Running Injury Free in the Dog Days of Summer

I was sitting in the Emergency Room with a very painful ankle, I could not move it....it was just hanging on the end of my leg. I had just had an x - ray and was noticing a lot of the doctors, nurses, and techs gathering a round an x - ray saying " wow - look at that" and "cool!". Well, guess what? That x - ray was mine - I learned - when a few minutes later the doctors called me over (in my wheel chair) to show me the results. A Pilon Fracture - Yup, basically I shattered my ankle - every supporting bone to keep me upright on my ankle was broken. 

How, you ask? Rock climbing - when it is Rock vs bone and a high velocity fall - Rock will win every time. Yes- I heard it crack. Immediately I knew it was bad. I very calmly called my Mom and asked her to find the nearest emergency room in the town we were in 3 hours away from their house. She immediately asked who was hurt and was surprised it was me because I so calmly asked her for the information. Next my awesome little brother piggy backed me the mile and a half walk out to the nearest road where we flagged down a car to give us a ride. It was a difficult hike for the both of us (imagine him carrying me that far and imagine my ankle bouncing around as we walked over uneven ground).

So back to the ER - this was devastating news for me - a shattered ankle is serious. I had all the doctors telling me I would never run again much less walk correctly. Well to me that was a challenge and after 2 surgeries, 3 plates and 14 screws and begging my orthopedic doctor to let me wear a walking boot ( with a promise on my life to not put weight on my foot for 4 months). Wearing a walking boot with my crutches for 4 months allowed me access to my ankle to do ROM and soft tissue work. I was on my way to proving the Dr's wrong. Did I mention I am a physical therapist? Thank the lord!  I knew what I needed to do to get myself going!  I am so thankful  for the blessings of my fellow physical therapists helping me with my rehab as well! 

On my journey I used what I knew and learned many new things. This journey made me a better therapist to my patients. I was more empathetic but less sympathetic ( when you are hurt too much sympathy keeps you from pushing yourself when you need to). Did I get back to running? Yes! 8 months after my injury I did my first sprint triathlon (5k at the end). Two ironman's later, several half ironman's and half marathons - do I still have an ankle that hurts? Ummm - heck yeah! But you know what? It functions. I had to learn to be the most efficient runner I could. So my point? I am passing some of the key things I used on to you to help keep YOU injury free. I use everything I list below not only for my runners but for my elderly patients wanting to walk and move better as well. Hopefully you find these pointers helpful!

1. Shoes - there are all kinds of shoes out there. But there are 3 main categories - neutral, stability, and motion control. To find out which type you are - go to your local running store like https://www.fleetfeetsports.com or http://www.charlotterunning.com and have them evaluate you. If you know a good physical therapist that can completely evaluate not just your foot but your whole body while running - even better. Once you figure out what type of shoe you need to be in figure out what brand you like and buy it! How to know what category of shoe your favorite brand is? Look up your shoe here: https://www.roadrunnersports.com. Now note of warning here: Once you figure out what your favorite shoe is DO NOT buy 4 or 5 pairs at a time and keep the extras in the closet. Why? Just sitting on the shelf the midsole of a shoe breaks down 50% after one year. So your shoe will not be nearly as supportive as when you purchased it new (this is why discount shoe stores can sell so cheap). Also change your shoes every day. It takes a full 24 hours for the midsole of a shoe to bounce back. So if you take a shoe off at 8 pm and put it back on at 6 am, the midsole has not had time to "reset". 

2. Posture - Have I lost you right there? Laugh, everyone seems to hate that word. But it keeps coming up for a good reason. Good posture = a good base = efficiency! Put weight through your feet and look down WITHOUT leaning forward - if you can not see your feet in your periphery vision, you are leaning way too far back and hanging out on the passive structures of your body (ligaments) rather than using your muscles to keep you straight up. This also causes rounded shoulders and forward head posture. Now try again but tilt forward till you can see your feet in your periphery vision. (stand sideways in front of mirror - because you will swear you are leaning forward like you are going uphill). This is your correct posture -  some other adjustments may be required to the tight structures of your body to make it perfect. 

3.  Midfoot Strike - Say what??? If you are an avid runner you have probably run across this term a few times. Now still standing there, where is your weight in your foot? Is it on your heel? If so, shift your weight until it is right before the ball of your foot (not on the ball or on your toes). Now you are on the midfoot. This will help you learn how to midfoot strike when you are running ( no matter your shoe). You have to learn how to feel this standing before you can learn it running!

4. Falling Forward - Now that we have talked about finding your posture over your center of balance, when you are running correctly, especially at first you will feel like you are falling forward. This is good! Honestly running is just controlled falling forward!

5. Gluteal Strength - aka Butt strength. This is THE most important thing to staying injury free - for your back, hips, knees and ankles. If you have weak butt muscles you WILL get injured. How to test? Act like you are going to sit down on a chair ( no actaul chair there ) or ladies - like you are doing the public potty hover. This means your butt is WAY out - your knees should NOT be past the end of your toes when you look down!  Now squeeze your butt muscles, how long can you stay there or can you get in that position at all? Try laying on your stomach - put a pillow underneath if you have back problems, now lift your leg straight back toward ceiling (no knee bending or arching or twisting your back - I recommend squeezing your butt muscles before attempting) .  How long can you hold it? If this is hard or you can not hold in an appropriate position with out twisting your back (have someone watch you) you probably need to strengthen those muscles. Strengthening this muscle alone will protect your IT Band. For those who have been running a while you know what I am talking about. 

6. Balance- Running is going from single leg balance on one leg to single leg balance on the other - very quickly. If you can not hold a single leg balance for 1 minute (especially without dropping your hip) you should reconsider running until you have done more strength, balance and core work. Not being able to hold your balance means that when you are running something in your system will be taking more force than it should and you will end up with a chronic injury or possibly a stress fracture.  I would recommend walking until you are stronger.

7. Cadence - a faster cadence equals less over reaching of your muscles, especially the hamstrings. Count your cadence over 10 seconds for one side (foot strike). How much is it? It should be around 15 (0n one side) per 10 seconds. If it is 12 or less your turnover is way too slow and you are putting too much pressure and stretch in your system when you run. Faster cadence = faster, more efficient running. The fastest runners in the world have the fastest cadence. I will tell you when I first started doing this I would swear I was shuffling! I used to take pictures of my patients to show them how much better and upright they looked with their faster cadence!

8. The 10% rule- only increase your total mileage 10% a week. This gives your body time to accommodate to the increased training and distance and remain injury free. This is especially important as we get older and our body is not quite as elastic. Example: If I run 20 miles this week total, the next week I can increase my total mileage to 22 miles, etc.

9. Hydration - So, so very important all the time, but more so in the summer! Did you know that being well hydrated decreases pain by a significant amount? Please make sure you are taking in enough fluids and electrolyte replacement as you sweat. A dehydrated body is one that is more likely to be injured!

10. Recovery - No you will not lose your training by decreasing your mileage for your recovery week. If anything you will be gaining fitness! Your body needs time to absorb training, ALL athletes need recovery. Recovery does not mean you stop training, you just reduce your volume for a week.  I reduce my training  at least 20 to 30 percent during my recovery weeks.(Following the 2o mile example - If I had built up to 20 miles, during my recovery week I would reduce my total mileage to 14 to 16 miles).  And you NEED to take them at regular intervals! When I was ironman training I discovered I did the best when I trained hard and increased mileage for 2 weeks then took a recovery week (reduced volume) on the third week. Most people do 3 weeks of increased intensity with 1 week of reduced. 

11. Doing the same thing the same way = insanity. If you discover you continually go from one injury to another while running, it is time to change!!

I hope everyone found this article helpful. These are things I had to learn to be really good at if I wanted to get back to being a healthy runner even with a bum ankle! 

Note if you are injured - please make sure you get some help! It is hard to evaluate and treat yourself!

Blessings Always!

April of Running Mom Photography