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This blog is my professional view and opinions on anything related to massage and fitness. This may range from new therapies, training modes, interesting aspects of massage or fitness, to food, recovery and other aspects to remain in good overall health.

 

By Lee Weston, Mar 1 2018 02:44PM

With the running calendar for the year getting closer and closer as spring is around the corner this is a brief blog regarding the most common running injuries and how to combat them. Up to 79% of runners will get injured in any given year (1), so making sure you know what the main ones are and how to prevent them it key to sustaining your fitness and reaching your running goals.


The most prevalent injuries unsurprisingly occur within the lower body injuries, however upper body injuries do occur as a result of falls or load carrying (backpacks etc).


The Most Common Injuries Resulting from Running:


1. Patellofemoral Pain (knee pain)

2. Iliotibial band (ITB) syndrome

3. Tibial stress Fractures/ syndromes

4. Plantar fasciitis

5. Achilles tendonitis (2)


Of these I have experienced them all apart from No. 3, thank fully, at some point in time and prevention is much easier, cheaper and less frustrating than trying to get over some of these injuries whilst continuing to train.


The aetiology (causes) of running injuries are multifactorial but the main ones being overtraining, previous injury history, inappropriate /poorly fitting footwear as well as poor running mechanics. These are confounded if there are a combination of these risk factors and then perpetuated by an increase in weekly running mileage and history of previous injury as found in male runners specifically(3).


Among many anatomical differences in your running style / mechanics (gait and leg length differences and foot arch height) the biggest factor which impacts on lower body injuries, that we do have control over, is muscle strength imbalances in the lower limbs. This is the easiest preventative measure to make when planning your run training along with making sure you have the correct foot wear. Imbalances place greater strains on particular areas of the body finally leading to injury. E.g. if your gluteals are weak and inhibited then you can end up having ITB or knee injury as a result. With weak muscles fatigue sets in quicker and this is when injuries can occur as joint integrity is compromised.


Top Tips to Reduce Injury Risk:


1. Listen to your body- if you're feeling fatigued and supposed to be doing a tempo run then don't, reduce the intensity and take it slow. Or even cross train taking a low impact option instead like swimming or cycling.

2. Develop a specific training plan that from what you know about your own body and weaknesses as well as how you like to train. Everyone is different and an off the peg 10km training plan may not work best for you.

3. Get fitted with the correct shoes to suit your feet and running gait as well as the intended terrain you plan running on. Replace every 400-500 miles too.

4. Mobility and flexibility- make sure you cool down and stretch post runs, use the foam roller, attend yoga classes and also book in some regular sports massages. This will keep you supple and stop your muscles getting tight and fatiguing potentially leading to injury.

5. Strength training is key- make sure you address your weaknesses and stay balanced. Work on a good foundation of muscular endurance and then focus on strength training on your areas of weakness to stop early fatigue and compromised running mechanics.

6. Nutrition and hydration- stay hydrated and make sure you fuel yourself when training and running, both pre, during and after to gain the most from your training into race day.


From my own experience, which is backed up by research (4), the majority of running injuries are due to a sudden increase in mileage or excessive mileage. Again, it takes experience to know when to back off and take it easy so if you have the guidance of a trainer, or experienced runner then listen to them as they will save you a lengthy and painful injury & recovery process.


If you want any advice on how to structure your training for a race, how best to increase your distance/mileage or in a strength training program to improve your running, then please get in touch and we can discuss how I can help you.


Currently I am training myself for my 1st 100km Trail Ultra Marathon in June and chasing a PB in my road ½ and full marathon in April.


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(1) Altman A, Davis IS. (2012) Barefoot running: biomechanics and implications for running injureis. Current Sports Medicine Reports 11(5):244-50.

(2) Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. (2002) A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 36(2): 95-101.

(3) van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SMA, Koes BW. (2007) Incident and determinants of lower extremity running injuries in long distance runners: a systematic review. British Journal of Sports Medicine 41(8): 469-80.

(4) Jacob SJ, Benson BL. (1986) Injuries to runners: a study of entrants to a 10,000 metre race. The American Journal of Sports Medicine 14 (2): 151-5.




By Lee Weston, Mar 13 2015 02:29PM

If you are craving some R&R and are looking to get away at the end of the season when the slopes are warmer, it is still really important to make sure you are well prepared. Below is some advice from my previous two seasons skiing and what I discovered when massaging a lot of tired skiers who failed to properly prepare for their eagerly awaited holidays. More often than not, skiers suffered with increased muscle soreness and fatigue, resulting in not being able to enjoy the slopes as much or ski for as long. At worse it resulted in musculoskeletal injuries from overload unconditioned fatigued muscles or unaccustomed movement patterns that the body couldn’t handle.


Nevertheless skiing is a great past time open to all ages and abilities. It gives everyone the chance to enjoy the mountain environment which has something special about it. You just have to know your limits and prepare correctly to gain the most from it.


Strength


Skiing and snowboarding all require strength and more importantly muscular endurance in your lower body predominantly. The main muscles that are worked are those that keep you upright; the gluteals, quadriceps, calves and back extensors. These muscles all extend our trunk and lower body limbs, working against gravity to stop us from falling awkwardly into a heap. As much as absolute strength is important, it is more the endurance of the muscle and the ability of the muscle to keep on producing a force over and over again. This is where conditioning for skiing is paramount for you to enjoy the sport.


Bodyweight


The best and most cost effective way to condition these muscles is to work with your own body weight performing squats, lunges (forward, backward, lateral and diagonal), step ups and deadlifts or good mornings. The aim here is to work within an endurance rep range and this should be 15-20 repetitions and working from 1 set up to 3 sets with 30-60 seconds between exercises repeating 2 to 4 times a week. The intensity of the exercises should be so that you can complete the rep range without stopping at a consistent tempo, not too fast, and controlled. Keep your eyes peeled for a blog to come on tempo of exercises in the future. Ensure that aim to perform the exercise through a full range of movement, so for example for a squat going down to thighs parallel or knees 90 degrees, even lower, If you can keep your heels on the floor and correct alignment of your back. By doing these exercises along with any low impact cardio vascular exercise (swimming or cycling) for 20 minutes or more, 1-5 times a week anywhere between 50-80% of your maximum effort will help strengthening and condition your lower body.


You don’t see an Oak tree with a small trunk and big branches


Our torso and upper body strength is still as important as our legs as the trunk transmits all the force from the upper body to the lower and vice versa. Our upper body acts as a counter balance supporting us to get up, helps initiate movements and possibly to help push ourselves along if we are skating on skis (or holding on to a skier’s pole if you are a boarder stuck on the flat!). More importantly it is key to have functional strength in our upper body to protect against injuries when we fall or get caught off guard and react instinctively to a stimulus, like catching an edge and putting our pole out to stabilise ourselves.


Push and Pull


To this end it is important to have relative strength to your own body weight in the key movements of the upper body: horizontal push and pull, vertical push and pull and a combination of these movements; and the trunk: flexion, extension and rotation. Again to ensure you are prepared for skiing it is all about endurance and not necessarily absolute strength. Most of these exercises are body weight however you may need an exercise band (relatively inexpensive from a physio or fitness shop).Perform these exercises, or similar variations: press ups, pull ups or band lat pull down, horizontal supine row or standing band row, standing band high pull, handstand press up (hard) or standing band shoulder press and dips. These should all be performed in the same rep ranges as the lower body.


Squeeze that bum


For the trunk you are essentially looking at static (without movement) and dynamic (with movement) abdominal & back exercises. Think about working your “core” (I don’t like the word core as it’s a bit of a buzz word) muscles in balance so to this end you should be doing static holds to engage the transverse abdominis like the plank, side plank and the supine bridge. Then for your dynamic exercises you could perform variations of supermans, deadbug, crunch, oblique crunch, back extensions and Russian twists. Again these need to be all in the same endurance rep and set range as previously mentioned. For those static holds, start with 30 second holds and increase by 10 seconds when you feel comfortable. It’s IMPORTANT that you are in control and draw in at the lower abdomen and squeeze the bum! We are not worrying about getting a six pack here!

Balance & co-ordination


Unstable surfaces


Skiing in spring snow is great as you get the sunshine but it is sometimes icy in the mornings and turns to slush very quickly. This means you have to hone in on your balance quickly in rapidly changing conditions, sometimes hitting patches of both in one run. Catching an edge it is common in slush and makes it harder for beginners but if you sink into turns and feel pressure though both feet and transfer the weight to appropriate foot to turn, you will cope better. This all requires balance and should be incorporated into you preparation. This tunes the bodies proprioception which is the feedback from what is happening at your joints to inform your brain of what to do in response to your limb and body positions. These exercise could be as simple as single leg balance (eyes open/closed/on tip toes), calf raises, small single and double leg hops (forward, backward, side to side & diagonal) and standing on a wobble board. Try these for 20seconds x2 and then build up by 10 seconds once you feel like you’re controlled and balanced. Ensure to engage your abdominal and gluteal muscles as these will really help to stabilise over the base of support. If you fancy more of a challenge when performing your body weight exercises then try to do them on a narrower base of support e.g. 1 leg squat or press up with 1 leg lifted, or with on an unstable surface. For example you could do a squat on a BOSU ball, plank with elbows on a Swiss ball or simply 1 leg balance standing on a cushion. This will get the body to respond quickly to small changes to remain stable over the base of support.


Integrate & co-ordinate


Now you can integrate all these movements and exercises above into approximately a 90 or 180 degree squat jump, two footed lateral jumps, a lunge and rotation or medicine ball diagonal chop. This integration helps co-ordinate the muscles and getting the body to strengthen the neural patterning of the movements so it becomes stronger and faster to respond when called upon.


Look to where you want to go


The best piece of advice I was given was from a seasoned freestyle skier when he took me on an off piste lesson. “Look to where you want to go and the body will follow”. Try it and it is so true. If you are strong enough in your legs, trunk and upper body and you have the ability for the body to quickly respond to keep you balanced (keen proprioception) you are less likely to get injured, fatigued and concentrate more on looking to where you want to go. If you look far enough ahead to your next turn, feel and sink into your feet, your trunk will be upright aiding in keeping balance over your skis. As soon as you are looking down your body will be follow and your weight falls over your skis instead of onto your fore foot (piste) and mid sole/heel (off piste). Try it, look up, feel with your feet and trust your legs and balance!


Top 5 tips to remain injury free


From my 2 winter seasons skiing and snowboarding here are my top tips to stay safe, injury free and have fun in or on the snow:


1. Rest when tired- don’t overdo it as this is when you fatigue and muscles can’t reaspond quickly enough. Pull in to the side of the piste, out of the way of everyone or even better a bar (see point 3) to have a rest.


2. Take it easy on your first couple of days- If you are not used to doing 5-8 hours of exercise a day in your normal day to day life don’t expect to be able to do it in mountains. Take it easy to prolong your enjoyment, and the legs.


3. Don’t ski under influence of alcohol- Trust me I have had plenty of experience of this in my time and been very lucky but know a lot of people who haven’t been as lucky - some coming off with serious injuries. When even slightly tipsy your decision making is affected, confidence increases and also your reaction times are slower. All can lead to possible injury. Just keep the lunch time pint in perspective.


4. Know your limits- Don’t be influenced by others around you and don’t be a sheep- especially off piste with the past couple of seasons being very unstable snow packs. Also it is better to have your bindings lower and skis to be lost than ripping your knee to pieces because you didn’t want to say to the ski fitter you are a beginner!


5. Concentrate even on the easiest runs- accidents can happen anywhere and most that I have seen are in the most unsuspecting places e.g. on a blue run, getting off a lift, stepping out the front door and waiting on the side of the piste. Always wear a helmet as you can be in control but it doesn’t mean the others on the slopes are. Be prepared at all times, you never know when you will hit a bare patch or ice!


Example body weight circuit for skiing:

15-20 reps x 2-3 times with up to 30sec rest between exercises and 1 minute between sets.


Circuit 1- Novice

Press up

Body weight squats

Band standing row

Plank – 30 sec

Band lat pull down

Body weight lunge

Band shoulder press

Back extensions

90 degree squat jump turns

*Could add standing split jumps as a CV station 30 sec


Circuit 2- Expert

Hindu Press up (on 1 leg)

Single leg squats

Supine body weight row

Plank on a Swiss ball (lift one arm/ one leg/ alternate arm & leg)

Handstand press ups (full or pike)

Pull ups

Clock lunges (forward, backwards, lateral & diagonal)

Medicine ball wood chops

180/360 degree squat jump turns

*Could add skipping or burpies as a CV station 30 sec


I hope this helps you prepare for your trip this Easter or even for next season.


More information


For any further advice regarding conditioning for skiing, sports or any specific injuries then please contact me. Having years of experience in this I will be happy to provide my services to help you achieve your goals.



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