Running: Injury Prevention (Part 2)

We’re coming very quickly upon tank-top weather: suns out, guns out. What does that also mean? Each and every single one of you are going to think about strapping those kicks on and running to shed some of that winter weight you put on through winterpocalpse 2013-2014.

Let me show you how to warm-up properly before you end up pulling up lame after trying to take that hill on too aggressively.

For the last piece on footwear and stretching, click here.

Injuries suck. How do you prevent them? Stretching? Warming up? Not even going out at all? Sure, you could just give up and resign yourself to a life of Netflix marathons and nip injuries in the bud: don’t do anything. Or you could be awesome and… not become Ben Affleck at the end of Dodgeball. Or Chris Farley in that SNL skit that I can’t remember.

The topic of the week is proper warm up protocol. “Oh, but I don’t need to warm up,” you say. Time for me to take you to school (aka the literature).

If you type in ‘warm up injury prevention’ in Google, you get 2.1 million+ results, with a ton of articles that have infinite amounts of data. Typing in the same results into PubMed yields a cooler and more precise 205 results. There are three main injury programs that have been developed (FIFA11+¹, Knee Injury Prevention Program², and Prevent Injury and Enhance Performance³ programs) which have been highlighted extensively in the searches I’ve done.

A systematic review done by Herman et al in 2012 which assessed the effectiveness of the FIFA11+ (11+), Knee Injury Prevention Program (KIPP), and Prevent Injury and Enhance Performance (PEP) programs showed that all three were effective in preventing lower extremity non-contact injuries.⁴

The 11+ protocol has lots of data in the literature and is the first page that comes up in the search terminology from Google. Warming up will increase oxygen uptake and core temperature which can facilitate an improvement in athletic performance.⁵ This protocol has also been shown to prevent injury in elite male basketball athletes.⁶

Alternatively, the KIPP and PEP programs have been shown to reduce injuries in adolescent soccer playing females.^7,8

After poring through the protocols of these warm up programs, these are all ultimately based in neuromuscular training and emphasis of mechanics prior to participation in sport. What does that mean? Moving properly will make sure you don’t jack your ish up during running or other dynamic sports.

Like the blog posts about squatting and lunging (here and here, respectively) the emphasis is on mechanics and teaching your body to move properly. Those mechanics that I have gone over are 150 million percent important in these movements – please review them if you have not read them before.

Now, I’m going to stop putting you to sleep get you moving before you go for that run. These exercises can all be found in each of the protocols which will be cited after the article.

1. Light running (yogging) 1-2 minutes
   1. Make sure your knees stay in line with your feet and your feet are not turned out.
2. Butt kicks; 30 seconds
   1. Not emphasizing how far you can travel over a certain amount of time, but how many times you can bend the knee to kick yourself in the butt.
   2. Make sure your stance knee (the knee you are not bending to kick yourself in the butt with) is in line with the foot and slightly bent.
   3. DO NOT hyperextend your stance knee.
3. High knees; 30 seconds
   1. Just like in the butt kicks, the idea is to get as many high knees as possible versus traveling far.
   2. Watch your stance knee motion. Don’t let it go inwards, and do not hyperextend the knee.
4. Lateral Shuffles; 30 seconds
   1. You are going to make big sidestep strides going to the left or right. Don’t let your feet slam together.
   2. Make sure the leg you land on maintains the knee alignment with the hip and foot.
5. Line Jumps; 30 seconds front/back, side/side
   1. Draw an imaginary line in front of your toes while standing up. While standing on your toes, jump forward and backwards over the line.
   2. Make sure your knees do not move in towards each other and are instead in line with your hips and knees.
   3. Keep your feet parallel and in line with each other.
6. Lunge Walks; 10-15x/leg
   1. Take a big step and drop the back knee towards the ground.
   2. Watch the front knee’s motion; don’t let it move out of line of the hip and knee.

Videos of these exercises will follow by the end of the week, so stay tuned.

Each of these exercises combined with stretching are important in training your brain. The theme of maintaining knee alignment and keeping it from moving out of alignment is crucial. Also important to remember is that this is not an overnight fix – retraining your brain takes willpower and practice, practice, practice.

Run safe,

Erwin

Sources:

1. The 11+ Manual. F-MARC. 13 May 2014. Available at http://f-marc.com/11plus/manual/ Accessed 13 May 2014.
2. Knee Injury Prevention Program. 13 May 2014. Available at https://www.luriechildrens.org/en-us/care-services/specialties-services/institute-for-sports-medicine/knee-injury-prevention-program/Pages/index.aspx Accessed 13 May 2014.
3. The Injury Prevention and Enhance Performance Program. 13 May 2014. Available at http://smsmf.org/files/PEP_Program_04122011.pdf Accessed 13 May 2014.
4. Herman K, Barton C, Malliaras P, Morrissey D. The Effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review. BMC Medicine 2012, 10(75)
5. Bizzini M, Impellizzeri FM, Dvorak J, Bortolan L, Federico S, Modena R, Junge A. Physiological and performance responses to the FIFA 11+ (part 1): Is it an appropriate warmup? Journal of Sports Sciences 2013; 31(13):1481-1490.
6. Longo UG, Berton A, Marinozzi A, Maffulli N, Denaro V. The Fifa11+ Program is Effective in Preventing Injuries in Elite Male Basketball Players: A Cluster Randomized Controlled Trial. Am J Sports Med 2012; 40:996
7. Labella CR, Huxford MR, Grissom J, Kwang-Youn K, Peng J, Christoffel KK. Effect of Neuromuscular Warm-up on injuries in Female Soccer and Basketball Athletes in Urban Public High Schools. Arch Pediatr Adolesc Med. 2011; 165(11):1033-1040.
8. Mandelbaum BR, Silvers HJ, Watanabe DS, Knarr JF, Thomas SD, Griffin LY, Kirkendall DT, Garret W. Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes. Am J Sports Med 2005; 33(7):1003-1010.