The Journey to Injury Free Running

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When it comes to race preparation, there is no “one size fits all” approach. Every individual is different – so are their needs and physical ability. People tend to view Physiotherapists as medical care providers who you go to when you are injured. That is not wrong – however, physiotherapists are experts in body biomechanics and are able to help you with your training programme as well. Apart from recovering from running injuries, physiotherapy can help with injury free running in terms of injury prevention and increased performance for serious athletes. One client who Chye Tuan, our senior principal physiotherapist was able to help with his race preparation is John.

Who is John?

John is a 49 year old Marketing Director who has always been active since young. In his thirties, the bustle of everyday life got in the way of keeping active and his physical activities were reduced to an occasional run or swim. He started to take part in races and triathlons 4 years ago when he was on a quest to revert to his former fitness level. During a regular work week, John runs, swims and bikes twice a week. If there is an upcoming race, his training ramps up to roughly 12 hours – running, swimming and biking 3 times a week.

Knee Pain and Hamstring Strain

John has been relatively injury-free but was first introduced to me at Core Concepts by his wife in 2017 when he experienced knee pain while running. After a thorough assessment and taking a detailed history of his lifestyle, it was determined that the knee pain was related to a knee ligament surgery that John had in his twenties. The pain was causing him discomfort while running and he was aiming to complete a triathlon at that time. Our physiotherapist developed a treatment plan that would help him to achieve his goal of pain-free running.

Subsequently in mid-2018, John sustained a hamstring strain and came back to see me again. After an assessment, it was concluded that the hamstring injury was likely due to 2 factors. The overuse of the hamstrings as a result of compensation for the weak knee, coupled with the increased intensity of his running volume as he was training for an upcoming race.

Achilles Pain

John managed to complete the race that he was training for and in October 2018, as he was preparing for Standard Chartered Singapore Marathon 2018, he came in with a pain in his left Achilles. This was due to tight calf muscles that were related to the strained hamstrings as well. John’s running technique was overworking his hamstrings and calf muscles, resulting in achilles pain as the calf muscles and achilles heel is one continuous structure. My short term plan was to help John reduce the swelling and gradually stretch and strengthen the calf muscles. John made a swift recovery and was able to complete the Standard Chartered Singapore Marathon 2018 just one month after.

injury free running
John finishing a triathlon race

Improving Running Biomechanics for injury free running

It was evident that John needed to improve on his running biomechanics to move towards the goal of injury free running. Thus, my long term treatment plan for John was to help him improve his running biomechanics by managing his running load and incorporating strengthening and stretching key muscle groups. As John is a high performing endurance athlete who regularly takes part in races, my treatment plan was built with 2 end goals. 1) To prevent injuries and 2) to perform better in races.

I then referred John to Kelvin, our team’s functional trainer. First, we worked on strengthening the hamstrings and glutes as these muscles are more explosive and powerful. We chose to focus on these muscle groups as they are more effective and sustainable for endurance running.

Kelvin: John had a calf strain and recurrent achilles tendon pain. He also had right knee pain about a month before his Ironman race. To reduce the load on his tendon, we had him doing calf raises and lunges landing on his mid-foot (among others) to strengthen his calves. These exercises were also planned to aid in pushing off and absorbing shock when he lands during running. For his knees, we worked on strengthening his hip muscles to help with knee stability. This was done by doing split squats, S/L balance w/ rows, split hops and lawnmower exercises.

Did we achieve injury free running?

John: From May through October 2019, I completed three half Ironmans and a bunch of smaller races, injury free and all in faster times than previous years. Chye Tuan and Kelvin were a great help! My advice to fellow runners out there who are suffering from recurring running injuries is that you will get better if you follow the treatment plan. Even though being injured is very frustrating at the time, be patient and follow through with the treatment plan. I improved speed and placings in every race I did in 2019 and have been fully fit since I recovered from the calf tear (skiing injury). The second thing, especially if you are not so young anymore, is devote enough time to strength and stretching. I probably still don’t do enough but I’m trying hard to fit this in as well!