4 Proven, Simple Ways to Prevent Running Injury
4 Therapy experts share the exercises they find most important for injury prevention in runners.
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When talking about goals, most runners are quick to rattle off times to beat, races to complete, miles to log, and any number of other performance-related metrics. Missing from many lists, however, is the one thing that makes all of those other aims possible: doing the necessary work to prevent running injury and staying healthy.
This could be because injury-prevention “prehab” is tedious, time-consuming, and not nearly as fun or flashy as big workouts or nailed long runs. It could also be because injuries are an unfortunate guarantee in our sport, leading some people to accept their fate and enjoy their health while they have it.
But anyone who knows the human body well will tell you: while we can’t avoid all injuries, there are certainly ways to lessen our chances. To find out how, I asked four experts — two physical therapists, one manual therapist, and one chiropractor, all of whom work with runners — for the daily prehab they suggest for passionate but busy runners. Here is what they recommend:
Pre-Run Dynamic Stretch
Marcus Allen-Hille is a manual therapy and orthopedic and sports massage specialist, and the go-to guy for elite runners in Boulder, Colo. “Injury prevention,” he explains, “is typically dependent on a global systems approach that brings a handful of components into balance.” These include sleep, nutrition, functional strength, soft-tissue care, and mental health — all of which overlap and interact. “So first and foremost, the one thing every athlete should do to mitigate injury is to pay attention to all of these components,” Allen-Hille says.
With that bigger picture in mind, there’s one dynamic stretch he recommends doing before each run. The dynamic component “prepares the joints and muscles for movement,” while the stretch itself “helps to lengthen adaptively shortened soft-tissue at the front of the hip and encourage balanced neuromuscular patterns.”
Here’s Allen-Hille’s step-by-step:
- Begin by facing a stationary object about 12 inches in height (fitness box, step, etc.).
- Place a pillow or folded towel on the ground about 8-12 inches in front of the box.
- While facing the box, place one knee on the pillow (with the top of the foot comfortably against the ground so you’re not pressing through your toes).
- Place the other foot up onto the box. (If you feel a moderate stretch in the hamstring of this leg, the object is too high).
- Keeping your torso tall and core engaged, inhale and contract your gluteal muscles on the side with your knee on the ground.
- While maintaining gluteal contraction, exhale and gently shift your hips forward into a lunge until you feel a comfortable stretch at the front of your hip. (Sometimes athletes will feel more of a stretch a little to the outside of the front. This is okay. Stop if there’s pain. Stretching shouldn’t hurt.)
- Hold position for two seconds and then relax back to start.
- Perform 20 repetitions on one side, and then switch sides for 20 more repetitions, making sure to exhale into each stretch.
Post-Run Mobility Exercises
Blake Russell — an Olympic marathoner, physical therapist, and owner of On Track Physical Therapy & Performance in Pacific Grove, Cal. — believes that all runners would benefit from a daily post-run mobility routine. The purpose, Blake says, is “to do a little reset and focus on common runner mobility problem areas.” They key is consistency. And five to ten minutes is long enough to reap the benefits but short enough to be sustainable.
Russell’s post-run fundamentals include:
- Hip flexor stretch. Make sure to get your hip and knee back, and take about five slow, deep breaths while holding the position. “Hip flexors usually need some extra attention due to lots of running and sitting,” she says. “A proper length-tension of these muscles is important for a healthy lower back and pelvic alignment.”
- Deep squat. Keep your heels on the ground. Russell says that this position promotes ankle mobility while also offering a gluteal stretch.
- Single-arm reach. Still in a deep squat, alternate reaching up towards the sky with one arm. This stretch is especially good for upper-back rotation.
Regular Strength Training
The biggest thing that Katie Gwyn — a former collegiate runner, physical therapist, and owner of Mondo Sports Therapy in Austin, Tex. — stresses to her clients is the importance of strength training. “It doesn’t have to be fancy or time-consuming,” she says. Just five exercises twice a week will suffice. But, unfortunately for the creatures of habit among us, Gwyn recommends switching up the exercises often, since our bodies are quick adapters to stress. She also believes that, although bodyweight works great for activation, it’s less effective for building strength.
So grab a med ball, kettlebell, barbell, or whatever you have access to, and rotate through Gwyn’s arsenal of favorite exercises for runners:
- Split squat at a Smith machine, backwards stepping lunges with the squat bar, single leg calf raises, single leg seated soleus raises, resisted hip abduction, adductor raises, standing or prone lying hamstring curls, leg press (she likes the incline version), single leg resisted hip thrusts, Bosch back extension, hex squats, Romanian deadlifts, resisted step ups with knee drive
- Plyometric work and med ball exercises are also great, especially for aging athletes — but approach gently and cautiously.
Frequent Hip Flexor Stretching
According to John Minen, an elite miler, chiropractor, and owner of Colorado Sports Chiropractic in Boulder, Colo., “Each athlete has his or her own individual movement dysfunctions that develop over time.” But a common limiter among the runners he works with is “their ability to fully extend their hips without utilizing compensatory movement patterns. This leads to overuse injuries of other muscles of the lower leg (calf strains, hamstring strains, Achilles tendonitis, etc.) and low back pain.”
Minen believes that addressing tightness in the iliacus and psoas (hip flexors) is a crucial part of preventing related setbacks — while possibly enhancing performance too. This requires a good routine in opening up that area, and like both Allen-Hille and Russell, he recommends daily hip flexor work. “It takes time to elongate tissue and obtain plastic deformation, so be consistent and think of this stretch as a part of your training,” Minen says.
Try Minen’s three-stretch progression:
- Kneeling hip flexor stretch. In a kneeling position, posteriorly tilt your pelvis until you feel a stretch, and hold it for 45-60 seconds. Multiple reps may be needed to adequately loosen the area.
- Standing hip flexor stretch. While standing, place one leg behind you in the push-off position, imagine “tucking your tail” if you had one, and feel the weight sink into the front of the hip socket that’s being stretched. For a deeper stretch, bend your knee on the opposite leg. Again, hold this stretch for 45-60 seconds and repeat as needed.
- Couch stretch. Start in a lunge-like position with your back knee resting on a cushion. Bring that foot up towards the buttock using your hands, and place the top of the foot up against a wall or couch back. Straighten your torso, “tuck your tail,” and find a nice stretch either in the front of the thigh or the front of the hip. Hold for 30-45 seconds.
If you suspect you aren’t getting the stretch you need on your own, or just feel overly tight, Minen suggests seeing a manual therapy professional who can help you work through it. This could be a chiropractor that specializes in active release techniques (ART), a physical therapist, or a sports massage therapist.
You’ll note that while the timing and technique vary, three of the four recommendations involve hip mobility, specifically, a hip flexor stretch. This stretch is so important because our lifestyles — the prolonged hours of sitting — compromise hip flexor length and mobility, which prevents us from fully extending our legs behind our hips, leading to an ineffective stride and an increased risk of injuries. Opening up your hips and restoring your natural balance and posture can help everyone who lives in the modern world prevent common running injuries.