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Training Tips

Isn’t all that running bad for your knees?

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The Centre for Sport and Recreation Medicine has been a proud medical sponsor of the Scotiabank Toronto Waterfront Marathon for 15 years. We’ve had the privilege of helping many runners make it to the start line and watch thousands of runners cross the finish line every year. New this year, we’re partnering with Canada Running Series to provide a monthly blog to support runners preparing for the race. Whether this is your first 5K or your 50th marathon, we wish you well in reaching your goal!

By: Alison Pinto, PT, FCAMPT, CAT(C)
Physiotherapist, Athletic Therapist

Good-intentioned people (typically non-runners) often advise runners to be wary of running so much because of the harm it will do to one’s knees.  While it’s assumed that pounding the pavement also results in pounding the cartilage of the knees, eventually leading to arthritis, this is not the case. In a recent study comparing runners and non-runners, Lo et al. determined there was no increased risk of symptomatic arthritis in runners and that running does not appear to be detrimental to the knees. Similarly, Chakravarty et al. looked at x-rays for a group of long distance runners and non-runners over almost twenty years and determined that runners did not develop arthritis at an accelerated rate compared to non-runners. It’s believed that running could even be protective against arthritis since running assists in maintaining a healthy weight and keeps muscles strong, thereby decreasing load on the joints.

Strong Glut Medius – Proper alignment

That being said, knee pain in runners must be common enough to coin the term “runner’s knee”. This type of injury (also known as patellofemoral pain syndrome, or PFPS) is characterized by pain in the front of the knee around the knee cap. Pain usually occurs while bending the knee, such as squatting, going down stairs, or running. While the pain can be sharp and hinder day to day activities, this type of injury is usually the result of a muscle imbalance and not structural damage to the knee. Since running is a forward motion, runners tend to develop tightness in the muscles that move the hip in that direction, namely the iliopsoas (hip flexor) and tensor fascia lata. Conversely, muscles that control the lateral mobility of the hip (gluteus medius and mimimus) are underused and become weaker. However, those lateral muscles are important to stabilize the pelvis and knee while running.

Weak Glut Medius- Leads to hip drop and knee collapse.

To test how strong your lateral muscles are, stand in front a mirror with your hands on the top of your hip bones. Now bend your right knee to lift the right foot off the ground. Ideally your hips should remain level and your knee should remain over the ankle

If your right hip dropped it indicates weakness in your left hip stabilizers. Hip drop leads to the knee collapsing inwards when all the weight is on that leg. As a result, the knee cap (patella) rubs against the ridges of the thigh bone (femur) instead of gliding smoothly in the groove. This leads to the sharp pain that is felt when bending the knee.

If you found that you were weak on one (or both) side, try this strengthening exercise:

  • Lie on your side with hips and knees bent slightly. Ensure shoulders, hips and heels are all in a straight line.
  • Keeping the feet together, lift the top knee as high as possible without rotating backwards through the pelvis. Ensure you feel the muscles of the buttocks and not the front of the hip working.

Repeat 3 sets of 10-15 reps, or as many as you can do with good form.

Don’t let runner’s knee hold you back. See one of our highly-trained therapists who can determine if you have any muscle imbalances which may be impacting your running. Visit our website at www.torontosportsmedicine.ca to book your appointment today.

References

Chakravarty, E. (August 2008). Long Distance Running and Knee Osteoarthritis: A prospective Study. American Journal of Preventative Medicine, 35(2), 133-138.

Lo, G. (February 2017). Is There an Association Between a History of Running and Symptomatic Knee Osteoarthritis? A Cross-Sectional Study From the Osteoarthritis Initiative. Arthritis Care & Research, 69(2), 183-191.

Tell-tale signs that you need a day off

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It’s often believed that “more is more” when it comes to training.  Runners get stuck in a mindset that the more they do, the better they become.  This is true to a certain extent, but oftentimes the value of a rest day gets forgotten.  If you have put your body through the wringer with workouts, long runs, and cross training without a day off, chances are you aren’t going to recover enough to reap the benefits of your efforts.  Instead, a cumulative fatigue can set in and leave you overtrained or burnt out.

Here are some tell-tale signs you might be due for a day off:

Altered heart rate:
This is noticeable particularly with individuals who train with a heart rate monitor.  Many of us have an idea of what our resting heart rate is, and if you don’t it’s worth figuring out.  When your resting heart rate is altered, it’s a sign that your metabolic rate is elevated to meet the demands of training.  A lower-than-normal heart rate can also be an indication that you’re overtraining.  When you’re feeling off, take a heart rate check and see if it’s trying to tell you to rest!

Increased irritability:
Overtraining can not only affect your physical state, but your emotional state too.  When you’re starting to burn out, moodiness, depression, and general irritability are common.  While we all know exercise is supposed to make us happier due to the blissful endorphin rush, these stress-fighting chemicals are released alongside cortisol which is a stress hormone.  If cortisol levels remain elevated for an extended period of time, it can negatively affect one’s mental health.  It can get to the point that running/exercising is no longer enjoyable, and anyone/anything can send you spiraling into a bad mood, especially if they ask about how training is going!  If that’s the case, take a day or two to reset and allow your body to relax.  Pop into a low key yoga class to really let your mind settle – just make sure it’s easy.

Extended muscle soreness:
When you’re training hard, it’s common to have delayed onset muscle soreness (DOMS) for one or two days after a workout.  The issue is when that muscle soreness is prolonged, or just doesn’t go away.   If you’re still sore after 72 hours, it’s worth scheduling a day off.  Working out on sore muscle can hinder any muscle building efforts.  Instead of trying to hammer out another workout session, or even pounding the pavement on an easy run, take that time to roll, stretch, refuel, and hydrate to allow your muscles to rebuild without being broken down again.

Insomnia:
When we’re tired from intense training, it’s usually easy to fall asleep.  However, when we’re extremely fatigued, insomnia can set in.  This is due to an overload on the body’s nervous system and hormonal system.  It’s crucial to sleep during the 10pm to 2am period as your body builds and grows during rest, not during training.  The stress of overtraining can lead to anxiety, impair our judgements, decrease cognitive function, and lower our immunity.  Anyone who has suffered from insomnia knows that it’s a negative cycle: the less you sleep, the more you worry about not sleeping, and the harder it is to sleep.  Taking a few days off and focusing on allowing the body to properly shut down at night could be the winning solution to one’s insomnia.

Unquenchable thirst:
Dehydration can play a huge role in overtraining.  Our body sweats during exercise, and the more you exercise, the more you sweat.  A good indicator of your hydration level is to look at the colour of your urine.  The darker the colour, the more your body is struggling to retain fluids because there isn’t enough circulating the body to properly hydrate you.  The dark urine indicates that the body is retaining as much water as it can while still excreting waste.  Therefore, the more hydrated we are, the more water we have in our urine making it more diluted.  Dehydration can also cause headaches, dizziness, muscle cramps, and irritability.  If these symptoms are present, be sure to add in some electrolytes into your water too.

Safety Tips for Runners

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Running safety is of the utmost importance, but sometimes it gets pushed out of people’s minds as thinking about the consequences isn’t appealing. Run-ins with bicycles, cars, dogs, or other people are all things that could have a potential risk associated with them. The best way to eliminate any fear or reluctance while out on a run is to be properly prepared. Follow these simple guidelines for best practices in run safety:

  • Know your route.  Make sure you’ve planned ahead according to what time of day you’re running at.  If there’s a route that’s well-lit and more populated, choose that if you’re heading out in the dark.
  • Tell someone where you’re going.  Not only is planning your route good practice for your own benefits, but it makes it easier to share with someone else.  If you’re planning on heading out on a solo run, inform a friend, significant other, or family member of where you’re going and how long you’ll be.  That way, should anything happen they’ll know where to go.
  • Be aware.  It’s easy to zone out while on a run, especially when we get into a good rhythm.  However, it’s important to keep tuned in to your surroundings throughout the entire run and not just when you deem it necessary.
  • Avoid headphones.  While it’s nice to have the company of some good music or an interesting podcast, running with headphones can eliminate the sounds of the things around you.  It can be difficult to hear an approaching bike, car, person, or even a foul ball from a recreational baseball game if you’re plugged in. If you must have your headphones, leave one ear out.
  • Be visible.  Don’t assume because you’re wearing a light coloured jacket that people will see you.  Instead, make the assumption that no one can see you and dress appropriately.  Wear high-vis gear such as reflective vests, headlamps, and other clip on lights so people know exactly where you are.
  • Bring your phone.  It’s always nice to leave your phone at home and take a break from the incessant buzzing of e-mails, texts and other notifications, but sometimes it’s smarter to bring it with you.  You can set it to ‘Do Not Disturb’ so your pocket isn’t constantly making noise, but at least you’ll have it in case of emergencies.
  • Carry ID.  Heaven forbid something does happen during a run, having a piece of identification can help if you’re injured or in a situation where you need someone else’s help.
  • Run with a group.  It can be a local running group, a friend, or your dog. When you run with someone it decreases the chance of being targeted as a victim, and provides a helping hand if you get hurt.
  • Trust your instincts.  Don’t put yourself in a situation where you feel uneasy.  If heading into the trails as the sun is setting doesn’t make you feel confident, stick to a well-lit path.  If there’s a person that doesn’t look trust-worthy, veer away from them or change direction accordingly.
  • Follow the rules.  Face oncoming traffic; look both ways before crossing the road; obey traffic signals; and check around you to avoid bumping into an oncoming or passing runner.
  • Vary your route.  Not only does it keep things fresh for you, mixing up your route can stop recognizable patterns.  Be sure to stay in familiar areas and keep in mind where the nearest open stores/businesses are.
  • Know basic self-defense.  Take some time to learn some basic self-defense moves to properly prepare you for any situation that may occur.

Running Solo

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By: Katrina Allison, Speed River Track and Field Club.
Photo Credit: Michael P Hall.

My name is Katrina Allison, and I am a 10,000m runner with Speed River TFC. I was born in Vancouver where I was introduced to the sport through the Thunderbirds Track Club, and then attended the University of Guelph where I competed for four and a half years as a Gryphon. Recently I have taken on my next academic chapter, where I am studying to become a naturopathic doctor in Toronto. I am now running post-collegiately, and am still coached by Dave Scott-Tomas and the Speed River group in Guelph. I’m currently gearing up for an outdoor track season after suffering an injury that put me out for the 2016 season.

Most runners would agree that running is an activity best enjoyed alongside their closest training partner or community running group. However, many of us will find ourselves lacing up alone at some point or another. While having a training group provides structure, a social outlet, and a little friendly competition, running on your own can also have benefits. The key is approaching solo workouts with the right mindset.

  • Stick to a schedule. If training on your own for an extended period of time, the flexibility of being able to fit workouts and runs into your own personal timetable is a definite plus, however it can also lead to a loss of accountability. If you procrastinate a run because there’s no group to notice your absence, it may lead to runs being skipped or pushed off. I recommend planning out your week’s workouts ahead of time. That way you can still navigate social events, work or school obligations, all while ticking off your training plan.
  • Download an upbeat playlist. Or don’t! If the hardest part of a solo run is getting out the door, having some tracks on hand that energize you and make you want to move can definitely do the trick. That being said, don’t be afraid of running sans tunes. You’ll be amazed at how therapeutic a run can be when you allow your mind to wander without the bombardment of the latest beats. Before you know it, you’ll be back at your door with a clearer mind and a few km’s in your legs.
  • Use GPS sparingly. Without the pressure of your training partner breathing down your neck, it may seem difficult to push yourself to the pace you know you’re capable of running. This is when a GPS watch can help give you an indicator if you’re way off pace, or right where you need to be. If you know what pace you normally run with a group, you can use that as a bench mark for solo workouts. But don’t berate yourself if you’re a second or two off pace; the mental toughness aspect of your workout is definitely higher than when you’re just coasting behind your workout buddy.
  • Change it up. Workouts can get monotonous when you don’t have playful banter to make the miles blow by. It may be helpful to constantly keep your body and mind guessing by trying new things. If the thought of doing the same set of mile repeats around the same park at the same time every Tuesday makes you sick to your stomach, it’s definitely time for some creativity. Hit the track one week, followed by trails the next. Throw in some hills, try change of pace workouts, find a cross training modality, and add in some strength training. Your fitness and your sanity will thank you.
  • Appreciate the chance to listen to your body. As much as running with others helps us to push ourselves, it can also cause us to push ourselves too hard. Training solo even one or two days a week can help you stay in tune with what you’re body is telling you, and give you the chance to comply with your body’s needs. You may even notice earlier indicators of overuse injuries that would have been drowned out by the latest recount of Game of Thrones with your pals. Go the pace that best facilitates your recovery and preparation for the next big race or workout, and check in with how your body is coping with your recent training.

Making it to the Start Line Injury Free

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The Centre for Sport and Recreation Medicine has been a proud medical sponsor of the Scotiabank Toronto Waterfront Marathon for 15 years. We’ve had the privilege of helping many runners make it to the start line and watch thousands of runners cross the finish line every year. New this year, we’re partnering with Canada Running Series to provide a monthly blog to support runners preparing for the race. Whether this is your first 5K or your 50th marathon, we wish you well in reaching your goal!

By: Alison Pinto, PT, FCAMPT, CAT(C)

As a Physiotherapist/Athletic Therapist, I often meet people only after they have sustained an injury and are looking for a solution to get back to their sport as soon as possible and advice on how to prevent the injury from recurring. By this point, a lot of them are frustrated because running was their form of exercise, a source for stress relief, and a method of accomplishing a new goal and now they can’t do it. So how do you save yourself from this frustration and avoid becoming sidelined by an injury? Here are some tips to help you make it to the start line of your race.

  1. Training

When choosing a training program, consider your current level of physical activity and running history. Training programs that have consistently high weekly mileage and high intensity runs (i.e. tempo runs, hill repeats, race pace runs) are best suited for people who have some prior running experience. Training programs that start with shorter distance and gradually increase to longer distances as well as start with steady runs and build to higher intensity runs are best suited for novice runners or those embarking on a new distance (such as 10 km to half-marathon or half-marathon to marathon).

In general, weekly mileage should increase by no more than 10% per week. This is due to the fact that muscles, tendons and ligaments take time to adapt to the forces placed on them when running and a larger increase in weekly mileage will often result in musculoskeletal injuries.  Another thing to consider is how far, how frequently, and how fast you are running. It’s best to change only one component at a time and to have a solid cardiovascular and muscle strength base before adding speed.

  1. Warm Up and Cool Down

The purpose of the warm up is to prepare your muscles, heart and lungs for more intense activity. Therefore, the warm up should mimic the movements you will be doing during the workout, but at a lower intensity. The warm up should be dynamic in order to gradually increase heart rate, breathing rate, and blood flow to muscles. For runners, this can include hip swings, high knees, butt kicks, heel raises, and light jogging. The cool down is mean to relax the body after intense activity.

Consider doing a light jog or short walk before completely stopping your workout in order to gradually reduce your heart rate and prevent blood from pooling in your legs (which may make you feel light headed or faint). Static stretches, held for 30 to 60 seconds, are best performed post-workout to restore muscles to their resting length.

  1. Cross Training

Cross training is considered to be any activity that is different from your primary sport. Whether it be cycling, swimming, weight training, or yoga, cross training is beneficial because it allows you to use different muscles or use your muscles in different ways so as to prevent repetitive and overuse injuries. Cycling and swimming are great low impact cardio workouts while weight training and yoga help build muscle strength, endurance and flexibility. Cross training can even be used as your recovery after a hard running workout to reduce muscle soreness.

  1. Dealing with Aches and Pains

When starting any new activity or increasing the intensity of an exercise, some soreness is to be expected. How do you know what is normal pain and what is a potentially an injury? “Normal” pain, also known as Delayed Onset Muscle Soreness (DOMS) occurs in the muscles that were worked due to micro-tears and inflammation. DOMS usually lasts 2-3 days and gradually reduces over time. Ice or light activity can be used to reduce DOMS. The good news is that the next time you workout at the same intensity, DOMS won’t be as bad since your body has adapted and become stronger.

“Bad” pain can occur in muscles too, but more commonly occurs in tendons and joints. There may be inflammation (swelling, heat, redness) around the area and the pain often lasts longer than 2-3 days. If the pain is lasting more than 5-7 days, is worsening, or is causing you to compensate in some way (i.e. limping while walking or running), it is best to seek help from a medical professional. Pushing through pain often leads to delayed healing as well as secondary aches and pains in areas that are compensating for the primary injury.

The Centre for Sport and Recreation Medicine has two locations in Toronto and a variety of health professionals to assist you in getting healthier, stronger and faster. Visit our website at www.torontosportsmedicine.ca for more information or to book an appointment with our staff.