In the last couple of years, running has gained widespread popularity as a form of physical exercise. More and more people run (either recreationally, professionally or semi-professionally), which proves to have a vastly positive effect from a health perspective. Running is a form of physical activity which provides various positive health benefits and is associated with reduced disability in later life (Chakravarty et al., 2008).
On top of that, it also acts as a form of relaxation and helps to manage and reduce daily stress. The most important positive effects are those affecting aerobic capacity and the cardiovascular system (Kusy and Zielinsky, 2014), which help to reduce the risk of coronary heart disease (Schroeder et al., 2007).
Besides the benefits running has on your health and the increase of the body’s metabolism, it also provides an additional competitive and motivational factor. This is evident in the number of participants competing at our biggest running event – the Ljubljana marathon. Only 673 runners participated in the inaugural event back in 1996, compared to the 24372 who took part in 2015. Besides the Ljubljana marathon, a number of smaller, increasingly popular running events started popping up.
With the spread of various running competitions, the line between recreational and competitive running has become increasingly blurred. There is absolutely nothing wrong with competitive running, however, it has to be understood that such type of activity (regardless of the runner’s physical preparation) requires a systematic training approach, which includes preventive exercise. Care must be taken to ensure a correct diet, a sufficient amount of sleep, a professionally planned and guided training regime as well as the incorporation of strength and flexibility exercises.
Both competitive and recreational running is a systematic sport, therefore, an appropriate approach to running should be taken. Mindless competitive running, which lacks systematic preventive training and running technique training, inevitably leads to injury.
Why do runners have to perform preventive strength training?
Why does it make sense for runners to perform strength training, even though running is a strictly aerobic endurance activity? Strength training is extremely important in achieving results. Increased muscle strength gained through a systematically planned training regime is inextricably linked to improved running form and consequently improved running economy and competitive results.
Sufficient muscle strength of the correct muscle groups is the main preventive factor in reducing the risk for running-related injuries. Unfortunately, nowadays, running is a physical activity related to a high incidence of overuse injuries, which annually affect 79% of runners (Goss and Gross, 2012). According to statistics, every year four out of five runners suffer a running-related injury. The main reasons for such injuries include a poorly planned training regime, overtraining, and negligence of strength and core stabilization training.
Improved running economy
Before we focus on injury prevention, let us briefly touch on the running economy. In order to thoroughly understand the subject of running economy, factors that improve (or worsen) running performance have to be introduced. The first factor affecting running performance is body composition. Individuals with a lower body mass are going to use less energy to maintain the same running intensity. The second vital competitive factor is the maximum oxygen uptake i.e. the maximum aerobic capacity. An increase in the maximum aerobic capacity is certainly the primary goal of endurance training. The final important factor affecting running performance is the technical running economy. Improved running technique allows the runners to use the right muscles in the correct intermuscular coordination, allowing them to consume less energy during the same running intensity.
“In regards to the previously mentioned factors, running economy seems to have the biggest effect on running performance.”
By definition, running economy refers to the amount of energy used to run at a certain pace (in the case of running we typically measure oxygen consumption) (Daniels, 2013). Runners, who utilize a more economical running technique consume less oxygen at the same pace compared to their peers, thus allowing them to achieve better running performance (Saunders et al., 2004).
How can a running economy be improved? Running economy can be improved with the correction of technical elements, such as stride length, foot positioning, and arm movement, and with the implementation of a suitable strength training regime. Muscle groups that have to be strengthened include the posterior thigh and hip flexor muscles as well as muscle groups of the lower leg. It is essential to track your progress and regularly correct potential bilateral or functional asymmetries (ipsi- and contralateral muscle imbalances).
Reducing the risk of running injuries
In addition to the positive effect of strength training on running economy and consequent running performance, an even more important benefit of strength training has to be pointed out. This factor is injury prevention. Strength training makes running safer and allows for a more positive experience within the running sphere.
As runners are endurance athletes exposed to high amounts of repeated physical strain, overuse injuries among them are very common. These injuries are not characterized by acute pain following the injury, but rather by an increase in pain during increased running activity. This pain gets progressively worse during running until it reaches a point at which it makes running and everyday activities no longer possible. Prevention of overuse injuries is mainly through proper running technique, which reduces the strain on the individual muscles, a correctly planned training system (with a gradual increase in running volume), and preventive muscle strength training. Strong muscles allow for optimal distribution of forces, which could otherwise (in the case of weak muscles) put a strain on the joints and tendons, leading to inflammation and pain.
Most common running injuries
Symptoms include annoying pain in the Achilles tendon above the heel which gets exacerbated during increased running volume and improves with rest. You should be aware that rest is not the solution, as the pain typically reappears when running activities are resumed. The first phase of the rehabilitation process includes strengthening the ankle extensor muscles (m. gastrocnemius and m. soleus), which should be achieved mainly through eccentric exercise.
Eccentric loading promotes mechanotransduction, which through intercellular signalling strengthens the collagen structure of the tendons and improves their resistance against external forces. Eccentric exercises should also be carried out due to the fact that a lot of eccentric muscle contraction (amortization and absorption of external forces) takes place during running.
Plantar fasciitis
Symptoms include pain in the heel area, accompanied by inflammation and long-term thickening of the plantar fascia. The injury occurs when repeated overload causes micro tears of the plantar fascia, leading to pain. The risk for plantar fasciitis is increased in individuals with weakness of the gluteus medius muscles and individuals with a low or high foot arch (weakness of the foot muscles) as well as due to incorrect choice of footwear and an overly quick increase in running volume. The rehabilitation is started by reducing inflammation and continued by eliminating the risk factors. A large part of the rehabilitation program is based on special strength training and appropriate physiotherapy techniques.
Iliotibial band syndrome
Sometimes also called runner’s knee – it is characterized by pain on the lateral side of the knee. Such pain indicates an inflammation of the iliotibial band (ITB), which is a fascial structure in the knee that acts as a passive stabilizer. The injury occurs due to weakness of the gluteal muscles and increased eversion of the ankle, which can be a consequence of the weakness of the foot structures. Thus, the active stabilization of the knee is reduced, leading to the increased strain of the ITB, which then begins to rub against the bursa of the knee, causing inflammation. The rehabilitation of the iliotibial band syndrome includes special muscle strengthening exercises, combined with therapeutic techniques, aimed at managing inflammation.
Patellofemoral pain syndrome:
The patellofemoral pain syndrome might be the most common pain syndrome of the knee and is characterized by indefinable pain in the anterior part of the knee. The cause of the patellofemoral pain syndrome is most often abnormal motion of the patella within the joint. The patella rubs against the surrounding soft tissues, causing inflammation. Patellar tracking disorder is usually caused by muscle head imbalances of the quadriceps (usually due to increased strength of the lateral head (vastus lateralis)), weakness of the gluteal muscles, and/or improper foot placement during running.
Muscle weakness greatly increases the risk for the majority of running related injuries. Modern rehabilitation approaches for the treatment of the previously mentioned injuries (PATELLOFEMORAL PAIN SYNDROME, ILIOTIBIAL TRACT SYNDROME, PLANTAR FASCIITIS and ACHILLES TENDINOPHATY) are based on the optimization of muscle strength, elimination of muscle imbalances and the improvement of joint mobility and running technique.
It is important to prevent and reduce the risk of recurring injury and the development of chronic conditions. During the first phases of the rehabilitation process, the application of suitable therapeutic techniques is key in order to reduce acute inflammation and relieve pain.
Why are runners often afraid of strength training?
“A common misconception present among runners is that strength training will cause them to gain a large amount of muscle mass, which is supposedly going to “weight them down”, negatively affecting their performance.”
This misconception is obviously not correct. The process of gaining muscle mass is not nearly as quick and simple, especially in endurance athletes. The gaining of muscle mass also depends on the predominant type of muscle fibers.
Individuals with predominantly fast-twitch (type II) muscle fibers gain muscle mass quicker than individuals with a higher percentage of slow-twitch (type I) muscle fibers. Slow-twitch muscle fibers are typically found in abundance in endurance athletes. These fibers do not possess the same hypertrophic potential as fast-twitch fibers. Thus, the likelihood for a runner to quickly gain a substantial amount of muscle mass that could disrupt his functional technique is extremely low.
How to perform strength training?
A systematical approach is of key significance. The strength training regime has to be adjusted to the individual runner, once running technique and has to be in line with the runner’s objectives and goals. The runner’s weak points and current physical preparation should also be taken into consideration. Based on all the mentioned factors, an appropriate training regime with suitable exercises and volume load should be developed – these are the most important strength training factors.
If we study the key strength training parameters, we can establish that the primary goal of strength training is to preserve muscle mass. A reduction in muscle mass (following an injury or due to the natural ageing process), is inevitably followed by a decrease in running economy and an increased risk of injury. A major portion of the exercises includes eccentric contractions (the muscle lengthens as the resistance becomes greater than the force the muscle is producing), as these positively affect the mechanical properties of the tendons. Part of the preventive training should also include plyometric exercises, which are based on eccentric and concentric contractions, allowing the tendons to store and utilize elastic energy during running, thus greatly increasing the running economy.
Particular emphasis in preventive programs should be put on core strengthening exercises. Poor core stability increases the likelihood of injury and at the same time reduces the running economy (Fredericson and Moore, 2005).
Some of the most common exercises
For the purpose of injury prevention, some of the most common injury prevention exercises are presented below. The incorporation of these exercises into your existing workout routine can help reduce the risk of injury. The exercises should serve only as an addition to the existing training or rehabilitation program, led by certified physiotherapy or kinesiology professionals.
Clamshell exercise
Single leg calf raises
Single leg bridges
Bulgarian split squat
Band resisted dorsiflexion of the foot
Preventive training has an extremely important role in the running training program. Such type of training improves running economy, which, according to scientific literature in regards to competitive performance, has been proven to be a more significant factor than the maximum oxygen uptake. In addition, preventive training also helps to make running safer.
At Medicofit we have prepared an individualized training program for runners as well as specific rehabilitation protocols for treating running related injuries. Annually, we treat more than 30 individual running related injuries.
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