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Running injuries! In this episode we invite Dr. Ben Shatto on the podcast and fire away with injury related questions sent in by Academy members.

You will learn when to self-treat an injury versus visiting a physical therapist, how to pick a PT, and great questions and answers about glutes, hamstrings, and muscle imbalances. Lots to love!

Running Injuries Q and A

Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

Questions featured in this episode:

1. Does he have one major symptom or sign that would tell us whether an injury just needs a few days rest vs a therapy or doctor visit? (Eg swollen? Hurts to touch?) -Mairead

This depends on the injury and pain level. Always listen to your body and if symptoms worsen or are not progressing in a positive way, ask for help. Swelling can indicate some damage is occurring. If you experience loss of motion or difficulty bearing weight go see a doctor. Like many things, you can use your common sense. It’s better to ask for help and not need it than to not ask and risk further injury.

2. I’d like any input on how to pick a good physical therapist once you need one, as at different times in my life I have been to several and some of them seem to be much more successful at athlete rehab and working with runners than others. Telling me to stop running or stop doing whatever sport I’m doing is not the answer, but I’ll do whatever stretch/strength that I’m given. -JJ

First and foremost, find a physical therapist that is also a runner. You can visit your local running store and ask who they recommend. Also look for additional certifications, such as OCS (Orthopaedic Certified Specialist) or SCS (Sports Certified Specialist). If you don’t like whom you are working with, please change physical therapists. A good rapport along with an understanding of your body and goals are critical. For more information refer to: http://aptaapps.apta.org/findapt/index.aspx

3. I have a partially torn tendon in the gluteus medius that attaches to the greater trochanter. After 7 months of physical therapy, chiropractic and cortisone shots, I have improved greatly. I have been running 2-4 miles over the last 2-3 weeks. But during the last run of 5 miles, at 4.5 miles I had pain again which lasted several days. Will I be able to run longer distances again without having surgery?  -Sharon

This is a major injury. Concentrate on building a stronger running base and not pushing too hard too soon. Progression should be very slow to avoid re-injury. To progress, keep within a pain-free distance and then at about 3 miles, start a run/walk protocol to slowly increase distance. Use this method to help progress your running base and time on your feet while avoiding pain: Avoid uneven running surfaces such as trails, assess your running technique (If it is a narrow base when you run, this puts more pressure on the IT band and gluteus medius. You may want to run with a slightly wider base), continue to work on improving your hip strength, focus on the gluteus medius, but also focus on the piriformis and other rotators of the hip in order to provide additional stability to the hip. Be sure to work on core strength. For more information, please refer to this article.

4. Would love to hear about “sleeping” glutes and what can be done to reawaken them!  -Britt

The most common cause of this is chronic sitting as well as poor posture from either standing or sitting. The treatment is to move more. Not to just stand more (although that is better than sitting), but move more. Focus on activities that activate the posterior chain such as squats, deadlifts, and bridges. Increase the neural input to the glutes. The more you use them, the more the neural pathways will be established and re-enforced. As part of cross training, implement core strengthening which will help to prevent low back pain. Here’s an guest post I wrote on low back pain

5. I was told I have multiple imbalances in one leg. One was tight ankles. My question would just be how do multiple imbalances happen? Is it genetic or is it just something that happens from injury? -Johari

Imbalances can be genetic. There are many different structural anomalies found in individuals. Having said that, most imbalances are from chronic poor posture: poor sitting posture, poor standing posture, asymmetries with common movement patterns (for example only crossing your left leg, or always sitting on the couch with your legs tucked under one direction). Try to spot train the imbalances and asymmetries as best you can. Work toward gaining symmetry in the body. Small changes over time will yield big results.

6. Please talk about treatment for proximal hamstring strains.  -Stephanie 

Hamstring strains can be tricky to recover from. Severe Grade II sprains can take 6-9 months to fully recover from. Minor strains may take 1-2 months. To determine if you can self-treat, determine severity of injury: Can you walk normally? How intense is the pain, and what brings it on? Was there bruising present at the site of injury?

Initial treatment is rest, ice, compression, and gentle motion. Avoid anything that causes pain.
As pain level and range of motion improve, start with soft tissue work by utilizing a foam roller. Initially stay away from the area of the injury. As the pain improves, you can work over the injured area.

Progression then would be to improve range of motion (ROM). Resume full motion without pain. Work on the strengthening of hamstrings as well as core strength. Start slow with strength and motion. Exercises eventually will be ball bridging, dead lift, and straight leg dead lift.

Remember to double your warm up time as you progress back into running. Also be sure the hamstrings are ready to be active. It’s very common to re-injure this area, so be careful.

Also Mentioned in This Episode

The Physical Therapy Adviser -Dr. Ben’s website. Ben Shatto, PT, DPT, OCS, CSCS is a physical therapist who specializes in managing orthopedic conditions and strength and conditioning. Ben has been running since 2005.

Carbon 38 -the best online shopping destination for fashionable, high performance women’s activewear. Save 15% as a MTA listener.

The Runner’s Toolbox free downloadable resource to help you prevent injury.

Exercises that strengthen glutes, hips, and hamstrings.

• Glute bridge- single leg for more challenge
• Single leg dead-lift- with weights for more challenge
• Bird dog
• Hip hikes- stand on step, balance on one leg, let hip drop and lift

Check out part two here which focuses on injury recurrence, plantar fasciitis, knee pain, ITBS and more!