Injury Prevention 101 – EGLGFG style

OK so this post started out as a very educational, “here are all my qualifications, listen to me” post. But then I realized that in order to do a post like that the way it should be done, it would be 938432621552174327 words long, no one would read it, and I would still probably steer someone in the wrong direction.

So instead of doing that I decided to change directions and make it more of a “here’s what works for me” post, enabling me to be a little more brief since most of my information will be anecdotal (i.e. what I do).

***CYA announcement – I do have education and knowledge behind what I say below – I’m a Certified Athletic Trainer and I have a master’s degree in Kinesiology. That being said, I am also a spectacular example sometimes of “do as I say, not as I do”. This post is a mix of my educational knowledge and what has worked for ME in the past. If you have an injury or would like to add supplements to your diet you should always consult your health care professional first.***

A Note Before I Begin…

One of the things I love about my profession/the world of sports medicine is that, as the old adage says, there is more than one way to skin a cat. There is more than one way to treat an injury, and many, many ways to help prevent injuries. We are all human, all different, and thus our needs are different as well. We all have different intolerances (gluten, dairy, etc), sensitivities, body mechanics (high arches, flat feet, etc) and pre-existing conditions that play into the causes of chronic injuries and the level of inflammation in our body.

I think it is so important to learn as much as possible about your own body, what it can tolerate, what helps it and what hurts it. Only then can we develop the best possible plan for keeping it healthy and working in it’s optimal form.

In case you were wondering, this is what a twice-ruptured and repaired achilles looks like after 7.5 years and 1 too many hill repeats...Know your body.

In case you were wondering, this is what a twice-ruptured and repaired achilles looks like after 7.5 years and 1 too many hill repeats…Know your body.

And without further ado,

5 things I do to help prevent running injuries

#1: Stretch AND Foam Roll.

I don’t know about you, but when I’m short on time the first thing I cut out is pre- and post- run stretching and foam rolling. Unfortunately there are so many injuries prevalent in running that can be caused or exacerbated by tight, inflexible muscles – tendonitis (achilles and patellar), plantar fasciitis, sciatica, and IT Band syndrome to name only a few. We compound that with the fact that many of us “recreationally competitive runners” go straight from a 5:45 am speed session to sitting at a desk for 8-10 hours. Hello tight muscles!

I am a big fan of both static stretching and foam rolling and I think both have a place in any flexibility program. Foam rolling is great for working out specific areas of knots in the muscle and for promoting blood flow to specific areas. I am not a superstar foam roller, but I’m trying to become better. When I foam roll I always do a complete lower body roll (i.e. all the major muscle groups in my legs + my glutes and hip rotators) but I generally focus on  the calf complex, the good ol’ IT band, and my hip rotators, which are chronically tight. A general rule of thumb I like to follow when foam rolling is that it should be uncomfortable but not painful.

Static stretching is good for flexibility, because typically, aside from eliminating muscle adhesions, foam rolling in and of itself will not increase the length (aka flexibility) of a muscle. Here is a decent study that was done regarding foam rolling and the length of the hamstring muscle. Basically, no change in hamstring flexibility was found in the group who foam rolled vs. the group who did NOTHING (no static stretching). Moral of the story: You gotta stretch.

Two of my go-to stretches for my chronically tight hip flexors

Two of my go-to stretches for my chronically tight hip flexors

IMG-20121220-00047

I love the above stretches, but if you’re looking for some really good running specific stretches go check out JASYoga’s blog, they have some awesome runner-friendly stretches for happy legs!

I am much better about stretching than I am about foam rolling. In fact, given that I accidentally left my foam roller out last night and my dog chewed it up today while I was at work, my foam rolling will be on hiatus until I purchase a new one…

#2: Supplement with Vitamin D3

***Anytime you add a specific supplement to your diet where toxicity is a possibility (i.e. taking too much allows too much to build up in your bloodstream, causing negative effects) I encourage routine bloodwork to make sure levels are normal. Everyone processes supplements differently.***

Vitamin D is a fat soluble vitamin (along with A, E, and K) and thus your body doesn’t get rid of extra through the normal channels (i.e. urine). Therefore while for most people it’s much more likely that you’ll have too little vitamin D than too much, if you are taking a supplement with more than 1000 IU per day you should get routine bloodwork to  make sure your levels aren’t too high.

Vitamin D is essential for good absorption of calcium, and plays a critical role in bone health. It also helps reduce inflammation and plays a role in neuromuscular function. Aka it’s pretty darn important, especially for runners, who are constantly producing more bone as the body responds to the stresses we put on it. Our bodies also use sunlight to create their own vitamin D, which is something to keep in mind when deciding whether to supplement.

Here is a great, very informative article on vitamin D from the NIH which includes symptoms of toxicity, recommended daily values (though these are low for most runners), pre-existing conditions and medications that can influence the absorption of Vitamin D, and foods that are good sources of the vitamin.

I was unsuccessful at finding an image of bone remodeling phases and the role Vitamin D plays, but my search keywords did lead me to this gem...BABIES!

I was unsuccessful at finding an image of bone remodeling phases and the role Vitamin D plays, but my search keywords did lead me to this gem…BABIES!

I’m actually relatively new to the whole Vitamin D supplementation thing personally, but I can’t tell you how many times I’ve seen this scenario at work:  Athlete has bone pain, goes to orthopedic physician, is diagnosed with either stress fracture or stress reaction. Orthopedic physician is good at their job so they test athlete’s vitamin D levels. I would say 95% of the time in that situation the athlete’s levels are low – maybe not low enough to be considered “clinically significant” for the normal population, but the low end of normal for an athlete is enough to contribute to a stress injury and prolong healing.

Factors that may contribute to low vitamin D levels:

  • living in a location that has lots of smog, many cloudy days, or very short days (i.e. Cleveland)
  • people who are active in high impact activities (i.e. running) will use more vitamin D and thus need more vitamin D than sedentary individuals
  • lack of sun exposure due to occupation – you run before the sun comes up and then spend all day in an office (UVB rays, which promote Vit D synthesis, do not penetrate glass)
  • people who don’t drink milk (heavily fortified with vitamin D) or eat processed cereals (also fortified) may need a supplement because many foods do not naturally have a high amount of vitamin D
  • some medications inhibit the production/absorption of vitamin D – most common being steroids and some anti-epileptic drugs.

How I use Vitamin D

Again, I’m not saying that “everyone should take a crapload of vitamin D per day”, because there IS a risk of toxicity. For some people though, it makes sense to supplement: Last year I got a stress reaction during my first winter of running in Cleveland (my first year in Cleveland I never ran more than 20 miles/week). As someone who has never had stress injury problems (at least in my running life) it kind of caught me by surprise – then I realized that in my previous “home” I generally was able to take in a significant amount of sunshine on my runs even in the winter and I am notoriously poor at putting on sunscreen (do as I say, not as I do) so I was probably synthesizing a good amount more of vitamin D then than I am in my current location.

I am currently supplementing with vitamin D daily and will probably continue to do so throughout the winter. But once the weather becomes nicer (aka I’m in the sun more) I’ll probably switch to only taking a significant D supplement 1-2 times per week. I switch up my sources of supplementation but most days I’ll take 2 calcium chews so I’m getting both D (1000IU) and Calcium, + a multivitamin with 400 IU giving me a grand total of 1400IU.

#3: Stay Strong

Growing up a gymnast, I’ve always had a pretty good base of strength, and while I’ve lost a lot most of it compared to where I was in college I feel that it’s extremely important in the realm of running to continue doing some form of strengthening. In gymnastics we never lifted weights, all our exercises were done with body weight, often sport-specific, and I’ve found that taking that philosophy to my running has helped. After a few weeks of running-only I definitely start to feel like I’m losing power and like my form suffers as a result. I also start to get random aches and pains, mostly in the form of patello-femoral pain (pain on the inside of my kneecap). Generally it only takes a couple of days of focused strength exercises and I’m painfree again!

I don’t do the same exercise program all the time, and often tailor it to where I’m feeling weak or where I’m getting aches and pains, but here are some things that are often a part of my routine:

  • I love this Core Circuit (scroll down halfway for core circuit) from running coach Mark Hadley. It’s short enough to squeeze in several times a week without feeling pressed for time, yet it is extremely efficient and works pretty much all the running specific muscles in the core. I often add the box step-ups from the Drill Circuit to this as well when I don’t have time to do the drill circuit in its entirety (which I’m also a fan of).
  • Yoga is one of my favorite ways to get strength training in and sooth my soul at the same time. My preference for strengthening purposes is Hot Powerful Flow, which is Vinyasa yoga. One week I’d been having some knee pains and I went to yoga in the hopes that we would do lots of chair pose…well my instructor must have heard my thoughts – we did some variation of chair pose for at least a third of the class and my knee pain literally disappeared overnight.
  • During my last marathon training cycle I had access to the weight room (and strength and conditioning coach) at Temple University and I swore by single leg squats – generally with around 115# on the bar or so… Single leg squats are great because they are running specific – more so than double leg squats – and if done correctly they also strengthen the ever important glute medius muscle, which is essential is preventing IT band issues. This time around I’ve only been doing body weight single leg squats but I’ve even found those to be quite effective.

    Single Leg Squat with a band around thighs - quad + glute medius strengthening!

    Single Leg Squat with a band around thighs – quad + glute medius strengthening!

  • Glute and hamstring Exercises. Running itself does not strengthen the glute muscles, but a strong “posterior chain” is so important for running. My favorites are single leg bridge, heel drive in quadruped (on hands and knees) stance with the leg both bent and straight, and lunge to high knee lift.

#4: The 2-day Rule

OK, Honesty Hour…I made this one up. Ain’t one shred of evidence-based research behind this puppy, it’s just straight up common sense and experience.  Out of all these options it’s also the one that I break most often with myself. But never with my athletes. What is it, you say? Simple: If something on my body (or one of my athletes’) hurts for 2 days in a row at the same intensity or worse, I do something about it. It has to be two days in a row and the pain has to get worse, or not get ANY better.

It doesn’t necessarily mean complete rest either. I may cross train, may integrate a heavy stretching/strengthening session, may ice that body part, may take a day completely off, or just slow down the pace significantly.  Anything to see improvement. The pain doesn’t have to go away completely, but it does have to be getting better every day in order to resume full activity.

Like I said, I unfortunately ignore this one a lot. I like to say that instead of ignoring I’m just convincing myself that it’s “not that bad”. Which is not something I should do because I know better, but hey, I’m human. What I do know, and try to keep in mind,  is that missing one day of running tomorrow is way better than missing 6 weeks of running in 2 weeks when you have a full blown stress fracture or your IT Band tendinitis has now become chronic.

#5: Integrate Natural Anti-Inflammatories Into Your Diet

This is another new thing I’ve been trying during this marathon training period and I must say, I do notice results. The physician that I work with has really been into “prescribing” natural ways to decrease inflammation rather than the go-to ibuprofen/naprosen scenario. Here are three of the natural anti-inflammatories I’ve been integrating into my diet:

  1. Raw Garlic – My dad has long sworn by raw garlic for it’s immune boosting properties, but lately I learned it also has anti inflammatory properties. I typically mix 2 cloves of garlic and 2 T Olive Oil in the food processor. Then I bake (or microwave) a potato and saute some spinach and top the potato with the spinach and the raw garlic/OO mixture. Delicious! 
  2. Turmeric – This is what the physician I work with typically recommends. He suggests 1 teaspoon of turmeric mixed with 1T olive oil poured into a V8 juice. I prefer to sprinkle turmeric on canned tuna. Basically I put as much on the tuna as I can without tasting it, usually I think I’m able to get close to a teaspoon on there.
  3. Fresh Ginger – I love using ginger when I juice, my favorite post run juice consists of 1-2 beets, 2 carrots, an apple, and an inch of fresh ginger. DELICIOUS!
  4. Ice – No, I don’t eat ice. But I DO use it on any aches and pains at the end of the day while I’m watching TV (and sometimes post run). I haven’t been real big on ice baths lately but I swore by them in college. In my opinion there’s nothing 20 minutes of icing can’t make feel better.

And there you have it – A super long post on things I’m doing to stay healthy.

Tell me what you think – too long? make sense? do you think I’m full of crap? learn anything? should I never ever ever write a post like this again – like ever?

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3 thoughts on “Injury Prevention 101 – EGLGFG style

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