It's that time of year again, I'm seeing the injuries from London Marathon training come through the door! The weeks are ticking by, the weather is improving (wishful thinking?) and you guys are pounding the pavement. So I thought I'd write a quick blog post on the problems I see the most in the clinic as a result of upping the mileage, and share a few tips on how you can try to prevent some of these common injuries.
A little bit of research for you all: a systematic review from 2015 summarised that of all the research they collated, the main risk factors for groin strains were previous groin injury, playing at high level, reduced hip abductor and adductor strength and low levels of sport specific training (Whittaker et al). Now, annoyingly, another systematic review from the same year has found that research (only a few papers met their criteria mind) thus far into prevention strategies for reducing the incidence of groin injuries have yielded no statistically significant results (Esteve et al 2015), but in my opinion given the risk factors stated previously, it would be wise to complement your running with abductor and adductor strengthening.
Adductors (inner thighs) need to be strong to protect against tears within the muscle, but equally abductors need to be strong to prevent overloading of the inner thighs whilst you run. If you have poor hip stability (weak abductors), the knee is more likely to creep inwards, and this has been shown to hugely increase the level of activation in your inner thighs with various exercises - work anything too hard for too long and it will buckle under pressure. Take home message is strength training to complement your running my friends! Glutes, glutes, glutes...
Make sure you're foam rolling your quads a few times a week, spending a good few minutes on each leg, and don't forget to work through both the inner and outer part of the front thigh, not just the front part (rec fem).
Ensure that your hip stability is good, important for the prevention of many injuries (as you've already seen) by doing controlled single leg strengthening work like single leg glute bridges, single leg deadlifts / squats etc and throw in some monster walks and squats with a resistance band into your strength training. Your knee should never be painful after or during, remember these tips and pieces of advice are prehab work NOT rehab, knee pain really should be diagnosed (book an appointment online here).
Looking from the ground up, make sure your trainers are offering you the right type of support - the ideal is really to have bought trainers following some sort of gait/ running style assessment so that they are specific to you, but it is getting a bit late in the marathon training to starting messing about with switching up trainers. However, if you're getting pain and a healthcare professional has identified that your ankles are the biggest and most obvious issue contributing to your injury, then some new kicks might just be your saviour!
Another 2015 review (Hamstra-Wright et al) looking in to risk factors for shin splints (medial tibial stress syndrome) in active populations found that the main predisposing factors were increased BMI, navicular drop (essentially collapsing through the inside arch of your foot, a.k.a overpronation), increased range of plantarflexion (think tight short calves) and those with an increased range of external rotation at the hip.
My interpretation of these results is that regular calf stretching and for those that require it, strengthening of the muscles that dorsiflex the ankle (e.g. tibialis anterior) is a good place to start, as well as (you guessed it, glute medius again) strengthening of muscles that control internal rotation at the hip.. combined with stretching of the external rotators.
If you've started to get pain from shin splints, please book in with someone as you need to have accurate assessment and diagnosis looking at your unique biomechanics, leaving it to get better on its own is unlikely to work unless you stop running completely, and even then when you start back it tends to come back pretty quickly. Do not ignore shin pain, as leaving it be and continuing with training could lead to a stress fracture.
Last but by no means least is shoulder pain, mostly tightness in the upper trapezius area of the shoulders. Boys and girls, please don't run with your shoulders held up by your ears - relax! Don't hold your arms and chest rigid like you're ready to punch someone, keep loose! Look straight ahead/ in front of you, not down, as this helps prevent shoulder rounding and helps you to get oxygen in whilst you're running. Moving nicely on to breathing, make sure you are effectively using your diaphragm - why? Upper chest/ rib breathers overuse lots of muscles around the neck/ shoulder area when breathing heavily, when the most efficient way to breathe is to effectively use your diaphragm (check the video below). On a personal note, I strongly believe yoga practice is one of the best things to encourage deep diaphragmatic breathing and keeping the shoulders down/ relaxed.. practice makes perfect!
Good luck to everyone preparing for the marathon this year, I don't envy you but I definitely salute you! If you're suffering with any of the above issues, book in an appointment with me at Balanced Osteopathy in Farringdon EC1 - book online here.
Thanks! Rebecca x