In clinical practice we control for variables and assess a runner’s gait on a treadmill or while walking down a hallway. This does not represent the reality that is ‘the outside’. It is definitely not representative of running in the beautiful front range of Colorado Springs. Ben Jelinek DC shares his personal story and thoughts on training to best prepare and protect the Colorado runner from injury. Lets face it, running outside has so much more benefit to our bodies than running on a treadmill in a gym. Not only is it more functional, with a greater and broader workout for your muscles, there are the added psychological benefits that come with being in nature.

Training for the Trail

3 things to consider when running outside

Everyone should be able to stabilize on any part of the foot whatever footwear you choose

“This is important for the unexpected things that could happen (when injury risk is high, like a rock sliding out from under you or hitting a curb wrong) so that you have a wide range of options if something starts to hurt.” Ben Jelinek DC

Foot strike depends on what you are doing

“If you are speeding up, or you are on unpredictable ground (mud, rocks that move) or ground that hurts your feet (lots of the rocks around here with minimalistic shoes), a toe strike is usually preferable because you can respond more quickly and generate more force with the stretch shortening cycle. Heel strikes are for controlling speed downhill. In between can be anything you feel comfortable with, more to the mid foot range, and should change as certain muscles get tired (if you are running uphill a lot you will probably bias heel strike). In my opinion, “what is the correct foot strike” only becomes a topic when we limit the majority of variables that running would include, limiting it to flat, predictable, unchanging ground for hours, instead of having to choose your steps and pay attention because the world around you is changing as you move.” Ben Jelinek DC

You can’t run as many miles with minimalistic footwear, and it is dangerous to run on difficult trails without feeling the ground

I once went for a hike and tried some running while wearing my high ankle, stiff, hiking boots. My first clue that this was not a great idea was how it sounded. Hikers in front of me could hear the ‘clomp, clomp’ of my heavy and stiff boots coming down the trail. I guess that was some benefit. The other was that I definitely had to pay more attention to wear I was placing my feet. I have also run in more minimalist footwear and that was ok if the trail was soft and there were few rocks. The opposite effect happened, people couldn’t hear me coming. I was a ninja on the trail. I again had to look more carefully where I planted my feet. There is a shoe option for you that is better for the type of trail you are on. Pick the right option for your conditions.

Training Ideas

Do balance exercises on a varied surface

Train in bare feet to increase proprioception or awareness

Use arm and leg motions to mimic running (Proprioceptive Neuromuscular Facilitation or PNF)

Start light and have smaller goals

Ben leaves us with this idea…

“It’s like squatting form. Lifting in real life, outside of the gym where we reduce variables to make lifting easier, is almost never done with feet parallel, on flat ground, weight evenly distributed across your back. Many times the “weight” you are lifting is awkward (furniture) or moving around (kids)… I think we miss a lot in preparing people for life outside the gym, or to return to running, anything that isn’t flat and predictable.”

Common running injuries

Ankle sprains

Lateral knee pain

Hip pain

A note about ankle sprains with runners

One of the most common ankle sprains that we see in clinical practice is not a ligament sprain of the anterior talofibular ligament but a joint injury to the lateral malleolus or ankle bone and its joint with the tibia. This is taken from Brian Mulligan, a Physiotherapist in New Zealand. Since sharing this idea with the physical therapy community in the US there have been more and more articles published.

What to look for

• Swelling to the outside of the ankle and foot that is significant
• Pain with turning your foot inward or inversion
• Pain with standing on the injured foot

How we check

Turn you foot inward, does it hurt on the outside of your ankle? Usually the pain is just in front of the ankle bone or lateral malleolus.

Next, using your thumb, support the ankle bone on the front. Turn your foot inward. Does your pain go away and your mobility improve?

If this test is positive, meaning that it helps, then your ankle injury is most likely a joint injury and treatment can be very successful.

If this is you then taping the fibula or lateral malleolus for support causes reduced pain and improved weight bearing immediately. Use the taping for 2 weeks while slowly progressing pain free walking and then running. 

R.I.C.E.

It is always a good idea with an ankle injury no matter the diagnosis or injury to rest, ice it, compress and elevate or get off of your foot.

Occasionally I have heard of that you should not ice an ankle sprain. Controlling your swelling will speed up your healing and decrease tissue damage. Swelling in tissue if it is excessive and if it stays too long will actually reduce healing by limiting the exchange of nutrients and oxygen to tissues. Basically, swelling, if left unchecked, slows healing. Short periods of repetitive icing can be very helpful in healing more quickly.

Diagnostic Ultrasound can be a good way to screen for fractures, ligament tears and swelling. This technology is the future of screening of injuries in physical therapist, chiropractic and medical offices. 

Lateral knee pain in runners

This is a common condition without a lot of answers.

Most typically this is an iliotibial band (ITB) or IT band issue. If you have ITB tension then you have a sacroiliac (SI) joint issue. This joint problem causes the hip muscles to reverse their firing pattern, the small tensor fascia lata (TFL) that attaches to the ITB says “I can do it!” when the strong hip muscles have given up. This creates painful restrictions to the outside of the thigh along the ITB.

Another associated problem is a weak or inhibited core.

Your core is not engaging. This will cause re-injury and creates a ‘ceiling’ to your training. Re-injury is common with runners when this problem exists. If you find yourself in a situation where you cannot progress with an activity or exercise or your pain continues to return then your core is the problem and getting this checked with diagnostic ultrasound is recommended. Check out the CŌR Strength Project for information about assessing and training the core.

Symptoms

Tightness and tension to the outer thigh

Pain to the outside of the knee

Pain occurs at the beginning and after a run

Pain gets worse at the end of your run

You are using rollers to work the outside of your thigh

Treatment for Lateral Knee Pain

Dry needling can be a fast way to reduce tension to the outside of the knee. This video is me dry needling my lateral thigh near the knee. My running improved right after with no pain and much less tension.

A potentially damaging self-treatment and something you should stop if you are currently doing this is rolling on your ITB.

Hip Pain in Runners

This goes along with lateral knee pain. This is usually a core problem and associated with a back and sacroiliac joint problem.  A quick screen for yourself is to look down at your feet. Do they point in the same way? Do they have the same angle? If one is point differently than the other than you have a high likelihood of a pelvic and low back issue and assessment and potential treatment is recommended. It also means that most self-treatments will be temporary and your pain will continue to return.