Most people spend a lot of time building capacity – very few train expression.

The post Why Performance Fails appeared first on RunTeach.

Jeff, a male runner in his 60s, contacted me about his persistent right-sided runner’s knee pain. For over three years, it had been a constant companion, sometimes completely stopping him from running.

He’d seen his local doctor, and when they couldn’t find anything definitive, he turned to a physiotherapist. Jeff had one session every week for three months! Think about that for a moment: 12 weekly sessions, a significant investment of both time and money, all hoping to get back to the sport he loved.

Sadly for Jeff, 12 sessions of physiotherapy made no difference to his knee pain at all. In fact, Jeff also had very tight hamstrings, a problem he’d lived with since his younger years, and the physiotherapy hadn’t solved that either.

Jeff told me he’d managed to get back to running himself by using a neoprene sleeve over his right knee. This allowed him to run almost pain-free, which was incredibly intriguing. He actually had three different knee sleeves: a thin neoprene one, a more robust one with a small hinge, and an even thicker one with a stronger hinge. None were solid, just varying thicknesses of neoprene. While these sleeves allowed him to run almost as far as he wanted, they were a real inconvenience to lug around and wear on every run.

Unlocking the Nervous System: The First Breakthrough

So, Jeff came in for a running and movement assessment. We went through a thorough, personalised set of tests and observations. As with all my assessments, some tests are designed to discover the effectiveness of certain drills or sensory stimulation methods. As part of this, using specific drills and sensory stimulation, we actually solved Jeff’s long-standing tight hamstring issue in about 45 seconds! No joke – 45 seconds! This immediate improvement hinted at the power of working with his nervous system.

His knee pain, however, was a different story. Satisfied that the various scans Jeff had undergone over the past three years showed no specific tissue issues, I carried out extensive sensory testing around Jeff’s right knee. We discovered he couldn’t feel the sensation of cold on a small patch of skin on the outside of his knee. This was a crucial clue, suggesting that his brain wasn’t getting clear signals from that area, almost like a ‘blurry GPS signal’ for his knee. When your brain doesn’t have a precise sense of where a body part is, it can’t control and stabilise it properly, often leading to pain. We confirmed this by doing some squats; his right knee pain was instant, and I could see his control was poor.

There was a possibility then, that when Jeff wore one of the knee sleeves, his skin was heating up, and this extra warmth was making up for the lack of cold sensation, helping to sharpen the brain’s map of his knee. I applied cold sensory therapy to Jeff’s knee for the rest of the assessment, and we retested the squats. This massively improved his squat control, and there was virtually no pain. Running on the treadmill was also much better with less pain. I sent Jeff home with some cold therapy drills and other knee-mapping exercises.

In our next session, Jeff reported he could now run a couple of kilometres pain-free without the knee sleeves, but any longer, and it became very painful. However, he could now walk completely pain-free. I felt we were on the right track with sensory input, so I did more testing and re-testing. I gave Jeff some more mapping exercises to do at home. At his next session, Jeff said he could run a bit further now, but was still lugging one of the knee sleeves around in a backpack because beyond 3 or 4 km, he was still getting terrible pain.

Decoding the Knee Sleeve: The ‘Aha!’ Moment

So, I took to my large whiteboard, and together, we reverse-engineered exactly what the knee sleeves might be doing. Now, Jeff was like a lot of runners I see in that when he has pain, he immediately associates it with some form of tissue damage. Even though I had spent considerable time explaining and demonstrating that actually, it was his nervous system reporting false alarms of threats, Jeff struggled to move away from “it must be a tissue-issue, and I might be making it worse by running on it without the sleeve.” This made it even more important to figure out what the sleeve was actually doing.

Given that the sleeves were all made of neoprene, they offered minimal muscle bracing or structural support. This was a tough concept for Jeff to grasp initially. But by demonstrating how his knee could still freely move in all directions, even with the thickest sleeve, he started to understand that it wasn’t providing the external structural support he assumed.

So what was it doing for him? We knew his knee was probably heating up a bit, and therapy around the cold sensory deficit helped, but there was something else more important for his brain. Then Jeff mentioned something that made my brain go into overdrive: sometimes he would stop his run and massage the outside of his knee, and this helped reduce the pain. Bingo! It suddenly clicked.

Through a specialist technique, I tested how his brain responded to different types of touch on his skin – specifically, how it reacted to skin being stretched and skin being compressed. I discovered that by applying decent pressure directly onto his skin, compressing it in that specific spot, he could squat completely pain-free. This included single leg squats, which he could never do before due to pain and lack of control. This was it! This was the missing piece!

The Ingenious Solution: A Small Piece of Tape

But obviously, I wasn’t going to follow him around pushing on his knee! So I came up with an ingenious, simple solution: a small, 6cm strip of kinesiology tape. I applied the tape in a very specific way, creating that precise skin compression in just the right spot. Jeff tested this on the treadmill, and just like that, he was pain-free! I cut some more strips for him to take away and taught him how to apply it, sending him a supporting video of him applying it to his own knee for reference.

At his next session, he was over the moon! He could now run more than 21km completely pain-free without hauling around those bulky knee sleeves. All he needed was a small, easily portable piece of tape. He carried several pieces with him when he went for a run; they’re so easy to pop into his pocket – no more heavy backpack!

We did some other mapping work at that session, but Jeff decided that now he could run pain-free and race half marathons again, compromising by sticking a small bit of tape onto his knee was the perfect cost/benefit ratio for him.

Your Brain is the Key to Pain-Free Running

I love stories like Jeff’s because they illustrate that even when someone holds onto the ’tissue damage’ belief, their running and their life can be profoundly transformed by working with their brain and nervous system. You don’t need to be a “believer” in neuroscience for it to work!

So, if you’ve been battling pain for more than a few months, and scans show no specific injury, or perhaps a past injury has long healed, it’s time to look beyond the obvious and start exploring the incredible power of your brain and nervous system.

To help you understand this often-overlooked aspect of pain, I’ve created a completely FREE mini-course specifically for runners which you can find here.

To access the FREE course you will need to create a free account on the course platform.

Important Note:
Jeff had already seen medical professionals before he came to see me. He had also undergone several scans so was confident there was no physical injury.

It is very important that if you suspect at all that you may have a physical injury then you must go and get it checked out by a medical professional. Nothing in this article nor in anything that I teach, suggest or recommend, replaces the knowledge and experience of a trained medical professional when it comes to acute injury. Please do not ignore the fact that physical injuries do happen, so ensure you receive the care you need.

The post From Three Years of Runner’s Knee to Pain-Free Half Marathons: Jeff’s Story appeared first on RunTeach.

Introduction

In the first article we looked at some common running injuries and also started to delve into the definitions of injury and whether there needs to be any physical tissue issue for you to experience physical pain. In this article we are going to dive in deeper to get a good understanding of what pain is and how it works.

Because pain is such a complicated topic and often very hard to explain without going into a load of science you probably don’t want to read right now, I’ve put together a short story to help you understand pain a bit better. We can then pull apart individual areas of this story in future articles to tease out a deeper understanding – something I regard as critical if you are going to manage and modulate your own pain.

The Whisper of Pain

It began as a whisper, a fleeting discomfort in Emily’s ankle as she ran along the embankment on a crisp, bright morning. At first, she dismissed it – she had felt her foot slip off a root, but it was a tiny movement; maybe she had banged it as she was loading up the kids’ bags as they rushed into the car for the school run. But over the weeks, the whisper grew louder, becoming a persistent throb that forced her to question: What exactly is pain?

This is Emily’s story, but it could be anyone’s. Pain is universal, yet deeply personal, shaped by biology, psychology, and even society. To understand pain, we must journey into the intricate world of neuroscience, where signals, chemicals, and perceptions weave a complex tapestry.

The Signal of Alarm

Pain begins its journey as a threat signal in the body, often as a response to potential harm. When Emily’s foot slipped off that root, specialised nerve endings called nociceptors sprang into action.

These nociceptors, which reside in her skin, muscles, and organs, are like tiny watchtowers. They detect extreme temperatures, pressure, or chemical changes and send electrical signals racing along her nerves to her spinal cord and brain.

In milliseconds, her body reacted – returning her ankle to its previous position before she was even consciously aware of what had happened. This is the power of the reflex arc, a rapid protective mechanism that bypasses the brain for speed.

The Brain’s Role in Pain

The signals from Emily’s ankle didn’t stop at her spinal cord. They continued their journey to the thalamus, a central relay station in her brain. From there, they were dispatched to various regions:

• The somatosensory cortex, which identified the potential threat’s location and intensity.
• The limbic system, which processed the emotional distress of her rolled ankle.
• The prefrontal cortex, which helped her brain assess the situation and decide what to do next.

Interestingly, Emily’s pain wasn’t just a physical sensation. It was shaped by her thoughts, past experiences, and expectations. This is why neuroscientists say pain lives in the brain.

Chronic Pain – When the Alarm Stays On

Weeks later, Emily’s ankle had long ago healed, but the dull ache persisted. She wondered: Why does it still hurt when there’s no injury?

This is the enigma of chronic pain, where the nervous system continues to send threat signals long after the initial damage has healed. Scientists have discovered that in chronic pain, the nervous system undergoes a process called central sensitisation, making it hypersensitive.

For Emily, this meant that her brain and spinal cord were amplifying normal sensations, interpreting even gentle touches as a threat and creating the experience of them being painful. This phenomenon explains why chronic pain feels so real, even when doctors can’t find a clear cause.

Pain and Emotion – The Brain’s Feedback Loop

Pain and emotion are intricately linked. On stressful days, Emily noticed her pain felt worse. On relaxing weekends, it seemed more bearable.

This is no coincidence. The brain’s pain and emotional centers are deeply intertwined. Neurotransmitters like serotonin and dopamine, which regulate mood, also influence pain perception. Stress can amplify pain by flooding the body with cortisol, a stress hormone that heightens sensitivity.

Emily’s story highlights the importance of addressing not just the physical, but also the emotional aspects of pain.

The Gate Control Theory – A Balancing Act

Emily’s movement coach introduced her to a fascinating concept: the Gate Control Theory of pain.

Imagine a “gate” in the spinal cord that controls whether threat signals reach the brain. By engaging in activities like running and other exercise, massage, sensory stimulation such as skin stretch or vibration, and even laughter, Emily could “close the gate,” reducing her perception of pain.

This explained why certain distractions, like playing her favourite music, seemed to help. Her brain was focusing on other signals, leaving less bandwidth for pain.

Phantom Pain – The Ghost in the System

One day, Emily met Sam, a veteran who’d lost his leg in an accident. Despite the amputation, Sam often felt excruciating pain in his missing limb – a phenomenon called phantom pain.

Sam’s story illuminated the incredible adaptability of the brain, known as neuroplasticity. His brain was still mapping the missing limb, generating threat signals as if it were still there.

Through techniques like mirror therapy, Sam was retraining his brain to quiet these phantom sensations, offering hope for recovery.

Pain’s Silver Lining

Despite its unpleasantness, pain serves a critical purpose. Without it, Emily’s system might not have reacted to control her ankle, potentially leading to severe tissue issues. Conditions like congenital insensitivity to pain, where individuals cannot experience pain, highlight its importance.

However, while acute pain is protective, chronic pain often loses its usefulness, becoming a condition to manage rather than a symptom to treat.

The Future of Pain Management

Emily’s journey led her to explore cutting-edge advancements in pain science. Researchers are developing treatments that target pain at its source, such as:

• Neuromodulation therapies, like spinal cord stimulators, which block threat signals.
• Personalised movement, exercises and drills specifically designed for that individual’s nervous system.
• Personalised sensory stacks, where certain sensory receptors are stimulated in specific ways and stacked together in response to the individual’s nervous system output.
• Personalised medicine, where genetic testing helps tailor treatments.
• Mind-body approaches, like mindfulness meditation, which retrains the brain’s response to threat.

The neuroscience of pain is evolving, offering new hope for millions like Emily and Sam.

Pain as a Teacher

Emily’s experience with pain transformed her perspective. She learned that pain is not just an output signal but a story – a narrative shaped by her body, brain, and environment.

Her journey underscores the resilience of the human spirit and the incredible complexity of the mind. While pain may be inevitable, understanding its science empowers us to rewrite its story.

FAQs

1. Why does pain feel worse during stress?
Stress releases hormones like cortisol, which amplify threat sensitivity by heightening the nervous system’s response.

2. What is central sensitisation in chronic pain?
Central sensitisation is when the nervous system becomes hypersensitive, amplifying normal sensations into threatening ones that result in an experience of pain.

3. How does the Gate Control Theory of pain work?
The Gate Control Theory suggests that “gates” in the spinal cord regulate threat signals to the brain. Distractions or physical activities can close these gates, reducing pain perception.

4. What is phantom pain?
Phantom pain is a sensation of pain in a limb or body part that has been amputated. It occurs because the brain’s map of the body persists even after the loss.

5. Can emotions influence pain?
Yes, emotions and pain are closely connected. Positive emotions can reduce pain perception, while negative emotions can intensify it.

6. What are emerging treatments for chronic pain?
Emerging treatments include neuromodulation therapies, personalised movement strategies, personalised sensory strategies, personalised medicine, and mind-body approaches like mindfulness meditation.

Conclusion

Through Emily’s pain story, you can get a basic understanding of what pain is and how pain works. Effectively, pain is an experience created in the brain in response to threat signals from your body’s tissues, combined with your previous experiences and your beliefs.

In the next article we are going to look at some specific case studies where I have worked with clients to modulate their experience of pain, including avoiding surgery and continuing to be very active and performing at a high level.

In the meantime, here is a great resource from Tame The Beast to help you understand pain a bit better: https://www.tamethebeast.org/

The post Running injuries and pain – 2 appeared first on RunTeach.

Common running injuries – what the research says

According to various research studies, Runner’s Knee (Patellofemoral Pain Syndrome) is the most common running injury, followed by Plantar Fasciitis (foot and heel pain). The graph below shows some more details:

The data for this graph has come from research studies conducted mainly between 1980 (Noble, 1980) and 2018 (Mulvad et al., 2018; Sahu et al., 2018) with the most often cited in blogs, articles, courses and presentations coming from 2002 (Taunton et al., 2002). It strikes me that more updated research is due, although there are a couple of more recent studies we can look at but it’s not enough to get a full picture of the current situation.

The first is a one-year study by Desai et al., 2020 where they found a 46% cumulative incidence of running-related injuries, with the knee (27%) and Achilles tendon/calf (25%) being the most common injury locations. As this study looked at runners who had a previous history of injury, it was slightly different from some of the other research. What is most interesting in terms of location is that again, the knee was the most common site of pain.

I’m always interested in what the definitions of a running related injury are in studies, and in how the experience of pain is reported. In this particular study, they used the following consensus statement:

“a running-related musculoskeletal pain in the lower limbs or back that causes restriction of running (distance, speed, duration, or training) in more than 66% of all training sessions in 2 consecutive weeks or in more than 50% of all training sessions in 4 consecutive weeks, or that requires the runner to consult a physician or other health professional.”

To me, the really interesting part about that qualification of a running-related-injury is that it is self-reported, and even if the runner consulted a physician or other health professional, there is no mention as to whether there needed to be any actual tissue issue – something that will become relevant shortly.

The other recent study was by Stenerson et al., 2023. This was a survey driven study, so again it relied upon self-reporting – in this case the responses were submitted anonymously. The aim of the study was to look at the relationship of overuse injuries and training parameters. They found that most runners (84.4%) had an injury history with 46.6% experiencing a running-related injury in the previous year. There was a slight difference in location with the foot and ankle (30.9%) being the most common site of reported pain followed by the knee (22.2%).

What is clear to me from all of these studies is:

1. The existence of an injury is determined by an experience of pain rather than any evidenced tissue issue such as fractures, lacerations, torn muscles, muscle strain or any other physical damage. This itself is actually a positive, or would be if it weren’t for most people’s current understanding and beliefs around the word injury.
   
2. The experience of pain is self-reported, and only provides information on the location of the pain, not necessarily the site of an injury, if indeed one exists. It is now well understood across several professions that where pain is experienced and where a physical injury may be present, are often not the same place.

There are other limitations as well, such as the researchers’ own biases and beliefs around pain and their interpretation of what pain might mean in the context of a runner. But let’s put these things to one side for now, as the two primary limitations I highlighted above are more than enough to be concerned with.

What we need to do is start making some distinctions around injury and pain, and update ourselves on what is really happening when we feel pain. This is exactly what this article, and the next few articles, are all about. Sit back, buckle up and open your mind – we’re going on a journey into the wonderful world of pain!

I’m injured!

But are you? How do you know? Did a running buddy say it was runner’s knee or ‘plantar f’? Yes, you’re in pain – but does that mean you are injured? Perhaps it depends on your definition of injury. Here are some of the common ones:

Medical Definition

“Injury”: Damage or harm caused to the structure or function of the body due to an external agent or force.

Source: World Health Organization (WHO). The WHO includes injuries in its International Classification of Diseases (ICD), defining them broadly as any physical damage caused by external factors, including trauma and poisoning.

​​Sports and Physical Activity Definition

“Injury”: Any physical complaint sustained during training or competition that results in the athlete needing to stop, limit, or modify their activity.

Source: Consensus documents from sports medicine organisations, such as the International Olympic Committee (IOC) and the American College of Sports Medicine (ACSM).

Occupational Health Definition

“Injury”: Physical damage arising from a specific incident or exposure in the workplace, such as cuts, fractures, burns, or musculoskeletal strains.

Source: Occupational Safety and Health Administration (OSHA) or similar regulatory bodies worldwide.

There are also legal definitions and psychological definitions, but they take us a bit wide of the mark for what we are learning about here. 

You’ll notice that two out of the three definitions above state that tissue damage has taken place, while the Sports and Physical Activity definition just mentions a physical complaint. Why is it important to notice this? Well, it highlights the fact that most official definitions, like most of our beliefs, support the idea that an injury has a physical damage element. This in itself isn’t really an issue, except for the fact that almost all of us link pain to injury, and therefore are linking pain to physical damage. This is the problem.

It is encouraging though, that the sports definition recognises, perhaps indirectly, that physical damage doesn’t need to be present for an injury to exist. This is helpful because we can say in this context that we have an injury without there necessarily being any physical damage. It frees us to have a pain that stops us from running without there needing to be an assumption that physical damage exists. If we all thought like this, some of the research would be more helpful: instead of looking for a physical tissue issue reason for a runner’s knee pain, we would automatically be taking lots of non-tissue issue possibilities into account as well. 

You may think I’m being really picky (I am!), but I feel it’s important because those studies on common running injuries are all based on some variance on the medical definition of an injury that includes an assumption (or foregone conclusion) that physical damage is present as well as pain. This is very limiting to us as runners as it brings in feelings of fear that we may further ‘damage’ our tissues, or that we need to spend weeks or months seeing injury specialists that are basing their (almost always well-intentioned) solutions around the fact that there is some aspect of physical damage or physical movement issue when there may be none at all.

In fact, there is some research (Van Mechelen, 1992; Vincent & Vincent, 2017; Salzler et al., 2020) that suggests that between 20% and 56% of runners report pain even though the original physical damage has long-since healed. This is what we call a chronic pain state. But I would suggest that even that percentage is on the low side; the research isn’t there to determine this one way or the other unfortunately, and with the varying definitions of injuries and outdated beliefs around pain, it is more reliable to look at what is happening in the pain neuroscience fields and learn from that.

It may seem like you’ve read a lot in this article so far and not moved forward much, but getting a background to what you hear and are told (even by medical professionals) about injury and pain is important as it allows you to put it all into context with your own pain.

The real point I want to make here is that we say “I have a running injury” when what would be far more helpful is to say “I have a running pain”. This frees us from making a possible incorrect assumption that there is always physical damage that we need to be wary of.

I know, this can be challenging and it’s far easier to carry on thinking as you have done, but making this paradigm shift can open up a whole new selection of possible solutions that could get you out of pain and back to running very quickly – and at a fraction of the financial cost.

To summarise this section:

• Most definitions of injury include some aspect of physical tissue damage.
• Most of the research around running injuries use some variation of these definitions of injury, so an assumption is made that there is a physical tissue damage element – even if that is only how we as non-scientists interpret it.
• We have read, listened, watched, been instructed about, taught, and been convinced that pain and injury are inseparably interlinked.
• This thinking is limiting our pain modulation and rehab options, and is often the primary cause for runners not being able to return to running sooner.

It’s time to break away from these limiting beliefs with a new understanding of how pain works and what we can do about it. Join me for the next article where we’ll dive right in.

The post Running Injuries and Pain – 1 appeared first on RunTeach.

But maybe you’re the complete opposite and you love going to the gym but have found that no matter how much strength work you do, you still get those niggles and quite simply, you’re not getting any faster. 

As a runner, if you do a quick search on the Internet for reducing your injury risk and/or improving your performance, you’ll discover very quickly that “getting stronger” is the top tip from almost anyone. And I’ve got to agree with all of them: getting stronger is one of the outputs we need to develop to keep us running for longer and working towards our running goals.

Strength Is An Output

You see, strength is an output from your system. It’s the result of a whole bunch of stuff coming together and allowing your muscle fibres to contract to whatever level is needed to achieve the task. That task might be lifting a kettlebell or handling the forces of running. In all cases though, one huge element in strength is stabilising a joint as you lift, move and run. In fact, I would even argue that in our day to day lives outside of an experimental lab, joint stabilisation is one of the main things our expression of strength is doing.

They all start with trying to activate the muscles themselves. You’re given squats, lunges, deadlifts, landmine lifts, single leg exercises and much more. This can work for some people, but if the rest of your system won’t allow your muscles to activate and contract well, at best doing these exercises will just take a very long time to get any results. More often than not though, they simply won’t help you get any closer to your running goals at all.

You Are Already Superhuman!

You already have so much strength within your muscles already. Your strength, or “expression of strength” as I prefer to call it, is controlled by your brain. It’s not just to do with muscle size. You have neural inhibitors that actually block and reduce the amount of strength you can use. This is primarily a protection mechanism so you don’t injure yourself if the rest of your body and system can’t handle the forces you are generating.

A good example of this is when you have a limited quality of movement around a joint. If you can’t move well and control a joint, your brain will not allow you to exert or try to handle large forces across that joint. In other words, your ability to generate strength around that joint will be limited. This can have a cascading effect throughout the whole kinetic chain – all the other joints in your body, even if they are nowhere near the weaker joint.

Traditional strength training can work, but it usually takes a long time and a lot of patience because you are forcing the development of a skill (how to stabilise a joint) by working at the sharp end and hoping that your system will respond without you getting injured. To me, this is inefficient and completely backwards.

There Is A Better Way

The RunTeach system uses the following process to help you develop the strength and resilience you need as a runner:

Strength is the final output of the process and often doesn’t even need to be trained directly, depending on your running goals and current ability level.

By first developing the skill of joint stabilisation through working directly with your brain and nervous system, you can unlock the neural inhibitors and unlock your strength. This often happens very quickly: we’re talking minutes or hours of training as opposed to months and years of training! Longer term results will take longer, but it’s all relative to your goals and how much strength you need to be a resilient runner. 

Having developed the appropriate level of skill you need, adding endurance to that skill will enable you to run longer and faster without increasing your injury risk – essentially, you’ll be able to keep being strong for longer distances, more sessions, and at higher speeds.  Once you’ve got that strength, keeping it tends to have a very low requirement in terms of exercise and time. In fact, running just by itself can be the main maintenance factor.

If you want to find out more about this really quite jaw dropping approach to getting stronger, I would recommend attending one of our Resilient Runner Workshops. You’ll not only learn more, but will be able to actually apply it to your running right away.

The post Stop! Does Strength Work, Work? appeared first on RunTeach.

Do you love going to the gym? Or perhaps you’re like me and just don’t enjoy it at all; it seems way too much hassle carving out the time for a strength routine when you could be out running. Sound familiar?

The problem is, whatever we hear and read about reducing injury risk, injury prevention, prehab and rehab, getting stronger is something that almost always tops the list. And in many ways the phrase…

…is absolutely correct. We do tend to be more robust and more resilient when we are stronger. We are also able to develop more power and have greater stability – two things that go hand in hand in helping us run faster. Furthermore, if you are a runner over the age of 40, research implies that we should pay even more attention to staying strong in order to improve our performance and reduce our injury risk.

So essentially, you’ve got to get stronger! But hang on a minute… What does that actually mean? Does it mean you need to make time for two or three weight training sessions per week? Does it mean you need to drop one run per week to focus on strength work?

If the very thought of it is making you anxious, the good news is that you may not have to do this at all. There are ways to help you get stronger without lugging giant weights about, or spending numerous hours per month doing resistance training. Actually, some of that might still be necessary, but as it will be super targeted it will be shorter in duration and you’ll see results far quicker and they’ll last far longer.

What Is Strength?

Before we get into that though, we need to look at what strength actually is. Here are some dictionary definitions:

The ability to do things that need a lot of physical or mental effort

Cambridge Dictionary

The Merriam Webster dictionary has these definitions:

Looking through each of those, I can apply them in my mind to running. But is that what most of us really think of when considering doing strength work in connection with running? Although it seems logical that we need to be strong to run, do we really think “I’m going to make myself impregnable, solid and tough!” Or do we just think “I wish I could run faster and longer without my knee hurting! I better make sure it’s strong enough”.

So dictionary definitions of strength don’t actually help us at all in a practical sense. And I’m pretty sure most of us think we’re robust enough already, until we aren’t of course.

Be honest here, how many of us would skip strength work if we didn’t really need to do it? What’s that – you are already skipping it?… Yeah, I hear that all the time from runners.

But that’s OK. To me, strength is like fitness. It changes in the different areas of your life. If your goal is to sit on the couch all day and watch TV, and you can achieve that goal, then you are both fit and strong enough to do that. Equally, if your goal is to run a 20 minute 5k, but you’re currently running a 25 minute 5k, then you are neither fit enough nor strong enough to achieve that goal. We can split this down a bit further to be more helpful.

If we leave fitness to one side for now – mainly because I view strength as just one aspect of fitness and this could get very complicated – and just focus on strength. We can view strength in a similar way in which I view resilience:

The ability for your body’s tissues to withstand the forces applied to them, in the intensity, duration and frequency which your activity demands.

So basically, you are strong enough if your body’s tissues can handle all the forces you chuck at them without either giving up (injury) or forcing your nervous system to introduce some red flags such as fatigue, niggles and the warning experience of pain.

To complicate it slightly, strength is also linked to your ability to produce power, which in turn helps you run faster. But let’s just keep this simple for now, as your nervous system won’t let you express high levels of power without first having a powerful expression of strength. If you just went “uh?”, then let me explain:

Strength can be expressed in two different ways:

When you run, your feet will typically only be in contact with the ground for between 220 milliseconds and 350 milliseconds. At the more elite end of running, the number is lower as the foot turnover (cadence) tends to be a little higher. And I know, we are all told to improve our cadence.

But the trick with improving cadence is also keeping good form and not just turning what may have been a half-decent heel lift at a slower cadence into something that resembles a fast shuffle, just to get your feet turning over faster. There is also the challenge of being able to put down enough power in a shorter amount of time, but I’m kind of moving away from the point here and these are topics for different articles. Back to strength…

With your feet being on the ground for such a short period with every step, you don’t have enough time to voluntarily think about keeping your joints stable in your feet, ankles, knees, hips, pelvis, back, shoulders and neck. This all needs to happen automatically or reflexively. It also needs to be coordinated across the different areas for improved movement efficiency. And while you may think that only being on the ground for a fraction of a second means that there isn’t enough time to even bother with joint stability because you essentially hop or lunge from one foot to the other continuously, the forces of running are such (up to 3 times bodyweight – possibly more depending on what you read) that stability in each step is critical. 

Many of us get away with less than ideal reflexive stability over short distances and when we are not tired, but ramp it all up and suddenly the impacts are amplified and before long we certainly know about it. The same is true if you start to push the pace. More pace generally means more force both into the ground and back up from the ground (ground reaction force), so your body’s tissues need to be able to handle the greater demands and the need for even better reflexive stability.

One great example that we can all observe is the classic hip drop. The next time you are running behind someone, look at the movement of their pelvis. If their hip drops down to the opposite side of their stance leg, then they are likely to have some reflexive stability issues. Ordinarily, if you have hip drop, you will be told to do lots of glute (maximus and medius) and core strengthening and integration exercises (hopefully), but if your reflexive stability is poor, you are still unlikely to be able to build or use that strength properly.

Mastering the skill of reflexive stability is, in my opinion, a relatively quick and highly efficient way to improve your overall expression of strength for running – far better than just lifting weights and hoping it will all work. You will feel more stable, be able to put more power into your running, and run longer distances more comfortably than you’ve been able to before. 

You will also be teaching your nervous system how to identify, activate and control your muscles (these are all individual skills by the way). This then forms a fantastic foundation for you to carry on with any other strength work you may enjoy doing, and it will have much more of a positive impact and the benefits are likely to stick around for longer.

For clarity, to improve your reflexive stability, you do need to do voluntary neural drive exercises (i.e. resistance training), but they need to be well designed so they stimulate and upregulate the parts of your brain and nervous system that control reflexive stability.

Summary

To summarise then, first think about reflexive stability when you think about strength in running. Once you have mastered this through well designed and personalised exercises, you may or may not need more strength work of the normal “just lift weights” kind. You may find that your running sessions already provide you with enough stimulus to keep improving your resilience and neural drive strength. Of course that does depend on your goals, but that’s a topic for another article…

The post What Is Strength In Running? appeared first on RunTeach.

I’ll present one case study here, and follow up with more over the coming weeks.

Firstly though, for the avoidance of doubt, tissue issues are real things. Strains, sprains, tears, breaks – they are very real and just because they may not always be associated with pain (but in most cases they are for the reasons mentioned in Part 1), if you are in any doubt whether you have a physical injury or not, then you need to get seen by a medically trained professional – ideally someone who has experience of dealing with active people and specifically runners.

OK, now we have established that, let’s start looking at some case studies where runners have come to me with painful knees, hamstrings, ankles, IT Band etc. In many cases they have had this pain for months and months, and a few of them have had the pain for years and have seen a wide variety of very well meaning professionals that have helped somewhat but not quite got to the source of the issue. I want to give you a high-level overview of how they presented, some of the things I tried; what didn’t work and then what did work (with varying degrees of success).

Runner 1: Outside of right knee very painful for the last three years.

Introduction

Runner 1, we’ll call him Jim as that’s not his name, came to me for a running assessment as he had been getting pain in the outside of his right knee for the past three years. The only way he could run without pain was with a knee brace. He had a number of different types of knee brace from simple thin neoprene ones to more sturdy neoprene ones with built in hinges. This last type was the one he used most often as it gave the best relief, although it was quite cumbersome and very hot to wear.

Over the previous three years he had seen different practitioners, and at one point saw a physio once per week for three months. Unfortunately, nothing worked and the end result was always the same – he had to go back to running with a knee brace.

He eventually came to me on a recommendation. Jim’s thoughts were that something about his biomechanics (running technique) was leading to the knee pain and if he could improve his technique the pain would go away. Jim was also very concerned that if he ran with the knee pain (i.e. without the brace), he would be doing himself damage and severely injure the tissues.

The assessment

I always start my assessments with some basic pain and neuro education. After listening to Jim’s background and discussing his pre-submitted health forms, I explained how pain and movement works through an applied neurology lens. I often begin this education piece with the information in Post 1 of this mini series and expand from there as necessary. I find this helps to relieve some of the fear that you may have over damaging tissue when you run in pain. Let’s be clear though, running through pain is never a good idea, but the reframing of pain Vs injury helps you to take a step back and look at your situation more objectively.

Following this discussion, I stuck a load of dots on Jim and observed him walking up and down my office; taking video for discussion later in the assessment. How you walk gives me a wealth of information about how well your brain and nervous system is integrating with your muscles, and how well you unconsciously control certain movements. Jim then walked on the treadmill as it gives me slightly different data, and then he did a very small amount of running (both barefoot and in shoes) so I could capture the most important movement patterns as he ran. Now onto the really fun bit.

The rest of the assessment was made up of lots of brain-based tests and drills designed to look at Jim’s movement patterns specific to running. So in this section, I’m looking for things like coordination, agility, stability (both conscious and reflexive), balance, and your ability to express and control strength in certain movements. In Jim’s case, I also wanted to look at his sensory system in depth. From Jim’s pre-submitted forms, I had designed some tests to specifically assess how his sensory input may be contributing and impacting his knee pain.

Sensory Mapping

You may not be able to fully appreciate why this is important, so let’s take a very brief detour into the world of sensory mapping…

Without wanting to go into any complicated explanations, science has revealed to us that you have a number of virtual maps of your body that sit in various areas of your brain. These maps detail parts of your body with particular reference to controlling movement. The only way these maps can be kept to date is through the sensory input that comes in from those areas. If the maps go out of date or get blurry, your brain cannot accurately identify where that body part is so cannot move and control it well.

If the brain doesn’t feel ‘safe’ in knowing where a body part is, you won’t be able to be strong in that area and you may well be inaccurate when trying to move. Let’s just say that the body part in question is your knee. If this map is blurry, then your brain cannot identify where your knee is, so it can’t move it well. In addition, this inability to move well spills over into not being able to stabilise your knee joint.

As I’m sure you can imagine, when you are running your ability to stabilise your knees is very important. If you aren’t able to do this, your brain doesn’t feel ‘safe’ and predicts that this could lead to a physical injury. In order to get you to do something about it (initially, to stop this threatening activity of running), it gives you the experience of pain. But get this, it may not be the map of your knee that’s blurry. It could be your ankle or your hip and your brain is using pain in the knee because it knows you’ll pay attention to it.

Updating Jim’s Brain Based GPS

Through the sensory testing, I discovered that Jim’s right leg had a much lower sensitivity to vibration, heat and cold. This was most pronounced around his right knee and right ankle. The maps of these areas, therefore, were not being properly updated as there were significant sensory mapping data missing. So the first part of my mission to help Jim run without knee pain was to begin updating those brain maps.

To help update the maps and to also start to improve Jim’s right sided reflexive stability, we spent a couple of sessions where we combined cold sensory input around his right leg with loaded coordination and accuracy drills. This involved exercises such as accuracy shoulder circles, banded punch outs using my reaction lights, and mobilising the nerves around his right side pelvis and right leg.

As we started to make changes, Jim started to feel better about his running and was doing a bit more – and he had ran twice the preceding week without the knee brace. We then started to see the impact of not having the required level of skill to stabilise his joints to the degree needed for an increase in his running. Over the past months, Jim had also had left heel pain but this had been secondary to his right knee pain so wasn’t an initial priority. Now, however, it started to feel worse. Jim had changed running shoes which may also have been a factor, but the main challenge was that he still hadn’t developed the necessary stability skill, and clear brain maps, that he needed in order to increase his running. Determined as ever, Jim was due to run a trail half marathon in a couple of days.

Although that race went well, it was clear that Jim’s left heel pain was now the priority. We shifted focus slightly to deal with that while Jim was still doing the brain mapping exercises for his knee. After a few weeks of doing the exercises, Jim’s heel pain had improved and we put our focus back onto his right knee.

We spent some more time clearing up Jim’s brain maps with a variety of exercises designed specifically to challenge his brain and nervous system to clear the maps up.

The Big Breakthrough

Jim could do a few runs a week now without the brace, and even went for a period of a couple of weeks where he didn’t wear it at all. However, he had become somewhat reliant on it from a comfort perspective. Jim had used his knee brace for so long that his entire belief system about his knee pain was firmly attached to his use of the knee: with the brace, he had no pain and felt fully confident in running up 13 miles. Without the brace he could run without pain, but was always on edge about the possibility of impending tissue damage because he didn’t have the knee brace supporting him.

So now I had the added challenge of changing Jim’s belief system so we could reduce his anxiety around running without a knee brace. As part of this process, we also looked together in some detail at what the knee brace was actually doing for him.

The first thing I did was to demonstrate that his knee brace wasn’t giving any real support to his knee joint at all. It was just a neoprene brace with some plastic hinges built in. Although it was a bit weighty and felt the part, the truth was that Jim could move his knee into every angle very easily and the brace didn’t stop him. If it truly was providing any kind of positional or rigid joint support, he shouldn’t have been able to do that. So if it wasn’t providing significant joint support, what was it doing that was making his running completely pain free when he wore it?

We looked next at whether the heat being generated by the brace was making up for the lack of cold sensory input that Jim had in his knee, and therefore helping to update his map on the fly. There was good logic around this, and if the brace was heating the skin then this would help clear up the map as he was running. This in turn would help his brain activate the muscles better and stabilise the joint: no threat, no pain.

Then Jim told me that at the times when he wasn’t wearing the brace, if his knee hurt he would massage it in the painful area and this often allowed him to continue running for a bit longer. So I decided to get Jim to do some safe exercises that nevertheless irritated his knee, so I could do some testing. Jim started doing single leg squats and sure enough his knee pain came back. So I checked the skin mobility around the relevant area and discovered that it didn’t move very well. Skin stretch and fascial stretch (the deeper layers of tissue) are important sensory inputs that also help to map out your joints, and for Jim the skin stretch sensitivity in that area was poor.

I had Jim squat again but this time I made contact with his skin in the relevant area around his knee at an appropriate firmness and depth, and his knee pain simply vanished. I learned from this experiment that Jim’s knee brace was giving him firm pressure and pushing layers of his skin together which was providing the necessary sensory input to complete the brain map and allow his brain to control and stabilise his knee.

After some more experimentation, I came up with a personalised taping strategy that provided the same pushing together of Jim’s skin and fascial layers. So I managed to replicate the benefits the knee brace was giving him with a simple single piece of kinesiology tape strategically applied, that was both more comfortable and more practical than lugging a hinged knee brace around. Jim found he could complete all of his runs totally free of any knee pain as long as he had used the taping strategy before he ran.

So the big lesson here is that Jim’s lack of sensory input from his skin and deeper layers of tissue in a small area near his right knee, was confusing his brain and stopping the brain maps of his knee from being correctly updated. Combine this with the other sensory deficits and the brain maps were constantly out of date. Because the maps were blurry, his brain couldn’t properly control his knee when he was running. This meant he wasn’t handling the forces correctly which was creating a large threat level for his brain. His brain interpreted this as being unsafe and produced a pain experience to get Jim to stop what he was doing.

Was Jim’s issue fully resolved? No, he still needs to use the tape until such a point where the sensory deficit has been improved. This is going to take time and dedication, and Jim may decide it’s easier just to use a small piece of tape on his knee each time he runs.

So No Strength Work Then?

It’s very common in cases of knee pain for you to be given a load of strength work to improve the activation and strength of the knee and surrounding areas. While this can work in some people at some times, I often find that this doesn’t address the source of the issue. Is strength the ultimate output we want? Yes, but how you go about achieving it is the key.

Jim, like you, already has an abundance of strength in his muscles without doing additional lifting. The goal wasn’t to add more strength. Jim simply wasn’t able to access the existing strength available to him. The goal then, was finding a way for Jim’s nervous system to effectively activate his current strength and help his brain in stabilising his ankle, knee and hips.

Through all of the mapping exercises we did, and then finally with the specialist taping, we were able to do just that. We did use resistance bands at times, but I used these to stimulate stability with light and moving resistance rather than direct lifting work.

As an added benefit, Jim had always had very tight hamstrings – so much so that he couldn’t forward bend towards his toes very far at all. In problem solving his knee and heel pain, we also hugely improved his hamstring flexibility and strength without ever directly working on his hamstrings. Things like that happen a lot when I work at the level of the nervous system.

Main Takeaway

If you’ve had knee pain (or ankle, hamstring, hip pain etc) for more than six to twelve weeks, maybe you need to be looking wider than just some calf raises, clams, squats and lunges. Perhaps your sensory system needs testing to see if there are reasons why your brain won’t allow you to access your current strength. My motto, learned directly from two of the experts I’ve been following for many years, The Gait Guys, is:

1. Develop the skill first.

2. Add endurance to that skill.

3. Finally, add more strength to that skill if it’s needed.

In Jim’s case, he had to develop a joint stability skill that was currently beyond what he had. We achieved this through mapping exercises, sensory therapy and taping. He is currently adding endurance to this skill through his running and other exercises, and a natural part of this process is accessing more of the strength you already have.

The post Why Does My Knee Hurt? Case Study 1 appeared first on RunTeach.

Earning The Injury – A Bigger Problem Than Just Knees

Along with the monumental growth of recreational running over the past 10 years or so, there has also been a huge increase in the number of runners getting injured. You may think that’s logical and it does make sense that if the total number of runners increases, so does the total number of injuries. So far so obvious.

But I think the ratio of injuries to runners has got all skewed and the same runners are getting more and more injuries in a shorter and shorter time. In fact, I think that running related injuries in some sectors of recreational running are so common that they are almost worn as a badge of honour! Injuries almost seem to be an inevitable part of being a runner.

This may be common, but it’s NOT NORMAL!

When is it alright to just accept that we get injured? Never! But that’s what seems to be happening and I get disheartened whenever I read about runners getting injured over and over again and often ask myself the question “why?”.

Back To Knees

OK, mini rant over.

So, why does your knee hurt? To answer this question we need to put injuries into two distinct camps:

1. Acute injuries that have just happened. For example, you’ve slipped off a curb (or stepped off the promenade which I witnessed an unfortunate gentleman do the other day on the beach) and twisted your knee and ankle. Or, two days ago you banged your knee really hard on the table leg and it’s swollen right up. Or, you’ve unfortunately tripped on a tree root and face planted like a good’un.
   
   I used to split the above type of injuries from the more common running injuries that tend to sneak up on you over time. But in this context it’s more useful to keep them together as ultimately if there are tissue issues, it’s a single point in time where the threshold has been breached and led to those issues – even if it’s been a slow burn to get to that point.
   
   All these are examples of an acute injury that may or may not have resulted in some tissue related issues (strains, tears, breaks etc). In all these cases, your brain thinks you’re pretty stupid and in order to punish you releases huge amounts of pain… No, not really – but your brain does think the behaviour that led to the acute injury was a bit uncalled for and creates a small packet of data called a Neurotag that it can push in front of you next time, just to remind you that doing it again may be a little silly and this can trigger caution – a good thing.
   
   What actually happens at the brain level is that the area that received the physical injury goes on heightened alert and special threat sensors in the tissues send signals to your brain alerting it that there’s either an issue or a possibility of an issue.
   
   If your brain thinks the situation is important enough (based on a lot of past and current data), it will produce an output to get you to change your behaviour. In the case of acute injuries it’s normally quite a bit of pain so you pay attention to not using the injured area until it’s had time to heal.
   
   The threat sensors, called nociceptors, stay at a high sensitivity until such a time that the tissue has recovered enough that you can go back to using it. Essentially, the nociceptors create a buffer zone around the injured area that if you try to access (i.e. move, put weight on, put force through, etc) the brain’s response is to create an experience of pain to remind you to back off.
   
   Under normal circumstances, most injuries will have recovered to a state where the sensitivity of the nociceptors has gone almost back to normal within six weeks. Under certain conditions this can take longer, but rarely more than 12 weeks for most of the common injuries. Of course, there are always exceptions so it’s always a good idea to get things checked out by medically trained bods if you are in any doubt at all.
   
   So, in summary: acute injuries, whether they actually result in tissue issues or not, are injuries that have happened somewhere in the last 6 weeks. They usually cause an increase in sensitivity in your threat receptors (nociceptors) that in turn triggers the creation of a buffer zone. This buffer zone is closely monitored by the nociceptors and they inform the brain if you try to breach it. In response, your brain creates the experience of pain to remind you to reign it in. Usually, but not always, this buffer zone shrinks as the tissues recover and the sensitivity of the nociceptors returns to normal.
2. “But I’ve had my pain for months!” I hear you cry. I know, I know, we’re coming to that now. The second category or injury was what used to be called chronic injury. This is the pain and apparent injuries that just go on and on and on. So what’s happening here?
   
   At this point it’s really useful to separate out injuries from pain. You may have gathered from the acute injuries section that injuries and pain aren’t necessarily linked. “Whoa!!! Wait, what???!”. That’s right, injuries and pain don’t need to be bed buddies – you can have one without the other. I know, mind-blowing isn’t it. But you actually already knew that. Here are some examples:
   1. Military personnel injured on a battlefield that don’t feel any pain until they are in a hospital.
   2. The guy in Australia who walked down the high street with an axe in his head, even stopping to buy a sandwich from a convenience store on his way to the hospital – didn’t feel a thing.
   3. That cut you just noticed on your finger and now hurts because you’ve seen the blood.
   4. Phantom limb pain where the pain is somewhere in the limb that’s no longer there.
   5. And countless other examples, both major and minor.
      

So what we are really talking about in this section is chronic pain rather than injury, now often referred to as long-term pain. This will make more sense in a minute, I promise.

Remember in the acute injury section I mentioned that usually, the buffer zone reduces within six weeks? Well, sometimes the system just doesn’t work very well for one reason or another. This means the buffer zone stays put and the sensitivity stays high. In fact, the sensitivity can even increase and this can become a real problem. The key thing here is that while the buffer zone stays where it is and the nociceptive sensitivity stays high, the actual tissues themselves are recovering exactly as they should. This results in…dun, dun, dun…..

Pain without injury.

So it is completely feasible, and actually very, very common, that if you’ve had pain for more than at least six weeks, your are moving into a chronic pain state where the injury (if there even was one at all – don’t worry, that’s for a different day) is recovering well but the system isn’t resetting. This results in your brain being tricked into thinking it needs to keep giving you the experience of pain so you avoid using the now non-injured area. 

Does that mean you should just push through the pain if you’ve had it longer than six weeks? NO! STOP! DON’T EVER DO THAT!

Pain MUST Be Paid Attention To

Even if you’ve had the same pain for many weeks, months or years, you should always pay attention to it. Pain is an output from your brain to let you know something isn’t right and you need to take action. Even if your nociceptive sensitivity and buffer system hasn’t reset properly, you still need to pay attention to the pain experience.

There are many things that could be triggering the threat levels in your nociceptors and stopping the system from resetting. Often, I find this is connected with a poor sensory or motor map of a joint at one side (or both sides) of the painful area.

If, as part of the original injury (even if it was years ago) some of your sensory ability may have been affected, the joint maps may be incomplete. Your brain uses this sensory input to help determine where a joint is, and how to activate and control the muscles and connective tissue in supporting the functioning of that joint.

This can also impact your ability to stabilise your joints when running, and you can probably guess that this itself presents a huge threat to the brain. In turn, your brain produces a pain experience to get you to stop doing the actions leading to the threat, and you get in a cycle of threat-pain-threat-pain etc.

This can be hard to break, particularly with traditional strength-type training and rehab as they almost completely miss the mark of how your system needs to be treated for those sensory systems to be up-regulated and stimulated.

Paying attention to your pain experience can give many clues as to the underlying cause(s) and is often not directly related to the painful area at all. Ignoring your pain experience can lead to unhelpful compensations that can then lead to other acute injuries, whether of the immediate kind or the slow burn kind.

So, Why Does My Knee Hurt?

Hopefully, this article has helped you to understand that injury and pain aren’t necessarily linked, and you can have one without the other. You will also appreciate that sometimes your system doesn’t reset correctly following an injury (or perceived injury), and this can lead to long-term pain because something is still causing a threat to your brain and until you deal with that something, it can be a very long road back. This is often the reason why you may get recurring pain in the same or a similar area.

So the real answer to “Why Does My Knee Hurt? AKA Runner’s Knee” is:

It Depends…

Over the next few weeks I’m going to write up some of the case studies of runners that I’ve worked with where we’ve approached their knee pain, as well as other “injuries”, at the level of the nervous system rather than just always going for “strengthen, strengthen, strengthen” in the traditional way.

This means that I’ve assessed how and why their nociceptive system isn’t resetting as it should, and we’ve designed specific drills and exercises, as well as things like specific taping strategies, to make incredible progress – even when they have already seen everyone else and done everything else.

I hope you’ve found this article interesting and it’s raised some questions about how you currently approach your running injuries and pain. As for the answers… you’ll need to open your mind and stay tuned for more articles.

The post Why Does My Knee Hurt? AKA Runner’s Knee appeared first on RunTeach.

Getting confused?

With up to 80% of runners being struck down by a running related injury in every 12 month period, it’s about time you took action to reduce your own injury risk.

All over the Internet you can find many ways to do this from Yoga for runners, a million different ways to stretch, mobility for runners, and of course everyone’s favourite, strength for runners.

Do you really have to do all of these? If not, which is best? How can you decide where to invest your time and money? Do you even need to invest any money because there are literally thousands of free posts and videos in all of the categories I mention above. Where do you start?

Stripping it back

Let me help by peeling it right back to bare bones – well, hopefully not literally, but you get my point. Let’s strip this thing down!

There is only one reason you get injured – your body’s tissues cannot handle the forces being applied to them. It actually is as simple as that… and as complicated as that!

Let me elaborate with a little more detail. Your physical tissues don’t know about miles or kilometres. They don’t know about trail runs, road runs or track sessions. They don’t even know about running. You could be swimming, cycling, rock climbing, digging out your allotment, skiing or rock climbing. All your physical tissues know about is mechanical force.

Mechanical force is simply the load that’s applied to your tissues (bone, muscle, connective tissue, skin, etc) at any given time. They can either withstand the force, or they can’t. If they can’t, they fail and injury occurs – simple.

When looking at mechanical force, we need to look at the three primary elements:

1. Intensity
2. Frequency
3. Duration

Intensity

Intensity is the amount of force; it’s the level of loading or impact. For example, if you whack yourself on the thumb with a hammer (don’t do this by the way), there is a higher intensity than if you poke your thumb with your finger (unless you are mega strong of course).

When running, the level of intensity tends to be influenced by how efficient a runner you are, your bodyweight (although you’d be surprised on this one), the speed you are running at, and the surface you are running on including the incline/decline, your ability to control how you land and your reflexive stability (joint stability).

Frequency

Frequency is the number of times the force is applied in any given period.

When running, you can look at frequency at both a micro and macro level. At a micro level, frequency is the number of steps you take in a minute. This is commonly known as your cadence, and most running watches will give you this number. Contrary to popular belief, there is no ideal cadence.

It was commonly thought that 180 beats per minute (or steps per minute to be more accurate) was the ideal, but this was misinterpreted from some track sessions of a very few elite athletes quite a few years ago. These days, most professionals and coaches accept that we find our own cadence to a certain extent, but under certain circumstances there is a range that appears to be more efficient in terms of performance and injury prevention. 

Personally, I like to help people achieve between 176 spm and 186 spm as I’ve found that to be a good range to encourage efficient form while also encouraging good performance. Current research isn’t conclusive in terms of injury prevention and cadence, but this is often because the research itself is flawed. There is some evidence that if runners with a slower cadence, who are also experiencing pain in certain areas, increase their cadence they can reduce their pain. But higher quality research is required to provide us with the data we need in order to make better decisions around cadence and injury risk.

Anyway, back to the point. If you have a cadence of 176 spm, your tissues are exposed to the forces of running 176 times per minute. You may think then, that a lower cadence is good, but it’s a bit more complex than that as with a lower cadence your feet are on the ground for longer – see Duration for more on this. As a side note, this is why some evidence points to a higher cadence – feet are on the ground for less time.

When viewed at a macro level, frequency becomes about the number of runs per week, month, year etc. Not paying attention to this is a leading cause of overtraining that in turn can result in your tissues not being able to handle the forces involved.

Duration

Duration is over how long the forces are being applied – it’s a period of time. Like Frequency, duration can be viewed at both a micro and macro level.

At a micro level we need to consider how long your feet are on the ground with every step, known as ground contact time and is measured in milliseconds. Most efficient runners have a ground contact time of 220 ms or less, whereas most recreational runners tend to trend from 250 ms to 350 ms or higher. Now, this is still a fraction of a second, but that small difference in time exposes your tissues to the forces of running for that little bit longer, and it makes a difference to both injury risk and performance.

At a macro level, you can view duration as the time you are out on each run, and your overall time running in a week, month, year etc. 

Why tissue fails

As you’ve just learned, mechanical force is applied to your tissues every time you go for a run. In fact, it’s applied all of the time in every moment of your life. It is present in an almost infinite combination of the three elements mentioned above, and how well your tissues are adapted to each combination determines whether they handle it or fail – or breach the threshold for your nervous system to be happy, and this then results in niggles and pain.

To reduce your injury risk you need to train your tissues to adapt to these forces – again, it’s as simple as that. There are ways to reduce the forces through improved efficiency (elements of technique for example), but there will always be forces your tissues need to handle.

To adapt, your tissues need two critical components. If these aren’t present, your injury risk  increases. These are:

1. Load: you need to overload your tissues for them to adapt
   
   
2. Recovery: I always say that “the magic happens in the recovery”. During recovery, your tissues are rebuilding and reorganising so they can better handle the same overload of forces the next time they are exposed to them

It is crucial to understand though, that:

1. If the overload is too much (any excessive combination of the elements of mechanical force), your injury risk increases
   
   
2. If the overload is too little, no or minimal adaptation is forced

The skill is finding the balance between these two, combined with appropriate recovery, and in line with your goals.

How to use this info

Now you have a simple overview of why injuries occur, let’s have a brief look at how you can use this knowledge to reduce your own injury risk. Again, at a foundation level there are some easy things you can do:

1. Frequency: This is probably one of the easiest areas to address, although not all runners actually want to take action here. When looking at frequency you need to look beyond just running. You need to look at what else you are doing in your life that’s exposing your tissues to overload. Remember, your tissues don’t have any concept of running, going to the gym or any other activity – all they know is mechanical force.
   
   Increasing the number of runs per week increases your frequency of loading while also reducing potential recovery time.
   
   Reviewing your overall loading activity, both running and non-running, and the amount and quality of your recovery can highlight areas where you are doing too much and not giving yourself appropriate time to adapt.
   
   
2. Duration: Another area that’s relatively easy to review if you are allowing your tissues to adapt or not. Look at the length of your runs and the length of your recovery periods. Similar to above, the longer your runs, the less time you have for recovery and the more you expose your tissues to the mechanical forces of running.

It’s very common when building up to longer distance events that we increase our mileage. While your body has no physical sense of distance, increasing your mileage will generally result in an increase in the duration of your runs. This exposes your tissues to potential overloading for more time before they get some recovery.

Paying attention to any sudden increases, as well as looking at your overall duration of both running and non-running loading activities can help you identify if you are allowing your tissues to adapt or gradually wearing them down.

I have deliberately missed out Intensity here as it’s more complex to address. This is where we need to look at efficiency which brings with it a whole bunch of skills training and skill endurance – my main passion and the focus of most of what I teach.

For now, making sure you are reviewing both Frequency and Duration will help you to reduce your injury risk and improve your overall running performance.

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Stiff, achy muscles is a common complaint among runners. Whether it’s your hamstrings, calves, shoulders, hips, thighs or back, I’m sure you know exactly what I’m talking about. So you do what we all do these days: you do an online search and find all manner of stretches that promise almost instant relief. But how effective are these stretches, and should we include them in our warm ups to avoid getting stiff muscles in the first place?

Stretching is one of those things that has been hotly debated for quite a few years now, and to be honest, the available research is inconclusive about the benefits that stretching promises to deliver. Having said that, there is overwhelming agreement that static stretching as part of a warm up can reduce your running performance. Further to this, here are some words from Eyal Ledermen in his book Therapeutic Stretching, Churchill Livingstone Elsevier, 2014, referring to stretching as part of a warm up before and after exercise: 

Wow, that’s some statement and you may be thinking “what the heck do I do with that? Do I just not do a warm up any more?”. Firstly, let’s keep our focus on stretching. An effective warm up should never have been just about stretching anyway, so removing the stretching part of it does not mean removing the warm up completely. See this short article to discover why a warm up is important and what it is aiming to do.

Secondly, all we’ve done here is basically said that stretching isn’t very effective and isn’t a necessary part of a pre and post workout routine. By the way, Lederman isn’t the only expert to say this. Jay Dicharry, MPT, SCS, who is recognised as an authority in biomechanics, says something very similar in his books, and there are plenty of other specialists in this field that agree. But what about stretching in a wider context? What about using stretching to recover your range of movement (ROM) from your stiff muscles?

Fixing The Wrong Thing

Here is where it all goes a bit murky, and we need to look at the different types of stretching, what our goals are, and what the underlying cause of our stiff muscles or restricted ROM is. Too often we attempt to fix the output or outcome rather than the source of the issue. For example, restricted ROM around your hip is an output. Is the cause stiff hip flexors, glutes, quads etc? No, because they are also outputs. It is true that the stiff muscles are likely to be holding a restricted ROM, but what’s causing the stiff muscles in the first place?

Also, attempting to stretch a stiff muscle is more often than not, the complete opposite of what you actually want to do. If the muscle is already stiff, attempting to stretch it may trigger more contraction and more stiffness. Stiffness (a partial contraction) is a protection mechanism from the underlying nervous system, so trying to pull apart a protected muscle by stretching it is just plain daft. What then are you supposed to do?

The easy answer is to find out why your nervous system is holding the stiffness in place. Have you overworked the muscle and your system wants you to stop using it until it’s recovered? Does your system feel unsafe when you use that muscle, perhaps because you have faulty mechanics and can’t use it properly and are prone to injury? Do you have stability issues that are causing your system to stiffen up certain areas in order to create compensatory stability? Do you have sensory mismatching or miscommunication across different areas of your nervous system?

A good example of this sensory mismatch leading to muscle stiffness is a difference in signals coming from your visual system and your internal balance system (vestibular). If your brain is receiving different information from each and it can’t match it up correctly, it will stiffen your neck to keep your head still to avoid you falling over, feeling sick and other motion/balance-related issues. Simply trying to stretch your neck out won’t help. It may feel good at the time, but until you address the underlying sensory mismatch, that stiffness will come right back.

Thinking It Through

This same type of thing is happening all over your body. So the next time you think that stretching out stiff muscles is the only way to get relief, just ponder a bit longer. What may be causing the stiffness in the first place, and how can you address that issue? Of course, stretching can feel great and it does have a “mapping” effect where it helps your brain to identify where parts of your body are, so I would never say don’t stretch. It’s more about being aware that stretching probably isn’t doing what you think it’s doing, and there are far more effective ways to reduce muscle stiffness, regain ROM and improve performance.

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