Solving The Injury-Prevention Puzzle
Tips to overcome chronic injury issues
Matt Fitzgerald—In March 2006 I finished a marathon for the first time in four years. The long hiatus was due to a maddening series of overuse injuries that included a recurring case of hip flexor tendonitis, calf strains and Achilles tendinosis, and topping them all, a three-year battle with patellofemoral pain syndrome (a.k.a. runner’s knee). During most of the four years between marathons I doubted I would ever again be able to train at a high level in this discipline, and indeed I “quit” running in despair at least half a dozen times.
What got me over the hump? It was not a single, all-encompassing cure. Instead, I simply tried everything and found that although most measures were dead ends, each of five distinct measures helped a little. When I finally got to the point where I was implementing all of them together (having discarded the various dead ends), I was once again able to run as much and as hard as I wanted to.
Since injuries affect most runners, I would like to take this opportunity to share with you the four pieces of the injury-beating puzzle I put together, in hopes that this information will enable you to avoid and overcome your own breakdowns.
First Piece: Targeted Stretching
Much has been made of recent research demonstrating that routine stretching does not prevent overuse injuries in endurance runners. While it may be true that a general stretching routine does not prevent injuries in general, any physical therapist worth her salt will tell you that certain specific injuries are caused in part by abnormal tightness in particular muscles and tendons, and that targeted stretches for these problem areas are effective in rehabilitating and preventing recurrence of these injuries.
A physical therapist whom I saw for hip flexor tendonitis discovered that my hip flexors were indeed abnormally tight and prescribed a pair of stretches to correct the problem, and they did in fact correct the problem. Every day I perform these two stretches plus just two additional stretches for a couple of other problem areas (my iliotibial bands and my calves and Achilles tendons), and that’s it. Stretching everything is a little like trying to true a wheel by loosening the spokes on both sides. Stretch only what’s too tight and you’ll see better results.
Second Piece: Corrective Strength Training
During my running comeback I spent an inordinate amount of time poring over abstracts of recent scientific studies on running injuries on MedLine. A few of these studies proved helpful to me. Among the most helpful studies I found was one showing that knee pain in runners is often linked to weakness in the hip abductors (the muscles that keep your pelvis from tilting laterally when you’re supported by only one leg) on the affected side. A simple test you can use to determine whether your hip abductors are weaker on one side than on the other is to perform a single leg squat with each leg. As you lower your butt toward the floor, eventually your thigh will rotate inward, swinging your hip outward, which is a sign that your hip abductors have become overwhelmed and need help from other muscles. If this compensatory action happens earlier on one side than on the other, that side is weaker and you are more prone to knee pain in the corresponding knee.
When I did this test I found that my right hip abductors were weaker than my left ones, and sure enough my right knee was the one that gave me pain for three years. So I started to even out the strength of my hip abductors by doing single leg squats, step-ups, and other such exercises three times a week, challenging my right side more than my left so that the gap steadily closed. It worked. Try it.
Third Piece: Gait Retraining
Conventional wisdom holds that the running stride you’re born with is the one you’re stuck with. But the conventional wisdom is wrong. Research has shown that particular running-related overuse injuries can be overcome by making key modifications to one’s stride. One of the leaders in this field of research is Irene Davis, Ph.D., P.T., and director of the Running Injury Clinic at the University of Delaware. I interviewed Davis a couple of times in connection with magazine articles and book chapters, and in the process I got some information that proved useful to me personally.
The most common injury-causing stride flaw is overstriding, or landing heel first with your foot well ahead of your body’s center of gravity, instead of landing flat-footed with your foot directly underneath your head. A simple way to correct this flaw is to tilt your entire body very slightly forward from the ankles (not the waist!) as you run, as though you’re constantly falling forward or running downhill. This little tweak all but forces your foot to land flatter and closer to your center of gravity. Correcting the overstriding flaw makes it easier to maintain proper stability in your hips and pelvis on impact and thereby reduces the likelihood of injuries including iliotibial band friction syndrome and runner’s knee.
Gait changes don’t come easily, but with patience and persistence you can make them successfully. Tilting forward felt unnatural to me at first, and I had to think about it with every step lest I revert back to familiar ways, but I kept at it and today my new and improved stride is as automatic as my old stride once was.
Fourth Piece: High-Tech Nutrition
Remarkably, doctors still do not know exactly what patellofemoral pain syndrome is. They used to think it was chondromalacia, or damage to the knee cartilage, but many runners with chondromalacia run pain-free, and many runners with knee pain don’t have chondromalacia. (I actually had cartilage-repair surgery on my bad knee and it did absolutely nothing to reduce pain or improve function.) The latest theory is that runner’s knee is caused by failure to fully repair between runs trauma suffered by the patella and the fat pad underneath it during runs, so that damage accumulates. Every runner experiences such trauma in every run, but some runners (especially those who overstride and have weak hip abductors) incur more than others, and the more you run, the less likely it is that the affected tissues will achieve complete homeostasis between runs.
By changing my shoes, strengthening my hip abductors, and retraining my gait, I succeeded in reducing the amount of damage my right knee experienced during any given run. Thus I was able to run more before the pain became debilitating. But I still wasn’t able to run enough. The final piece of the puzzle I needed was some means of repairing the damage more quickly between runs. I found this puzzle piece in a special supplement called hyperimmunized milk factor (HIMF). HIMF is a collection of anti-inflammatory proteins derived from cow’s milk. By reducing post-workout inflammation, it facilitates faster tissue repair in athletes in whom inflammation has become chronic. Within three weeks of beginning to take a daily HIMF supplement I noticed a marked reduction in knee pain and was able to run 20 miles for the first time in 4 years. A month later I ran my marathon. The puzzle was complete.
About The Author:
Matt Fitzgerald is the author of Iron War: Dave Scott, Mark Allen & The Greatest Race Ever Run (VeloPress 2011) and a Coach and Training Intelligence Specialist for PEAR Sports. Find out more at mattfizgerald.org.