New Year - New You? - For The Runners
I had a lady come to me who had quite a bad roll out/inversion sprain while running over Christmas.
This has prompted me to create a quick checklist for those who are going into 2018 with running goals, just coming back from injury.
This is the most common running injury I deal with in rehabilitation and it gets more than it doesn't in the end, in my experience.
This is a clinical way of looking at how to get back stronger than ever before.
Good Luck, hope it helps somebody!
- After the injury, the area is more susceptible and likely to re-injure, especially if the problem was to do with the anterior talofibular ligament in the ankle for example. Sprains are slower to heal as ligaments do not have a rich blood supply and usually occur due to repeated injury situations and imbalance.
- Once you leave the acute & sub acute stage of injury, you will need to consistently concentrate on strengthening the injured area, increasing/restoring proprioception, mobility and building strength. One of the main factors you need to remember is that although it will go from the acute to the remodeling phase, this is the point where you need to consistently continue with mobility and exercises, separate from running, in your own time. If you do not continue to restore but most importantly maintain balance and homeostasis, then the ankle is still susceptible to re-injury, and will go again at some point. A few runners, sadly, see running as the only exercise they need to do. Going back to posture I would want them to realise that it is a full body movement and all of their structure is being affected. It is imperative that we get into the habit of working the body globally and picking up on dysfunction before it exacerbates. You need to continue with this even after the ankle feels completely better and good to go.
- Going back into running on the ankle with faulty movement patterns will cause re-injury so the exercise should not be rushed or overlooked in a hurry to get back out hitting personal bests. If needed, you should be checked by a qualified movement analyst, soft tissue therapist, physiotherapist or performance coach to make sure that your home care exercises are correct and transferable to your unique, individual running technique and vice versa. The way you perform, the way you recover, is specific, to you. It's not a simple process. Make sure you are in a positive position to be running.
- Even if you keep to your home care and have your technique analysed, you will need to take into consideration that you need to come back slower, much slower. Even if the ankle feels fine running, you need to be aware that you have just come out of injury and pushing the area past it's current level of fitness and endurance will lead you back down a path of instability and pain. It would be advisable to start off walking or jogging on an inclined treadmill or stick to the softest, flattest ground possible. If you go out running again on uneven surfaces too soon or over tax yourself it will heavily risk re-injury. Pace yourself. Less is more.
- Your running shoes may be a factor to re-injury if they place your joint or the stability of your foot/knee in a compromised position. It would be advisable to get a pair of shoes that support the gait of your foot and the joint. If this is not possible you could look at getting insoles provided to help cushion the force/promote a higher level of stability and controlled motion. (Although I'm not a big fan at all in most cases) Really in that case, I feel unless it is a 100% nailed on vital necessity, that has implications, for no implementation, then instead of getting insoles, you need to work with somebody who can actually effectively "Rebuild" your "Arches."
- The over all posture of your body and your movement patterns away from exercise and rehabilitation will be a massive factor. I would advise you to be concentrating on areas you may have never looked at, such as the way you sit in a chair, how you stand and holds yourself in work. Do you overuse or under use any areas? No matter how much effort, strengthening, conditioning or home care is received, if we always break the progression with faulty movement patterns, then we are always going to be more susceptible to injury, globally. Become more body aware in general and be careful of things you may never have looked at before, like stopping wearing high heels or paying more attention to your positioning when stood making tea every night in the kitchen. It's the little things that add up. It's useful to know that marathon runners also use approx 79% slow twitch fibres during performance. This plays a big part in posture. The length and balance/strength of their muscles working together as agonists and antagonists need to continually be addressed. This means if you are running, postural and diaphragmatic mechanics are a necessity.
- Stress and fatigue levels could be a factor on tissue state and complacency in movement/performance. Even if you are in a positive state of wellbeing, the injury creates stress responses within the body. Relax and try to improve the quality of your sleep and correct breathing technique. Stress and anxiety for example are very serious areas that need to be focused on and addressed in people's lives. Our nervous system affects who we are, how we function, think, react, perform and live. This will affect sleep, regeneration and repair, weakening immune response, breathing, motivation and performance. If we can't rest, we can't relax, we can't recover. Physical exertion is a nervous system response, that requires the necessary and adequate responses back in return. Put simply, the changes in the body that occur during sympathetic arousal can take its toll and eventually exhaust, leading to many dysfunctions and health problems. You cannot expect to be able to train, develop, recover, prosper and benefit, if your mind isn't right. It's a neuromuscular connection.
- There will be more strength to the medial line than the lateral line of the ankle and the surrounding areas, so this needs to be addressed again with home care, soft tissue work and strengthening exercise. (if your injury is a roll out/inversion sprain too)
- Your hydration levels and nutrition will also be an integral factor of performance and repair. Stay hydrated and follow a balanced healthy diet - Don't be afraid of carbs!!!
- If walking on joints carrying excess weight is detrimental, then running is a no go.
What A Day To Be Alive
Disturb the paradigm.
Lee Cleaver - Soft Tissue Specialist - Movement Analyst - Elite Performance Coach