Minimizing the Risk of Running Injuries with Strength Training

By Rebecca Weiner, PT, DPT, ASTYM certified for Athletico Physical Therapy

The days are longer and the weather is finally nicer, which means more people will be out running. Thinking about running that neighborhood 5k or half marathon this summer? When deciding between which training program to follow, make sure you don’t forget to incorporate strength training. Strength training is believed to help with injury prevention in runners.

In fact, research shows that a strength training program including resistance and plyometric exercises performed 2–3 times per week for 8–12 weeks is an appropriate strategy to improve speed and form for middle and long distance runners. What’s more, runners who performed resistance training three or more times per week were approximately 50 percent less likely to experience a running-related injury. The study also showed that the combination of running and resistance training increased both short- and long-term  endurance performance in sedentary and trained individuals.

Based on the facts stated above, it is important to strength train while training for your next run – whether it’s a 5k or 26.2 miles. This does not by any means mean that you have to bulk up. You just need to make sure you are working the muscles that support you during your run to make you more efficient and less prone to injury.

Here are some exercises to help strengthen your lower extremities:

Leg raises: Begin lying on your back with one knee bent and your other leg straight. Engaging your thigh muscles, slowly lift your straight leg until it is parallel with your other thigh, then lower it back to the starting position and repeat. Try to keep your back flat during the exercise and keep your leg straight. Complete three sets of 15 and add ankle weights to make it more challenging.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Sidestepping with resistance: Begin in a standing upright position with a resistance band looped around your ankles. Step sideways, maintaining the tension in the band. Walk about 10 feet and then repeat in the opposite direction. Make sure to keep your feet pointing forward and to keep your trunk upright.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Squats: Begin with standing tall with your feet shoulder width apart. Bend your knees, sitting your hips back with your chest upright. Return to standing and repeat. Add dumbbells to make it more challenging. 

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Bridge with ball squeeze: Begin lying on your back with your legs bent, feet resting on the floor, and a ball between your knees. Engage your abdominals as you gently squeeze the ball between your knees and lift your hips off the ground into a bridge position. Hold for about 2-3 seconds and then lower back down to the ground and repeat.

Minimizing the Risk of Running Injuries with Strength Training Minimizing the Risk of Running Injuries with Strength Training

Crossing the Finish Line

These are great exercises to get you started with strength training and to help you avoid running injuries when preparing for your next race. Don’t forget to also cross train and take days off from running. If you do experience any aches or pains during your training, please consult a physical therapist at your nearby Athletico for a free injury screen.


Long Distance Running Won’t Kill Your Knees

By Dev Mishra, M.D., President, Sideline Sports Doc , Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • There’s a common belief that running leads eventually to arthritis in the hips or knees but evidence shows that runners have no increased risk for arthritis and in fact may have lower risk than the general population
  • The biggest risk factors for developing arthritis are prior injury or surgery to the joint, family history, and high body mass index

I see a lot of folks in my clinical practice with hip and knee arthritis and many of them have extensive running histories. Most of these folks believe that it’s the long term running that eventually led to the arthritis, but the belief that running causes knee arthritis is probably a myth.

The idea that running can lead to arthritis makes sense. You run on a hard surface for long distances and over many years the impact leads to wear and tear. Seems pretty logical, right? Well the available evidence points us in a different direction.

There have been several good quality medical studies done over the years to study the relationship between running and arthritis. I want to highlight three that have some interesting and relevant points.

This study published earlier this year specifically studied marathon runners. These were experienced high mileage runners, average age 48 years, typically training about 36 miles per week. They’d completed an average of 76 marathons! About 47% reported hip or knee pain but only about 9% had arthritis. The strongest predictors of hip or knee arthritis were older age, family history of arthritis, and any prior surgery on the joint. But marathon running itself was not predictive of arthritis.

This study of about 75,000 runnersis pretty impressive for the number of people who participated. It’s incredibly difficult to get information on that many individuals. The author used the National Runners’ Health Study and the National Walkers’ Health Study. During a multi year follow up, about 2.6% of the runners reported arthritis, and about 4.7% of the walkers reported arthritis. These are pretty low numbers since the generally accepted prevalence of arthritis amongst all U.S. adults over 55 years of age is about 18%. The author believed that the most meaningful reason is that the body mass index (BMI) of the runners was less than the walkers, and presumably both are lower than the average BMI for the general population.

And here’s another interesting study titled “Why Don’t Most Runners Get Knee Osteoarthritis?”These authors used motion capture imaging and force plates in the ground to estimate forces across the knee joint with running and walking. They found as expected that there’s quite a bit more load across the knee joint with running (8x body weight) vs. walking (3x body weight). But the runners have longer stride lengths than the walkers, which meant that they took fewer steps over a given distance than walkers and had fewer impacts. The runners also experienced any pounding for a shorter period of time than when they walked, because their foot was in contact with the ground only briefly with each stride.

The net effect was that the amount of force moving through a participant’s knees over any given distance was equivalent, whether they ran or walked. It’s an interesting mechanical explanation.Logo

So these and other available scientific evidence indicate that running itself is not a risk factor for developing hip or knee arthritis. The strongest risk factors appear to be prior surgery or injury to the joint, a family history of arthritis, and a high BMI. If you start out running with a healthy joint there’s good reason to believe you can run healthy for many years. This myth is probably busted.

Is Running Bad For Your Knees?

Spend enough time in the average weight room and you might walk away thinking that running is the root of all exercise evil: It does a lousy job at burning fat. It’s less exciting than C-SPAN and, haven’t you heard, it messes up your knees. But if you’ve been avoiding the treadmill based on the word of the guy who seems to live under the squat rack, you might want a second opinion.

Running is far from immune to scrutiny, as this very site has proven multiple times over, but the negative long-term impact it has on the joints is often wildly overstated, if not flat-out wrong. As Janet Hamilton, an exercise physiologist and run coach with Running Strong in Atlanta puts it, “Joints are meant to move. And running is arguably one of the most natural movements you can do as a human.” Hamilton points to research that consistently shows running—and running a lot—actually improves knee health.

She’s not wrong: In one study of nearly 100,000 runners and walkers, researchers found that frequent running did not increase the risk of osteoarthritis—the most common form of arthritis, linked to wear and tear of protective cartilage and connective tissue—even among seasoned marathoners. In fact, researchers found that osteoarthritis was half as common in runners as it was in walkers. Of course, there’s a good chance that the running group was self-selecting—that people who didn’t experience knee pain in the first place were the ones who stuck with running. But it still says something that after a seven-year followup among people who had no osteoarthritis to begin with, it was walkers who developed knee problems in greater numbers.

X-ray evidence suggests that osteoarthritis is actually more common in soccer players and weightlifters than it is in long-distance runners, says Leigh-Ann Plack, a physical therapist and advanced clinician with the Hospital for Special Surgery in New York City, and author of a review on running and osteoarthritis.

Hamilton thinks the lower risk of osteoarthritis could be due to the fact that running stimulates the production and circulation of synovial fluid, a type of lubricant that nourishes the joints, as well as the fact that runners—at least, more serious ones—tend to maintain better strength and mobility in their muscles. When researchers at Brigham Young University stuck runners with needles to extract and study their synovial fluid, they found that 30 minutes of running decreased the fluid’s levels of inflammatory proteins linked with poor cartilage turnover. (It’s worth noting that the study was small, and the researchers were unable to get enough synovial fluid from about half of the subjects.)

So if running is so great for your knees, then why do so many people complain of knee clicks, or a condition literally known as runner’s knee? Partly because the vast majority of people who run have a combination of muscle imbalances and less-than-stellar form, says James Gladstone, an orthopedic knee surgeon and sports medicine specialist at Mount Sinai Hospital in New York City. “The best thing you can do for your knees as a runner,” he says, “is make sure to have proper mechanics and proper muscle balance.”

Running can also backfire in people with pre-existing osteoarthritis or knee damage, since it can stress the knee with up to eight times the force of walking, according to one review. In healthy subjects, this can be a good thing—stress causes microscopic damage to the cartilage, and as you recover, the tissue grows back stronger (it’s like building muscle in that way). However, that stress can be too much for already-osteoarthritic knees to handle, Gladstone says.

Even if you’re not prone to injury, following these guidelines will help you stay that way the next time you step on a treadmill:

How To Prevent Injury From Running

Get Stronger
Strength coaches like to say, “Running doesn’t make you strong. But you need to be strong to run.” This Insta-worthy expression has some truth to it, largely because running is a repetitive exercise that involves a select group of lower-body muscles, a limited range of motion, and only hits one plane of movement, Plack says.

For example, running does little to train the hip abductors, the muscles on the outside of the hip that help you move from side to side, Hamilton says. As a result, many runners have underdeveloped abductors. Research shows that weak abductors can lead to IT Band syndrome—a persistent ache on the outside of the knee that just won’t quit. “Begin running only after you have built a foundation of strength—muscle and tissue strength, not just aerobic strength—to support it,” Hamilton says. Once you start running, perform some form of multi-planar(forward-and-backward, side-to-side, and rotational) strength training at least a couple of times per week.

Deal With Underlying Issues
If you have issues with your skeletal alignment, such as flat feet, high arches, knock knees, bowed legs, or leg-length discrepancies, get some help from a trained professional, Hamilton says. The same goes if you’ve had knee aches, plantar fasciitis, or any other exercise or running problems in the past. A physical therapist or kinesiologist can help get to the bottom of any issues and address their underlying causes, which will help prevent any issues—knee or otherwise—from cropping up mid-run, she says.

Hire a Coach
Running is a natural movement, but most people don’t do it correctly. For example, excessive stride length is a common form misstep that can put excessive stress on the knees, Plack says. So if you want to run faster, you shouldn’t try to take bigger strides. Schedule an appointment with a physical therapist, kinesiologist, exercise physiologist, or certified run coach to evaluate and shore up your running form. Some knee-protecting strategies may be as simple as shortening your stride or as involved as identifying and strengthening muscle imbalances, she says.

Take It Slow
Make the transition to running gradually and build your endurance slowly over time, Hamilton says. “Aerobic conditioning responds relatively quickly, but it may take longer than that for your muscles, tendons and ligaments to adapt to the training load.”

As a general rule, experts recommend not increasing your total training load (distance + speed + duration + frequency) any more than 10 percent per week. Hamilton notes that some runners may need to stay closer to five percent. Some might be best off increasing only every other week. “It’s also good to avoid applying too many versions of ‘more’ in any given workout,” she says. “In other words, do hills or a longer workout rather than hills and a longer workout.”

Schedule Recovery Time
“Overload plus recovery equals adaptation and improvement. Overload without recovery equals injury,” Hamilton says. The exact amount of recovery you need depends on multiple factors including your fitness, how hard you’re pushing yourself, your current running and strength training routine, and your overall physical and mental stress levels, she says. High-tech strategies such as heart rate variability can help you determine when your body needs light exercise or no exercise at all. But “listening to your body” will also get the job done.

Find the Right Shoe
Much like rotating the tires on your car, mixing up the running shoes you use throughout the week can lower your risk of injury, according to research from the Sports Medicine Research Laboratory in Luxembourg. Researchers believe cycling through shoes mixes up the stress placed on your joints and tissues, which prevents overuse injuries and strengthens a wider range of muscles. Hamilton recommends buying your shoes from a running specialty store that has software designed to record and analyze how various shoes affect your running form and pattern.

Don’t Train Through Pain
“If something hurts, step back and investigate the situation and address the underlying cause of the symptom—not just the symptom itself,” Hamilton says. Generally, any pain that is sharp or strikes the joints is reason to cut your workout short. Sometimes the cause is obvious: Maybe you tripped over a crack in the sidewalk or got cocky and pushed your workout too hard too fast. If it isn’t, or if the pain isn’t completely gone in a couple of days, seek professional help, she says. Again, a physical therapist with a specialty in running will be your best bet for identifying the problem and solution.

By K. Aleisha Fetters for TONIC



H.C. Martensen works in the AlloSource tissue processing core where he is faced with the powerful realities and possibilities of tissue donation and transplantation every day. He also has the utmost confidence in the allografts that he and his tissue bank colleagues produce, so much so that he recently requested one for his own transplant.

Over the summer H.C. returned to his former university, Colorado College in Colorado Springs, for an alumni soccer game. He played on the team in college, and since then remained very athletic, participating in triathlons and skiing. However, at the time of the game, it had been a while since he’d played soccer. Following a cutting motion on the field he felt his leg let go below the knee. H.C. instantly knew what had occurred, not only because of his work, but also because a close friend had sustained a torn ACL just
three days prior.

Shortly thereafter a surgeon confirmed it – H.C.’s ACL and lateral meniscus were torn
and he needed surgery and an allograft transplant. Although the surgeon did not
historically use allografts from AlloSource, H.C. made a special request to have his
graft come from the tissue bank. His surgery required a patella ligament bone-tendon-bone graft, which he received from a 33-year-old male donor.

“Just a few years older than me,” H.C. said. “It added to the perspective that I’ve had.

I’m presented with the reality of the business we’re in everyday. Seeing young donors come in is hard. Now that I’ve personally benefitted I’m further grateful for the gift of donation and even more aware of what we do.”

Since his surgery in June, H.C.’s recovery has been progressing very well and he just
completed his final functional evaluation in physical therapy. Although his knee isn’t yet 100%, he knows it shouldn’t be back to normal this soon after the injury, and his road to recovery has been swifter than other patients with similar injuries. Of course, H.C. intends to make the most of his gift of life – he will be training for triathlons.