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(originally published on trailrunner.ca)

It is fun to negotiate rocks, roots, narrow pathways and slippery surfaces of the trail until you lose it with a fall. Maintaining focus, wearing trail appropriate shoes and being light on your feet are the main strategies to avoid becoming horizontal while running. From a sports medicine and conditioning perspective there are also a few other things to work on to prevent a crash landing. Optimizing these trainable factors could be the difference between executing a successful corrective maneuver and nursing a sprained ankle (or worse).

Balance
Having good balance means that you can maintain equilibrium in more challenging situations. Moving quickly over uneven or twisty terrain and experiencing visual compromise such as going from light to shade can definitely increase the balance challenge. Balance can also be negatively influenced with age, fatigue and prior injury.

Exercises to improve balance are:

1. Single leg deadlift
2. Tandem walking (heel to toe) along a balance beam, log, painted line or tape on the floor. More challenge to go backwards.
3. Hands and knees or kneeling balance on an exercise ball (30-60 seconds)

Proprioception
Proprioception is the position sense that gives feedback about where our body is in space. The mechanism of proprioception helps protect our muscles and joints from injury. For example, when the ankle rolls excessively inward because of uneven terrain our proprioceptive system reflexively causes muscle contraction to protect the lengthened ligament and stabilize the joint. Because soft tissue injury and pain negatively impact proprioception, it is important to retrain this system after sprains and strains.

Exercises to work on proprioception are:

1. Wobble board circles, both directions, eyes level
2. Single foot hopping in a quadrant with precision landing important
3. Single foot hop down from a box with good alignment on landing

Reaction Times
The time it takes for our body to respond to a stimulus, like a wobbling rock under our foot, is our reaction time. The slower our stabilizing reaction takes, the greater the potential for injury. This is an inherent ability but can be improved with practice. Proper rehabilitation after injury, mental alertness, proper warm up and appropriate clothing in cold temperatures are all considerations in improving a reaction interval.

Exercises to improve lower body reaction time are:

1. Standing on one foot partner ball toss
2. Sustained balancing on unpredictable surface like wobble boards and BOSU balls
3. Kicking a ball back and forth with a partner or against a wall; soccer drills

Lower Body Joint Mobility
Stiff knees, hips and ankles can decrease joint resilience, impair balance and impact agility. Ankle and hip mobility are commonly reduced in experienced runners due to the repetitive and generally linear motion of the sport.

Exercises to improve mobility are:

1. Wobble board circles
2. Deep squats
3. Myofascial techniques like rolling to help release tight deep hip rotators and calf muscles

Multidirectional Control
Being physically able to move well in all planes of motion at a moment’s notice can be a handy ability when trying to stay on your feet. Moving sideway to avoid a puddle or root, or hopping diagonally from rock to rock are common maneuvers on the trail.

Exercises to improve this control are:

1. Basket weave running drills
2. Sideways and diagonal hops off and on the BOSU ball, more advanced to do on one leg
3. Pylon drills with directional change

Running is more fun than rehab. Stay on your feet!

— By Louise Taylor

What does cross training mean?

Instead of only participating in a single sport where similar motor patterns and muscle fibres are used repetitively, cross training integrates other activities that complement the primary activity. Common activities for runners are swimming, cycling, weight training and yoga.

Why cross train?

With distance running the main movement is forwards. Using other activities that use muscles differently can help balance the body, maintain better joint mobility and keep the mental aspect fresh. Low impact activities tend to be good pairings. Improving running economy, cardiovascular fitness, strength, and mobility are key goals as well as changing the mental focus. Improving upper body strength and making soft tissues more durable are also good reasons to cross train.

Who should do it?

Every runner at some point in their training cycle.

Runners who don’t tolerate high mileage.

In the off-season for injury prevention, mental rejuvenation, and fun.

Pool running, anti-gravity treadmill, weight training, and bike can be great options when injured.

Primary Benefits of Common Cross Training Activities

Walking: Low Impact (LI), good for building endurance, walk/run programs increase volume with less stress on joints

Hiking: LI, upper body workout with poles, elevation gain and descend for strengthening

Swim: LI, upper body conditioning, core strength, lengthening and decompression effect of being in water, hydrostatic pressure helpful for inflammation, kickboard to help hip mobility and strength

Pool Run: LI, good for maintaining aerobic conditioning, belt on or off for less or more challenge, most like running without impact loading, good resistance training for trunk and arms

Bike: LI, 30-60 second power intervals for high-intensity bursts, mountain bike to work on power, road to work on muscular endurance

Triathlon: three sports in one, variable workload and muscle activation patterns, build cardiovascular endurance in all sports, interval workouts, LI options in swim and bike.

Obstacle Course Racing: multisport, includes run fitness with general fitness, upper body strength, fun and challenging

Weight Train: good to work on muscle imbalance and increase shock absorptive strength of lower body, strengthen upper body and core for durability and assist in power production, even one set 8-12 2-3 x/w heavier loads beneficial

Plyometrics: skipping, box jumps, single leg hops strengthen connective tissues, high-intensity workouts to build power

CrossFit: full body workouts, focus on strength and explosive power, good carry over to Obstacle Course Racing, rope climbing, box jumps, deadlift, burpees, variety with Work Outs of the Day and also flexibility with the range of motion workouts

Pilates: good for mobility, stability, body awareness, endurance, posture

Yoga: many types available, good focus of hip openers, calf and hamstring flexibility, trunk strength, meditative, breathing, hot yoga good for acclimatization for hot and humid races, restorative yoga for helping tight overworked muscles, Vinyasa flow classes for more cardio training

Nordic Ski: classic skiing is similar linear motion to running, more upper extremity use, winter break from trail running, skate ski requires higher intensity effort and lateral hip motion

Alpine Ski: power and strength conditioning

Alpine Ski Touring: good aerobic training without LI, work at elevation good for aerobic conditioning

Soccer: aerobic conditioning, agility, interval workout

Rowing: upper body and leg strength, interval train, breath control

Racquet Sports: high-intensity anaerobic workout

Elliptical: similar movement to run without impact

Martial Arts: mobility, strength, mental discipline

Find out what to expect during a Physiotherapy Running Assessment

For a physiotherapist, the primary objective in performing a running assessment is to address injury issues. Sometimes, despite appropriate rest and good treatment, running injuries can be quite persistent. It is our goal to determine causative factors, create an intervention strategy and formulate a return to run plan. Injury prevention can also be a key aspect of assessing a runner. As we are not running coaches, it is not our role to provide comprehensive training programs, but we can certainly address programming as part of injury management. 

It is important to know that there is not only one way to run. Our bodies are all different and movement patterns differ because of this individuality. There are some factors that have been researched and shown to impact joint loading forces, injury risk and running efficiency. We will examine these factors in relation to how you can run most effectively, efficiently and without pain.

When you come to Movement Sports Clinic for a running evaluation you can expect the following components: subjective history; physical evaluation; treadmill running video analysis and recommendations. These components are explained in more detail below. The process takes about an hour. You will need to bring runners and be prepared to run for a few minutes on a treadmill. Tighter fitting clothes are best for observation. Women should wear a tank or jog top. Men can wear a singlet type shirt or be shirtless.

Subjective History

When determining the cause of an injury, particularly persistent or recurrent ones, we need to know a lot about you. Many questions may not seem relevant but all add up to what is unique about your body, how it responds to training stress and what makes you vulnerable to injury. Here are some of the things we will ask about so you can help prepare your answers:

Youth Activity Levels: Sports you did as a youth will influence your body as an adult. Bone density, flexibility, agility and muscle fibre type can be altered through active childhood and adolescence.

Injury History: This is a big one as it speaks to the durability of your body and toughness of your connective tissue. Also, once injured, there is a higher likelihood of re-injury.

Stress and Sleep: High stress and poor quality sleep make us more likely to get injured and less likely to recover quickly.

Medical History: Cardiac issues, bone density, medications, history of cancer, surgeries and pregnancies can all influence how the body deals with training, impact stress and tissue healing.

Current Injury: What is going on with you now and when did it develop. What treatments have you had or what have you done to self-manage. What treatments, diagnostic imaging, and type of practitioners have you been working with. What has helped and what has not. Were there any big changes in training (frequency, duration and intensity) leading up to the injury.

Running History: Information such as age you started, what types of races you have done, personal best times, quality and frequency of training and whether you have a coach will all influence injury likelihood.

Running and Racing Goals: Are you competitive, do you just want to run for fun and fitness, are you tackling a new distance or an ultra?  All these factors need to be considered to formulate the best plan.

Shoes and Orthotics: Your shoe choices, experiences and use of orthotics can all provide more information about what has influenced you and your body as a runner.

Training: How often you run, weekly mileage, speed work sessions, days off and cross training are important factors. Whether you weight train, go to yoga or Pilates, or do triathlons is also important to know.

Goals: What is it you want to accomplish? Just get running again, run 10km, tackle a marathon or ultra? Goals and motivation are helpful in building a timeline, managing expectations and formulating a plan.Physical Assessment

Physical Assessment

This section includes a movement screen where you are asked to do some basic movements to help assess mobility, balance, strength and stability. We also examine

This section includes a movement screen where you are asked to do some basic movements to help assess mobility, balance, strength and stability. We also examine joint range of motion, muscle activation patterns and tissue extensibility. Muscle strength is also tested. Palpation for taut muscle bands and tender points can help us localize sensitized areas in the body. Remember that just because an area is sore doesn’t mean it is the cause of the injury. Stiff hips can cause knee pain, poor trunk control can make hips weak, a sore ankle can cause gluteal inhibition. We want to determine the source of injury, not just treat the pain.

Treadmill Video

Watching a runner from different angles in slow motion will complement what we find in the physical examination. How much bounding in the stride, numbers of foot falls per minute, arm swing pattern, leg cross over pattern, foot strike, body lean, trunk rotation, hip drop and breathing are all factors to consider. We will review the video with you to help point out relevant findings and improve your body awareness.


Recommendations

After considering all the information gathered, we are able to come up with recommendations for injury management, prevention or improved efficiency. Recommendations are usually one or more of the following: home exercises to help deal with mobility or stability issues, gym programs to build strength, running cadence changes, running drills, training modifications, treatment in the form of manual therapy or dry needling, diagnostic imaging, or referral to sports medicine physician.

Our goal is to get you back running and meeting your movement and performance goals.

Videos can be emailed to you on request.

We look forward to seeing you in the clinic soon!

Watch the video below for an inside look at a Physiotherapy Running Assessment!

Mini Band Work Out

Mini Bands

The mini band is an easy to use and portable tool for resistance and mobility training. For runners, activating muscles in different planes of motion can help resolve typical muscle imbalances. Working muscles and joints through full range of motion is also healthier than just relying on the mobility created from running alone.

Muscles that get dysfunctional or inhibited in runners are commonly found at the hip. Many stability muscles exist here and work to control hip motion throughout the stance phase of the stride. Although it may not look like it, there is rotation and side to side motion at the hip that needs to be coordinated, stable and strong.

The following exercises have been shown to activate and strengthen these hip muscle groups. Aim for doing one to three sets of 10-15 repetitions. There should be some feeling of fatigue. Focus on the muscles that should be working. Feeling the muscles work has been shown to be very helpful for improving recruitment. Bands come in different colours representing different resistances.

Keep in mind that just doing exercises may not necessarily recruit the right muscles. The body is pretty efficient at taking the easy way out. If a muscle is inhibited or weak, it may not automatically activate. Compensations are very common. If you are unsure about the effectiveness of these exercises, an assessment with one of our physiotherapists will help get you on track. We often have to address muscle tightness or compensatory patterns first, before a muscle will start activating again.

1. Clamshell

Purpose: lateral hip stability, hip range of motion
Muscles: gluteus medius and minimus
Common Compensating Muscles: hip flexors, quadriceps, hip adductors, foot investors, trunk
Key Points: Mini Band is above knees. Lay on your side with knees bent to 90 degrees and hips open 45 degrees from the waist. Shoulder, hip, and ankle should be in a line. Tip body forward slightly to prevent the body from rolling backward. Lift top knee up, keeping heels together and let toes come apart. Open hips as far as you can go without rotating backward. Hold 3-5 seconds, slowly lower the top leg. This can be quite difficult, so it is fine to start without the band and build it up.

2. Bridge

Purpose: Hip extension, hip range of motion
Muscles: Gluteus Maximus
Common Compensating Muscles: Hamstrings, back extensors, quadriceps
Key Points: Mini Band is above the knees. Hamstrings and quadriceps often want to take over for the gluteals, focus on the buttock muscles. Laying on your back, bend knees to 90 degrees or more. Place feet slightly wider than hips and push knees out into the band (this helps activate the gluteals). Lift hips up using the buttock muscles. Lift until the body is level from shoulder to knees. Hold 3-5 seconds and then lower. Bend knees in further or lift toes up to minimize overuse of quads or hamstrings.

3. Monster Walk

Purpose: Lateral hip stability
Muscles: Gluteus Medius and Minimus
Common Compensating Muscles: Hip flexors, quadriceps, hip adductors, foot invertors, trunk
Key Points: Mini band is at the ankles or around the feet. Stand with hands across the chest and feet hip width apart. Take small steps forward keeping hips wide. Keep trunk from twisting. Take 10-15 steps forward and then do the same walking backward. Rest between sets to let the muscle burn settle. This should be felt at the lateral hips and is generally felt more with the backward walk.

4. Standing Clock

Purpose: Balance; hip activation in multiple directions
Muscles: All hip muscles
Common Compensating Muscles: trunk, hip flexors
Key Points: Mini band around knees or ankles (harder). Stand tall on left leg and visualize that you are standing in the middle of a clock. Pull leg towards 2 o’clock, 4 o’clock and then 6 o’clock. Repeat 5-10 times and then do the mirror image on the other side. Repeat to feel fatigue in hips. Both standing and moving legs work in this exercise.

5. Squat

Purpose: hip, ankle and knee mobility; trunk stability, quadricep and buttock activation
Muscles: Many; good to focus on buttock
Key Points: Mini band above knees. If unable to lower into a 90-degree deep squat, try a heel lift or can use a ball behind the back and against the wall. Push knees out into band, feet hip width apart or wider. Lower hips to 90 degrees or lower. Use gluteals to straighten up again. Back should not bend more than 45 degrees forward as you squat.