Injury-Prevention and Rehab for Runners and Non-Athletes

I've had over 10 friends ask me what types of exercises to do to help cure lower body joint injuries. These are friends who run and friends who don't run. And I generally tell them all the same thing: strengthen the glutes (butt), stretch the hip flexors (front of hips). So I decided I'd better just write a post to encompass everything I've been repeating to one person after another, but in a way that involves a little more explanation as well as example exercises.

I'm no scientific expert in this area nor am I a doctor, so just take all of this with a grain of salt. The purpose of this post is to give you an idea of what has generally proven to work for me and so many other people time and time again with injuries and injury prevention... Whether you're a 20-year old avid runner with a sore hip, a non-runner in your 50s with foot pain, or any other type of person with any combination of issues stemming from the lower body. I cannot tell you that the following exercises will cure anything, but I can tell you that these exercises as a general rule will at least be highly likely in aiding in recovery as well as prevention of so many issues. 

Before we begin, you need to understand the following two muscle groups. The first is the hip flexors (front of your hips in charge of flexing hips) and the second is the glutes (butt and side hip muscles in charge of extending or opening hips). See the following two images below for a visual:

The photo below is of the glute (butt) muscles:

https://lowbackpainprogram.com/glute-muscles-weakness/

The photo below is of the hip flexor (front of hip) muscles:

http://www.crossfitreality.com/hip-flexors/

It's also helpful to understand that good hip extension is the root of good running form. Strong and powerful glutes allow the hips to open up and they can only do so if the hip flexors are flexible. Check out the photo below to better understand what hip extension actually means. In the photo on the right, this guys left hip is extended. The front of his hip is wide open. This extended position happens when you push off the ground while running to propel yourself forward. It's easier to visualize if you imagine this guy in the photo running up a flight of stairs in slow motion. Imagine his left leg pushing off a step as hard and fast as possible. To do this he needs to really squeeze his left glute muscle, and in doing so, he would force his hips to open up wide like in the photo. That motion is so important for runners. With strong glutes and loose hip flexors, you can really extend and open the hip up and when you're able to do this, running becomes much more effortless.

http://www.irunfar.com/2014/11/low-back-pain-during-running-tips-for-ultramarathon-runners.html

The Kenyans are known for their ability to really extend their hips to a large angle, part of why they are such great runners. Watch the following video in this FANTASTIC article to see just how incredible their hip extension is:
http://www.kinetic-revolution.com/running-its-all-in-the-hips/

So now that you understand what hip extension is, why it's so important and what muscles are involved, you should also realize that most Americans who sit for even just a couple hours a day have tight hip flexors and weak glutes. And although it'll hamper your ability to be a great hip-extending runner like the Kenyans, it'll also lead to muscle imbalances or injury. When you sit, your hips are in a flexed position. Your hip flexors are in a shortened position and your glutes are in an extended position. Over time, this causes the hip flexors to become tight and the glutes to become weak. And this causes a cascade of other issues. You could almost visualize this "sitting" issue as being at the top of a tree chart, where every other lower body problem originates from this one big underlying "sitting" problem. So logically, it makes sense that correcting this imbalance will aid in correcting other imbalances. See chart below:

Everyone is different. I can't tell you for sure that tight hips will lead to tight back muscles in everyone. This chart is just supposed to give you a general idea of what I'm talking about when I say sitting causes a cascade of other problems. Sitting might cause weak glutes which might cause hamstring overuse which might cause a hamstring tear. Or sitting might cause weak glutes which might cause glute inactivity which might cause hip pain which might cause IT band syndrome which might cause knee pain which might cause ankle pain which might cause shin splints which might cause...... who the hell knows but SOMETHING! Either way, in such a large majority of people it might as well include you, it all generally stems from weak glutes and tight hips. SO...

We strengthen the glutes and stretch the hip flexors.

Now I am going to give you some simple and more complex exercises to do this. It is very important to note that this strengthening of the glutes and stretching of the hip flexors can BOTH aid in fixing a current injury and prevent future injury or pain. Once again, everyone is different, and you should probably consult with a doctor if you are seriously injured, since strengthening injured muscles can actually cause severe damage. You need to use your best judgment for your own condition when reading this post and trying these exercises.

There are so many exercises that can help but I'm not going to go through every variation. I'm only going to go through my personal workout routine and how I structure it.

As an ex-personal trainer, I know a thing or two about what I'm saying here. But I wasn't a trainer long enough to really build my exercise vocabulary to that of a personal trainer who's been in the field for years and years. I understand how muscles work and because of that and my creativity, I've become pretty good at figuring out how to move my body in order to correct an imbalance that is causing pain or injury. I don't like to spend much time in the gym strength training. Partially because I'm lazy and partially because I'd really just rather be out on the trails running! 

For those of you who run and race, something that might be helpful for you to understand is how to break down your year based on a race you're training for. Your body shouldn't try and handle hard workouts all the time. You need to go easy and then go hard. So you should start your training with "stabilization phase" exercises, move on to "strength phase" exercises, and if you are an athlete I'd even recommend moving to the "power phase" in order to improve your running further. For rehab, stabilization is the phase you want to focus on and for injury prevention, both stabilization and strength are the phases you want to focus on. So below I am going to list some simple exercises for each phase. There are 100s of exercises but once again, I'm only going to put what I personally do.

Stabilization:

• 3-5 sets, 20 reps, glute bridge
• 3-5 sets, 20 reps, stability ball hamstring curl
• 3-5 sets, 20 reps on each side, single leg touchdowns (on floor, on squishy mat, on bosu ball, etc.)
• 3-5 sets, 20 reps on each side, side leg lifts (or lateral band walking or cable hip abduction)
• Core work including plank, crunches, pushups, or any other mostly non-weighted exercises like this.
• 3-5 sets, 20 reps on each side, heel drops (add weight over time)
• ***Do these every day or every other day for a few weeks to a few months depending on how trained you already are. Specifically beneficial to begin this stage while in your off season of running. This helps maintain good form when you aren't running very much. These exercises are also very beneficial for a non-athlete or super recreational athlete to do throughout the whole year.

Strength:

• 3-5 sets, 10 reps, barbell squats (or stability ball squats - technically a stabilization exercise - against wall)
• 3-5 sets, 10 reps, barbell deadlifts or single leg touchdowns holding dumbbells ( for touchdowns, still can choose to do on floor, on squishy mat, on bosu ball, etc.)
• 3-5 sets, 10 reps on each side, lunges with dumbbells 
• Rock climbing is a good overall strength activity to build overall core muscle and improve running posture and every day life posture
• ***Once you've added these in, do everything two-three times per week as you are starting off your running season. Do for a few months while you're increasing your running mileage. This phase especially after already having gone through the stabilization phase will specifically aid in injury prevention as you rack up your mileage.

Power:

• 3-5 sets, 10 reps, kettle bell swings
• 3-5 sets, 10 reps, running up and down stairs
• 3-5 sets, 10 reps, uphill sprints
• 3-5 sets, 10 reps, squat jumps
• 3-5 sets, 10 reps, ice skaters (jumping from side to side for work glute medius)
• ***Once you've added these in, do everything one-two times per week as you are entering your final couple months of training before a race. I'd only recommend these exercises for athletes who are looking to improve their abilities in their sport, not for those trying to recover from an injury. Avoid these exercises if you are injured. 
• ***Also note that during a period of tapering during the couple weeks preceding a race, go back to the stabilization phase of exercises and stop doing strength and power exercises. This will allow the body to recover and prepare for race day.

Now in ALL these phases, you should be stretching your hip flexors. Remember from the beginning of this article that that's one half of how to fix the "sitting" issue. One part was strengthening the glutes, which a lot of the above exercises will do. But the other part was to loosen up those hip flexors that got tight from chronic sitting. There are many ways to do this. Below are a few images. It's also very helpful to foam roll your hip flexors too. Stretching and foam rolling all muscles can be very beneficial and something I'd highly recommend during every session of all phases of strength training.

http://www.teachpe.com/training-fitness/stretching/hip-and-groin-stretching-exercises

http://www.physicaltherapyfirst.com/lower-extremity-stretches/hip-flexor-stretch-foot-on-chair/

https://www.youtube.com/watch?v=bgj6QtOVLVA

In the photo above, the woman is letting her left leg hang loose off the edge of the table. This stretches out the huge psoas muscle, which makes up part of the hip flexor group of muscles. This giant muscle connects the lower spine, through the pelvis and into the inner thigh. It is far too common for this muscle to be tight and when it is it commonly causes lower back pain because of that attachment point in the spine. It's a GIANT and powerful muscle in charge of so much while running... see image below. It's very important to keep this muscle loose and healthy for proper hip extension while running.

http://www.spine-health.com/blog/essential-role-psoas-muscle

I want to remind you that this is just what I do during a year of off-season and training. There are SO many other exercises you can either google or learn through a personal trainer. You can look up how to perform these exercises on youtube if you are unsure of anything. It's extremely important that you don't perform an exercise if you are unsure of proper form. You can easily get injured or cause an overuse injury by performing an exercise repeatedly with improper form. 

I also want to add that I don't do every exercise in each phase every single time I go to the gym. I'm also not strict with how often or which days I go to the gym. I really try to listen to my body, as cliche as that sounds. If I'm in the strength phase but don't feel like performing those heavy weight exercises, I might spend the session just doing core work or some side leg lifts. Other times I end up performing more than 5 sets at a lighter weight. I honestly think a part of my success with my exercise routine is the way in which I change it up every time. I apologize for the word vomit exercises I'm about to spit up here, but I do exercises in different orders each time. If I do single leg touchdowns holding a dumbbell in just my right hand this time, next time I might perform it with a dumbbell in just my left hand, and next time with dumbbells in both hands. Maybe instead of just doing a plank for 60 seconds like I did last week, I decide this week to do a plank until almost failure and then go right into 30 crunches to give my abs an extra burn. Sometimes I do barbell squats and then stretch while resting before going into my next exercise, such as kettle bell swings. And sometimes I like to turn it into a circuit where I do squats, then kettle bell swings, then deadlifts, then side leg lifts and then crunches all one after the other with little rest in between. And then I rest and stretch at the end of each circuit. There are so many ways you can combine these exercises in order to shock the body into trying something a different way. Just be careful and don't force yourself to do something you aren't ready or comfortable doing.

It's possible I've misrepresented information or not explained it clearly. So I'd love to hear from anyone with thoughts or questions about this post! I really just wanted to help people who are dealing with a muscle imbalance and are unsure of what to do about it. I really hope this post has helped!