TIPS ON STARTING A WALKING OR RUNNING ROUTINE


RUNNING AND WALKING YOUR WAY TO WELLNESS

Working with running-related injuries has fascinated me for a long time. Runners, whether they are seasoned athletes or recreational weekend warriors, are some of the most self-motivated and resilient people I know. For years, I have gradually seen an increase of injuries among runners in the clinic.
Back in 2008, I suffered from an Achilles tendon (calf) strain with some affectation along the plantar fascia (bottom of the foot) while training for a run. It caused me to stop running for a few weeks to gradually heal myself and retrain back into shape. This led me to further seek out experts in the physical therapy realm and to understand the concept of injury prevention with running. I found I was able to apply this not only in my practice but in my personal life as well. I now run recreationally as a means to enjoy the outdoors.
Running outdoors allows me to vary my workouts and take me beyond the four walls of a gym. It’s a more scenic workout, depending on where you go. I like doing a jog/walk interval, as it allows me to rest in between and enjoy the trails of the Pacific Northwest. I was born and raised in Iloilo, the third fastest growing city in the Philippines, and coming to this part of America is a treat. Having lived in both Washington and Oregon, I feel that Southern Oregon has a good pace, more inclination for outdoor activities, moderate winters, and the people are definitely warm.
I really love trail running and walking more than anything. Cooper Creek Trail in Sutherlin, Oregon, is one of my favorites, as well as some of the trails along Highway 38, where you get to visit about 10 waterfalls on the way to Crater Lake. Each waterfall has its own trail too. I especially love the trails of Susan Creek Falls and Toketee Falls in southern Oregon. Both are perfect for more moderate hikes.
WALK TO START GETTING HEALTHIER
If you are starting to become more active outdoors, start with a simple walking routine. Start with walking at a comfortable pace for 10–15 minutes on level ground, and do it every morning and afternoon to slowly improve your endurance. Doing this routine for 30 minutes a day helps you slowly progress toward jogging or running, if that is your goal.
You can progress by either increasing your time to 20–30 minutes in the morning and afternoon or by slowly incorporating inclines or slightly hilly ground. Make sure to maintain a good pace to further improve your cardiovascular capacity. Ensuring the proper progression helps you prevent injuries and opens up more opportunities for transitioning to jogging or running.
Walking has more benefits than you think. In a meta-analysis study, walking reduced cardiovascular events by 31%, and it cut the risk of dying during the study period by 32%. These numbers were equal in both men and women.
When transitioning from walking to jogging, it is important to slowly progress your routine so that your cardiovascular system adapts as you increase your speed. Try doing a walk/jog pattern at a 2:1 ratio of walking to jogging. That means walk two minutes followed by jogging for one minute. Do this for 20 minutes and slowly progress toward 1:1 ratio of walking to jogging. Try this out for at least two weeks and then progress to adding more time to jogging as you feel better.

RUNNING INJURY PREVENTION
5 TIPS FOR SUCCESS

1.     Dynamic Warm-ups. Maintaining good flexibility aids in the prevention of musculoskeletal injuries and improved sports performance. Stretching as a form of warm-up prevents sports-related injuries (1). When it comes to stretching, dynamic warm-ups proved to be superior compared to static stretching and it improved performance in three different sports tests versus static stretching and no warm-ups (2). The stretching routine should allow for 15 minutes and immediately followed by the actual sport or physical activity (3). Furthermore, not only does it help in overall flexibility of your body prior to a sport, dynamic warm-ups have been shown to increase flexibility of the hamstring and the quadriceps muscle groups more significantly than static stretching (4). Here are three of my favorite dynamic warm-ups:

a.     Walking knee tucks: Standing on one leg, grab the knee of the opposite leg and pull toward your chest until a stretch is felt in the glutes. Keep head and chest upright. Hold stretch for 1-2 seconds. Step forward and pull knee to chest with other leg. Alternate legs as you walk forward.



b.     Walking quadriceps pull with overhead reach: Standing on one leg, bend the opposite knee and bring your heel toward your bottom. Grab the ankle and pull until a gentle stretch is felt in the front of the thigh. Next reach the opposite arm overhead. Hold stretch for 1-2 seconds. Alternate legs as you walk forward.


c.     Spidermans with trunk rotation (Advanced): Get down in a push up position, Step forward with your left foot so that the knee forms a right angle. Push your hips back and come up on your heel and toes (heel in the front and toes in the back). Drop your hips back down and raise your left arm up while twisting back until you feel a tight stretch. Hold the position for 1-2 seconds. Perform the same on the other side and continue to alternate for about 2-4 repetitions.




2.     Conditioning. Perform strengthening and conditioning exercises at least twice a week to prepare you for running. It can be very simple and easy to follow. Studies showed that the wall squats, forward step ups (not listed below) and lateral step ups produced significant activation of the Gluteus medius and Gluteus maximus muscles (6).

a.     Wall squats – Single leg: Stand with back and head flat on the wall with both feet about 1-2 feet away from the wall. Lift the left leg up as shown in the picture and slowly lower your body until your right knee is at a right angle like you are sitting on a chair. Hold the position for 2 seconds. Repeat for about 8-10 times and perform on the other side. If this is too difficult, you can partially squat the knee that is weight bearing (before you reach right angle). If this causes symptoms like pain or cramping, discontinue the exercise.


b.     Lateral lunges: This is a good basic drill for both beginner’s conditioning as well as a warm-up for more advanced athletes. Stand with both feet aligned with your shoulders. With the feet parallel to each other and facing forward, step the right foot to the side and lunge over on that leg with the weight on the right heel (with foot flat on the floor). This will force the weight to be transmitted to the gluteal muscles on that side. Hold the position for 1-2 seconds and perform on the other side. Perform alternating side lunges for 8-10 repetitions.


c.     Lateral step ups: Find a step that is between 6-12 inches in height. With both feet facing forward and parallel to each other, step the right foot up shifting your weight onto the right leg and lifting your entire body weight with that leg. You may step the left leg up or keep it off the step for a more challenging exercise. Step the right leg down. Repeat 8-10 repetitions and perform on the left leg as well. Progression will be increasing the height of the step.



3.     Cool down: Foam rolling. Foam rolling allows your body to prevent tightening after a run or walk and improves the circulation after an active activity. Some people use this as a warm-up. I prefer using this method as a way to cool down and improve muscle flexibility, therefore, preventing future injuries. See our website for short videos on how to do foam rolling. 

4.     Running shoes. If you are a new runner, look for a shoe that is comfortable to you. Do not believe in the latest hype. Having 2-3 shoes in rotation is important because each shoe vary in cushioning and support, thus creating different types of loads on your joints, tendons and ligaments. Rotating through different shoes through the week alters the different forces applied to your body and allows different tendons and ligaments to handle the load. This may help prevent overuse injuries. I encourage patients to bring their running shoes to their PT appointment so we can evaluate them and give advice on choosing the right shoes.

5.     Persistently recurring injuries. If you continue to experience discomfort, pain or difficulty in your run, it may be time to consult with someone who understands movement patterns, body mechanics, and training habits. People vary in their body types, nutrition and fitness levels. I may recommend coming in for an evaluation with a specialist and have some testing done. Call and ask your local physical therapy office to see if they have a running injury specialist.

In the last decade, I have really enjoyed working with runners of all levels and I encourage you to get out there and experience the joy of running. Be sure to follow the 5 tips for success to train safely!

References:

1. Woods K, Bishop P, and Jones E. Warming-up and stretching for improved physical performance and prevention of sports-related injuries. Sports Medicine Journal, 1985 Jul-Aug 2(4):267-78 Aukland, NZ

2. McMillan, DJ and Moore. Dynamic vs Static Stretching warm-up: The effect on power and agility performance. Journal of Strength & Conditioning Research / NSCA. 2006 Aug 2003(3):492-9

3. Woods K, Bishop P, and Jones E. Warming-up and stretching in the prevention of muscular injury. Sports Medicine Journal 2007:37(12):1089-99

4. Aguilar AJ, DiStefano LJ, Brown CN, Herman DC, Guskiewicz KM, Padua DA. A dynamic warm-up model increases quadriceps strength and hamstring flexibility. 2012 Apr 26(4):1130-41

5. Boren K, Conrey K, Le Coguic J, Paprocki L, Voight M, Robinson TK. Electromyographic Analysis of Gluteus medius and gluteus maximus during rehabilitation. Int J Sports Phys Ther. 2011 Sep; 6(3): 206-223

6. DiStefano LJ, Blackburn JT, Marshall S, Padua D. Gluteal muscle activation during common therapeutic exercises. J Orthop Sports Phys Ther. 2009 Jul; 39(7):532-540

7. MacAskill M, Durant T, Wallace D. Gluteal muscle activity during weightbearing and non-weightbearing exercise. Int J Sports Phys Ther. 2014 Dec; 9(7): 907-914


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