Tuesday, February 10, 2015

Injury prevention work- the 2015 edition - part 1.

As the astute reader may have noticed, (I'll confess, I had to Google "astute"), I frequently reference "injury prevention work" in my weekly log?  So....what exactly is that?

(several people have asked me just that question - hence this series of posts).

Well...it's a lot of things.  As an injury prone runner, I probably spend nearly as much time on injury prevention work as I do running.  "Injury prevention - it's a lifestyle choice."  Or something like that. 

It probably works best to break this discussion into categories - mainly pre-run prep, daily maintenance, and regular strengthening (done 1-3 times a week).  In describing them, I'll hit one per post, starting with today's post on pre-run prep.

Pre-run Prep:

These are the exercises I do before every run, to get me ready to run.  I'm a bit hesitant to publish them, not because they're secret or proprietary, but since they are what I need in order to be ready to run.  They are focused on my weaknesses and imbalances.  I strongly doubt any other runner has exactly my imbalances; we all have our own little issues.  So take this as an example of what one person does, rather than a specific model to emulate.

My specific issues are: hip flexors that get very tight and pull stuff out of alignment; glutes that like to turn off (especially right); a pelvis that likes to get slightly twisted; and a right ankle that likes to "lock up."  If I run with these issues acting up, at best it's a lousy run where I feel like I'm driving a car with a flat tire; at worst I get injured.  So they need to get fixed.  Again, and again, and again.  These exercises are not optional - if I oversleep, I just run less so I can fit them in before.

Hip Flexors: My prep starts with stretching out my psoas and quads - ideally stretching each for a minute (so total of 4 minutes and change here).   For the quads, I use a shortened version of the "couch stretch" (again, just a minute).  For the psoas, I use the "kneeling hip flexor stretch" shown here.  (note - sometimes if my knees are a bit tender I do a standing quad stretch in lieu of the couch stretch - not bearing weight on my knee makes the stretch a bit gentler on the tendons in that area).

Ankle: After that, a pre-flight check.  As I noted, my right ankle likes to lock up - lax ligaments (much tightened by prp/prolo, but still not perfect) allow bones to shift slightly, especially my tibia and fibula.  The shifted bone/s then block my ankle joint, somewhat akin to a rock getting stuck in a hinge.  This has the expected result - my ankle can't dorsiflex the way it should, which throws my whole gait off.  Imagine running with a pebble stuck in the front of your ankle - that's almost exactly what it feels like.

So, pre-run, I need to make sure the ankle's working.  I start by performing a lunge with my right foot forward.  Is my ankle moving freely forward in a full range of motion, or is it blocked, causing my shin to collapse to one side or the other if I try to force it?  If the latter, then I need to fix it, which I do via this exercise and a looped yoga strap I keep tied to a piece of heavy furniture.  Essentially I step into the loop of the strap so that the strap lies against the front of my ankle, and then gently flex my ankle by squatting/lunging.  I repeat the "talo-crural" mobilization and the test lunges until the ankle's behaving itself.  Credit to Sport and Spinal PT of DC and Robert Gillanders for teaching me this one.

(occasionally my ankle also locks up mid run - if that happens I can also do a bastardized version of the mobilization by using my hand to replicate the band across the front of the ankle.)

Hip/pelvis alignment:  My next step is to check my hips and make sure everything's straight there.  I do this by performing this "running man" exercise that I learned at Capitol Rehab in Arlington.  If everything's good (about half the time), then I perform the exercise equally well on both sides.  If I'm out of whack, then I balance very well on my left, and struggle on my right.

I fix this by realigning - I lay on my back, with my hip and knees both flexed at 90 degrees, and run a stick in front of my left quad and behind my right hamstring, holding each of the stick ends with my hands.  Then I simultaneously pull my left quad in towards me while contracting the right glute to drive the right leg out, with each leg pressing against the stick.   Hold for 3-5 seconds, and then repeat a few times.  Follow this up by letting my feet fall to the floor as if I was going to do a bridge, and sticking a yoga block between my knees.  Squeeze the block hard for a few reps of 3-5 seconds - at some point I usually feel a satisfying "pop".

Then get up and repeat the running man exercise.  If I'm balanced, then yay.  If not, back to the floor for another round.

Glutes:  Finally, after hips and ankle are good, I activate my glutes.  I do this by returning to the floor in prep for bridge pose - back and feet on floor, knees flexed.  I then pull one knee into my chest, which forces me to hold my back in a neutral position so that I have to use my glute (otherwise I end up using my back).  Then I perform a one legged bridge, making sure that I feel the glute firing, and repeating until the glute is working without me needing to think too hard about it.

After all this, I'm ready to run.  Of course, if I have a long car ride between now and my run, I may have to repeat some of this once I'm on site, but it's much abbreviated.


How much time does it all take?  Well, I generally allow about 25 minutes in the morning for it.  I generally don't need all that - it really depends on how I am.  If I'm training really heavily, or (ironically) have slept really soundly, then it takes more time to get going - everything's just so stiff.  The good thing about occasional insomnia is that when I do get out of bed, it doesn't take too much prep to get stuff working.

Murphy's law does dictate that if I don't allow for the full 25 minutes in my morning pre-run, then I will need that time.  And that means that I end up late for (or skipping) the run.  I hate missing runs, but it's better to skip a run than to run with my body out of whack and get injured.  One unplanned day off is better than several.

Coming next week: my daily routine.


  1. Super interesting. Since my only injuries have been my dumb hips (and related issues), I've done mostly pre-run exercises to stretch and awaken the hips, and to activate the glutes. The hip alignment sounds familiar to me; I've done it, too, and sometimes "pop" the pubic symphysis. It can move out of alignment (but rarely, luckily).

  2. Huh, so you stretch before running? I stretch in the afternoon separate from running, since I've always heard that static stretches pre-running are bad, but it's great to see that you have had good results.