The Runner’s Body Maintenance Guide: Prehabilitation Guidelines

Get your running program off the ground, and more importantly, land it without injuries!

Why is this important?

A ¼ of experienced runners are out with an injury at any given time, and up to a 1/3 of novice runners on average will get injured and stop running for good!

But…that’s good for you right, because you treat runners!

Yes and no. Although treating runners keeps us busy, too many runners stop doing it when they get hurt, and that can have disastrous consequences for their general health if they are not getting their minimum requirements of activity and exercise, and we think running is a great way to do that.

Why Else do we like running?

Minimal equipment is needed

Build strong bones, tendons, ligaments and cardiovascular system

Activate many yummy chemicals

Very portable

Great legs?

Prevent chronic diseases!

What chronic diseases are we trying to prevent?

From the CDC:

  • 50% of all adult Americans have one or more chronic diseases, while 25% have two or more.
  • In 2010, 7 of the top 10 causes of death were chronic diseases, with heart disease and cancer accounting for 48% of all deaths.
  • Arthritis, obesity and diabetes are all associated with significant disability over the course of a lifetime.
  • In 2011, more than half of all adults reported not meeting the minimum requirements for aerobic or physical activity, and 76% did not meet the requirements for muscle strength building.
  • The risk factors are well known: smoking, diet, inactivity, sodium and alcohol, stress.

What’s the impact of this?

In 2006, the 50% with one or more chronic disease were responsible for 84% of all health care spending.

This is also a huge quality of life issue

Does running help these?

Social, physical and mental benefits of running include:

  1. Happiness – a 2007 study in Psychological Behavior showed the same neurological changes with running that also occur with the use of addictive drugs.
  2. Weight Loss – besides the obvious calorie burn, training at 70% of your VO2 Max will produce Excess Post Oxygen Consumption (EPOC) meaning your afterburners are firing and you continue to metabolize at a faster rate. Add to this the mildly appetite suppressant effects of physical activity for a powerful tool.
  3. Strengthen your body – concerns about arthritis and running are decidedly unproven.
  4. Stay Sharp as you age – running and other forms of physical activity help stave off mental age-related decline.
  5. Reduce the risk of certain cancers, or augment the stress of cancer treatment.
  6. Add years to your life with physical activity – YEARS!
  7. Stress Less – Running is used as treatment in depression, anxiety etc.

Before you dive in

get these checked:

  • Blood pressure, blood sugars, cholesterol – talk to your doctor. If you have multiple risk factors or a significant family history, more extensive testing may be needed before you go full-tilt.
  • Arthritis, flexibility and strength, and previous injuries – talk to your physical therapist. You may need to do corrective exercises and stretches to be able to handle the challenge on your body.

How do I get started?

Maybe you’re already running some or even a lot. Unless you happen to be a kinesthetic genius naturally, we recommend getting involved with a group or training program. You will learn the basics of a gradual running progression and have access to other runners and coaches. Between that and following these guidelines, you’ll be well on your way!

Now, how about that prehab program? Or, “Ask Dr. Science”

Huge variability and findings exist in the running related research, and much fewer prospective studies exist to predict outcome from doing specific things. So how do we come up with our action plan?

Well, the good news? Your body is actually pretty resilient…

This means we take a sensible, bio and neuro-mechanical look at the forces involved with running, and find the activities you can do the MAJORITY of the time, and how to move MOSTLY well to give yourself the best shot at not being one of the 20-30%+ who will ‘medical-out’ of your get-into-running program.

About these recommendations

Remember, results may vary. These recommendations are based in equal parts science, experience and common sense. Anything that doesn’t feel right or doesn’t work for you probably isn’t right (at least at that moment) and shouldn’t be forced. If in doubt ever, don’t be afraid to pull your parachute and come talk to us.

The Prehab Guidelines

Everyone has a limit – know what yours is

Starting out? Use a combo of walking and running and build from there. The terrible “toos” – too much, too fast, too soon – avoid em’!

What about that 10% rule?

It’s unproven and when tested, 20% of study participants still get injured. Advice? Learn to go by feel, HR variability, other physiological signs, mood (rings) and in general stay below your 80% max exertion for 80% of your workouts. Some will follow a ‘hard, easy, easy’ type of schedule to make sure they are getting enough recovery. Many pros typically take a 20-40% reduction in intensity or distance once monthly for up to a week.

So…recovery is a good thing?

It’s a really really really good thing. If you want to make a paper mache pyramid you’d build it layer by layer, but you’ll have to wait till that layer is really solid before adding the next one. Your body is dynamic and will respond to forces to become stronger, which happens… during recovery! The challenge? It’s easy to track your week to week progress and gains when you’re actually running by counting time, distance or some other measure. How would you track your recovery? Getting some data and a coach can you build a rock solid plan.

What is your body telling you?

Listen to your body! Those little nagging aches, pains and twinges mean something. Knowing when you need recovery (foam rollering, a cold plunge and self-massaging for example) and when you need rehab is important to learn about your body. Listen to your body. If you’ve taken time off to let something quiet down, ease back in to your full program, don’t jump right back to your expected or target intensity.

Avoid Overstriding

Yes, the dreaded heel-strike! DON’T DO IT! But…are you sure you’re not doing it? Up to 1/3 of runners who believe they don’t heel strike actually do, so find out for sure. Have a friend or friendly PT video you and see what’s up. Kinesthetic cues that may help include ‘shortening your stride’ and ‘increasing your cadence’ – make a mix of awesome songs in the 170-180 beat/minute range and rock out. Some folks can heel strike and will naturally do so, but they’ll be most successful if they are NOT also overstriding.

Strengthen your body

And by strengthen your body, we really mean strengthen those HIPS! And some other bits too, but REALLY STRENGTHEN THOSE HIPS! We’ll give you some exercise examples to help you get started.

Emergency hot spot? PRICE it baby!

Protect, (active) Rest, Ice, Compression and Elevation. It’s all about blood flow…BUT! This isn’t a hall pass to stop moving – find something else to do that’s active.

Should I do speedwork or high-intensity training?

Variability is good for your body, and you will adapt more quickly and build more power if you incorporate some speedwork and intensity (think ‘intervals’ here). However, it’s easy for new runners to start blasting away at linger too hard and long close to your absolute maximum effort, so we need to dial it back. See ‘10% Rule’ above and do some math: Elite athletes keep their faster than tempo pace training to 20% or less of their training volume, and may spend only 5% total at a maximum effort. When you’re starting out, a 10’ mile may be a maximal effort for a while.  It’s ok to push it if you’re healthy, but stay at tempo or slower for 80% of your miles. The smart pros will recommend you make your hard days hard, but really keep your easy days easy, and have more of those in the mix.

To stretch (or not), and WHAT to stretch (or not)

Move your body before running to warm up. Save your stretches for AFTER you run, preferably when you are warmed and relaxed.  Good ideas include checking the length and stretching any limitations in your hamstrings, calves, hip flexors and quadriceps muscle groups. Depending on your form and how well you use your core, stretching your back may be necessary too. Remember, physiologically most of our time is spent in the middle of our body’s ranges of motion, and stretching can raise subliminal alarm bells and shout ‘danger, danger!’, so play some Barry White, bring some roses, and give your body lots of stretching related TLC. Make a date of it…

Exceptions: some forms of stretching actually use movements and contractions to produce length – thumbs up! However – because you are lengthening muscles, STILL give yourself at least 30-45 minutes before you go out and hammer. The best US sprinters have folks (like me) use something called Active Isolated Stretching with them before they race, but only up to about 45 minutes before they toe the line.

How about cross training?

Glad you asked! Earlier I recommended a ‘hard, easy, easy’ day schedule as an example. This applies to RUNNING – you are encouraged to get on your bike, elliptical, get in the pool and move every single darn day.

How about shoes?

Do they fit well and are they comfortable?  There is a boomerang effect with running shoes and research – something catches on and goes huge (minimalism and motion control for two examples), and… then the research starts to come in. Unless you have a specific need, trend towards more neutral shoes that fit you really well, OTC inserts that feel good and start there. Your friendly running-shoe store fit expert can help you a TON. Just remember though, someone else’s ‘this really worked for me’ is GREAT! But… maybe not great for you, so be open-minded and experiment until you find your perfect fit and shoe. And also keep in mind shoes will not heal injuries and weren’t designed to correct training errors and neuro or biomechanical problems with your stride.

Lastly, with love

I’m always asked what the best home exercise/aerobic activity/exercise machine etc. it, and in truth, it’s really the one that YOU USE or DO! And, for long term success, it helps if you love it, at least a little bit.  Each of you will approach running the way you approach anything romantically in your lives – some, with great initial enthusiasm and excitement, some with cautious trepidation, some with a look over your shoulder for the next best thing, and some with a married till death perseverance. You’re in good company if running finds its forever home with you, but as long as you DO SOMETHING, it doesn’t really matter that much. But I hope you stick with it.

See my earlier blogpost for some of my current favorite running exercises and movements.