The 2023 Chicago Marathon saw a record 45,000+ participants toe the line – an indicator that running is in its height of popularity. While a common form of physical activity, running is associated with a high prevalence of overuse injuries in the lower body. It is estimated that 50% of runners experience an injury every year and 25% of runners are injured at any given time.1 The high rate of overuse injuries in runners, at large, results from drastic changes to training volumes, repetitive impact on joints, and a failure to correct muscular imbalances. How can runners reduce their injury risk? Prehabilitation is the answer.
“Prehabilitation,” or, “prehab,” when incorporated into training routines, enhances running efficiency and correct technique, thus improving running form and performance and reducing injury risk.22 In this month’s Recovery Round-Up, our physical therapists identify the physical demands running requires and highlight common injuries associated with running. We also provide a prehabilitation exercise program designed to help you maintain optimal performance without skipping a stride.
What are the physical demands of running?
Impact Absorption
Running requires the body’s joints to absorb up to eight times our own body weight with every step. Proper leg biomechanics and strong muscles, tendons, and bones are essential to distribute landing forces evenly and prevent repetitive impact injuries.
Hip and Core Stability
The hips and core provide the essential stability needed for safe and effective gait mechanics. Running predominantly alternates between single-leg positions, making single-leg stability especially important. Hip and core stability also contribute to proper running posture.
Foot/Ankle Flexibility and Strength
The foot and ankle act as a suspension system for the entire body, adapting to uneven surfaces upon impact and propelling the body forward during push off. This is necessary for force absorption and proper stride length, respectively.
Hip Flexion/Extension Range of Motion and Strength
Flexion (forward motion) and extension (backward motion) of the hips are the primary mechanics of running. Adequate hip extension range ensures proper stride length, while adequate hip extensor strength powers propulsion. In addition, adequate hip range of motion and flexion strength minimize overstriding and improve speed.
Rotational Strength and Range of Motion
Symmetrical rotation strength and range of motion of the legs, pelvis, and spine are vital to distributing forces exerted on the body. Rotational strength improves speed and energy efficiency.
Highest Proportion of Injury Prevalence1
- Medial Tibial Stress Syndrome (“Shin Splints”)
- Achilles Tendinopathy
- Stress Fractures (tibia, fibular, fifth metatarsal, navicular, and calcaneus)
- Ankle Sprain
- Quadriceps/Hamstring Tendinopathy
- Patellar Tendinopathy
- Meniscal Injury
- Glute Strain/Tendinopathy
- Calf Strain
Running Prehabilitation Exercise Routine
After discussing the physical demands of running and common injuries, let’s dive into a prehabilitation exercise routine to help you run safely, improve running form, and minimize risk of injury.
Heel Raises
Stand tall near a wall for balance support. While keeping your knees straight, lift your heels as high as you can. Slowly return to the starting position. Complete 3 sets of 15-20 reps.
Bridge with Banded March
Lie on your back with a resistance band wrapped around your feet. Elevate your feet on a stable surface 12-24 inches off the ground. Engage your core and glutes while you bridge your hips into the air until your feet, hips, and shoulders are aligned. Flex one hip to a 90-degree angle while maintaining the original bridge position. Alternate flexing each leg 90 degrees. Complete 3 sets of 10 reps per leg.
Lateral Step Down
Stand tall with one foot hanging off the edge of a sturdy step. While keeping all your body weight on your planted foot, lower your body to tap your opposite foot flat on the ground without transferring your weight to the tapping foot. While lowering your body, be careful that your knee does not move past the toes of your planted foot. Return to starting position. Complete 3 sets of 12 reps per leg.
Side Plank with Leg Raise
Lie on your side with your knees aligned with your hips; your bottom knee should be flexed 90 degrees and your top knee fully extended. Position your elbow so that it is directly below the level of your shoulder. Lift your hips in the air so that your knee, hip, and shoulder are in alignment. Maintain stability in this position while you slowly lift and lower your top leg. Repeat on the opposite side. Complete 3 sets of 15 reps per side.
Dead Bug with Swiss Ball
Start by lying on your back with your shoulders, hips, and knees bent to 90 degrees. Place a Swiss Ball in between your hands and knees. Engage your abdominals by pressing your lower back into the ground and apply pressure into the ball with your hands and knees. Slowly extend one arm and the opposite leg, while maintaining pressure into the Swiss Ball. Alternate sides. Complete 3 sets of 8 reps per side.
Bird Dog
Start in a quadruped position, with your hands directly under your shoulders and knees directly below your hips. Find your neutral spine position by identifying the midpoint between a fully arched and fully rounded spine. While keeping abdominals engaged, raise one arm and the opposite leg until they are aligned with your trunk. Avoid any arching, rounding, or twisting of your spine while performing the movements. Repeat with opposite arm and leg. Complete 3 sets of 8 reps per side.
Single-Leg RDL to March
Begin by balancing on one leg with your opposite hip flexed to 90 degrees. Tilt your trunk forward, while pushing your hips backwards as far as you feel comfortable. Your back should be flat, free of any rounding or rotation. Return to the starting position while preventing your foot from touching the ground. Repeat on the opposite leg. Complete 3 sets of 8 reps per side.
Box Jump
Begin by standing on an 8-12 inch box in a single-leg stance position with your opposite foot hovering off the box. Hop off the box, landing on the hover foot as softly and quietly as possible. Land on your midfoot and use the bend of your ankle, knee, and hip to absorb the force from the jump. Hold the single-leg stance position for 1 second after landing. Do not allow your knee to cave inwards towards the midline of your body. Repeat on the opposite leg. Complete 3 sets of 6 reps per side.
Skater Hops
Begin in a partial single-leg squat position, with your left leg crossed behind your right leg. Hop laterally onto your left leg and absorb the impact by assuming a partial single-leg squat position with your right leg crossed behind your left leg. Repeat hopping side to side in one fluid motion, while swinging your arms to assist with momentum. Only jump a distance that you feel safe and comfortable controlling. Complete 3 sets of 12 reps per side.
Failing to prepare for running’s biomechanical demands can lead to injuries, reduce running efficiency, and result in poor technique and performance.The prehabilitation program offers a proactive way to enhance your running longevity. For maximum benefit, complete the program at least twice weekly, ensuring a rest day in between sessions.
If you have any questions or want additional guidance, please contact physicaltherapy@shiftlife.com or Schedule a Physical Therapy Appointment for an in-person assessment of your strength, range of motion, and running mechanics.
In Real Health,
Scott Robin, PT, DPT & Avis Jason, PT, DPT
SHIFT Physical Therapists
- Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci 2021;10:513 22. ↩︎
- Vincent HK, Brownstein M, Vincent KR. Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners. Arthrosc Sports Med Rehabil. 2022;4(1):e151-e162. Published 2022 Jan 28. doi:10.1016/j.asmr.2021.09.032 ↩︎