Running is all fun and games until you experience your first injury.
I have experienced my fair share of running injuries. In fact, just name it! I've probably tackled it at some point in my life. I know, that sounds really bad considering I am a personal trainer. Let me explain myself..
In my teens, I ran almost every day. This was when I was young, full of energy, didn't know anything about anatomy, and rest days were reserved for when I died (is that how the saying goes?). This was the time in my life when I experienced **overuse injuries **. These injuries occur from chronic, repetitive movements. Eventually, without enough rest your body will break down. And that is what I experienced time and time again. When I was a teen, I didn't lift weights or do any mobility work. I pounded the pavement every single day. Later in this post, I'll dive deep into our first culprit, the ITB Syndrome.
In college, I got a lot better at stretching and applying yoga to my routine. However, I would begin to get knee pain under the knee cap due to my knee cap "shifting" during my runs. It wasn't until I applied physical therapy exercises and a band to wrap around my knee, that I finally ran pain free. Later, I learned this was called Patellofemoral Syndrome.
Fast forward to post-college trainer Amanda, I am well versed in many common injuries but had recently experienced a new hip pain. I could not figure out its' wrath until truly understanding the mechanisms. This pain was what I would call "just plain annoying". My glute med and piriformis were on fire most of my spring half marathon training. I began to self-diagnose this as piriformis syndrome.
If you experience hip pain during your runs, look no further. This guide will give you the tools to understand why your experiencing pain, how to fix and how to combat it from returning.
ITB Syndrome
The Iliotibal band is a collection of muscles that run laterally from your hip and attach to the knee. People who suffer from ITB syndrome will complain of a burning sensation on the side of the knee when bending it; commonly during a run or going down steps. This burning feeling happens mainly to those who excessively drop the opposite hip and twist the injured knee during a run.
For example, when my left ITB flares up it is normally due to a long-mileage run when my hips get fatigued. My right hip tends to drop which causes my left knee to twist inward. This is also called "knock knees" and truly only happens to me when my form breaks down. Another key point to note is the fatigue and weakness in my hips is the root cause of the pain in the knee.
So now that you understand the mechanism of ITB syndrome, it's time to apply exercises that will strengthen the hips (to in-turn fix knee pain).
Seated Lateral Band Pull Aparts
This exercise can be performed with a tight band and a place to sit. Placing the band around your knees, pull the band apart using your glutes, hips and quads. This will strengthen your hips lateral flexion and help decrease strain on the knee from ITB tightness.
Foam Roll Glute Med + Max
ITB causes extreme tightness and it is very hard to stretch this muscle. This is where foam rolling can help. By foam rolling the glute med + max, you can increase the flexibility in the ITB and help elevate tight hip pain.
Figure 4 Stretch
After foam rolling, a static stretch like the standing figure 4 stretch can hit both glutes, ITB and piriformis muscles.
Patellofemoral Syndrome
This is deemed as the most common knee pain reported from runners. The pain occurs under the knee cap and is most present during prolonged periods of sitting (flexing the knee). There have been a lot of studies and research around why this injury occurs and it is found that the root cause stems from hip weakness (do you see the common theme?). When running with weak hips, your patella is more likely to shift during your runs. This knee shifting pattern only happens because the hips aren't able to support the load and impact of running.
There are many different ways to alleviate pain from patellofemoral syndrome; many people use orthotics or knee straps. I use a knee strap and never experience my knees caving in while I wear it during runs. There are a few exercises that can help strengthen your hips and work on external rotation of the knees as well:
Lateral Band Walks
Lateral band walks help to strengthen your hips by pulling against resistance. I like to do these before and after a long run. This ensures my glutes are turned on before my run and serve as a great therapy exercise post run.
Foam Roll Quads
Foam rolling the quads will help to stretch them! Tight quads are a risk factor to developing patellofemoral pain. Foam roll the quads before your run to prevent risk of injury.
Piriformis Syndrome
This little muscle protects the femur from becoming fractured from running. It attaches from the head of the femur to the hip bone. Although it is meant to protect you from injury, this muscle comes into contact with the largest nerve in our body, the sciatic nerve. As the piriformis is working while you're running, it begins to irritate the sciatic nerve which may cause pain and tingling all the way down the back of the leg.
The greatest treatment (and prevention!) is to stretch the hip rotators and abductors. These muscles - the glutes and piriformis- work together to cause this sciatic nerve irritation.
Following stretching, it is important to strengthen these muscles to prevent reoccurring pain. The following exercises help strengthen the glute med, which is a prime contributor to weak hips and sciatic nerve pain.
Standing Clam Shells
Standing clam shells involve balance and hip mobility. This specifically hits the glute med, a muscle that contributes to piriformis syndrome when weak.
Lying Clam Shells
This version takes balance out of the picture and allows you to focus on simply engaging one glute med at a time.
Sleeping + Sitting Position
I made the mistake many times of sleeping on my stomach, with my knee bent and out to the side. This feels good to my sciatic nerve initially; but this is a shortened position of the piriformis and may actually contribute to more tightness. It is better to sleep on your side with a pillow between your knees. The same rules apply to sitting; figure 4 feels like a good idea until your piriformis becomes extremely tight and causes more irritation. Work to sit with your legs straight out in front of you or practice getting up from your seat multiple times a day.
Hip and knee pain are bound to happen in your running journey; but knowing how to combat and strengthen the muscles involved that will keep these issues at bay. I rarely experience any pain in my hips or knees because I have learned so much about the contributing risk factors. These exercises have saved my running career and continue to make pounding pavement enjoyable for me. I have helped hundreds of clients alleviate these issues with the previous exercises and more. The most important note is to always prioritize strengthening your weaknesses.
If this was helpful and you want more information on running injuries that you're experiencing, reach out! I would love to give you my tips and tricks for successful, pain-free running.