Posted on

The one legged runner

When I started to work with Roddy knee pain was robbing him of the enjoyment he got from his morning run.

A 2:30 marathon runner, he really felt he wasn’t running freely.

The pain wasn’t crippling him but it was always there.

Some days it was barely noticeable but on others, it was like toothache nagging away at him.

But always worse after a longer run.

He couldn’t comfortably get into certain positions in his yoga classes.

Especially those that required a deep flexed knee position..there he got a sharp pain.

And even the child pose was really uncomfortable.

He was one of the classic “uninjured” injured athletes I see regularly. 

You can still train and play but you don’t feel like you used to.

The years haven’t been kind and accumulated niggles are having an impact.

Movement is a bit restricted.

Nothing seems to flow the way it used to.

In part due to tissue adaptations but mostly down to the behaviors you’ve learned to allow you to keep on trucking.

Great on the one hand…it allows you to keep training but, eventually, a real handbrake in terms of performance.

There often isn’t a need for big changes or to take a complete break.

It’s much more about finding the gaps in your training and filling them…

Checking how you move and work on any glaring restrictions…

And helping you solve the problems yourself.

Roddy, like many, had lost the ability to balance on one leg.

As soon as he got into that position he felt like he’d fall over.

Yet being comfortable here is essential to pain-free running.

It’s your mid-stance position.

If you are unable to get there you’ll load your leg very unevenly.

What you start to see are three compensations when you are running.

  • The knee flexes too much when your foot hits the ground
  • The knee extends too fast.
  • A lateral drop of the pelvis on the support leg

These aren’t just limited to runners…

Pretty much anyone with knee pain will demonstrate them.

The reason for this?

A lack of posterior knee stability.

You need the calf and hamstring working as a team to prevent the early knee extension.

This in turn places you in a position where the whole leg is working better.

You don’t get excessive knee flexion.

The glutes then have time to do their job and the lateral tilt disappears.

And like I had planned it that is where Roddy is now.

Not just running without any pain but running faster.

Yet his training isn’t geared towards running faster… he’s all about enjoying his running having left his competitive days behind him.

But here’s the kicker…

He’s running around 30 seconds per km faster with no extra effort.

How’s he doing this?

Because he’s got two legs again.

For the last few years, he’s pretty much been running on 1 leg.

His injured leg barely contributed to pushing him forward.

He says it’s most noticeable on hills where he feels a lot more powerful and doesn’t slow down anything like as much.

If your knee pain has been impacting your ability to train…

If sitting for long periods means throbbing pain around your knee…

Or your knees are starting to go snap, crackle, and pop when you stand up.

I’ve put together my top 3 knee pain exercises here for you to get started.

My Top 3 Knee Pain Exercises

https://www.dropbox.com/s/rty0xzwkpb9rbxb/Top%203%20Knee%20Pain%20Exercises.pdf?dl=0

Posted on

What happened when I didn’t take my own advice

The time I didn’t take my own advice

4 years ago I hurt my hip/back. I was mucking about with some pretty aggressive mobility drills and over did it.

At first I didn’t think it was too bad.

Within an hour I couldn’t sit down comfortably.

It got worse as the day went on. By the following day I was sitting down on my right bum cheek and slowly lowering my left onto the seat.

It took me 8 weeks to get back to lifting in the gym to return to normal.

But it took 8 months before I was running well again.

All because I didn’t follow my own advice.

There’s a big leap going from being in pain to pain free.

A big one from pain free to regaining strength and movement.

And a bigger one from regaining strength to restoring the resiliency needed for running.

It’s NOT about doing more work but doing the right work.

It’s not about a whole bunch of different exercises but about progressing the correct ones. I stopped my progressions too early in my rehab and paid the price.

I should have been back running pain free in 3 months once I started running again not 6.  On top of not completing the rehab I rushed the return to running part too.

It’s very embarrassing.

I was out for a nice easy 30 minute run and got to the halfway point when I noticed my hip. A couple of minutes later it wasn’t a “feeling” it was pain.

Shooting pain right through my left glute.

Fan-*********-tastic I thought to myself. I tried walking for a bit then running again but it was still sore. A little less so but sore none the less.

The problem was twofold.

  1. I hadn’t followed the rehab right through to the end
  2. I had returned to continuous running too soon.

This meant I had missed out on the very important last phase.  Creating resilience.

It’s here that we bulletproof ourselves. Where the activities are demanding and ensure that we know that once complete we are good to go.

The upside of this is a return to running program I created off the back of my own, painful, experience. You can get it here if you would like it

The moral of the story is…

Just because you are pain free does not mean that you are “good to go”. 9/10 this is definitely not the case.

It doesn’t make any difference if it is your hip like me or your knee. You need to go through the full process to ensure that you are as robust as can be.

Posted on

Osteoarthritis – The End Of The Road?

It is not unusual to see people who have been informed that they have changes in a joint related to osteoarthritis. Two cases I have come across recently were handled completely differently.

The first was informed that, yes there were signs of osteoarthritis but don’t worry you don’t need to stop running. The second was similarly told that there were signs of arthritis but that was about it. No other advice was given or suggestions made.

Not surprisingly their point of view about the pain they were suffering was a bit different Continue reading “Osteoarthritis – The End Of The Road?”

Posted on

Practising what you preach – graded exposure and progressive overload in rehab

I injured myself in mid November last year. Nothing serious just a mild grade 1 tear in vastus lateralis, one of your quads, when doing some heavy squats. I took it easy for a couple of weeks and gradually worked back into things. I then tore it again in the first week in January! To say I was not happy would be an understatement.

 

man squatting

What went wrong?

Continue reading “Practising what you preach – graded exposure and progressive overload in rehab”

Posted on

Ankle mobility, are you missing some?

Are you missing ankle mobility? Having sufficient range of movement in your ankle is important. If you want to run fast or jump high having good ankle range of movement in dorsiflexion is essential.

This is not just in the sporting environment but simply to walk well we need good ankle mobility. The movement that important is the ability to pull your toes towards you. A lack of dorsiflexion is linked with increased injury risk with achilles tendinopathy and patella tendinopathy having been shown to be impacted by a lack of ankle mobility in dorsiflexion. Continue reading “Ankle mobility, are you missing some?”

Posted on

Knee pain and running: where it is tells you what it is

What are the most common causes of knee pain in runners?

There are 3 conditions that are likely to cause knee pain in runners; patella tendinopathy, ITB syndrome and patellafemoral pain. How do you know which one you have?
Whilst they all cause knee pain where the pain is lets you know which one it is that is that you are suffering from.

 

 

 

  1. Illiotibial Band Syndrome

ITB syndrome is a complaint that runners will often talk about but describe a pain in a different area. The true site of pain from illiotibial band syndrome is on the outside of the knee. The pain will be felt at and above the condyle of the femur. One of the common held thoughts is that it is caused by your ITB being tight but the problem here is it is supposed to be. The ITB is part ligament part tendon so should be pretty stiff so that it can do it’s job properly.

The pain that is felt when people talk about having tight ITB’s is generally more to do with tight quads.  The pain coming from the illiotibial band syndrome isn’t from the ITB itslef but from tissue underlying it. Another name for it is ITB friction syndrome because of how it rubs the underlying tissue.

When dealing with ITB syndrome we want to first calm things down. Playing with running frequency, duration or intensity are all useful to find the combination that helps. Increasing your stride frequency can also help. Increasing your stride frequency to between 160-180 spm reduces both the time spent in the air and the force you hit the ground with. Both of these reduce the chances of being in the zone that causes the irritation that creates the pain in ITB

In this post I expand more on illiotibial band syndrome

2. Patellofemoral Pain

Patellafemoral pain or PFP is where the pain exists on the front of  the knee  and can be along the edges or under neath the knee cap, patella. the pain will often present itself when sitting for long periods or on ascending hills/stairs. PFP is a particularly frustrating problem as the there hasn’t been any one biomechanical or physiological factor that accounts for it. PFP is more of a general overload of the tissue surrounding the knee rather than a specific biomechanical fault. This overload can be from one sudden incident such as a fall or repeated micro-trauma for an extended period.

 

For runners the problem is often more one of repeated micro trauma. In this situation the tissue becomes reactive because it never really gets a chance to recover from the previous bout of exercise. This is where load management becomes important. When looking to increase mileage or other variables it is better to make small regular increases rather than larger ones. Perhaps starting at 10% per week and gradually reducing this to 5%, then even 2.5%. In doing this you are allowing time for the tissues to adapt and get stronger and more robust by not exceeding the ability to adapt.

3. Patellar Tendinopathy

Patellar tendinopathy differs from PFP in that the location, whilst still on the front of the knee, is much more specific in location.  Sufferers of PFP will feel  pain below the knee cap in the patellar tendon itself. This is good news as having an exact location makes it much easier to treat.

The great thing about tendinopathy injuries is that we can treat them following some basic guidelines.

  1. Reduce pain.
  2. Build Strength.
  3. Increase power
  4. Improve movement

This doesn’t mean that you have to stop running but rather alter the fequency, intensity or distance. It might be that you run less frequently and keep the distances the same or that more frequently but shorter runs each time. Each individual will react differently to the demands of exercise which is why various strategies often need to be tried before finding the one that suits you. To reduce the pain and fit in with the clients schedule it may be that it is a case of running every 48 hours but in a run/walk manner.  Sufficient training stimulus must be maintained and by performing the run walk we never exceed tissue tolerance.

When building strength the progression will go from static, isometric, work to slow movements to faster movements. The isometric movements also help in reducing the pain as well as building strength and flow into pure strength development. The heavy strength work allows for sufficient demand to force adaptation in the tendon. The power development work sets you up for transitioning into more running specific work that finishes off the rehab.

All 3 examples of knee pain should follow a graded approach to the rehab process. The final phase of the rehab process should incorporate drills that better reflect the demands of running. This is the case in all of the 3 of the problems above where the ultimate focus needs to be on returning you to running better than before.

 

 

 

Posted on

Lower limb injury assessment

The first step in any injury assessment is what previous injuries do you have. The biggest predictor of future injury lies in your injury history. As a result looking into your injury history will play an important roll in deciding on what needs to be done. If you have previously injured your ankle, knee or hip these are areas we need to investigate in the injury assessment. We do this becasue of the scale of the impact they have on the way you move. Two of the more important things that we are looking out for in the clinic are asymmetries and pain.When we are assessing movement we are looking to see both how good it is and does it cause pain. Continue reading “Lower limb injury assessment”

Posted on

How to manage runners knee

Runners’ Knee is a common complaint with runners. 10% of runner’s will experience some sort of knee pain in any given year. Given it’s so common what causes it and what can you do about it?

Generally most injuries runner pick up are of a “repetitive strain” nature and runner’s knee is no exception. Given the nature of running, this isn’t really that big a surprise. There aren’t really many demands in terms of changing direction or speed. It is very much about simply putting one foot in front of the other. Continue reading “How to manage runners knee”