6 Steps to Injury-Free Running

Sports doc Jordan Metzl’s get-stronger, run-better plan.

This is adapted from Running Strong: The Sports Doctor’s Complete Guide to Injury-Free Running for Life, by Jordan Metzl, M.D.

Why do you run? Because it feels good. Because it relieves stress. Because it fills you with energy. Because it makes you happier. Because it enables you to eat pie. I get that, because running is important to my life, too. As a 32-time marathoner and 12-time Ironman triathlete, I love to push my limits. But the number one reason I run is the pure joy of it.

But it’s pure hell—physically and emotionally—when you’re injured and you can’t run. I get that, too. It’s the reason I became a sports doc. Ripping my ACL in football practice in med school was devastating, but I can now say it was the single most important event to influence my work as a sports physician. It’s what drives me in my medical practice to help my patients. I have developed a get-stronger, run-better, stay-injury-free plan built on several principles. Follow these rules and you’ll be able to keep running in good health.

  1. Build a strong kinetic chain.

You love running, right? Maybe it’s the only physical activity you really want to do on a regular basis. And you know that to be good at anything, you need to practice, so to be a better runner, you need to run—absolutely! And that’s one excuse runners give for doing no strength training. Then there’s this: When your sport of choice involves the great outdoors, sunlight, fresh air, cruisin’ down the road, over the trail, or along the beach, who wants to be stuck inside a sweaty, smelly gym doing semi-static strength exercises? I get that. I’m a runner, too. But I also want to run for the rest of my life and run to my fullest potential, so I strength-train two or three times a week.

Running is great, but it can create muscle imbalances or accentuate ones you already have. If you have a weak left hip abductor, for example, your left knee may come under extra strain when you run and over time may get injured. When you run—when you do any kind of movement—multiple muscles, bones, and joints are called on to work together to create fluid motion. Your feet, lower legs, knees, hips, lower back, core, arms, and shoulders are all part of your running kinetic chain, and when one link isn’t working, the repercussions can be felt all the way up or down the chain. When you strengthen all the links in the chain and maintain good flexibility from top to bottom, you’ll run stronger and stay injury-free.

  1. Isolated, single-muscle exercises aren’t worth your time.

Now that I have introduced you to the kinetic chain, you will understand why I’m going to tell you to walk right past the exercise machines at the gym. When was the last time you were lying on your back pushing something heavy up over your chest as you do when you bench press? Whether you are running or cleaning up the garden or putting food shopping away, you are using your whole body. Many muscles fire simultaneously or in rapid succession along your kinetic chain to create that fluid, beautiful thing we call movement.

So you need to strengthen your muscles in ways that use your whole body and with exercises that mimic movements you actually do in real life. This is called functional strength training. The exercises in my IronStrength workout for runners are full-body exercises and, with the exception of the arm moves, they rely on your body, not weights, for resistance. Plus, there’s a bonus: Many of them mimic the movements you use in running, so they build strength right where you need it.

  1. Single-leg exercises should be a priority.

Single-leg squats, lunges, and hops build incredible strength and stability. The benefit of great balance isn’t just to prevent you from falling on your bum. A stable runner is a healthy runner and a more efficient runner. One of the most important elements of injury-free running is good alignment. When all the links in your kinetic chain are in the right order, your body can better handle the stress of running and more gently absorb ground reaction forces—the forces that drive up your leg when your foot strikes the ground.

With strength and stability, you move more efficiently; all your energy is focused forward, in the direction you want to go, instead of being wasted in wiggling hips or wobbly knees. Finally, think about the stance phase of running: Your foot is planted on the ground, you lower your body, and then you push back up as you go to push off. You are kind of doing a single-leg squat, so including single-leg exercises in your strength workout builds muscles specific to running. Good idea, don’t you think?

  1. A strong butt = a happy life.

The good old gluteus maximus is a runner’s best friend. And a lot of us sit on it for way too many hours every day. This is the biggest and strongest muscle in your body. When it hooks up with gluteus medius and gluteus minimus—well, they make a powerful threesome that generates most of the propulsive force when you run. Your glutes also join forces with your core muscles to provide stability when you run. Here’s what happens when you don’t have stability: As you run, you get too much movement in your hips, too much motion in the ocean; your hips rock up and down. Picture this: As you plant your right foot, let’s say, and your right hip drops down, your right knee is forced inward toward your left leg.

It’s not a pretty picture, and this movement can mess up the tracking of your kneecap and lead to an injury called runner’s knee. It also pulls on your iliotibial band (ITB), a thin band of tissue that runs from your hip joint along the outside of your thigh and attaches just below the knee to your tibia. Over time, pulling a tight ITB over the bony protuberance on the outside of your knee creates soreness in the band called iliotibial band syndrome, which can be a real pain to get rid of. You may even find that the inward movement of your leg causes you to overpronate, which can lead to foot problems, shin issues, and trouble all the way up to your hips. This is your kinetic chain in action unfortunately, not a positive action. Strengthen that butt and your troubles will disappear.

  1. You can control pain with strength.

As I mentioned earlier, when I was a first-year med student, I tore my ACL playing soccer. Eventually I had surgery, rehabbed, recovered, and became a runner. Fifteen years after blowing up my knee, I noticed pain in and around the joint. Sure enough, it was arthritis. In my search for a solution, I tried anything and everything. As a sports doc, I knew I wasn’t going to be able to cure the arthritis, but there had to be a way to reduce, if not eliminate, the discomfort so I could keep running.

One day I saw a notice for a functional strength-training class, and I decided to give it a try. The next day—no kidding—my knee felt better. This was a discovery that would change my running life (and change yours) forever. As I got into strength training and plyometrics, I learned that when my legs, hips, and glutes were strong, my knee hurt less. Today these knees have seen 32 marathons and 12 Ironman triathlons, and they are still going strong.

By shouldering more of the physical workload, strong muscles support vulnerable joints. When some of the load of running is transferred from your joints to your muscles, pain eases and injury progression slows down. And that’s not all. Strong muscles make joints more stable. A stable joint is a healthy joint and is much less likely to get injured ever.

  1. Sleep is the most important activity of the day.

An ever-increasing number of studies show how important sleep is to the health of our minds and bodies: to memory, focus, cognition, mood, creativity, healthy blood pressure, healthy weight, a healthy immune system. And catching all the z’s you need every night makes you a stronger runner. On the flip side, research shows that exercise helps you fall asleep faster, stay asleep longer, and enjoy quality z’s, with one caveat, according to the National Sleep Foundation—that you exercise at least 3 hours prior to hitting the pillow.

When you fall asleep, though it’s lights out for your conscious self, several other systems are up taking the night shift. These are the hours when your body repairs muscle, builds bone, ramps up red blood cell production, restocks glycogen, and reviews and stores the neuromuscular learning that occurred during your day’s run. Cut the shift short and your body doesn’t have time to do those jobs thoroughly. Night after night of not enough sleep increasingly wears you down mentally and physically. Not only will your running performance suffer, but you will also be more prone to injury—and, oh yeah, your general health will suffer too. Earlier I talked about holding daily exercise sacred. Do the same for a good night’s sleep. A solid eight hours makes for great recovery, ensures all systems are ready to go, and puts a shine on your health and a smile on your face. Sweet dreams.

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