There is no shortage of people who want to discourage you from running. “It’s bad for your knees!” they knowingly proclaim. Worryingly, some of these people are Medical and Health Professionals. Aren’t we supposed to be encouraging Australians to be more active? So what’s with this?
Is there evidence to link running and knee injury?
Well yes and no. If you take a group of runners and monitor them over the course of a year, some will get injured- and the most likely part of the body that will sustain the injury is the knees. There are a few studies that have looked at this, and the numbers vary from study to study but the consistent themes are; running comes with injury risk; and the knee is the most likely spot you’ll feel it.
But does this justify the blanket rule that running is bad for your knees? If so, we would also have to conclude the golf is bad for your back, swimming is bad for your shoulders and cycling is bad for your neck. Should we also avoid these forms of physical activity?
Why do some runner’s knees get injured?
There is no single answer to this, and the reality is that injuries that develop over time generally do so because of the convergence of a number of factors. Here is a case study that can illustrate this point:
Steve is 45 and works long hours as a Chartered Accountant. He spends extended stretches of time at his computer, occasionally getting up to make another coffee. He often skips lunch, but when he can sneak out he usually grabs whatever is quick and easy from the Bakery across the road. After work he drops in to his local for a quick beer or two with a couple of mates, before getting home in time for dinner with the family. When the kids are off to bed, the feet are up and he spends more time than he should watching Netflix. His sleep is short and poor in quality as a result.
Steve sees his Doctor who informs him his blood pressure, blood glucose and waist circumference are all trending towards the red-zone, and that he needs to start doing some exercise immediately to turn things around. Steve heeds the warning, so early Saturday morning he laces up his ten year old sneakers he usually wears to mow the lawn, chucks on a t-shirt and shorts and gets out to his local Park-Run 5km. Steve starts out confidently but after about 500m starts to puff and pant. By 2km his knees and lower back are getting sore but he is a determined bugger, so he drags himself across the next 3km with a slow, loping stride. ‘This will only get easier’ he tells himself, and to his credit he repeats this torture for the next 3 weeks.
By Sunday after week 4, his knees are swollen, sore and hot to the touch. He sees his Doctor again the following day and fills him in. “Well you shouldn’t have started running, don’t you know running is bad for your knees?! You should walk, or maybe ride a bike instead”.
Was running the problem here? Or what is that Steve, although well-intentioned, just plunged himself into a task he was completely under-prepared for and hurt himself as a consequence?
Steve’s current lifestyle needs a dramatic overhaul- his overall health could benefit greatly from making some improvements to his diet, reducing his sedentary time, reducing his alcohol frequency and making sleep a greater priority.
Steve could get some advice on footwear by someone who knows what they are talking about. He could also invest some time and money speaking to an expert on how to build his body and his running form so that when he does run he has the strength and the technique to do so more efficiently.
This sounds like an awful lot. But the reality is that running is hard on your body but that is why it can impact our health in such profound, positive way. Our body adapts and evolves to physical stress if it is dosed out appropriately. It is worth making the health changes to equip your body to not only meet the demands of running, but to thrive on them.
Running is not inherently bad for your knees. Running does put your overall health under the microscope, and penalises you for what you neglect. Rather than discouraging people from running, we as Health Professionals should be encouraging our clients to audit and refine how they take care of themselves.
It would be rhetorical to say: that your body is special. And you would only want the best to be guiding you through your health and well-being safely. And yet, one can still be suggestible- picking up dodgy anecdotal tips from ‘that guy’ on the lat-pull-down machine.
I have personally experienced the exercise benefits, being safely loaded, and moving with confidence with one of my colleagues. Leaving my body and surrendering to an expert has given myself a deeper appreciation of the importance of finding an expert in human movement. I have always been on the other side to what I have been accustomed too- and as bias as it sounds: my colleagues here at iNform health really know how to manage and care for their clients.
Here are three reasons why you should be exercising with an expert.
1. Your tissues need time to adapt to load.
Your tissues, all the way down to the extracellular matrix- are for ever adapting to stressors and making proteins. Prescribing appropriate load- will ensure ones tissues will safely adapt; which will add a host of benefits to ones neuromuscular system. Reduced risk of tendonopathies, appropriate motor learning and myonuclei growth (muscle hypertrophy). On the contrary, excessive loading that exceeds the capacity of the neuromuscular system can induce the contra effects to the aforementioned. Tendon pathology, disorganised motor learning due to inappropriate load and systemic inflammation (abnormal prostaglandin levels) due to poor tissue healing.
2. Assessing the capacity of the neuromuscular system before undertaking load is paramount- and if neglected, your ‘health professional’ is going in blind.
If there is a muscle inhibition due to de-conditioned tissues, or a previous pathology that was poorly rehabilitated, would you feel safe to be loaded? Or if you were unable to co-contract your gluteus maximums, or have adequate lumbo-pelvic control? And yet, you may still be subjected to axial loading in your first session…! A thorough musculoskeletal assessment can identify any red flags and give your health professional valuable subjective/objective information to prescribe appropriate exercise correctives. This will then ensure more complex movements are performed safely.
3. Co-care is so important in addressing the whole individual.
Here at iNform, our clients are closely monitored by a wonderful internal/external team of allied health professionals; ranging from: GP’s, physio’s, osteo’s, chiros, pod’s and psychologist (without exhausting). All working and communicating together for the greater good of your physical and mental health. Co-care leads to better clinical outcomes, a proper working diagnosis, and the right form of treatments that benefit you the individual.
So, next time you are wanting to move with confidence. Be interrogative with your research. Find an evidence based approach that doesn’t involve a lecture from ‘that guy’ wearing a weight belt with a skimpy muscle singlet (stereotyping much?).
The British Journal of Sports Medicine recently published a review of the evidence for Strength Training as a strategy to reduce injuries in Athletes- and the results are impressive! For those that tend to just read the first few lines of an article, take this away. If you are an athlete, or you coach athletes, strength training should be a priority in your programming if you want to reduce injury risk. For the rest of you, please read on.
This article was by Lauresen, Andersen and Andersen (2018). Below is a summary:
6 studies were included, totaling 7738 participants aged between 12-40 y.o.
The average intervention duration was 21.39 weeks.
Average volume of training was 80 reps per week.
Average intensity was 8.39 RM (these means the maximum number of repetitions that can be performed for a given exercise).
Strength Training reduced sports injuries by 66% with a 95% confidence interval of 52% (combined results from 4 of the 6 studies).
A 10% increase in strength training volume resulted in reduced injury risk of 4%.
No injuries occurred as a result of the strength training throughout the interventions.
Strength training was both safe and effective for adolescents as well as adult athletes.
Why? The Mechanisms
The authors can only speculate as to why strength training helped protect athletes from injury, but their proposed mechanisms to explain its effectiveness are:
Preconditioning- effectively toughening up the muscles/tendons so they can deal with greater loads.
Variation of loading across the body so that parts of the body that are not stressed by the sport take more of the load in the gym.
Improved coordination and technique in the gym crossing over to movements in sports.
The authors concluded with the following recommendations for strength training, and I advise that if you choose to trust an Exercise Professional to help you or your athletes commence a strength training program that they can demonstrate an understanding and adherence to these principles.
Commence with a familiarisation period so that the athletes can develop the confidence and capability to perform the exercises correctly.
Ensure the athlete is supervised in the gym so that exercises can be completed well and loads are monitored accurately.
Loads are individualised to the athletes capability and are altered appropriately over a training cycle.
Exercises are varied across the year of training.
I would add in that it is also important that the strength training program is correctly synchronised with the training and competition schedules, so the Exercise Professional must be in regular communication with the athlete’s coach. For example, during an athletes off-season they can focus on improving function and technique; during pre-season switch to muscle building; and within season aim to build/maintain strength and power. The Exercise Physiologists at iNform have extensive experience managing the strength training programs of athletes across many sports. If you would like to speak to one of our EPs about the services we offer athletes, please contact us!
Lauersen, J. B., Andersen, T. E., & Andersen, L. B. (2018). Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries: a systematic review, qualitative analysis and meta-analysis. Br J Sports Med, bjsports-2018.
Recently the Journal of Sports Sciences published a Systematic Review detailing the factors associated with injury in Elite Junior Tennis players. It is important that coaches and parents of such athletes are aware of the findings (Oosterhoof et al, 2018).
Risk Factors for Lower Back Injury
Previous Lower Back Injury:
Previous injury is often a good predictor of future injury. Why? That is not clear, but one reason may be that rehabilitation of injuries is often not done to the level that it needs to. Rehab is often done adequately to get a player back on the court, but functional deficiencies can remain. This can predispose the athlete to recurrence, or to injury of another part of the body due to compensation. Elite Junior Tennis players should undertake their rehabilitation under the guidance of a Physiotherapist and Exercise Physiologist that are experienced in this field.
Training Loads > 6hrs p/wk:
Elite Junior Tennis players will be training and playing at least this amount. So how do we mitigate against this as a risk factor? For one, the athlete needs to have a good recovery repertoire and be diligent with it. A recovery program should be personalised for the athlete, but some common features of an athlete recovery plan are; adequate sleep; good diet, hydration and nutritional support (protein especially); massage; stretching and cold-water immersion. Secondly, Functional Resistance training can help build strength in muscles and tendons, mobility in joints, stability in movement, balance and spatial awareness. If your child, or an athlete under your guidance does not have a recovery plan, and/or is not undertaking a quality, personalised functional strength program I would speak to a qualified and experienced Exercise Physiologist to help them build one.
Risk Factor for Upper Extremity Injury
Fewer Years of Playing Experience
The authors do not specify what it meant by ‘fewer years of experience’ so we can only speculate. But generally speaking, when a young person starts at a new sport, their body is going to be exposed to forces that they may not be conditioned to deal with. I recommend that young people new to tennis undertake an overall movement capacity assessment, such as the ‘Movement Screen’ (Movement Screen ). This will identify any functional limitations that can be corrected through a functional strength training program. We use the Movement Screen with all of our young athletes at iNform.
Risk Factor for Lower Extremity Injury
Interestingly, in the studies included in the aforementioned review players that regularly stretched the muscles of the lower body had an increased risk of injury than those that didn’t. This is counterintuitive for most, as stretching is supposed to be good for us, right? Stretching can be useful for increasing the mobility of a restricted joint. However stretching can also acutely reduce our muscles responsiveness and power. So there are pros and cons to stretching for athletes. If an athlete is going to be prescribed stretches, they should be recommended only for areas that display movement restriction (and have shown a positive response to stretching) and should be timed so that performance is not impacted negatively. The Exercise Physiologists at iNform can easily identify whether a young tennis player would benefit from stretching, and recommend when is best to do it.
Whilst there are injury risks associated with playing Elite Level Tennis at the junior level, they can be mitigated by taking an intelligent and strategic approach to the young athletes programming. The Exercise Physiologists at iNform have extensive experience helping Elite Young Tennis players stay strong and healthy and on the court.
Jacobien H.F. Oosterhoff, Vincent Gouttebarge, Maarten Moen, J. Bart Staal, Gino M.M.J. Kerkhoffs, Johannes L. Tol & Babette M. Pluim(2018)Risk factors for musculoskeletal injuries in elite junior tennis players: a systematic review,Journal of Sports Sciences,DOI: 10.1080/02640414.2018.1485620
Our list of the 3 best core exercises offer the perfect way to keep your spine health and your abdominal muscles strong and functioning well – no matter where you are!
Those of you who have had some previous ‘iNform experience’ would be fully aware that we tend to stray away from traditional abdominal exercises like crunches, for those movements that train the core in a more movement specific manner.
Now, first and foremost, a bit of a disclaimer – these traditional exercises are unquestionably anatomically correct.
With this I mean that they do indeed train the abdominal muscles – although they certainly don’t really train them in a manner that replicates how they work in the real world.
You see, the muscles of the trunk (AKA, your core) make up a seriously complex system that plays a multitude of roles which are dependent upon the scenario in which they are placed.
With this in mind, they act to stabilise the spine and pelvis during high force and high velocity movements, they transfer force from one limb to another (for example, from the hip to the arm during throwing movements), and can also initiate movement of the trunk itself.
Which should make it pretty obvious as to why traditional abdominal exercises really don’t do enough.
But don’t worry – we have got you covered.
The 3 great core exercises outlined in this article provide a simple way that you can train the muscles of the trunk in an effective and efficient manner. These can be performed at home, and offer a fantastic means of enhancing your ability to stabilise the spine and transfer force – ticking all of the boxes for us.
3 Best Core Exercises You Can Do at Home
So, onto our exercises.
The first cab off the rank is the deadbug.
Extremely simple in premise, this great exercise offers one of the most effective ways to improve core strength and improve spinal stability, while also enhancing the trunks ability to transfer force between the upper and lower limbs.
Moreover, it can be performed anywhere and at any time.
Start by lying on your back with your feet and hands in the air. Your knees should be bent to 90 degrees (you should ultimately look like a ‘dead bug’). In this position brace your abdominals and press your lower back flat into the ground.
Proceed to drive one leg out, while simultaneously lowering your opposite arm back. Extend both out as far as you can without your lower back raising off the floor. This movement should be slow and controlled.
Return to the starting position and repeat on the other side – this is one repetition.
We can thank well known coach Tony Gentilcore for the perfect demonstration
An oldie but a goodie!
When performed appropriately the side plank trains the muscles of the trunk and the hip in a manner that teaches proper spine and hip control. This means a healthier spine, and a stronger trunk – both of which are pretty important of you ask me!
Start lying on your side with your elbow directly under your shoulder. You should be able to form a straight line from the bottom of your feet to the top of your head.
Lift your hips and trunk off the ground, ensuring that they are held in a straight line and completely rigid.
Hold this position for 20-30 seconds, and then repeat on the other side.
Here is a perfect demonstration by super coach, Dean Somerset.
Our third and final option is a specific plank variation that aims to correct the unwanted postural deviations we see as the result of prolonged periods of sitting. I really like this plank variation for a couple of reasons.
Firstly, it is seriously brutal. As a result, you only need to do sets of 15-20 seconds to get a decent effect, and get your abdominal muscles working overtime.
Secondly, it’s really hard to perform incorrectly. Once you get yourself in the proper position, if you ‘lose it’ you will feel it straight away. As a result, you can be sure that this exercises is doing exactly what its supposed to – which is building essentially building a strong and resilient human!
So, without further ado:
Start in a traditional plank position, with your elbows placed directly under your shoulders while you are up on your toes.
Shift your hips up so that they are slightly elevated, and squeeze your glutes as hard as you possibly can (imagine you are trying to crack a walnut…).
While in this position, actively ‘drag’ your elbows towards your knees (your elbows shouldn’t actually move, this should simply increase tension).
Hold this position with maximal tension for 15-20 seconds.
And another excellent demonstration provided by Dr John Rusin
Putting it all Together
So, doing these in a single (very short) session at home might look something like this.
Deadbug 20 reps either side
Side plank 20 seconds either side
RKC plank 20 seconds
Then rest for 1 minute and repeat the cycle 3-4 times, for a grand total of 10ish minutes.
Simple, and effective.
Take Home Message
I appreciate that you may not have the time available to get in a solid gym session every single day – but to say you don’t have the time to do anything is inexcusable. The program provided using the 3 core exercises outlined can be performed in as little as 10 minutes.
Not to mention it can be done literally anywhere, offers the perfect way to promote back health and enhance trunk strength, and allows your burn a little energy in the process.
I often get asked how does the brain deal with pain? The brain is a highly complex organ so lets not think of the brain regions as an entity; more like a highway of networks communicating. To understand how the brain makes pain, I will use the analogy of networks like a map. You may come to have some gratitude towards your brain, as your brain is only doing it’s absolute best to protect you.
So how does your brain deal with pain? Here’s an everyday analogy
Keeping to the network analogy: lets say you are meeting a friend for a coffee at a new unbeknownst location. You lock in the coordinates in your mobile app, and away you go. You start briskly walking and come across a busy pedestrian crossing. Of course you wait until the green logo flashes for you to safely cross.
As you continue to walk a cyclist rings their bell to notify you of their passing. The initial noise was alarming, which caught you by surprise. However the cyclist speeds on by, and you are back to absorbing the beautiful sunshine.
Further up the road you notice a branch impeding the footpath from the previous days storm. You decide to live a little, and jump over the branch thanking your exercise physiologist for the strong bones. Your heart rate settles back down, and your mobile app notifies you that you are five minutes from your destination.
As you see the coffee shop in the distance you close down the app taking your eyes briefly off the footpath to put your mobile phone away. Within a matter of milliseconds a car pulls out of the driveway while your head is still down. You put on your own breaks, by contracting your muscles with great force to prevent walking into the red jeep.
The driver gives you a wave in courtesy, and takes off. Still feeling a little startled, a memory comes up of your one and only bike accident. Five years ago with a red sedan, while you were training for your maiden triathlon. You consciously rub your right shoulder. Your friend meets you with a warm smile and hug. You both sit down, and your friend notices that you look a little ‘stiff’.
Breaking down the perceive threats so that we can understand how your brain deals with pain
The following analogy contains many contexts that I am going to break down with you, and most importantly reduce the threats. In my analogy I constructed a few events during the walk to the coffee shop that all have contextual meanings that the brain must process. Most are safe, with a couple having more meaning, can you guess which ones?
The pedestrian crossing is a safe means to cross the road. Although the crossing is busy with traffic. The brain likes the safety of the green light. What about the speeding cyclist? Although the cyclist bell would have been initially startling- fast acting areas in your brainstem enable you to respond quickly, the cyclist was also being courteous, while speeding off, which your brain processes the comforting visual information of safety.
What about the branch on the footpath? Haven’t you been strength training with your exercise physiologist? and feeling confident and strong? The quick jump activates the fight and flight system to release adrenaline to contract your muscles quickly, the brain enjoys these types of acute stress.
Now, how about the red jeep pulling out in front of you without any warning? Now here is an acute threat. However there are some added contexts to consider. The colour of the jeep is significant (remember the red sedan?), along with the colour red meaning: stop, hot and danger! And what about the significance? Weren’t you training for your first triathlon before being knocked off- with a subsequent right shoulder injury?
That is a pretty significant event that your brain ought to remember with great detail to protect you. However, the accident happened five years ago. Still, every time you see a red car, you notice that you hold onto your breath.
Lastly, your friend used the word “stiff” to describe your seated posture. What comes to mind when you think of stiff? Stiff can be in reference to your muscles tightening up reducing mobility, and maybe activating that neat fight and flight response again. But do you need it this time?
Can you see how everyday events can trigger the networks in the brain to communicate on: sound, vision, memory, colour and muscle tone? And how the significance of the event, even though it happened five years ago, can still alarm the brain to protect you?