talk to the boosters or parents, fund raiser • Talk to your cross country coach about what their warm-up includes – i.e. static stretch vs. jog/run only vs. dynamic warmup vs. athlete led social gathering
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1. Callahan, Lisa R. MD, Fields, Karl B. MD, Grayzel, Jonathan MD, FAAEM. “Overview of running injuries of the lower extremity.” www.uptodate.com Sept 2016 2. Bredeweg, Steef W, Zijlstra, Sjouke, Buist, Ida. “The GRONORUN 2 study: effectiveness of a preconditioning program on preventing running related injuries in novice runners. The design of a randomized controlled trial.” www.biomedcentral.com 2010, 11:196 3. Buist, Ida, MSc, Bredeweg, Steef W, MD, van Mechelen, Willem, MD, PhD, Lemmink, Koen A.P.M, PhD, Pepping, Gert-Jan, PhD and Diercks, Ron L, MD, PhD. “No effect of a graded training program on the number of running-related injuries in novice runners. A randomized controlled trial.” The American Journal of Sports Medicine, 2008 Vol.36, No 1. pg 33-39 4. Rauh, Mitchell J, PT, PhD, MPH, FACSM. “Summer training factors and risk of musculoskeletal injury among high school cross-country runners.” Journal of Orthopaedic & Sports Physical Therapy, Oct 2014, Vol 44, No 10 pg 793-804. 5. Michaud, Thomas C, MD. “Injury Free Running: How to build strength, improve form and treat/prevent injuries.” www.humanlocomotion.com 6. “Injury Prevention for Runners.” Sports Medicine Institute International. www.smiweb.org 7. Yamaguchi, Taichi, Takizawa, Kazuki, Shibata, Keisuke. “Acute effect of dynamic stretching on endurance running performance in well-trained male runners.” Journal of Strength and Conditioning, Nov 2015, Vol 29, No 11 pg 3045-3052 8. Baltich, J., Emery, C. A., Whittaker, J. L., Nigg, B. M. “Running injuries in novice runners enrolled in different training interventions: a pilot randomized controlled trial.” Scandinavian Journal of Medicine & Science in Sports, 2016 9. Furman Institute of Running & Scientific Training (FIRST) www.furman.edu 10. Ronnestad, Brent R., Mujika, Inigo. “Optimizing strength training for running and cycling endurance performance: A review.” Scandinavian Journal of Medicine and Science in Sports, Aug 2013. 11. Erickson, Travis M., MS, CSCS. “The benefits of strength training for endurance athletes.” NSCA’s Performance Training Journal, Vol.4, No 2 pg 13-17 www.nsca-lift.org/perform 12. Chapman, Robert, PhD. “Dynamic warm-up/Flexibility/Core for Distance Runners.”