Starting an exercise program can be intimidating... You're nervously excited about the changes in your life that are "sure to come" and want to put your best foot forward. Then you get to the gym and sign the waivers and see the line, “first consult with your doctor before beginning a training program” to assure that you are healthy enough to engage in the rigors of training. What does this mean? What will they look for? How can you decrease your likelihood of being a part of the well publicized “80%” (Active.com) of runners who experience an injury each year. A physician will likely check your heart and lungs to assure that you are healthy physiologically before clearing you to continue, but as a Doctor of Physical Therapy and as a running and triathlon coach, there are several other things that should be assessed to insure you have the greatest chance of a successful season and the lowest chance of developing or exacerbating injuries.
This is the number one thing that people think of in regards to training for a race and particularly in regards to injury prevention. In fact, the same Active.com article referenced above discusses how important the “10% Rule” is in decreasing your chance of sustaining an injury. The 10% Rule states that increases in overall load (mileage and intensity) should not be increased by more than 10% each week to allow your body to adapt to the demands placed on it by training. The initial questions that I ask clients is how much they are training currently? how long they have been training at that level? and how long they have to prepare for their upcoming event? If they haven’t been building base fitness or if the increase in load is more than desired, I know that they'll need to focus more on other areas of training to accommodate for the fact that they’re not able to build endurance over an appropriate duration.
The next aspect of overall health that needs to be assessed to prevent running injuries is strength. It’s pretty easy to find articles on the importance of glute, hamstring, quad, core, calf, and foot strength in running and increasing strength makes logical sense to decrease the risk of injuries. Does your body have the strength to manage the loads being placed on it throughout the course of a training program? In order to differentiate between strength and the next aspect of a proper health exam, picture strength as two stationary cars with their bumpers touching and then slowly accelerating and pushing into each. There will be damage done to both cars but the strength of the bumper is much better at handling slow load increases than sudden impact. Returning to running, clients who are assessed at the beginning of a training program often show moderate to good strength but still end up getting injured. Why is this? This leads to the next aspect of our conversation.
Power is a product of force/strength over a unit of time, measured most often in athletics as Watts. When you think of running, cycling, swimming, and jumping, cutting, and turning during other sports, each movement performed requires that it be done quickly. The speed at which your muscles respond to imposed loads matters in injury prevention more than just strength alone. Returning to the car analogy, those same bumpers with the same overall force will deform and be damaged more if the force happens immediately (think a collision) as opposed to being slowly distributed to the bumpers. Training athletes to increase their power is not just important to improve their performance but also to decrease the risk of injury.
Moving on from the more usually discussed items, the next topic that needs to be assessed to decrease risk of injury is balance. Balance is the ability to remain upright and steady and is broken up into static (not moving) and dynamic (moving) balance. Running is a dynamic activity that requires balance from the foot up the chain all the way to your thoracic spine, shoulders, neck and head. Most runners are familiar with pronation and supination and generally focus on using shoes and external stability to improve in these areas instead of improving their underlying balance deficits. Moving up to the knee and hip, if you see your knee collapse in when your foot hits the ground, the problem may be strength and power related, or may be result of poor balance. Many athletes understand how to improve their strength but do so in a way that doesn’t improve balance. This can lead to diminished improvements in running performance and continued risk for developing injuries.
The final area that needs to be assessed to insure that you’re ready for your upcoming season is mobility. Our big toe, ankle, knee, hip, low back, and thoracic spine all need to have the appropriate mobility independently as well as relationally to allow us to be injury free and also effecient in running. Similarly in cycling and swimming, we need to have appropriate mobility throughout our body to allow forces to be more evenly distributed and shared instead of leading to the development of overuse injuries.
Training for a race can be a difficult task and making sure that you’re adequately prepared, knowing which areas you struggle will help you be able to focus on the areas that you need to develop. Set yourself up for success by seeking help before you become a part of the injured athlete statistic.
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