Injuries

Many common running related injuries result from runners who only run and who do not have good overall muscle development and strength. Having well-developed leg muscles can help support the joints, tendons and ligaments that support your running. Having a strong core can help you maintain proper running posture in the latter stages of a race when fatigue sets in. And having a sufficiently developed upper body can help you propel your body forward and reduce some of the dynamic impact force caused with each footfall.

Below is a modified workout program I learned from a friend who is a United States Navy SEAL officer. This workout consists of five small routines done with little rest between sets. Each routine focuses on a specific move (push-ups, pull-ups, sit-ups, dips, and single leg squats). I typically perform six circuits throughout each day. These can be done at home, at the office, on the road in a hotel room or at the gym. They rely only on body resistance.

EXERCISE REPS Pull-up 5 Chin-up 5 Behind neck pull-up 5 Pull-up 5

EXERCISE REPS Quarter leg-ups 25 Lactic acid flush 15 seconds Quarter leg-ups 20 Full crunches 25 Quarter knee-ups 20

EXERCISE REPS Full dips 25 slowly

EXERCISE REPS Right leg squat 25 slowly Left leg squat 25 slowly

Wouldn’t it be nice to be indestructible? Haven’t we all had those periods in our training and racing where we feel like all we need to do is add a little more mileage, a little more quality, and we’ll be right where we want to be? Then bang, we’re down. Achilles, hamstring, hip, knee, foot. What happened? What was the straw that broke the camel’s back? You look back and try to unwind how you got to where you are, which is…injured!

Strength training, core training. Yes, you’ve heard it, read it and maybe are doing it. Good for you. I do it too, but sometimes it’s not enough for the amount of stress we put on our bodies. What I want to talk about is something a little more unconventional, and something I have used extensively here in Hong Kong that can really help unwind a tight body. Dry needle therapy. No, not acupuncture, although acupuncture may help with other issues.

According to Liam Fitzpatrick, an Australian sports therapist who specializes in trigger point, muscle and fascia release using various modalities, including dry needling, “Dry needling is very useful when a specific trigger point needs to be released. It can be more effective than hands on soft tissue work (massage and stretching) because the introduction of a foreign body into the muscle or other soft tissue stimulates a fight response and the body sends all the ‘good stuff/fresh blood’ to that specific area to flush out the muscular contraction or adhesion. With massage or stretching, the target is very broad and the response not quite so strong.” Sound like what you need? Read on…

My first experience with dry needling was in South Africa. Four days before Comrades last year, I found myself on a sports physiotherapist table in Durban hoping for a solid rub down before the race. The physio thoroughly worked through my legs, hips and back, but got to my calves and said “wow, this calf is kind of locked up. Do you mind if I pop a needle in there?” Knowing that Comrades was an uphill course that year, and knowing that my calf was my weak spot, and judging from her thoroughness and expertise in physiotherapy (she was the lead physio for all physio stations along the Comrades course), I thought, what the heck, I trust her, let’s see how it goes. Basically she took an acupuncture type needle that was longer and broader in diameter than a typical acupuncture needle, and inserted it into my calf. Deep. Into the belly of my soleus. I felt a deep ache as if my calf was on the verge of a strong contraction. Then she cheerfully said “I’ll be back in 15 minutes. Give a shout if you need anything.” So for 15 minutes I sweated, ready to let out a cry at any moment, thinking my calf was going to go into a horrible contraction. Relax, relax, relax, I told myself. The contraction never came. Slowly the muscle released. I was very sore that night and the next day, but I had a range a motion I haven’t had in a long time. And I had zero tightness or issues running the 54 miles of pavement with an uphill slant that was Comrades 2011.

“Dry needling” means that the therapist is not using any fluid for injections. The needle is dry. If the needle was a vehicle for transporting anything into the body (i.e. flu shot), it would be a “wet” needle.

How does dry needling differ from acupuncture? Acupuncture works on a meridian system where needles are inserted into the body along meridians that tie to energy pathways in the body as well as organs (i.e. Kidney, Liver, Spleen). The goal of acupuncture is to move your qi (pronounced “chi”), and to stimulate different organs that may be in a depleted state. I have used acupuncture for helping with sleep, digestion, as well as to help recover energetically.

Dry needling for sports therapy differs significantly in two ways: 1) The needle is placed where the “pain” or tightness is; and 2) Needles are typically longer/larger and are inserted deeper than acupuncture needles. Often dry needles for sports injuries will be inserted at an angle until the therapist hits some resistance which may signal an adhesion or a locked up muscle. The needle is then just slightly drawn back and possibly reinserted deeper.

There is an art to dry needling. If you want to try it, make sure you find someone who is trained and well practiced in dry needling for sports therapy. When I was living in Bend, Oregon I couldn’t find anyone who practiced dry needling, so I asked an acupuncturist to try the dry needling technique. Unfortunately, I never experienced the degree of muscle release that I was looking for. Once I moved to Hong Kong, I sought out a therapist who used dry needles, thinking HK was a place where I could find this East meets West type therapy. Here in Hong Kong, I see Liam Fitzpatrick at Myoactive Therapy. Liam has been using dry needling along with other modalities on athletes here in Hong Kong for the past 6+years. He has been instrumental in getting me back on my feet after a hip and hamstring injury left over from tripping on a run shortly after Western States last year. It’s only been in the last six weeks of consistent dry needling of my hamstring, hip and back that I have been able to get back to running without any pain.

Running without pain is all we ask for, right? Then we can add in the mileage and the quality that enables us to do what we love - - run on the edge.

Every year one of every three serious runners will incur a running-related injury. Two thirds of these injuries result from training errors (J Am Acad Orthop Surg 1995;3:309-318). Dr. Stan James, MD paraphrases a colleague’s “rule of too’s” stating “athletes court disaster when they exercise too often, too hard, and too soon and too much after injury and attempt remediation too little and too late,” (JAAOS 1995;3:309). The “rule of too’s” summarizes most controllable factors in avoidance of injury. Of course there are other factors such as trauma, intrinsic biomechanical problems and possibly age. But I’d like to focus on the most common risk factors, as these training errors are also avoidable.

Unfortunately, what constitutes “too much” varies according to individual athletes as well as their chosen activities. Some people are more susceptible to injury when they increase hill work while others are more at risk from increasing speed work. Athletes need to learn to listen to their bodies, as most overuse injuries develop slowly over time and can be successfully dealt with if caught early. If you have difficulty deciding what discomfort feels like injury and what is just benign muscle soreness or fatigue, consider working with an experienced coach (preferably one with an athletic training, physiology or physical therapy background) until you learn to read your body well.

There are some general guidelines in avoiding the trap of the “rule of too’s.” Do not increase weekly mileage by greater than 5-10% per week. Do not add or increase your speed or hill work while your are increasing mileage. Do not add speed work concurrently with hill work additions. Be extremely careful in returning to previous levels of running following lay-offs due to injury, pregnancy or simply time away from the sport.

In addition to following the general rules above, I schedule time away from training. I usually take one day off a week, and always take at least two weeks (yes, 14 day in a row) off from training each year. Following these two weeks of no training, I take an additional 4 weeks off from running. During this time I ski a lot, use cardio machines at my office (mostly elliptical), hunt, hike, snowshoe and generally explore non-running fitness options. I feel guilty and lazy when I’m not training, but really enjoy the following 4 weeks of alternative sports. And when I return to my regular program, I’m physically recovered from a long year of training and racing, and, perhaps more importantly, I am mentally fresh, alert and in love with running once again.

Please note that I do not believe everyone needs to take a full 6 weeks off from running each year. It is just what I do. It works particularly well as I spend my winter ski racing. Some runners don’t have the luxury of loving a non-impact sport. And some of these people may do well with 2-4 weeks a year off from running. But I do credit my longevity as a very competitive, frequently-racing ultrarunner to my low winter mileage and love alternate sports.

Once injured, runners need appropriate rest, which usually doesn’t mean a complete layoff from running. They also generally need skilled care and/or advice as to specific musculature which needs strengthening or stretching in order to remediate the current problem and avoid its future recurrence. As mentioned above, the return to running often needs to be slow and calculated. There are exceptions to this, but generally one benefits from a measured return to full function. As there is so much variability in running injuries and there causes, I will recommend here that people seek care soon after recognizing injury. Be sure your provider experienced in treating runners. I have known massage therapists, trainers, physicians, chiropractors and physical therapists with passions for treating runners. Seek these people out. Find one with whom you work well and develop and maintain a relationship with this health care professional. He or she will get to know the needs of your body (and mind) and can be invaluable in the treatment and prevention of injury.