Many runners have the same problem. Getting back into the groove of training goes well. Getting back into a regular training schedule goes as planned... and then it happens. Old, familiar problems begin to creep in. Those demons you wish were long behind you return for more.
Base training, or maintenance runs, are a must in terms of maintaining fitness and keeping your body a well-oiled machine. The first 6-8 weeks of most race training programs transition a runner from base training to workouts that are physiologically stressful, difficult, and intense.
Without this level of intensity, little training adaptation will be made and one's fitness remains flat. If the contrast is too stark, perhaps too many hard miles, or speed work too fast, injury is the inevitable result. The pattern that I've seen much of as of late lies between the hips and ankles.
Similar to Rock Climbing
Frequently rock climbers have difficulty with hand injury. This can most often result from imbalances between the large muscles of the upper arm and the smaller connective tissue in the hands and forearms. As activity increases, the larger muscles develop power more quickly. The soft tissue in the hands, small structures in the fingers, requires more time to adapt to these stresses.
Middle to late stage race training is similar. As speed and power in the hips develop, the ankle can easily be over powered when training is out of balance. What follows is a mix-match of injuries that occur in the lower leg, ankle, and foot. These injuries often leave athletes and practitioners alike scratching their heads, but the pattern is clear: the ankles are being overpowered by the hips.
injury v dysfunction
Running injury, a topic which continues to perplex many, is often too focused on anatomical parameters. Injuries are often grouped together by a common region of the body they may occupy ("lateral knee injury") or sometimes by common tissue types ("tendon injury"). Physical therapists identify movement dysfunction, not specific anatomical diagnoses.
This special approach helps identify contributing factors as well as potential solutions. It also makes physical therapists excellent at identifying injury risk factors. Because PTs have expert knowledge of biomechanics, it's easy to identify a particular movement dysfunction and then assess individual components of the involved parts.
Overpronation is a great example. Overpronation, excessive loading of the instep of the foot, is a common complaint among runners. In typical movement, overpronation leads to a cascade of mechanic changes of the chain from joint to joint. This movement dysfunction disproportionately stresses the joint connecting the big toe to the foot, can overload and/or collapse the arch, cause additional stresses to the inside of the knee joint, and load additional strain to the lateral quads and piriformis.
A focus on injury is like putting out a fire. A focus on movement dysfunction can help identify problems before they explode.
When the Hip overpowers the ankle
In runners, as speed increases, forces at the ankle increase. As forward thrust increases from the large gluteus maximus and quadriceps, they must be matched by the calf. The gluteus maximus and quads create shear force through bulk, as some of the largest muscles in the body. The calf, an intricate complex of more than three muscles uses the largest tendon in the body to utilize explosive elastic energy and the most efficient lever class at the ankle to maximize efficiency.
Although these systems work quite differently, they must be equal. When the ankle is overpowered, a runner will have difficulty in toe off with reduced "toe rocker," rolling off the front of the foot as the body moves forward. In a dysfunctional system, the heel will stay on the ground too long. High level forces will not be attenuated through the ankle and foot as anatomy has intended and other areas take on excessive loading at a price.
- Runners with neutral toe off to supinated toe off will have excessive ankle dorsiflexion and may aggravate the outside front of the ankle joint at the capsule. There may be excessive stress of the high ankle joint in the beginnings of what is similar to a high ankle sprain.
- Supinated runners may overload the lateral column of the foot, resultant in cuboid syndrome, or lateral metatarsal stress fractures.
- Pronated runners may have excessive flattening of the arch with the beginnings and/or development of plantar fasciitis.
- Pronated runners may also overload the big toe with development of bunion (hallux valgus) or stiffing of the big toe joint (hallux limitus).
- Excessive loading of a weak ankle can also lead to muscle/tendon injury of the tibialis posterior causing pain at the top of the arch, as well as injury of the primary bender of the big toe (flexor hallucis longus). The former is often representative of more chronic overloading.
- The most common overload issue I've seen this year is of the calf itself, most often with Achilles tendinopathy in distance runners, and as of this week, tears in the calf itself, more common among racquet sport athletes (Tennis Leg). The most severe of these can also include partial Achilles' tendon tears in the younger population.
Screening and Prevention
As a running specialist, I've witnessed the preponderance of relative ankle weakness at all levels from leisure and fitness to semipro. I've learned the importance of thoroughly screening ankle strength in patients. Assuring strong ankles is but one component in injury prevention for runners and running athletes alike, however a component that can easily be found in very little time.
In a single leg stance, a normal healthy adult should be able to rise to tip toes a minimal of 25 times. That may seem like a lot, but in athletes, this number goes up. Although a standard in runners is less well defined, most high performing athletes are cable to perform this feat 35-40 times. For sprinters, sub-3 marathoners, and ultra runners, this number I suspect will need to be in the 40s.
Other ankle strength screening tools for athletes may be too complex to perform without a trained professional, but if you are unable to perform the one above, you may have some work to do...particularly if you have a history with any of the above injuries. If you're having repeated issues with injury, make sure you get to the root of the problem. Simply taking time-off isn't a real solution.
Until next time, don't stop moving!