The How To Prevent Running Injuries Manual
Presented by
Sports + Orthopedic Leaders
Tammara Moore, DPT, OCS, ART
R
unning is a passion for many. It can be one of the most satisfying activities we do and has
tremendous benefits. Running can place considerable stress on the body and many runners suffer
a broad range of lower extremity and back injuries. Many of these are caused by overuse,
otherwise understood as an overload or breakdown of certain tissues. The most common injuries we see
are those related to cumulative trauma. These can include: foot pain, achilles tendinitis, shin splints,
plantar fascitis, knee pain, iliotibial band syndrome, hip and low back pain.
How do overuse injuries occur? Usually an injury will occur due to an overuse of a muscle or other
traumatized soft tissues such as a tendon. Injuries can be caused by: inadequate rest or overtraining; not
allowing for proper recovery, poor nutrition, muscular imbalances, altered firing patterns, predisposed
malalignment, poor flexibility, weakness, and/or improper shoes selection.
More injuries occur with running than swimming or cycling, and this can be due to the increased forces
in the body of over 2-3 times skeletal shock to the joints as opposed to walking. Injuries can occur from
acute injuries, cumulative small tears such as microtrauma, or reduced oxygen to cells which is called
hypoxia.
The Cumulative Injury Cycle
The cumulative injury cycle can
occur with repetitive effort. With
fatigue, increased pressure, tension
or friction can occur in the tissues.
The body will lay down tough scar
tissue to repair the area. This is
the body's attempt to stabilize an
overworked area. This can result
in fibrous adhesions in muscles or
soft tissues in the body. As a
result, muscles become shorter
and weaker, and may not able to
transmit effective power or “give”
like we ask them to function in
our athletic activities.
Repetitive
Strain Injury
Acute Injury
Local Sprain/
Strain
Constant
Trapped nerves may not transmit
Pressure or
signals and prolonged friction,
Michael Leahy, DC, CCSP
Tension
pressure or tension can result
in inflammation. This can over time reduce range of motion in structures, and lead to a loss of strength in
the area. Tingling, numbness and weakness can also occur and increased pain signals are a result of this
cycle.
Sports + Orthopedic Leaders
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13 Tips to Prevent Injury:
1. Listen to your body:
Allow for recovery, particularly if one feels irritable, possesses low motivation, or has an inability to get the
heart rate up in the workout and a feeling of tiredness, moodiness, disruptive sleep patterns. Test the
morning heart rate; if it is 10 beats higher, there is a good chance that your body is in need of serious
recovery. It is good to take some needed rest.
2. Avoid overtraining. Studies show that the best injury predictor may be the amount of training you
completed last month. It is well known that fatigued muscles cannot protect associated connective tissue
structures, and this increases the risk of damage to bone, cartilage, tendon and ligament. Total mileage for
running is an excellent indicator of your injury risk. A good rule of thumb is not to increase your mileage over
10% a week. Recovery time reduces injury rate by giving muscles and connective tissues an opportunity to
repair.
3. Get regular massage, particularly during your buildup phase, and during recovery. No longer are massages
just to “feel good”. I find that massage helps tremendously to release muscle restrictions, improve blood
flow, remove lactic acid, relax the nervous system, and improve one's recovery after training. It is essential
to incorporate into an athletes' program and should be a part of ones' body maintenance schedule.
4. Strengthen weakened muscles. Many athletes who have been sedentary and start to exercise more
vigorously may have problems that pop up due to some underlying weakness or muscular imbalances. It is
extremely wise to couple resistive training with swimming, biking and running. Increasing training should
correspond with an increased effort for stretching and strengthening.
5. Allow plenty of time for proper warm-up and cooling off and stretching after your workout, while the
muscles are still warm.
6. Replacing shoes after 400-500 miles and using adequate shoes for your type of arch. For example, a
hyperpronator needs a more stable heel counter or a motion control shoe, whereas someone with a high arch
may tend to supinate more and may not need an extremely rigid shoe. It's good to try many shoes in order to
get a good fit and run in them in the running store before you buy them.
7. Treat even minor injuries with the RICE principle: rest, ice, compression and elevation. Do not train when
experiencing pain, which can lead to further injuries and other compensations. It's important not to train hard
when you are stiff or have muscle soreness from the previous effort. The next effort should be easy.
8. Muscular imbalances can result in the repetitive motions of swimming, cycling and running and the poor
postures associated with being in the bike position. Motion in these sports occurs primarily in the sagittal
plane (forward motion). As a result, many athletes may develop tightness of their rotatore muscles and those
that allow side-bending and rotation of the spine. Another underlying cause of injuries is inadequate motion in
the hips and pelvis. Exercises that improve rotation and sidebending are important exercises for the runner...
”use it or lose it”!
9. Strength of the core is essential for transmitting forces in the body. The core of the body is where you
derive power. It provides the foundation for all arm and leg movements. Body movement is a complex event
with agonist-antagonist structures working together in synergy to provide strength, stability and motion while
at the same time the body is also able to stabilize in all three directional planes of motion. This is essential for
optimal performance, symmetry and fluidity in the athlete. Core muscles are comprised of the multifidus, the
interspinalis, intertransversii, rotatores, abdominals, transverse abdominus, internal/external obliques, erector
spinae, and quadratus lumborum thoracolumbar fascia. It's important to remember that the body has a kinetic
chain with relation to all its parts and these relationships affect one another. It is therefore common to see an
athlete who complains of foot pain that may actually have a problem with spinal rotation or hip weakness
that is contributing to an overuse of the foot structures. This is just one example.
10. Exercises can go a long way in preventing these imbalances from resulting in an injury. It is important to
perform a daily stretching program and incorporate strength, training and core stability exercises into a
runner’s training program.
In summary, stretching maintains flexibility and will avoid the cumulative muscle shortening that can occur
with repetitive activity. Best to do these after your workout!
11. What to do if a musculoskeletal injury occurs:
Rest, stop further activity and apply ice. It is known that ice can reduce inflammation and swelling, speeding
healing time, and also this would be used particularly after a hard workout if soreness shows up. Elevation
and compression can help with swelling. Seek care if the pain persists more than a few days. Endurance
fitness and efficiency of running takes months and years to develop. Emphasizing consistency and patience
13 Tips to Prevent Injury:
is key. If you are new to this sport, build up gradually and learn proper techniques in all disciplines.
If you are having pain: See a physical therapist or medical provider who works with runners. Get a
biomechanical analysis. If you are having any residual pain during or after a workout, seek medical care with a
practitioner that understands these types of injury from a prevention standpoint. A full evaluation of your
problem can avoid further injury and return more quickly to activity. I have found that Active Release
Techniques® to be an effective treatment for most musculoskeletal injuries coupled with appropriate and
specific rehab exercises and can return the athlete quicker to full activity and improve performance by
improving the body's efficiency.
12. Running: Follow the 10% rule. Increase weekly mileage no more than 10%, and after 3 weeks there
should be a decrease in one's mileage to allow for proper recovery. We've already talked about maintaining
proper running shoes and replacing when worn. Try to run on soft terrain or trails to decrease skeletal shock
and pounding stress to the joints.
13. Last but not least, have fun! Enjoy a balanced perspective on training.
A Few Common
Biomechanical Faults with Running:
1. “Foot caves in” (dropped navicular or arch)
Weakness of posterior tibialis, foot intrinsics, anterior
tibialis, tight gastrocnemius or soleus
2. Poor knee control, knee “caves in”:
Poor stability of gluteus medius in the hip, poor
quadriceps control
3. Anterior pelvic alignment
Limited hip extension usually a tight psoas; poor
core stability
4. “Forward flexed trunk”
Tight psoas, rectus femoris, abdominal shortening
(rectus)
G
A
I
T
5. Asymmetrical arm swing
Many causes, can include poor trunk rotation; tightness
of transverso-spinalis, multifidi; core or scapular weakness;
upper trapezius tightness
6. Asymmetrical shift or transfer of weight
Lumbopelvic/ hip weakness or stability and/or muscular
tightness
7. Shortened stride and posterior tilt of the pelvis:
shortened hamstrings
SOLUTION?
Get a biomechanical assessment that includes functional
movement testing and video analysis to identify and
design a custom performance program to optimize your
running efficiency.
What we look for with running gait.
Abnormal shoulder
How stable and mobile are the
and arm motion.
joints, muscles at a region?
Is it normal or abnormal?
Abnormal shifts of
the spine or pelvis
Pelvic, torso and
leg rotation
Abnormal deviation
of the knees.
Hip flexion
and extension.
Hip moving in
or out from
normal position
Abnormal pronation or supination
of the ankles or feet.
A
N
A
L
Y
S
I
S
• Quadriceps Stretch • ITB Stretch with a Roller • Supine Bent-Knee Raises • Hip Internal Rotator Stretch •
• Hip External Rotator Stretch • Cervical Stretch • Posterior Shoulder/Rhomboid Stretch • Forward Ball Roll Out •
• Gastrocnemius Stretch • Pectoral Stretch • Psoas Stretch with a Roller • Thoracic Spine Extension • Side Planks •
• Hamstring Stretch • Adductor Stretch • Single Leg Balance • Bilateral Heel Raises • Bow & Arrow Stretch •
• Lumbar Rotation Stretch • Resisted Side Steps • Quarter Squats • Quadruped with Alternate Arm/Leg Raises •
Quadriceps Stretch
1. Lie on stomach with strap hooked
around foot.
2. Keeping back and neck in neutral,
pull foot towards buttock until you
feel a light stretch in the front part of
the leg.
3. 3 Sets x 30 second holds.
ITB Stretch with a Roller
1. Lie on your side with hip resting on
top of roller and body supported with
your elbow and opposite foot.
2. Keeping neck and back in neutral,
gently roll On the outside part of the
thigh between the hip and knee.
3. 1 Set x 1-2 Minutes.
Supine Bent-Knee Raises
This is a fundamental exercise for recruiting the
deep abdominal muscles and for lumbopelvic
control. The athlete lies on her back, with knees
bent and feet flat on the floor. She then braces
the abdominal wall, holding the lumbar spine in a
neutral position, and slowly raises one foot 6-12
inches off the ground with alternate legs.
Common errors when performing this exercise include rocking the pelvis, abdominal protrusion, or
an inability to maintain the neutral (midrange) lumbar curve. If this happens, discontinue the
exercise for a rest period. Quality more than quantity is stressed. Progression: The exercise can
progress to alternately extending the legs and lowering to the ground. Once the athlete can
maintain stability with alternate leg lifts. She can add alternate, overhead arm raises for greater
challenge. The add alternate, overhead arm raises for greater challenge. The arm raises should be
performed slowly, while maintaining lower abdominal bracing.
• Quadriceps Stretch • ITB Stretch with a Roller • Supine Bent-Knee Raises • Hip Internal Rotator Stretch •
• Hip External Rotator Stretch • Cervical Stretch • Posterior Shoulder/Rhomboid Stretch • Forward Ball Roll Out •
• Gastrocnemius Stretch • Pectoral Stretch • Psoas Stretch with a Roller • Thoracic Spine Extension • Side Planks •
• Hamstring Stretch • Adductor Stretch • Single Leg Balance • Bilateral Heel Raises • Bow & Arrow Stretch •
• Lumbar Rotation Stretch • Resisted Side Steps • Quarter Squats • Quadruped with Alternate Arm/Leg Raises •
Hip Internal Rotator Stretch
1. Lie on back with ankle resting
on opposite knee.
2. Keeping back in neutral, grasp
behind knee and pull leg towards
chest until you feel a light stretch
in your gluteal area.
3. 3 Sets x 30 second holds.
Hip External Rotator Stretch
1. Lie on back with both knees bent.
2. With one hand grasp behind knee
and with the other hand grasp
behind ankle.
3. Gently pull your shin so your
knee comes up towards opposite
shoulder.
4. 3 Sets x 30 second holds.
Cervical Stretch
1. Sitting up straight with hands behind
your back, grasp each forearm with
opposite hand.
2. Gently side bend your head to one
side until you feel a light stretch on the
side of your neck.
3. 3 Sets x 30 second holds.
Posterior Shoulder/Rhomboid Stretch
1. Sitting up straight, grasp your elbow
and pull arm across your chest. Make
sure to keep both shoulders from
elevating.
2. Gently side bend your head to the
opposite side until you feel a light
stretch on the posterior portion of the
shoulder and shoulder blade area.
3. 3 Sets x 30 second holds.
Forward Ball Roll Out
1. Kneeling on the ground with elbows supported on a Fit-Ball with
neck and back in neutral.
2. Slowly roll the ball out so the shoulders and hips both move as one
unit. Keeping your neck and back in neutral.
3. Move out as far as you can without loosing neutral position.
4. 3 Sets x Fatigue.
• Quadriceps Stretch • ITB Stretch with a Roller • Supine Bent-Knee Raises • Hip Internal Rotator Stretch •
• Hip External Rotator Stretch • Cervical Stretch • Posterior Shoulder/Rhomboid Stretch • Forward Ball Roll Out •
• Gastrocnemius Stretch • Pectoral Stretch • Psoas Stretch with a Roller • Thoracic Spine Extension • Side Planks •
• Hamstring Stretch • Adductor Stretch • Single Leg Balance • Bilateral Heel Raises • Bow & Arrow Stretch •
• Lumbar Rotation Stretch • Resisted Side Steps • Quarter Squats • Quadruped with Alternate Arm/Leg Raises •
Gastrocnemius Stretch
1. Standing with your knees straight
and the balls of your feet resting on
the edge of something (stair, half roller,
curb etc.).
2. Gently feel a light stretch on back
part of the calf.
3. 3 Sets x 30 second holds.
4. Repeat same stretch with knees
bent.
Pectoral Stretch
1. Lie on your back with spine resting
on top of a roller. Make sure head is
supported on the roller.
2. Gently allow arms to lay to the side
over the
roller as if
making a 'T'
with your
arms.
3. 1 Set x
1-2 Minutes.
Psoas Stretch with a Roller
1. Lie on your back with a roller
underneath your hips.
2. Grasp behind one knee and gently
pull knee toward your chest until you
feel a light stretch on the opposite
hip flexor.
3. 3 Sets x 30 second holds.
Thoracic Spine Extension
1. Lie on back with a roller underneath
your shoulders and both knees bent.
2. Keeping belly button sucked in
towards your spine, lift hips off the
ground so your spine is parallel to the
floor.
3. Gently roll back and forth so the
roller covers the length of you shoulder
blade.
4. 1 Set x 1-2 Minutes.
Side Planks
1. Lie on your side with upper body supported on your elbow. Make
sure your entire body is perfectly straight as if you were standing.
2. Suck your belly button towards your spine and lift your hips off
the ground. Keep you neck and back in neutral.
3. 3 Sets x Fatigue
• Quadriceps Stretch • ITB Stretch with a Roller • Supine Bent-Knee Raises • Hip Internal Rotator Stretch •
• Hip External Rotator Stretch • Cervical Stretch • Posterior Shoulder/Rhomboid Stretch • Forward Ball Roll Out •
• Gastrocnemius Stretch • Pectoral Stretch • Psoas Stretch with a Roller • Thoracic Spine Extension • Side Planks •
• Hamstring Stretch • Adductor Stretch • Single Leg Balance • Bilateral Heel Raises • Bow & Arrow Stretch •
• Lumbar Rotation Stretch • Resisted Side Steps • Quarter Squats • Quadruped with Alternate Arm/Leg Raises •
Hamstring Stretch
1. Lie on back with strap hooked
around foot.
2. Keeping knee straight and back
in neutral, pull leg up until you feel
a light stretch on the back of the leg.
3. 3 Sets x 30 second holds.
Adductor Stretch
1. Lie on back with strap hooked
around foot.
2. Keeping knee straight and back in
neutral, pull leg up and out until you
feel a light stretch on the inside part
of the leg.
3. 3 Sets x 30 second holds.
Single Leg
Balance
1. Standing up
straight, balance
on single leg.
2. To challenge
yourself, stand
on various
surfaces (pillows,
rolled up blankets
etc.) or close
your eyes.
3. 3 Sets x 1 Minute balance time.
Bilateral Heel Raises
1. Standing with your knees straight
and the balls of your feet resting on
the edge of something (stair, half roller,
curb etc.).
2. Gently lift your heels off the
ground and rise up onto the balls
of your feet.
3. Slowly transfer
onto a single leg
and lower
yourself back
down with total
control and no
wobbling.
4. 3 Sets x 15
Reps.
Bow & Arrow Stretch
1. Lie on your side with arms resting on top of each other.
2. Rotate through your spine and move your top hand back as if
stringing a bow.
3. 3 Sets x 30 second holds.
Lumbar Rotation Stretch
1. Seating up straight with one leg
outstretched and the other leg bent
so your ankle is behind opposite knee.
2. Rotate through your lumbar spine
toward the bent knee side and rest
elbow on opposite knee.
3. 3 Sets x 30 second holds.
• Quadriceps Stretch • ITB Stretch with a Roller • Supine Bent-Knee Raises • Hip Internal Rotator Stretch •
• Hip External Rotator Stretch • Cervical Stretch • Posterior Shoulder/Rhomboid Stretch • Forward Ball Roll Out •
• Gastrocnemius Stretch • Pectoral Stretch • Psoas Stretch with a Roller • Thoracic Spine Extension • Side Planks •
• Hamstring Stretch • Adductor Stretch • Single Leg Balance • Bilateral Heel Raises • Bow & Arrow Stretch •
• Lumbar Rotation Stretch • Resisted Side Steps • Quarter Squats • Quadruped with Alternate Arm/Leg Raises •
Quadruped with
Alternate Arm/Leg
Raises
This exercise prepares the athlete for the
proprioceptively more-challenging, moredynamic exercises of the trunk. It
specifically engages the multifidi—the
deep transverse spine stabilizer and
extensor of the lumbar spine.
Resisted Side Steps
1. Place Thera-band around ankles and
stand in a mini squat position.
2. Gently side step paying special
attention towards not hiking up your
hip or rocking your body back and
forth like a weeble wobble.
3. 3 Sets x 15 Reps
Quarter Squats
1. Standing with feet about shoulder
width apart.
2. Keeping neck and back in neutral,
hinge at the hip and bend at the knee.
3. Make sure
knees do
not move
out past
your toes or
let your
knees buckle
in towards
each other.
4. 3 Sets x
15 Reps.
The athlete should position herself on all
fours. She then braces the abdominal
wall as described above. While
maintaining a midrange/neutral curve of
the lumbar spine, the athlete should
raise the right arm and the left leg
(opposite upper and lower limbs)
into a line with the trunk, while
preventing any rocking of the pelvis or
spine (excessive transverse- or coronalplane motion). If it helps to maintain
alignment, the athlete may use an object,
such as a foam roller or wooden dowel,
placed along the spine, for added tactile
feedback. The leg should be raised only
to the height at which athlete can
control any excessive motion of the
lumbo-pelvic region. She then performs
the exercise raising the left arm with the
right leg.
Two Locations:
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ORTHOPEDIC
LEADERS
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PHYSICAL THERAPY SPORTS PERFORMANCE
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Oakland, California 94618
P 510.547.1630
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www.solpt.com
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Santa Cruz, California 95062
P 831.425.3588
F 831.425.3538
www.solsantacruz.com
This information is provided as a learning resource for the benefit of our clients. It is general in nature and is not intended to replace
personal consultations with your medical professionals.