388 | Best Exercises to Prevent Running Injury and Pain

[00:00:05] Welcome to the Optimal Body Podcast. I'm Dr. Jen.

[00:00:08] And I'm Dr. Dom. And we are doctors of physical therapy, bringing you the body tips and physical therapy pearls of wisdom to help you begin to understand your body, relieve your pains and restrictions, and answer your questions.

[00:00:19] Along with expert guests, our goal of the Optimal Body Podcast is really to help you discover what optimal means within your own body. Let's dive in.

[00:00:29] Running injuries. This is such a hot topic, and especially as we're getting into cooler and cooler seasons that are changing, maybe people are running on different surfaces.

[00:00:38] It's really crucial to have this conversation. Now, of course, one of the questions that I get asked a lot is, can I wear Vivo Barefoot shoes for running?

[00:00:47] And my answer is, it depends. Now, if you have been a barefoot wearer or you've been in Vivo Barefoot shoes using code OPTIMAL20 to get 20% off of your order,

[00:00:58] and your feet are already accustomed and used to that barefoot style, they've already built the strength, they're already, you've been walking and working out and feeling good in them, yes, you can start running.

[00:01:09] And they actually have some incredible trail shoes that I highly recommend for running that have a bit more support just in terms of the traction for the ground, not in terms of support for your arch, but support for your general environment outdoors or even on a track inside.

[00:01:27] That's going to feel a little bit better on the body than just doing maybe a lifting in the primus light.

[00:01:33] So I highly recommend a lot of their trail running shoes, and they have some incredible trail running shoes.

[00:01:39] So even if you're not ready to run yet, but you're hiking and you're hiking in different environments, especially with the weather changing, they have some crazy cool boots.

[00:01:47] So if you have not checked out Vivo Barefoot, we're going to have that link down in the show notes, but check them out.

[00:01:53] Use code OPTIMAL20, you get 20% off any Vivo Barefoot shoes that are not already discounted.

[00:01:59] That's a huge discount.

[00:02:01] So do not pass this up.

[00:02:03] And then we'll go into more ways that you can prevent running.

[00:02:07] But it's really cool to see Dom has had a history of high arches and, you know, having a lot of issues with his feet.

[00:02:15] And now he runs every day in barefoot shoes.

[00:02:19] So it's really cool.

[00:02:20] And he's doing sprints and he's doing longer runs.

[00:02:22] And it's just, it's cool to see how his body has adapted and he's not getting pain.

[00:02:27] And I'm just, as a spouse, just so proud to see it.

[00:02:32] And it's possible.

[00:02:33] So again, get yourself in Vivo Barefoot shoes.

[00:02:35] Start strengthening your feet now prior to even running in them.

[00:02:38] And eventually you can be like Dom and start running in them.

[00:02:41] So today we're talking about what kind of program or exercises can you be doing to help prevent running related injuries?

[00:02:49] And I think running has become kind of a new fad is what I hear from a lot of people.

[00:02:54] A lot of people are doing it.

[00:02:56] A lot of people are picking up running.

[00:02:57] So we want to talk about approaches that you can use to better help to prevent injury.

[00:03:04] I've been running.

[00:03:05] You have been running.

[00:03:06] I've probably been running more recently than I have ever in my life as far as just like distance running.

[00:03:13] And this is definitely an interesting topic because you hear about running as, you know, everyone talks about, oh, people get injured so much in CrossFit.

[00:03:20] People get injured so much doing different activities.

[00:03:23] Running is one of the highest injury incident rates in recreational activity.

[00:03:28] Because it's just repetitive movement.

[00:03:30] Because it's a repetitive movement.

[00:03:31] People get into running and they're like, oh, great.

[00:03:33] One mile felt great.

[00:03:34] Let's go for two miles.

[00:03:36] Let's go for three miles.

[00:03:37] And they ramp up too quickly.

[00:03:38] Because although it doesn't seem like a huge jump going from one to two miles, that's double.

[00:03:43] And if you're doubling the amount you're running or even adding, you know, going from two to three miles, like hitting overuse can come really quickly for people.

[00:03:52] And I'm notorious for this as well.

[00:03:54] You know, I'll run a couple miles two or three times a week.

[00:03:58] You know, that's probably my average.

[00:03:59] But I don't do anything else.

[00:04:01] I don't do an effective warmup.

[00:04:03] It's mainly me like get the dog on the leash and start jogging.

[00:04:07] And so I was interested in seeing what this study had to say as well.

[00:04:12] Exactly.

[00:04:12] So we're going to talk about the difference between a top-down approach and a bottom-up approach and what that really means.

[00:04:18] So top-down, we're kind of looking at really focusing more on the hip and core aspect of strength and stability here versus, you know, and how that compares to preventing injury in running compared to just focusing on the foot and ankle complex.

[00:04:36] And then they compared both of those groups to just static stretching.

[00:04:40] Yeah.

[00:04:40] So there are three groups.

[00:04:41] And we're specifically going off of this recent study that was done called Hip and Core Exercise Program Prevents Running-Related Overuse Injuries in Adult Novice Recreational Runners, a three-arm randomized control trial.

[00:04:56] The three arms Jen just outlined.

[00:04:58] And I think it's important to understand we're focusing on adult novice recreational runners.

[00:05:04] These are probably people running, you know, five to eight, five to 10 miles a week.

[00:05:10] Again, novice.

[00:05:11] They're just starting or they have not been running for a long time.

[00:05:13] So we're not looking at expert runners.

[00:05:15] We're not looking at people who are training for the Olympics.

[00:05:17] And I always am interested.

[00:05:19] They use the control group as a static stretching group.

[00:05:22] And often the control group is supposed to mimic like what people might just do in general.

[00:05:28] And I think that static stretching is become like getting out of favor as something that you should do immediately before, you know, going to exercise.

[00:05:37] Right.

[00:05:37] You know, it's starting to become more known that like, no, I shouldn't just sit and do a couple static stretches before going and running.

[00:05:43] But again, if we're working with novice recreational runners.

[00:05:45] They might not know.

[00:05:46] People just might not know better.

[00:05:47] Yeah.

[00:05:48] I got to do something like.

[00:05:49] Exactly.

[00:05:50] They might just be throwing their leg up on a wall and doing a hamstring stretch real quick or doing a calf stretch.

[00:05:56] Put the arms across the body quick.

[00:05:59] And go for a run.

[00:05:59] And run.

[00:06:00] So, yeah, it could be a fairly accurate depiction of what the average person might do compared to these other two groups.

[00:06:07] Yeah.

[00:06:08] What's unfortunate is that we don't know exactly what they did for their programming.

[00:06:12] They didn't outline exactly what the program was.

[00:06:16] We even found the full article and it doesn't exactly outline, which I think is an issue with research in general.

[00:06:22] Researchers, for some reason, don't think it's important to tell us the exact exercises or the protocol.

[00:06:28] And you can reach out to them and I'm sure find out.

[00:06:30] But it didn't outline it.

[00:06:31] So, I'm like, how can we accurately say what we think?

[00:06:34] However, I think that also allows you to understand that there's, you know, not get carried like stuck in a box, essentially.

[00:06:43] Because a lot of times it's like, oh, well, here's the one exercise that I should be doing.

[00:06:47] Or here's the one exercise protocol that I should be doing to prevent injury.

[00:06:50] Where it's really like, well, no, if you focus more on like hip core strength and stability.

[00:06:56] Because there are so many exercises that you can do that incorporate hip and core, right?

[00:07:02] Rather than just here are the eight exercises that you have to do every single time.

[00:07:07] You know, because we don't live life in a study.

[00:07:10] We live life, you know, as we're sometimes going to be in like a hotel room.

[00:07:15] And don't have access to things that we might have at home or in a gym or in a different area.

[00:07:20] So, I think understanding that hip core training can mean a wide variety of things.

[00:07:25] As well as foot and ankle training can mean a wide variety of things.

[00:07:29] And what?

[00:07:29] There were a couple examples that we did find through somebody else who was doing a review on this research article.

[00:07:34] They said a couple of the exercises included.

[00:07:36] One was just banded hip flexion strengthening.

[00:07:40] Yeah.

[00:07:41] So, lifting your leg up.

[00:07:42] Up towards your body.

[00:07:43] Having like a band around your foot.

[00:07:45] A resistance band around your foot.

[00:07:46] And a single leg bridge was another one.

[00:07:49] And then for the foot and ankle, there were banded ankle exercises.

[00:07:53] So, we're just assuming that it was just using a band and doing ankle movements in different directions.

[00:07:58] Again, unclear what directions.

[00:08:01] Exactly what it was.

[00:08:01] And exactly what they did there.

[00:08:03] And single leg stance on a stability on a foam pad or something.

[00:08:08] Which even right there, I look at that single leg stability on a foam pad.

[00:08:12] Like, that's pretty heavy hip and core activation too.

[00:08:17] Like, we give that exercise to people who are dealing with hip and core stability issues.

[00:08:21] And so, foot, yes, your foot's definitely working.

[00:08:23] Your foot and ankle is working.

[00:08:25] But that's like a full chain exercise.

[00:08:27] Yeah.

[00:08:28] Global exercise.

[00:08:29] This is the other problem with research, right?

[00:08:30] It's hard to just pinpoint like one area of the body and not say that we're working globally as well.

[00:08:38] Like, we talked about as well, you're doing a single leg bridge on the floor.

[00:08:43] You're pressing through your foot.

[00:08:44] You're still activating through the foot and ankle as well as using the hip and core.

[00:08:48] So, you know...

[00:08:50] It's really hard to isolate.

[00:08:52] It is hard to isolate.

[00:08:53] But we're looking in general what program helped best, right?

[00:08:58] Was it the one focused around hip and core or was it the one focused on foot and ankle?

[00:09:03] And how did that compare to just static stretching?

[00:09:06] And static stretching, again, we're probably looking at just like static stretching the hamstring,

[00:09:11] static stretching the calf muscles, static stretching the quads.

[00:09:16] You know, so how does this compare to all of that in terms of trying to prevent injury?

[00:09:22] Yeah, and you may have heard it in the title that I read of the study.

[00:09:26] But it was found that the hip and core program was the most effective.

[00:09:31] There was an average weekly prevalence of overuse injuries that was 39% lower.

[00:09:36] And the prevalence of substantial overuse injuries was 52% lower in the hip and core group compared to the control group.

[00:09:44] The thing that I thought was even more interesting was there was no significant difference observed

[00:09:49] between the ankle and foot group and the control group in the prevalence of overuse injuries.

[00:09:54] And a higher incidence of acute injuries was observed in the ankle and foot group compared to the control group.

[00:10:01] So throughout the whole duration of this 24-week study,

[00:10:05] they found that the foot and ankle group performed the worst.

[00:10:09] They had the most injuries overall.

[00:10:11] And the only one that stood out was the hip and core group had significantly lower injuries in pretty much all categories.

[00:10:20] But the other thing I still think is really important to point out as well is that although the hip and core program reduced injury,

[00:10:28] it by no means eliminated that.

[00:10:30] So it showed that 42% of the participants in the hip and core group still sustained at least one overuse injury compared to 54% of the control group.

[00:10:42] And about two-thirds of those injuries are substantial, meaning enough to take you out of running.

[00:10:48] Yeah.

[00:10:48] And there was this interesting graph that showed, because that was just the overuse injuries, not including other acute injuries.

[00:10:56] And there's this graph here that shows the survival of the runners who made it through the full 24-week program without any injuries.

[00:11:07] And the hip and core group, it looks like they're around 37% of people that made it through the whole program without any sort of injury.

[00:11:15] And for the ankle and foot and control group, that number was closer to 20% to 21% for each of those groups.

[00:11:23] So it's like the ending message too was like, regardless of what three groups you're in, especially if you're a novice runner, you need to have a plan.

[00:11:31] Yes.

[00:11:32] Because injury is so prevalent, especially in novice or new runners.

[00:11:38] Exactly.

[00:11:38] And I think that's what's also key here is that as much as we can say, okay, do these exercises, they're going to help to prevent injury.

[00:11:46] There is never one exercise protocol.

[00:11:49] There's never one exercise that is overall going to prevent injury because injury in itself is so complex.

[00:11:57] Like, yes, we have, you know, how are we programming our running, but also how are we programming our life?

[00:12:04] Like extra stress can get in the way, lack of sleep, lack of how we're taking care of our bodies, just our job, our day-to-day life.

[00:12:12] Like there's so many other factors that contribute to injury that this is why research studies become really difficult.

[00:12:19] But this is also why it's really good just to have an overall awareness of saying, okay, it's not enough to just work on my ankle mobility, my toe mobility, my ankle strength.

[00:12:30] I need to look up the chain.

[00:12:33] Which I think is silly in general, like to just be focusing foot and ankle, like calling that the bottom-up approach.

[00:12:39] Which, okay, great, like we said, there was the balance activity that in the foot and ankle group of exercises that was hip and core related.

[00:12:48] And I don't want to discount the study because it was over 300 participants.

[00:12:52] The statistical relevance is pretty powerful.

[00:12:55] If you're going to focus on one, like you have just time for a couple things before you go on a run, like maybe make them hip and core related.

[00:13:01] Which to me makes a bit of sense.

[00:13:04] If you don't have that central hip core control, like what's it doing down the chain to the foot versus just having focused on something foot and ankle related.

[00:13:12] I generally wouldn't recommend that to somebody before they go and run.

[00:13:16] I'm usually recommending doing stuff that activates the hip and the core.

[00:13:20] I generally would recommend doing some sort of like lateral plyometrics, some bidirectional plyometrics.

[00:13:26] And this is where research again is difficult because you can't test everything.

[00:13:31] You can't test every single type of program.

[00:13:33] Like what if we had a combined hip, core, foot and ankle program altogether?

[00:13:37] How would have that performed?

[00:13:38] What if we had a group that was doing more dynamic plyometric type exercises as their kind of priming activity before they went on their runs?

[00:13:49] But this is why, again, cross training becomes so incredibly important.

[00:13:53] So rather than just going on a run, kind of like Dom said he does sometimes.

[00:13:58] Yes.

[00:13:59] Too consistent.

[00:14:00] So rather than just hopping out and going for a run, like what are you doing outside of that?

[00:14:05] I understand if running is now your passion, something that you want to be focused on.

[00:14:09] Are you also strength training?

[00:14:12] Are you also bringing in this core awareness and this core understanding?

[00:14:15] And a lot of people don't understand the impact of how our core works with our hips or maybe we overuse our hips because we're not utilizing our core enough.

[00:14:24] And this is why, you know, we have a whole core plan on Gen Health that helps to highlight exactly what the core is and how the hips work with the core in all different directions

[00:14:34] in order to help you better understand this entire core hip complex.

[00:14:39] Because it's more than just strengthening the hip flexors.

[00:14:43] It's more than just strengthening the glutes.

[00:14:45] It's how does it all work together?

[00:14:47] And I think that's where it's so important as any kind of athlete.

[00:14:53] If you are working out, you're a type of athlete, right?

[00:14:57] So any type of athlete, whatever you're doing, are you cross training?

[00:15:02] Are you getting other aspects into your body in order to help support?

[00:15:06] I'd say that's where we see the most people who end up in that overuse scenario is the people who just go and run.

[00:15:13] Yeah.

[00:15:14] Like that's all they do.

[00:15:16] And yes, some people get to a point where their body has compensated and gotten used to that and they are so conditioned to do that activity consistently.

[00:15:24] But especially if it's something where you're progressing up to a point, we need that cross training component.

[00:15:30] And that's why I'm so into plyometrics specifically, being a part of that cross training.

[00:15:34] And people aren't sure sometimes like, why would I need to do plyometrics or jump training if I'm just running?

[00:15:41] But in reality, running is a plyometric activity.

[00:15:44] You're launching yourself from foot to foot.

[00:15:47] You should be able to control that with each step.

[00:15:50] And that's where the overuse comes in because maybe you can do that for half a mile.

[00:15:56] Maybe you can do that for a mile or five miles.

[00:15:58] But once you start getting into six, seven, eight miles, or if you're in that novice stage and you're going to the two, three mile mark, is your body still able to control that transfer of weight from one foot to another without having compensation somewhere along the chain in your ankles or your knees or your hips?

[00:16:17] Your hips or your core, anything else that comes up along the train.

[00:16:21] And this is where it's also so important, even just talking about postpartum and getting back into running.

[00:16:27] It is so incredibly important not to just focus on like, okay, you know, it's been the six weeks.

[00:16:34] I'm told that I can go back to working out now.

[00:16:37] But how is your core working with your hip dynamic and your pelvic floor?

[00:16:42] This is so incredibly important to start to rework.

[00:16:46] And then how are you able to tolerate single leg hopping?

[00:16:49] Because if you cannot tolerate single leg hopping or you find that you get leaking or back pain or hip issues, like this is something you should be testing in order to get back to running.

[00:17:00] And this is why I also think it's crucial if you have the availability and the access to going to see a pelvic floor therapist before getting back into your regular exercise routine, no matter what that may be.

[00:17:11] Just having that checkup, just having that awareness from a professional to see how the whole core engagement pelvic floor hip complex is all working together is going to be so helpful so that you're helping to prevent injury.

[00:17:26] Again, we said we can't fully prevent injury, but we can do things to help mitigate injury.

[00:17:32] And I think that's our point.

[00:17:34] Yeah.

[00:17:34] And to the point of having someone supervise your sessions or your progress back into activity, that was another thing in this study that all of the sessions over the 24 weeks, I'm a little confused too here by something because they say that they started off with two sessions, you know, two sessions a week where they would do short five-minute warm-up.

[00:17:54] They're specific, their group-specific exercises, and then the same progressive running program, all supervised by physiotherapists.

[00:18:03] But then later in the study, they kind of mentioned it at the end of methods like, oh, there was a five-week period mid-summer that the sessions weren't supervised, and they were told to do three to four sessions on their own at home.

[00:18:17] So, yeah, I was interested.

[00:18:18] Why was it three to four when they were doing it on their own instead of two?

[00:18:22] And they did list as a limitation of the study that it would be good to see how participants perform if it's all self-directed.

[00:18:29] Yeah.

[00:18:29] Because not often are people with a physiotherapist two times a week or 24 weeks straight.

[00:18:36] Right.

[00:18:37] And that's just, I think, would be a study more in the compliance or how people can follow a self-directed program on their own.

[00:18:44] But, yeah, this points out that when under supervision, the top-down approach performed better.

[00:18:51] Mm-hmm.

[00:18:52] And that's that.

[00:18:52] And like Jen mentioned, we do have that core plan.

[00:18:55] We have a hip and a core plan on Jen Health.

[00:18:59] There's also warm-ups and cool-downs that are part of the membership that do include and incorporate.

[00:19:05] There's a cardio-based one that incorporates both hip and foot and ankle-based stuff.

[00:19:11] And because it's the holidays, we want to give our audience a little bonus.

[00:19:16] So, if you have never started a Jen Health membership, you can go start the free trial.

[00:19:20] But use code OPTIMAL10 when you start that and it'll give you a little bonus discount on your first month coming into the new year.

[00:19:28] There's so many plans on the program that you will have content galore to be able to work through over the course of next year.

[00:19:38] Thanks so much for joining us for another episode.

[00:19:40] Do you have any friends or family that are runners, anybody who has been dealing with injuries due to running?

[00:19:45] Pass this episode along to them.

[00:19:47] Share it during the holidays, the gift of more information about how to better take care of your body.

[00:19:52] If you haven't, please consider go leaving a rating and review on your favorite podcasting platform.

[00:19:56] We hope everyone out there has an amazing holiday and happy new year.

[00:20:00] And we'll see you next time on the Optimal Body Podcast.