15 Nov The Best Prehab Exercises For Running Injuries
Are you a runner trying to stay healthy so that you don’t have to stop running? If you’re looking for exercise solutions for a running injury and want to learn running injury prevention knowledge, you’ve come to the right place. We have simplified the literature investigating common running injuries to bring you not only our favorite but the most effective runner’s prehab exercises. In this article, you will learn runner’s prehab exercises that you should be doing as well as the knowledge that will protect you against common running injuries!
Runner’s Prehab Exercises: The Realities Of Running
Running is one of the most popular forms of exercise in the world. However, up to 50% of all runners may sustain an injury that will impact their training or running performance. Long-distance running imposes highly repetitive forces, which can be up to 8x the bodyweight of the runner.
“A marathon runner takes an average of 25,000 steps during a race1.” You can only imagine how much total load is imparted on the body! “Often, it is the number of repetitions that is responsible for the development of an injury. Four of the most common clinical entities are anterior knee pain, iliotibial-band syndrome, Achilles tendinopathy, and plantar-fasciitis (1).”
A lot of people think that you can just grab a pair of shoes and start running, which can be true. However, failure to prepare may set you up for failure. “You don’t run to get fit, you have to be fit to run.” Without proper training, education, and an understanding of healthy running hygiene habits, issues may arise that can keep you from running. The Running [P]Rehab Program will teach you the best cross-training routine for runners and education to help you maintain optimal running health.
An article from International Journal of Physical Therapy in 2013 by Nielsen et. al classified running-related injuries based upon etiology with an emphasis on pace and volume. The results from the study based on prevalence are below:
- Patellofemoral Pain Syndrome
- Iliotibial Band Friction Syndrome
- Plantar Fasciitis
- Patellar Tendinopathy
- Achilles Tendinopathy
- Gastrocnemius Injuries
Best Exercises For Running Injuries: Start With A Simple Warm-Up
Don’t underestimate the value of a simple warm-up! Preparing your body for an upcoming activity can really go a long way! Whenever we work with a runner dealing with an issue, we always add in a pre-run warm-up coupled with at least 3-5 minutes of fast-paced walking prior to running just to increase internal body temperature and increase muscle activation so that the body is ready to run!
The 5 Most Important Exercises For Runners
Public Service Announcement For All Runners – you need to watch this video! Strength training is an essential component for success with running, however, it is a common lacking component in most runner’s training programs. In this video, you’ll learn our top 5 favorite strength training exercises for runners, why they’re important, and slight modifications and variations so that you can find the best fit for you and your workout routine!
Best Exercises For Running Injuries: The Value Of Core Strengthening
Let’s face it, there are a TON of exercises for the core. A lot of them would likely help with trunk and pelvis stability, but these three have specific implications for runners. Runners should perform core exercises that also target hip abduction and external rotation to help resist dynamic knee valgus, which is a risk factor for knee-related pain. Below you will find our favorite runner’s prehab exercises for the core.
“There is a tendency for the hip to collapse into adduction and internal rotation as the hip flexes during weight-bearing. This triplanar motion is most commonly observed during the weight acceptance phase of high-demand activities such as running or landing from a jump. As a single joint muscle, the gluteus maximus is best suited to provide 3-dimensional stability of the hip, as this muscle resists hip flexion, adduction, and internal rotation. (3)”
Here are three core exercises that target the gluteus maximus in a prone position.
- Hip extension
- Donkey kicks
- Fire Hydrants
Best Exercises For Running Injuries: Proximal Hip Strengthening
According to Kang et al. 2013, EMG amplitude of the gluteus maximus (GM) was highest when the hip was in 30˚ abduction, and another study by Kwon and Lee in 2013 found GM EMG amplitude to be the highest when the knee was flexed to 90˚. Try bunching these three exercises back-to-back and doing multiple sets for time to build endurance! Once these exercises get easy, you can progress to upright standing exercises targeting the glutes. These are a must runner’s prehab exercises!
Best Exercises For Running Injuries: Storks With Swiss Ball
Don’t forget, running is a single leg sport! Proximal hip strengthening for runners should primarily focus on unilateral exercises working on triplanar hip stability!
Best Exercises For Running Injuries: Calf Strengthening
In addition to glute and core strength, the gastrocnemius-soleus (GS) complex also has an important role during running and is an essential runner’s prehab exercise muscle group. “Peak forces in the Achilles tendon can be estimated; these forces range from 6-8x bodyweight, with the greatest forces generated during mid-stance of running.1” Also, the literature suggests 90% of the force at the ankle in running is efficiently absorbed and transferred by the Achilles tendon via elastic potential energy.
The musculotendinous unit of the GS and Achilles tendon is responsible for shock absorption and force generation. That means running demands eccentric and concentric muscle action from this unit. Also, we know training increases the tensile and maximum static strength of the tendon. Exercise increases collagen synthesis, the number and size of the fibrils, and the concentration of metabolic enzymes. (1)”
We want to train this unit in that exact way. This is a great drill for runners as it focuses on calf strength with the hip and knee in an extended position that also incorporates a single leg stability component. Be sure to add this exercise to your training regimen to improve your single-leg strength, balance, and control.
Calf Strength Is Important When We Consider ‘The Brake Test’
Depending on how you run and your foot strike pattern, the brake test may be really valuable for you to perform with your running shoes. This is especially important for a midfoot or forefoot striker as this pattern is going to increase the demand on the gastrocnemius-soleus (GS) complex! You can read more about how to change running form HERE! Additionally, we really emphasize education with our Running [P]Rehab Program with almost a dozen education videos because most running injuries are due to training errors.
Best Exercises For Running Injuries: Soleus Strengthening
Creeper carries are by far one of the most effective soleus strengthening exercises for a runner. Not only does it strengthen the soleus muscle, but it is an axial loading exercise, which is very important for runners and their bone health!
Common Reasons For Running Injuries: Poor Landing Mechanics
Have you ever watched a runner from afar and question who is controlling who? Is the person maintaining appropriate stiffness throughout their body and pushing against the ground to propel themselves forward, or is the person getting bullied around by the ground and their form shows for it? Let us be clear, running is significantly different than performing box depth landings shown below, but it makes for a good depiction of this analogy!
It has been reported that the knee is the most common location for an injury(2) . This may be due to the fact that the knee eccentrically absorbs more than 40% of the energy associated with ground contact. Running has been shown to increase the external force on the knee 5x the force of that generated while walking (1)!
The position of the trunk and pelvis in relation to your center of mass has a huge impact on the direction of force directed at the knee. “For example, excessive movement of the COM over the stance limb during an activity such as landing from a jump on one foot could move the resultant ground reaction force vector lateral to the knee joint center, thereby creating a valgus moment at the knee (3).” An example of this includes leaning your trunk over the leg in contact with the ground in an attempt to keep your balance.
Hip adduction promotes dynamic knee valgus, “which would be expected to strain the soft tissue restraints that limit knee valgus such as MCL and ACL (3). Without even taking trunk and pelvis position into account, “the peak valgus moment is two and a half times greater during running that it is during walking(1) .”
Theoretically, repetitive stress to structures in poor kinematic positions may increase the risk of sports-related injury. It is important to train the body to move in an optimal strategy and limit poor movement patterns such as excessive dynamic knee valgus. Practicing landing and working on these faulty mechanics is a great drill to add to your running training program. It has been shown that using the hip extensors to absorb external forces from the ground can reduce the knee valgus moment in women post-op ACL reconstruction4. Hip strength or motor control? The debate continues, but likely it is a combination of both that should be considered in a runner’s training program. Be sure to have the sound on to learn MORE!
Best Exercises For Running Injuries: Improve Landing Mechanics
According to an article by Powers 2010, “The external moments (force couples) created by the resultant ground reaction force (from the ground) are resisted internally by muscles and noncontractile tissues such as ligaments and the joint capsule.” This is referred to as shock absorption, which happens over a period of time once the foot makes contact with the ground.
Active shock absorption happens during eccentric muscle contraction such as the hip and knee bending after it contacts the ground. Leg stiffness is inversely related to active shock absorption. However, leg stiffness is directly related to the loading rate. So, the less the hip and knee bend at initial contact through stance, the faster passive structures including the hip and knee joints are compressed. If not addressed, this can lead to issues such as bone stress injuries. Bounding is one of my go-to runner’s prehab exercises!
A study by Teng and Powers in 2015, concluded increasing trunk lean and hip flexion during running can decrease the energy absorbed at the knee. Here is a bounding exercise to promote active shock absorption with hip flexion. We want to maximize the use of the gluteus maximus and active shock absorption by allowing the hip to flex during landing. The best cues to use are land softly and stay quiet! The less sound you make, likely the more active shock absorption you are doing!
“You don’t run to get fit, you have to be fit to run.” Without proper training, education, and an understanding of healthy running hygiene habits, issues may arise that can keep you from running. The Running [P]Rehab Program will teach you the best cross-training routine for runners and education to help you maintain optimal running health.
- Van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41(8):469–80; discussion 480.
- Powers CM. The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective. J Orthop Sport Phys Ther. 2010;40(2):42–51.
- Tsai L-C, Powers CM. Increased Hip and Knee Flexion During Landing Decreases Tibiofemoral Compressive Forces in Women Who Have Undergone Anterior Cruciate Ligament Reconstruction. Am J Sports Med. 2013;41(2):423–429.
- Kang S-Y, Jeon H-S, Kwon O, Cynn H, Choi B. Activation of the gluteus maximus and hamstring muscles during prone hip extension with knee flexion in three hip abduction positions. Man Ther. 2013;18(4):303–307.
- Kwon Y-J, Lee H-O. How different knee flexion angles influence the hip extensor in the prone position. J Phys Ther Sci. 2013;25(10):1295–7.
About The Author
[P]Rehab Chief Content Officer
Craig was born and raised in Blackwood, New Jersey and grew up with a passion for sports. Craig played soccer at a competitive level through high school. Craig found interest in physical therapy as a career after experiencing it first-hand due to a quadriceps injury. Because of this exposure, Craig went on to college at Pennsylvania State University to pursue his Bachelor of Science degree in Kinesiology with a focus in Movement Science. Craig has experience with athletes at the D1 level as he worked with Penn State Women’s soccer team. After undergrad, Craig packed his bags and drove to California to pursue his Doctor of Physical Therapy at the University of Southern California. With his spare time, Craig enjoys golfing, hiking, traveling, and spending time with his wife and dog. Craig has a special interest in helping younger athletes with adolescent athletic development and working with soccer players, golfers, and individuals going through ACL rehab.