Running to Avoid Injury Advice

Penthesilea514

Hi! I have been training to run for the past year now starting out with C25k last April and ran a 5k in July with no issues. One week later, while running downhill, I got a sharp pain in my left knee. I stopped, walked home and when it didn't get better with some rest, I went to the doctor who told me I had pre-patellarfemoral sydrome (runner's knee). I did some PT exercises for a month or so and eased back into running slowly. My knee still gets sore after a run but with NSAIDs and a rest day between runs, it hasn't been a major problem and doesn't hurt during my runs. After my last run (Sat), I noticed that my right Achilles tendon was sore (not enough to make me limp but noticeable and has gotten better). I am NSAID/elevation/resting. I do yoga once a week and stretch with resistance bands after each run and weight train once a week with a personal trainer. I got my gait analyzed last year (pre-injury) at a local running shop and use Saucony Omni's for running and nice socks from there too (can't remember off the top of my head). The total mileage on those shoes is pretty low because I don't run huge numbers and had an injury last year (probably like 120 miles, absolute tops).

I have been adding a half a mile a week to my totals in the last 6-7 weeks after my injury (9 miles a week now, 2x 2 mile runs during the week (M/W) and 5 miles on Sat with at least 5-10 min walk warm up and cool down each time) to train for a 10k in a few weeks. I go slowly (really only looking for endurance/completion at this point, not speed). I am worried I am doing something wrong. I feel like I am not "really" injured (even my previous diagnosis was "pre") but I REALLY don't want these things to progress to the point of injury. I am heavy (230 lbs, 5'5) but I found I really really like running and races and has been a big motivation for me. I try to eat more protein but I am not the best at hitting my daily MFP goal (average 50-60g/day) and drink a lot of water (64 oz/day+).

Basically (after all of that) I am just looking for general training guidelines/advice Am I adding too much mileage? Could it be gait related? Do I need to beef up some strength training? Do I need a more dynamic warmup/cooldown routine? Or is this just normal running stuff that I need to manage and I am being paranoid? I want to do a half marathon before I turn 30 in November but I want to do it safely. I appreciate any tips- thanks!

CollieFit

So far you haven't mentioned anything about shoes and gait.

Did you have gait analysis before you bought your current shoes?
Do you pronate? Do you supinate? Are you flat footed? Do you have fixed or flexible arches?
Do you heel strike?

TavistockToad

Sounds like you need to rest till it stops hurting. Maybe see a PT to get some strengthening exercises?

TavistockToad

CollieFit wrote: »

So far you haven't mentioned anything about shoes and gait.

Did you have gait analysis before you bought your current shoes?
Do you pronate? Do you supinate? Are you flat footed? Do you have fixed or flexible arches?
Do you heel strike?

OP did mention gait analysis

CollieFit

I meant she hadn't mentioned any particulars about her gait, e.g. "I'm a flat-footed heel striker with rear foot pronation" etc.

CollieFit

Patellofemoral syndrome is associated with a whole host of stride flaws, often either higher up (hip weaknesses) or down below (ankle problems).

http://running.competitor.com/2014/03/injury-prevention/are-you-committing-these-form-flaws_292

http://www.running-physio.com/pfps-gait/

briscogun

I had the Runner's Knee issue years back, but it stopped with: 1) Rest. I stopped running until it got better, and 2) I changed my stride. I was over-striding and taking too large of steps, which was causing me to strike the ground too hard. When I started taking smaller, quicker steps, it never came back.

Good luck!

Penthesilea514

CollieFit wrote: »

So far you haven't mentioned anything about shoes and gait.

Did you have gait analysis before you bought your current shoes?
Do you pronate? Do you supinate? Are you flat footed? Do you have fixed or flexible arches?
Do you heel strike?

I got a gait analysis pre-injury and was told I do not pronate or supinate and I am not flat footed. I don't know about the arch specifically, sorry- but I have never had an arch issues in the past.

I midstrike with my foot, although I have noticed if I get tired I can heel strike occasionally. I do have a short gait, I have been told to lengthen it by someone offhand but that was not very specific of helpful to me.

Thanks for the feedback- I will read over those links! Very helpful, thank you

Penthesilea514

TavistockToad wrote: »

Sounds like you need to rest till it stops hurting. Maybe see a PT to get some strengthening exercises?

Thanks I will likely do that (again).

Penthesilea514

brian_gunther wrote: »

I had the Runner's Knee issue years back, but it stopped with: 1) Rest. I stopped running until it got better, and 2) I changed my stride. I was over-striding and taking too large of steps, which was causing me to strike the ground too hard. When I started taking smaller, quicker steps, it never came back.

Good luck!

Thanks for feedback! I am starting to think my stride (and maybe, strength) is not good. I run by myself and am not part of a running club, so other than someone saying I need to lengthen my stride once (stranger at gym), no one else has commented on my form. And good luck to you too!

CollieFit

Your feet sound okay from your description.

Read the bit in the links that refers to hip weakness and inward rotation of the femur (i.e. running a bit knock kneed for a better way of explaining it), that can also cause runners knee. Maybe a trip to a sports physio?

TavistockToad

CollieFit wrote: »

Your feet sound okay from your description.

Read the bit in the links that refers to hip weakness and inward rotation of the femur (i.e. running a bit knock kneed for a better way of explaining it), that can also cause runners knee. Maybe a trip to a sports physio?

I have that! Thankfully no runners knee though!

Penthesilea514

CollieFit wrote: »

Your feet sound okay from your description.

Read the bit in the links that refers to hip weakness and inward rotation of the femur (i.e. running a bit knock kneed for a better way of explaining it), that can also cause runners knee. Maybe a trip to a sports physio?

Hmm, sports physio. I will check that out- never thought of going beyond physical therapy.

Hip/femur: Maybe I can get my husband to video me running so I can see myself a bit better and look for that. It sounds like I need to make sure I engage specific muscle groups while striking (from the articles) and perhaps increase my step rate but I will look into that more.

Great advice, thanks.

robininfl

You go slowly? I like to use the small, quick steps sort of jogging, and that has kept me pretty safe, and worked for others I know. Mid-foot strike, lift and push.

Like this:
newtonrunning.com/pages/run-better/

For "sprinting" (and I use that word in the most general sense possible) I do reach out farther with legs but still stay on top of it, when the front foot hits my body is there over it. That actually feels like good form but it's not sustainable for me, it doesn't work at the lower speed.

Running backwards helps me to find the glutes and hamstrings for running forwards, too. So I do that as part of the warmup. Maybe hocus pocus but it helps.

Penthesilea514

robininfl wrote: »

You go slowly? I like to use the small, quick steps sort of jogging, and that has kept me pretty safe, and worked for others I know. Mid-foot strike, lift and push.

Like this:
newtonrunning.com/pages/run-better/

For "sprinting" (and I use that word in the most general sense possible) I do reach out farther with legs but still stay on top of it, when the front foot hits my body is there over it. That actually feels like good form but it's not sustainable for me, it doesn't work at the lower speed.

Running backwards helps me to find the glutes and hamstrings for running forwards, too. So I do that as part of the warmup. Maybe hocus pocus but it helps.

I do have to remind myself not to look down while running (a bad habit from starting running on a treadmill and starting at the time), but I have gotten better with my head and arm position recently- mainly because it feels so much better not to get so tense while running.

My cadence is not 180 steps/min it is slower (more like 140-150 steps/min). Another article suggested a metronome to help, I may try using music that has that cadence (I think I saw Spotify has some playlists for different speeds). And changing up my warm up may help some too.

Thanks so much for the information!

robininfl

Penthesilea514 wrote: »

robininfl wrote: »

You go slowly? I like to use the small, quick steps sort of jogging, and that has kept me pretty safe, and worked for others I know. Mid-foot strike, lift and push.

Like this:
newtonrunning.com/pages/run-better/

For "sprinting" (and I use that word in the most general sense possible) I do reach out farther with legs but still stay on top of it, when the front foot hits my body is there over it. That actually feels like good form but it's not sustainable for me, it doesn't work at the lower speed.

Running backwards helps me to find the glutes and hamstrings for running forwards, too. So I do that as part of the warmup. Maybe hocus pocus but it helps.

I do have to remind myself not to look down while running (a bad habit from starting running on a treadmill and starting at the time), but I have gotten better with my head and arm position recently- mainly because it feels so much better not to get so tense while running.

My cadence is not 180 steps/min it is slower (more like 140-150 steps/min). Another article suggested a metronome to help, I may try using music that has that cadence (I think I saw Spotify has some playlists for different speeds). And changing up my warm up may help some too.

Thanks so much for the information!

180 per minute isn't magic, but quicker shorter steps are easier on your body than the reaching-out-and heel striking. The high cadence playlist on spotify is pretty good.

And of course the cool-down and stretching but think you already have that under control. I got the book "Ready to Run" from Amazon, he talks a lot about how much mobility is necessary for a healthy run. I had never considered that before, because running just seems like a natural human thing that doesn't need a large range of motion. I don't have to stretch to walk, why would I have to stretch to run? But apparently I was wrong about that. The joints don't work right if things are too tight or unbalanced.

blues4miles

Have you tried different shoes since you first got the injury?

I went Road Runner and got fitted back in the day. I struggled with injuries. Then I went to a small, local running shoe store and got fitted again. The shoes I got there were a lot better. Road Runner and other big box stores have a tendency to try to 'correct' your gait, but can in fact make it worse. Better to try on a few pairs with an expert and see what feels best. Also, if you are shoes are old even if they are low mileage it might not be a bad idea to get new ones. I have found as an obese person who runs I go through mine quicker than other folks.

I wouldn't mess with your gait too much. Small, quick steps are good but trying to be a midfoot striker when you are naturally a heel striker etc. could cause more injury.

Maybe try some more cross training if you can? Weight training is great, are you doing full body exercises like squatting and dead lifts? It could be strengthening your muscles will help prevent injury, more times a week might help. Also cycling or swimming might have positive effects, as might just getting some more walking in.

MeanderingMammal

CollieFit wrote: »

I meant she hadn't mentioned any particulars about her gait, e.g. "I'm a flat-footed heel striker with rear foot pronation" etc.

Grid Omni are a strong motion control shoe with a 12mm heel-toe drop. That's generally going to be for a severe overpronator.

Penthesilea514 wrote: »

I got a gait analysis pre-injury and was told I do not pronate or supinate and I am not flat footed. I don't know about the arch specifically, sorry- but I have never had an arch issues in the past.

I would go somewhere else and get another shoe fitting, the shoes you'r running in sound inappropriate for your needs.

It sounds like you need some advice from a physio. Stretching with bands may suggest that you have a general flexibility issue, you shouldn't need to supplement with bands for post run recovery stretches. It also sounds like your core strength could be an issue, although Yoga should help that. Astanga is probably best for improving core strength.

Improving your core will also help with the head dipping forward point you mention. Lean from the hips, and look forward. If you look down you put yourself into a hunched position that places more strain on your lower back and hips.

kristinegift

Agreeing with @blues4miles and @MeanderingMammal here. Their advice sounds solid to me.

Go to a small running shop and have your gait tested again. The Omnis sound wrong for you. I wore Omnis for years back in the day to "correct" a pronation issue, but when I switched to a neutral shoe almost all of my knee problems went away. I keep on top of it with core/strength work (a lot of planks and glute bridges, lunges and squats) to keep my muscles more or less in balance. Some stores will try to correct your form with shoes, and others will give you shoes to accomodate it; go with the latter, it's best to keep to whatever comes naturally, rather than strive toward "perfect" form unless you're looking to go elite some day

pomegranatecloud

You probably still have muscle imbalance issues. Have you stopped the PT exercises? Make another appointment with your orthopedist if it's not improving. Here are stretches and exercises my doctor gave me to do for patellar-femoral syndrome: media.wix.com/ugd/08484c_47be39d553fe493aa39d798d7443d5c0.pdf

I've also found the MYRTL routine helpful. It's quick, and I do it most of the exercises after my runs:
PDF: njsportsmed.com/files/myrtl_routine.pdf
Video: https://youtube.com/watch?v=2GLrKr54yA0

Penthesilea514

Thank you all! I went to a small local running shop for the first shoes- I was told the Omnis are good for stability- but after all the discussion yesterday, I did do more research and saw that they are for pronation too. I was going to get new shoes in the next month or so, so that works out well. I will try and do more research before I go in so I can talk more to the sales person. They were very nice and (unfortunately) the only running shop for several hours, so I will go back to them unless another opportunity presents itself.

I have been working on my strength a little with some exercises from the PT but I think I need to beef that up more too from what I am hearing.

pomegranatecloud wrote: »

You probably still have muscle imbalance issues. Have you stopped the PT exercises? Make another appointment with your orthopedist if it's not improving. Here are stretches and exercises my doctor gave me to do for patellar-femoral syndrome: media.wix.com/ugd/08484c_47be39d553fe493aa39d798d7443d5c0.pdf

I've also found the MYRTL routine helpful. It's quick, and I do it most of the exercises after my runs:
PDF: njsportsmed.com/files/myrtl_routine.pdf
Video: https://youtube.com/watch?v=2GLrKr54yA0

Thanks for the great resources- I will try to focus on these more than I have been.

kristinegift wrote: »

Agreeing with @blues4miles and @MeanderingMammal here. Their advice sounds solid to me.

Go to a small running shop and have your gait tested again. The Omnis sound wrong for you. I wore Omnis for years back in the day to "correct" a pronation issue, but when I switched to a neutral shoe almost all of my knee problems went away. I keep on top of it with core/strength work (a lot of planks and glute bridges, lunges and squats) to keep my muscles more or less in balance. Some stores will try to correct your form with shoes, and others will give you shoes to accomodate it; go with the latter, it's best to keep to whatever comes naturally, rather than strive toward "perfect" form unless you're looking to go elite some day

Haha no elite here, just having fun!

MeanderingMammal

Penthesilea514 wrote: »

Thank you all! I went to a small local running shop for the first shoes- I was told the Omnis are good for stability- but after all the discussion yesterday, I did do more research and saw that they are for pronation too.

Stability shoes are for overpronation, as in they stabilise the foot and help avoid rotational stresses. Because of the high heel-toe differential, and the amount of cushion, stack height, they're not really the type of shoe to enourage you to take a midfoot or forefoot strike.

All that said there is no one true way(tm) when it comes to footstrike, and when someone starts getting religious about it it's time to listen to someone else. The main thing to think about is to land your foot below, or just in front of, your centre of mass. That avoids excessive loading on the lower leg, and it reduces the amount of excess energy loss from overstriding.

So there is nothing wrong with a 12mm differential, lots of shoes have it. My road running shoes have either an 8mm (Saucony) or a 6mm (Inov-8) drop, and my trail shoes have a 4mm (Saucony) or 3mm (Inov-8), as the lower drop gives me much better ground feel and control when I'm trail running. The transition into the lower drops takes time though and can have quite an effect on your muscular system as you transition. It'll cause some soreness as you adapt.