Running-specific strength training—it makes sense!

AMAA Journal, Winter, 2004 by Bruce R. Wilk, Megan M. Greco, Jeffrey Stenbeck

Personal experience supports the concept that running injuries can be treated in many different ways. The most appropriate and efficient way to manage these injuries is through respecting the healing tissue, retraining the tissues to perform a function, and then making those tissues stronger and more powerful in order to perform at one's best. This path is easily demonstrated through sport-specific strength training for running injuries.

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In our clinic, we train patients through functional activities that mimic the action of running throughout the healing process. This is done through closed-chain kinetic activities, postural drills and plyometric exercises. The difference with this approach, compared to more traditional physical therapy intervention, is the specific goal of returning to running with increased strength and power and an improved dynamic postural awareness. These functional activities are discussed below.

Closed-chain kinetic exercises involve activities where the distal aspect of the extremity is fixed to a stationary or moving object. This causes a co-contraction of the extremity's musculature, representing a more functional form of strengthening. Compare this to an open-chain kinetic activity, where the distal aspect of the extremity is not fixed, as in the case of non-weight bearing leg extension. This open-chain activity isolates the quadriceps muscle, but this particular isolation is not seen anywhere in the running sequence.

Postural drills are introduced early in physical therapy intervention to fine tune proprioception and establish a neuromuscular connection. The development of this connection establishes internal cues, reinforcing an efficient posture. Plyometrics are used to develop power and speed secondary to the explosive eccentric-concentric muscle shortening relationship. To promote greater running efficiency, plyometrics help the patient gain an understanding of running technique, coordination and balance.

Each of these interventions is used in combination with the right timing as the running injury heals. Not all patients complete all stages, or they may progress through the stages at varying rates. In some cases, patients are seen only to manage the more acute by-products of their injury. However, a well-rounded program, progressing through all of the stages, helps the patient recover to a stronger, more injury-resistant and posturally aware running form.

An injured structure goes through different phases of healing, starting with the acute injury. Stage 1 involves temporary rest from the insulting activity, ice, compression, elevation and early range of motion of the injured structure. In Stage II, we regain flexibility of the running musculature, including hip flexors, extensors and rotators, and knee and calf musculature--but not forgetting the head, neck and shoulder musculature. Patients also learn an awareness of positional posturing at this time. They will require this foundation with subsequent exercises for balance, coordination, strength and speed.

Stage III begins the strengthening phase. Using closed-chain kinetic activities, the patient builds upon his postural and proprioceptive exercises to reinforce a new neuromuscular connection. Visual and tactile cues, resistive tubing and external challenges on various surfaces begin improving the patient's mind-body connection, as well as strengthen muscles in a functional pattern.

Stage IV involves the return to running. Using the treadmill and gait analysis, the patient puts together all of the different stages of their physical therapy. Efficient running strategies called "glides" are used to increase balance and coordination. "Accelerations" (progressively increasing running speeds) will promote muscular strength and speed. Plyometrics are incorporated to improve power in the running muscles. All of these different stages of training will return the patient to a better level of function with an increased confidence.

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Case Study

Craig, an amateur marathon runner, was seen in our clinic two weeks prior to his first marathon, having strained his hamstring during a long run. This was three days after the injury had occured. Since he was in Stage I of healing, he was instructed to rest from running. He then was treated with therapeutic pulsed ultrasound and cold modalities, and performed biking activities to maintain his cardiovascular conditioning for the upcoming race. One week following the injury, gentle flexibility exercises were added to improve hip and knee ROM as well as hamstring, hip flexor and calf muscle length. He went on to complete his first marathon two weeks after this injury with a finishing time of 4:30.

Craig was again in the office several months later after another hamstring strain during a long run. He had eight months remaining before his next marathon, which allowed us some time to proceed through all the stages of intervention. As before, in Stage I, while maintaining cardiovascular condition, he endured therapies that included decreasing the inflammatory response of the tissue. In Stage II, he continued to restructure his running posture and proprioceptive sense through postural drills. By this time, the hamstring tissue appeared free from inflammation and was pliable enough to begin strengthening.