London Marathon

Marathon preparation: taking care of your knees

taped marathon knee injury

Marathon preparation: taking care of your knees

It's hurtling towards us at a huge rate of knots, like Brexit, Christmas and Whitsun all rolled into one, but none of these require the same volume of physical, mental and emotional preparation as the London Marathon* (except perhaps Christmas....). As your mileage racks up, certain areas can get tighter, having a knock-on effect elsewhere - in particular the outside of the knee.

If you notice that your running style has started to involve a little more of either your foot turning outwards whilst your knee is facing forwards or your knees turning inwards whist your foot is facing front, this can often end up to soreness in the outside of the knee, increased tension in the iliotibial band (ITB) and/or tightness in the outside of the hip. As the miles increase and this pattern is repeated, it can become very sore. However, there are a few things you can do to check the cause of this.

Where does it come from?

The reason the knee will be turning inwards, or the foot relatively turning out will be related to one of 3 areas:

  • Tight calf muscles

  • Weakness/inhibition of the hip rotators

  • Overactive lateral hamstrings

Knee valgus - this isn’t A Good Thing.

Knee valgus - this isn’t A Good Thing.

Tight calf muscles:

If the alignment issue corrects by doing a decline small knee bend (see images below), it is likely the calf muscle (particularly the gastrocnemius, fact fans) is likely to be part of the main drive of the problem.

Decline small knee bend

Decline small knee bend

If you think you aren't stretching your calves out sufficiently, then start. As soon as possible. If not sooner.

As we fatigue when we run, certain muscle groups will become less effective leaving us with few options to propel us forwards. It often comes down to the calf to drive this and if they aren't getting a sufficient stretch, then the change in mechanics can become problematic. Stretching the calf with a straight knee (fully straight) and holding for up to 20 seconds at a time will help. Not only after a run, but check and stretch regularly through the next few days too.



Weak hip rotators:

If the decline small squat doesn't correct things, it is likely to be a problem with the rotators in the hip, including gluteus medius and some of the deeper rotators. Some light conditioning work can help resolve this problem



Overactive lateral hamstrings:

Difficult to spot on yourself, but if after toe off, your foot tends to turn outwards as the knee comes forward, the outer hamstrings might be dominating the movement. Exercises to balance out knee flexion by using the more medial hamstrings can help, as can identifying which of the other two problems need addressing and working on all of them



Anything else?

Lateral quads stretches can be really useful for this. Think of doing a normal quads stretch (i.e. heel to backside) but stretch using the opposite hand to the affected leg and pull it across to the opposite buttock and push your hip forward. This should favour the outside of the quads around the tight area



Do I really need to stretch?

Stretching is a bit of a faff and it means extra time added onto your run, however it is one of the key practices at this stage to return you ready to run again when you need to train. Just do it!


* other marathons, indeed, other long distance races do exist.



Don’t ignore your niggles or pains this late in your marathon training. Call us for an appointment on 02030 12 12 22.



Words by Paul Martin. Images courtesy of www.medi.de and runningreform.com.

9 weeks to the London Marathon - our top tips and injuries to avoid

Always choose your running kit with care!

Always choose your running kit with care!

9 weeks to the London Marathon - our top tips and injuries to avoid

Congratulations! You are now only 9 weeks from the London Marathon (other marathons are available).

Here are a few tips on how to keep going and avoiding breaking down:

  • Follow a training plan that not only says run. Two short runs and a long run on a weekend. Add in strength and conditioning, plyometrics, cross training and yoga/pilates. This can help with injury prevention and potentially faster times.

  • Your training will hurt. The marathon will hurt. The massages will hurt, everything will hurt. You need to stay motivated and have discipline. You will have good and bad days during your training. You have to be motivated to get out and run, but to keep this up takes discipline. Remember why you are running this race.

  • Be realistic with your finish time especially if it’s your first marathon! Race management is essential. Don’t go off to hard and fast! You can't just double your half marathon time adding 10-15 minutes and expect to run the marathon in that time. Aim to finish your first marathon.

  • Race nutrition: find what works for you! Sweets and Lucozade for energy can help, but be aware of overdoing it with these, try dried fruits, nuts and electrolyte drinks.

  • To stretch or not to stretch! The evidence is conflicting so do what works best for you.

  • Tapering is essential in those last 2-3 weeks. Don’t try and squeeze in one more long run.


Here are the 7 most common injuries and how to manage them:

  1. Runner's Knee: Patellofemoral pain syndrome (PFPS), is the irritation of the cartilage on the underside of the patella (kneecap). This can flare up during or after long runs. Be aware of foot over-pronation (excessive inward foot rolling) and weakness of the quadriceps, hips, or gluteals. Introduce rest days and reduce mileage. Uphill running can be less painful. Work on strengthening of gluteals, quadriceps and hamstrings. Avoid downhill running. Introduce low impact exercise like cycling, cross trainer or swimming. Try shortening your stride.

  2. Iliotibial Band Syndrome (ITBS): the ITB lies along the outside of the thigh from the hip to the knee. ITB irritation occurs if you take up your mileage too quickly. It’s a stubborn nagging injury. Be aware of foot biomechanics. Hip and gluteal weakness maybe a factor. Rest days and ease off mileage can help. Use a Cross trainer. Mix up the direction of your runs. Try shortening your stride.

  3. Achilles Tendonitis/Calf injuries: Achilles tendon connects the two major calf muscles to the back of the heel. Increasing your mileage too quickly, hill sessions and sprints can aggravate the Achilles. Be aware of tightness of your calf muscles. Stop if you have pain during or after running. You cannot run through this injury. Early diagnosis is essential. Days off will significantly increase your chances of getting back to running. Eccentric stretching and calf strengthen gastrocnemius and soleus muscles are advised.

  4. Hamstring Issues: Muscles that run down the back of our thighs. Be aware of muscle imbalance of quadriceps (thigh) over powering the hamstrings. Sudden strong pain and bruising, significant injury, extended rest required. Less intense, chronic overuse injury, you can usually run. Running a slow, easy pace is usually less difficult than attempting intervals or hills. Cycling, pool running, and swimming helps. Strengthen and stretching your hamstrings will help avoid injuries.

  5. Plantar Fasciitis: Small tears or inflammation of the tendons and ligaments that run from your heel to your toes. Pain is a dull ache or bruise along your arch or on the bottom of your heel, is usually worse first thing in the morning. Be aware of foot biomechanics, high or flattened arches. Avoid increasing mileage too quickly. Tight hip flexors, weakness and tight claves, weak core muscles, and a history of lower back pain can also contribute. This is a nagging injury, running is possible but can delay healing. Pool running and swimming to the keep pressure off your feet. Calf stretches and strengthening. Good fitting shoes are essential.

  6. Shin Splints: Achy pain that results when small tears occur in the muscles around your shin bone. Prevalent in new or returning runners doing too much, too quickly, wearing the wrong shoe or a pair with too many miles, and high arches or flat feet. When pain strikes, ease off your running to a comfortable level for a few days to a week, then slowly up your mileage using the 10 percent rule (no more than 10 percent increase per week). Bike, pool run, and swim.

  7. Stress Fracture: Stress fractures develop due to cumulative strain on the bone. Runners most often have stress fractures in their shins, feet, hips or heels. They are one of the most serious of all running injuries and are a result of over training. More common in women than men. You cannot run through this injury. Expect 8-16 weeks off from running depending on the severity of your injury.


If you suspect you have any one of the above injuries do not hesitate to make an appointment with us by calling us on 02030 12 12 22. Correct management of your injury is essential.

Deferred Entry

If you do have to withdraw from the 2019 London Marathon, you are guaranteed a place in the 2020 race – unless you had already carried your ballot entry over from 2018 or are running for a charity. You have until 20:00 on Saturday 27 April 2019 to complete the withdrawal form on the Virgin Money London Marathon Deferrals page.

Words by Nick Smith.

NoviceRunnerNik: Supporting Your London Marathon Runner

London-Marathon-2017-big-ben.jpg
 

NoviceRunnerNik:  Supporting Your London Marathon Runner

You might not be a marathon runner yourself, you might not even be a runner but in a moment of madness you might have offered to cheer on your favourite marathon runner in the marathon to end all marathons, the Virgin Money London Marathon.

Of course, other marathons do exist and the following blog post is also applicable to pretty much all marathons.

Years ago, possibly even before she took up running, our NoviceRunnerNik promised her husband that in the unlikely event he was ever successful in gaining a place in the London Marathon ballot, she’d be on the course to support him on his way around. Last year, after five years of rejections, he finally got a place, the same year in which his sister also got a place via the ballot on her first attempt!

So here are NoviceRunnerNik’s top 10 tips for supporting your London Marathon runner:

1.       Choose your runner carefully. If you fancy a fun stroll around London, stopping for a couple of pints, a wander in the park, a tasty lunch, whilst popping up on the course now and then to wave at your hero  then make sure your runner’s target finish time is around 6 – 7 hours. Don’t make my mistake of thinking I could do all of that whilst supporting a runner targeting 3 hours 30 mins. You just won’t have time to do much except rush about on public transport and cheer a lot.

2.       Plan your cheering carefully in advance and tell your runner where they should expect to see you so that they can look out for you. There are lots of online guides available which will tell you distances and times for various finishing target times. Don’t be over ambitious on number of cheering spots. Public transport, road closures and the sheer number of people out and about mean that getting around is slow. I only had a vague plan so my husband missed me on all three occasions he ran past me (although other runners from our running club did spot me and my signs so I wonder if my husband can actually recognise me in a crowd!).

 
Fancy dress hats for spectating might well be a good idea - easy for your runner to spot you!

Fancy dress hats for spectating might well be a good idea - easy for your runner to spot you!

 

3.       Make a sign or two to hold up to cheer everyone on. You could go with encouraging signs such ‘Run Well Mr B’ or ‘You can do it!’ but I’d also have at least one sarcastic one to hand ‘Smile – you paid to do this!’ for deployment in the last few painful miles.

4.       Make meet up arrangements beforehand. The sheer number of people in the finish area means that mobile phone signal is patchy to non-existent at times, particularly after the 4 hour finishers come in. The finish area has letters of the alphabet on poles – arrange to meet your runner by a certain letter – avoid the most popular surname letters to avoid the big crowds.

5.       If you’re a runner, go to the London Marathon Expo. Your runner will have to register at the Expo on the Friday or the Saturday before the marathon, unless they’ve got a friend who’ll do it for them. The Expo is worth a look around with some great talks, interesting demos, more running kit than you could possibly ever want and lots of freebies and samples. If you have any sense you’ll leave your credit card at home, or you’ll arrive back with A Little Miss Chatterbox running vest, a Love Hearts running vest and some beetroot energy bars. None of which you actually need. True story.

6.       Don’t attempt to go to the start line with your runner. The course starts well away from the finish line and most runners seem to need to depart their accommodation at the crack of dawn to join the massive loo queues early. Have a lie in and then get to around Mile 5 or just after, before the Elite runners come through as it’s really exciting to watch them and then the whole crowd surge through.

7.       Be prepared. Take waterproofs / SPF 30 depending on the weather forecast, snacks, drinks, a good sense of humour and wear running shoes (a top tip from our very own Paul Martin who advises that people will chat to you if you look like you might be a runner!) or other comfortable shoes.

8.       If you see a useable loo, use it. You don’t know when you’ll next come across one!

9.       Enjoy a fab day out. Enjoy the cheering, the banter, the fancy dress spotting.  My personal favourite last year was a man running barefoot, dressed as Jesus, carrying a 2 metre high cross! Do stop for that pint but do keep an eye on the clock. I was still sinking my one and only pint of the day (overpriced and in a plastic glass) near Mile 24 when I realised that my husband had probably just finished. He had – just ahead of his target time - in 3 hours 27 mins 27 seconds! I still beat him to our meet up point as he spent quite a bit of time having his blisters attended to by the medics.

10.   Be patient, getting home is slow. Don’t forget that your marathon runner has just run 26.2 miles, not to mention all of that walking to the start and from the finish. They will be slow. But they will be wearing a very large London Marathon medal - I don’t know why they make them so heavy, seems a bit unfair! -  and a beaming smile! People will offer them seats on the Underground. Strangers will ask you what your runner’s finishing time was and you’ll proudly tell them down to the second.  Enjoy the reflected glory!

 

He did it!

He did it!

 

Words and images by NoviceRunnerNik.