Run Healthy The Runner's Guide to Injury Prevention and

Treatment - 1st Edition

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Jason Allen; Senior Art Manager: Kelly Hendren; Illustrations: © Human Kinetics; Printer: Versa
Press
We thank Finish Line Physical Therapy in New Rochelle, New York, for assistance in providing the
location for the photo shoot for this book.
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E8314
To the coaches I had at a young age who instilled in me a lifelong love for
this sport; my family (especially my mother, who helped this physical
therapist become a writer); the mentors who have taught me both the
importance of lifelong learning and how to care for, inspire, and be inspired
by my patients; and every patient I’ve treated, from whom I’ve learned so
much.
– Emmi

To my parents who believed in me, even when I didn’t; to my wife and son,
who inspire me and challenge me every day; to my athletes, who put their
trust in me and allow me to do what I love.
– Jonathan

To every coach, scientist, and healthcare professional who lent me their

expertise on my running and writing journeys.
– Allison
 Contents
Acknowledgements
Introduction
Exercise Finder

PART I THE RUNNER’S BODY

1 Understanding the Body’s Tissues and Their Healing
Processes
2 Navigating Your Treatment Options
3 Injuries to Muscle and Bone
4 Soft Tissue Maintenance

PART II BODY REGIONS

5 Feet and Toes
6 Ankles
7 Knees
8 Hips
9 Low Back

PART III COMMON CONDITIONS

10 Plantar Fasciitis
11 Achilles Tendinitis
12 Shin Splints
13 Hamstring Tendinitis and Tendinopathy
14 IT Band Syndrome

PART IV HEALTHY TRAINING

15 Principles of Smart Training
16 Ideal Running Form
17 Nutrition and Fueling
18 Alternative Therapies and Myth Busting
References
Index
About the Authors
Earn Continuing Education Credits/Units
 Acknowledgements
This book would not have been possible without the help, input, support,
and professional expertise of even more people than we are able to name
here.
We want to thank Alison McGinnis, Morgan Mowers, Cuyler Hudson,
Rachelle Bordlee, and Darlene Aguillard for reading early drafts of many
chapters of this book. You helped ensure that we brought the most current,
useful exercises to athletes in a way that makes sense to them.
Likewise, we thank the Gray Institute and the Postural Restoration
Institute for their contributions to the field of physical therapy and to our
understanding of movement and rehabilitation. Thanks also to Lauren
Antonucci of Nutrition Energy, for your valuable contributions to the
nutrition content we have shared.
Thank you to Devang Patel, Chelsea Frengs, Ryan Pinerio, Nicole Sin
Quee for dedicating your time and bodies to pose for the pages of this book,
and Danny Weiss for brilliantly capturing the not-always-easy-to-explain
poses that we requested. Thanks to Michael Conlon and Finish Line
Physical Therapy for generously letting us use your state-of-the-art New
Rochelle facility for our photo shoot, and thanks also to Rabbit and Brooks
for outfitting our models.
Finally, we owe a great deal of thanks to Michelle Earle, Cynthia
McEntire, and the entire publishing team at Human Kinetics. Without your
tireless work (and patience), this book would not exist. We are thrilled to
have worked with you to get such an important guide out of our heads and
into the hands of runners who need it.
 Introduction
Running is the world’s oldest organized sport—and for good reason.
Nothing could be simpler than putting one foot in front of the other. The
Sports & Fitness Industry Association estimates there are more than 47
million runners in the United States, and it’s the most popular participatory
sport for middle school and high school athletes as well as adults. Young or
old, big or small, fast or slow, people run for competition, for the numerous
health benefits, and—believe it or not—for fun.
Yet as straightforward as running is, it’s not without some inherent risks
and challenges. If you’ve ever found yourself in pain while running, or if
you’ve missed workouts because of injuries, you’re far from alone. In fact,
of those nearly 50 million American runners, about half of them were
sidelined by an injury last year alone.
Although some injuries fall into the “nature of the beast” category, many
can be avoided or minimized with a smart approach. If you get injured,
quick diagnosis and prudent treatment can make the difference between an
ailment that keeps you off the roads for a few days and one that’s a season-
ender. Everyone from weekend warriors to elite runners can benefit from a
program that helps them address the cause of injuries as well as assists in
their treatment.
In the pages that follow you’ll find both clinical and practical
information presented by a doctor of physical therapy who specializes in
treating runners and endurance athletes and has been a runner herself for
more than 20 years, competing in distances ranging from the 1500m at the
D1 level to the Boston Marathon, and an exercise physiologist and coach
who has worked with endurance athletes (including world champions and
world record holders) for more than 30 years. Written for runners, as well as
coaches, parents, and health professionals, Run Healthy: The Runner’s
Guide to Injury Prevention and Treatment helps the reader gain a better
understanding of how the musculoskeletal system functions and responds to
training, how to identify an injury, when rest is necessary (versus training
through the injury), and when to seek professional treatment.
We start off with an anatomy overview, explaining the different types of
tissue that make up the body’s musculoskeletal system. From there, we take
a deeper dive into some of the most common and frustrating injuries
runners encounter. We show you how to identify, avoid, and treat
everything from muscle strains to tendinitis, from stress fractures to
iliotibial band syndrome. In addition to the clinical side of things, we take a
look at common form issues that can lead to injury and how a combination
of strength work, mobility exercises, and running drills can help you clean
up your form and improve your running economy and performance. Finally,
we offer some insight into alternative and complementary treatments,
helping you separate fact from fiction.
Run Healthy: The Runner’s Guide to Injury Prevention and Treatment
includes anatomical drawings to help you understand the physiology, as
well as photographs demonstrating the exercises and drills. We’re confident
that the combination of objective, clinical advice, coupled with practical
anecdotes from our experience treating and coaching runners, will prepare
you for years of healthy and productive miles.
Happy running!
 Exercise Finder
Exercise Page Warm- Cool- Mobility Strength Prehab Rehab
number up down
Feet and toes
Splay your feet 37 X X X X
Toe yoga 38 X X X X X
Active assisted range 39 X X X X
of motion for toes
Arch stretch 40 X X X X
Pronation driver 40 X X X X
Arch activation: 41 X
Supination driver and
short foot
Three-way balance 42 X
driver
Toe separators 44 X
Ankles
Soft tissue mobilization 53 X X X X X
Ankle massage 53 X X X
3D calf stretch 54 X X X X X X
3D banded strength 55 X X X
exercises
Knees
3D kneeling hip flexor 64 X X X X X
stretch
Long arc quad 65 X X X
Single-leg split squat 66 X X X X
(Bulgarian split squat)
Lateral toe taps 67 X X X X
Monster walks 67 X X X X
Wall sit 71 X X X X
Exercise Page Warm- Cool- Mobility Strength Prehab Rehab
number up down
Eccentric squat on an 72 X X
incline board
Double-leg squat 72 X X X
Single-leg squat 73 X X X
Box jumps 74 X X X
Multidirectional hops 74 X X X
Hips
Foam rolling the glutes, 86 X X X X X
TFL, and quads
Trigger point release: 88 X X X X X
Hip flexor (psoas)
Hip floss 88 X X X
3D pivots 90 X X X X
Common lunge matrix 92 X X X X
Deep squat 94 X X X X X
Posterior capsule 95 X X X X
stretch
Resisted hip isometrics 96 X X X X
Standing hip internal 98 X X X X X
rotation lunge
Core stability 99 X X X
Low back
Foam roll thoracic 106 X X X X X
spine
Thread the needle 107 X X X
3D arm matrix 108 X X X
Runner’s lunge with 109 X X X X
focus on arm drive
All-four belly lift 112 X X X X
3D plank with hip 113 X X X X
drivers
Elbow-to-knee side 114 X X X X
plank
Shin splints
The claw 140 X X X X
Exercise Page Warm- Cool- Mobility Strength Prehab Rehab
number up down
Heel walk 141 X X X X
Hamstring tendinitis and tendinopathy
Hamstring trigger point 147 X X X X
release
Nerve floss 148 X
Isometric bridge 152 X X X X
90-90 hip lift 153 X X X X
Hamstring curl 154 X X X
Bridge 155 X X X X
Double-leg towel slide 156 X X X
Single-leg towel slide 157 X X X
Nordic hamstring 158 X X X
Hip extension 159 X X X
Bridge with feet on 160 X X X X
foam roller
Bridge marches 161 X X X
Hex bar deadlift 162 X X X
Single-leg Romanian 163 X X X
deadlift
Hip thrust 164 X X X X
Ideal running form
High knees 198 X X X
Marching 199 X X X
A-skips and B-skips 199 X X X
Running 200 X X X
Butt kicks 201 X X X
Straight-leg bounding 202 X X X
Carioca (grapevine) 203 X X X
Strides 204 X X X
Upper-body drill 205 X X X
 PART I
THE RUNNER’S BODY
 CHAPTER 1
Understanding the Body’s
Tissues and Their Healing
Processes
Before we delve into the specific injuries that affect runners, let’s get a
sense of what our bodies are made of. Understanding the different types of
tissues that make up our musculoskeletal system, in particular, is critical to
understanding what is malfunctioning and, in turn, how the body will heal.
In this chapter, we’ll differentiate muscle, tendons and ligaments, bones,
and connective tissue. As you read about specific injuries later in the book
—for instance, a muscle strain versus a bone stress injury—you can better
identify them and recognize what can be done to heal injuries and prevent
them from occurring again.

Geography of the Body

When we think about the human body and its different internal structures, it
can be helpful to think of it as a topographical map. Although the earth’s
mountains, oceans, plains, and deserts are interconnected and unmarked,
topographers have labeled them so that we can navigate and understand the
world we live in. Scientists, likewise, have mapped out the human body.
And just as sometimes there are no physical boundaries that correspond
with a country’s made-up borders, the human body also exists as a
continuum: Muscles morph into tendons, which connect to bones. These
structures have a lot in common, but they also have distinct differences. We
will explore both similarities and differences in this chapter.
 Muscle
Muscles are the power generators of our body. They are what enable every
movement we make, from an individual heartbeat to the thousands of steps
it takes to run a marathon. Let’s look at the basic composition and function
of muscles as we journey down the road of injury, resilience, and
performance.

Muscle Composition
Muscles are made up of countless individual fibers (figure 1.1), which are
the contractile units that your brain can tell to shorten in order to generate
force and power. Muscles are highly vascularized, meaning that they have
an incredibly rich blood supply. This allows oxygen and nutrients to be
delivered very quickly to muscle tissue, which aids exercise recovery and
injury rehabilitation because blood delivers what tissues—including
muscles—need to heal.

Figure 1.1 Structure of skeletal muscle.

Muscle Contraction
Muscles contract in three basic ways (figure 1.2). All are critical for
performance and are integral in strength training. If you are recovering from
a muscular injury, the muscle tissue will be able to tolerate different types
of contractions at different points in the healing process.

Figure 1.2 Types of muscle contraction.

An isometric muscle contraction occurs when a muscle contracts without

any actual movement of the body. Think of squeezing a ball in your fist or
pushing against a wall: No movement occurs, but a force is present. These
types of muscle contractions enhance blood flow to muscles and can be
incorporated early on in the rehab process to promote tissue healing
(Neumann 2010).
A concentric muscle contraction occurs when the muscle fibers shorten
or move closer together. A simple example of this is a calf raise. An
example from running is the contraction of the calf muscle as you push off
the ground, propelling your body forward. When recovering from an injury,
concentric is usually the second type of contraction that the tissue can
handle safely.
An eccentric muscle contraction occurs when a muscle contracts as it is
being stretched or lengthened. This often occurs when you’re trying to resist
gravity. Think of slowly lowering your arm to put a glass down, controlling
a squat with your quadriceps muscles as you sink lower, or absorbing the
shock of impact with your quad muscles (as your knee bends) when
running. Eccentric contractions are the strongest type of contraction, but
because the forces involved are generally greater than in other types of
contractions, they can be damaging for healing tissue (Neumann 2010). The
benefits of eccentric muscle contraction can’t be overstated when realigning
tissue fibers, promoting blood flow to injured tissue, increasing resiliency,
and reducing the risk of reinjury to specific body parts. However, eccentric
contractions can be counterproductive to the recovery process if done too
soon.

Triplanar Movement
The role of muscle contraction is to move our bones and joints in any of
three planes of motion (figure 1.3). Not every joint will move in all three
planes; some of our joints are designed for stability (knee), while others are
designed for mobility (hip, ankle). Yet to thoroughly understand movement
and running, we need to attend to all three planes of motion.

Figure 1.3 Three planes of motion: sagittal, frontal, and transverse.

The first is the sagittal plane—flexion and extension (think “front to

back”). This is the primary plane of motion in which we run. The second is
the frontal plane, which is adduction and abduction, or side to side. Finally,
the transverse (or horizontal) plane is where we get rotation, both internal