Running

Is running bad for your knees?

Whether you are a seasoned marathon runner or a beginner jogger, time and time again you've probably heard this: RUNNING TOO MUCH IS BAD FOR YOUR KNEES.

As a Physiotherapist who runs frequently, I'd be a millionaire if I was given a dollar every time I was asked the question, “Will running damage my knees?" or being told, "You're a Physio, you should know that running damages your knees!"

The fastest woman in Singapore - the author holds the women's half marathon national record of 1hr 23min 14sec!

The fastest woman in Singapore - the author holds the women's half marathon national record of 1hr 23min 14sec!

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FACT: RUNNING IMPROVES YOUR JOINT HEALTH

A 2016 research done with more than 2500 Osteoarthritis Initiative participants shows that running has no correlation with knee damage. Another study also found that running decreases inflammatory markers correlated with knee pain and degeneration. The study discovered that the cyclical loading of the knee joint during running promotes healthy cartilage turnover in the knees. The bending and straightening of the knee, along with the loading and unloading of the knee during running, circulates the joint fluid and provides nourishment to the surrounding tissues.

(Disclaimer: Current studies on running and knee degeneration are limited to recreational runners with no existing knee issues. Research is inconclusive for runners with previous injury history. However, excessive long distance running can result in a situation where the knee is overwhelmed. When this happens, the knee joint is no longer able to counter the inflammation effectively, risking the potential for joint degeneration.)

So is it okay for you to run ten marathons one after another then? The answer is NO. If performed in the wrong manner, running can injure you, just like any other sport!


What are the 3 main causes for running injuries in Singapore?

1. LOADING ON AN IMBALANCED STRUCTURE

Running is a sport that involves symmetrical weight bearing. Ultimately our running speed is only as fast as our stronger leg can work. In my experience as a physiotherapist, identifying the areas of muscular strength and length imbalances appear to be the most straightforward way of pain reduction and injury prevention.

I can often get my patients to run without pain by simply identifying and tackling their weak and tight muscles. If the weaker leg begins to lag, the stronger leg starts to take on more responsibility in moving the body forward. Muscular strength imbalances put you at a risk of overworking the stronger leg. Otherwise, the weaker leg simply ends up working way beyond what it can manage. It is crucial to have symmetrical strength so that both your legs are working together to propel the body forwards.

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2. OVERLOADING

Overtraining – or overloading the capacity of your muscles is another common cause of running injuries. During a hard training session, your muscle fibres break down, and for that period, your body is temporarily weaker. At this stage, you must rest to allow your muscles to repair and heal, after which it is stronger.

A sudden increase in mileage or accumulation of high mileage without adequately resting can prevent the healing process of your muscles. Excessive loading can eventually exceed your muscles’ loading capacity. This is when injury occurs.
 

3. OVERLOADING ON AN IMBALANCED STRUCTURE

This is the most common cause of exercise related injuries in our modern-day society. Running is an efficient sport to raise our heart rates and burn calories, so it is no surprise that it is the go to exercise for the "weekend warriors". These people are generally inactive during the work week, and then come weekend, switch gears from zero to five and do a marathon-distance run.

These runners are essentially overloading onto an imbalanced muscular system – a result of accumulated sitting from Monday to Friday. Muscles can change its length tension if you stay in the same position over a period of time. Therefore, sitting for too long can lead to certain muscular imbalances such as tight hip flexors, weak glutes, weak abdominals, tight lower back muscles…just to name a few.

If you are a weekend warrior, you should consider incorporating a couple of short pre-habilitative exercises during the weekdays, to minimise the number of imbalances before you begin any heavy training regime on the weekends.


How can Physiotherapy help prevent overloading injuries?

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  • Ensure that your muscles have adequate loading capacity to take on your current training load.
  • Use different functional testing to make sure your muscles can tolerate and sustain loads relative to your training level.
  • By analysing your movement patterns – such as running hard on the treadmill, a Physio can gather clues as to whether your muscles have adequate capacity to load well at higher running speeds.
  • The Physio can then prescribe you with the right type of exercises to do to complement your training regime.

Remember not to bump up your running volume too fast and too soon. Happy running!


ABOUT THE AUTHOR

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Mok Ying Rong is a Physiotherapist at UFIT Clinic. With an intense passion in the musculoskeletal field, she utilises a holistic manual approach alongside an energetic desire to get people back to a pain-free status. Ying's niche is in analysing and treating issues related to the running biomechanics. 

Ying is also an avid sportswoman. She started off as a competitive swimmer before transiting towards triathlons, and finally establishing herself in the run scene. Her more memorable achievements include breaking the Singapore National Half-Marathon record in the 2016 Gyeongju Half Marathon, and representing the nation in the 2015 World Cross Country.

Ying's first hand sporting experiences allows her to relate better to people who are passionate about sports.

5 tips to bounce back quickly from DOMS

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Anyone and everyone who has exercised at one point or another in their life has experienced Delayed Onset Muscle Soreness, or DOMS for short. It’s that achey feeling you feel in your muscles 2-3 days post exercise, and it can often be quite painful – limiting your movement to a point where stairs seems like Everest, or you find yourself looking for a toilet with grab rails to help you into position!

Some people actively look for DOMS, and feel they haven’t worked hard enough unless they experience it. Other people, on the other hand, refuse to workout for the next week if they get any soreness after a workout. So who is right – is DOMS something to be afraid of or encouraged? And what is the best way to get over it so that we can get active again?

The science behind what exactly causes DOMS is not 100% clear, but most people agree that it is caused by micro-tears to the muscles, which leads to inflammation as they heal, causing the pain. What we know for certain is that DOMS arises in the first 24 hours post-exercise, and typically peaks 48 hours after exercise. It leads to a temporary decrease in force production for the first 48 hours post-exercise. What is clear is that lactic acid accumulation is not a component of this process, and should not be blamed for your DOMS. Eccentric training (lengthening the muscle with tension applied - for example the lowering phase of a bicep curl or on the way down in a squat) definitely leads to a lot more DOMS than fast, concentric weight training.  

So is it bad for you? In a word, no. However, it will limit your effectiveness in any subsequent exercise or sport sessions over the next two to three days, which will limit the amount of work you can get through. Importantly, it has been linked with an increased chance of injury within this 48 period, through its inhibition of certain muscles and reduction in range of movement - so try to avoid playing a football match the day after doing a heavy legs squatting session!

Recent research points to the ‘repair’ process your muscles are undergoing as the source of the pain. As your muscles are repairing themselves, they release a substance called bradykinin along with other enzymes to create growth, which causes blood vessels to enlarge and nerves to become more sensitive. The combination of the sensitized nerve endings and the increased fluid in the area lead to the pain and ‘stiffness’ felt within the muscles.

The good news is that this ‘pain’ you feel is a sign you are getting stronger, and you are getting some benefits from the training you are doing as the body goes through the damage-repair cycle. A word of caution – more DOMS does not necessarily mean you are working harder, it can just mean that you are not training very smartly, and have overloaded a particularly weak area.

 

So what can you do to reduce DOMS quickly to get back into the gym? Here are a few tips:

  1. Warm-up and cool down before and after your session. Having an effective warmup and cool down has been shown to reduce DOMS in untrained individuals versus individuals who received neither. Your warmup should include the areas of your body you are about to workout, and you should be at least breathless by the end of it. Cool down should involve stretching, and a lot of:

  2. Foam Rolling: If you don’t know what a foam roller is, find out. Buy one, and make it your friend. Foam rolling has consistently shown to be effective at improving range of movement in tight athletes the day after high intensity workouts, and reduce DOMS. The more recent research points to a neuro-physiological affect on your muscles (desensitization of the nerve endings in your muscles) as the mechanism behind foam rolling, which may be why it is effective on DOMS.

  3. Manual therapy/Massage/Acupuncture: If your DOMS is particularly bad, speak to your friendly local physio about manual treatment and acupuncture to hasten your recovery. Both are effective.

  4. Active Recovery: Research has shown that lightly exercising the area the day after a heavy session can reduce the recovery time. For example, after a heavy squatting day, jump on a stationary bike the next day for a gentle 20minute cycle. Your legs will thank you!

  5. Nutrition and Hydration: Being well hydrated, and feeding your working muscles with good fuel should be the cornerstone of any workout program. Don’t waste your time in the gym if you are not paying attention to this outside of the gym. You will recover quicker, and you will make more progress if you do!

 

Final Word

It is unlikely you will avoid DOMS altogether when you start a new strength program. It is not something that you should be afraid of, or that should keep you away from the gym. However, pain does not need to be present in order for you to achieve progress in your conditioning. If anything, intentionally causing DOMS will only limit the amount of work that you can do in subsequent sessions, potentially slowing down your progress.

The ultimate goal of any training program is to find the optimal balance between work and recovery. The key to a great training program is to find that sweet spot where you are doing enough micro ‘damage’ to create a muscle adaptation, without crippling you for the next two days and making you miss your next session!

Recover well!


About the author

Declan is Clinic Director for the UFIT Clinic and a fully qualified, registered physiotherapist. He is passionate about helping his patients achieve their long term goals through identifying their weaknesses and imbalances, and developing a strategy to eradicate them. 

Find out more about Declan right here.

Pre-habilitation for runners with Mok Ying Rong

Meet Mok Ying Rong, our new physiotherapist at the UFIT one-north Clinic. A competitive runner and Nike Sponsored elite athlete, Ying is Singapore’s Half-Marathon record holder,  and well placed to help clients recover from sporting-relating issues!

She’s joined up with #ROCKrunners in the lead-up to the Singapore Standard Chartered Marathon, where she’ll be giving talks on one of her passions – running pre-habilitation!

Tell us about your sporting and running background

I’ve always been too active! I started competitive swimming in primary school and represented my swimming club and school at national and club levels. I moved on to triathlons in high school before running seriously at 16 and representing my school, Raffles Girls Secondary, at national meets. I was getting on the podium at these and decided to try national level events.

At first, it was intimidating running with the giants but as I ramped up my training and became more systematic, found myself winning more and more races. I’ve always been self-coached, I feel very tuned-in with my body, and pretty soon, found myself knowing what works and what doesn’t. My first race representing Singapore was the Asian Cross Country in Bahrain when I was 16.

What have been your career highlights?

Signing a contract with Nike when I was in high school and representing Singapore in the 2016 World Cross Country Championships. The partnership with Nike really boosted my confidence in my training and racing, and I’ve been representing them for almost 7 years and am simply thankful for their unwavering support.

My most significant career highlight is definitely winning the 2016 Gyeongju Cherry Blossom Half Marathon, breaking the Singapore Half Marathon record by 2 seconds! My time was 1:23:14 and I vividly remember it to be one of the most painful and intense race I have ever done.

How do you train for your races?

I select the main races I’ll do at the start of the year and then periodise my training phases. Some overseas races pop up and I take them in my stride. I’ve always believed in the journey, rather than an end-goal as running is my passion, and always make sure I do my conditioning and prehab work so I can progress my running fitness safely.

What got you into physiotherapy?

I was getting my fair share of injuries, my most tragic moment being having 5 stress fractures at one time over my left foot. I also had multiple shoulder issues from swimming. I started to do my own research to understand why I was getting injured which sparked my interest in physio and I knew this was the career for me.

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What is pre-habilitation?

As a physiotherapy student, I did workshops with companies and small interest groups, spreading my passion for pre-habilitation (prevention instead of rehabilitation) for runners. I initiated a project called ‘RunFree’ when I was in my 3rd year, which believed that running should be free for all, made possible if people can run free from injuries. I’ve run sessions for anyone wanting to progress their running safely, including a movement screen based on research and running biomechanics, followed by guidance with these runners on a safe running program.

What’s in your head before a race?

I’m still bad at this – always getting nervous before a race! But my favourite mantra for myself would be – just run! Just get out and run. No fear! ☺

Come and meet her at the UFIT one-north Clinic or within the UFIT running community very soon.

Foot pain: To treat or not to treat?

When we exercise frequently it's inevitable we'll get aches IN OUR ANKLES AND FEET FROM TIME TO TIME.

In the case of UFIT Clinic client Evy Theunis, a trip to senior physio Declan Halpin was definitely worthwhile after she experienced an extended period of foot pain.

FIND OUT about her steps to a solid recovery after an achilles tendonitis diagnosis ... 

"At the end of my pregnancy, my left achilles started to hurt. I didn’t think much of it, and assumed it would just disappear after delivery.

Little Alexander came, but the pain in my left foot stayed! Short walks would still really hurt, so I decided to go see a doctor who referred me to a physio – and there came UFIT Clinic's Declan Halpin!

Apparently I had developed Achilles Tendinitis, and was in for a couple of months of recovery. No running, no tennis, no cycling outside, no lunges, no step ups, NO HEELS, no nothing, HELP!!!!

My plan to get back in shape before I would go back to work went out the window - or so I thought. Let alone do the Spartan race I had planned for in November.

But thanks to my weekly appointments where Declan stretched and massaged my Achilles (we did accupuncture as well), and thanks to the new exercises he gave me to strengthen my heel muscles, we quickly started seeing progress.

(An important point to note: when your physio gives you exercises, do them - sounds logical right - but most people apparently don’t. And it makes a huge difference).

As I was on a mission, Declan really worked with me to help me get as much variation in my training possible without jeopardizing or slowing down my recovery. I negotiated a lot :-)

All in all, it took us about 6 months to get me completely back to normal, AND, with the help of Declan’s magic hands, I made it to Bintan and finished my first Spartan!".

The award-winning UFIT Clinic is Singapore’s leading exercise rehab, injury recovery and women's health clinic. It's holistic approach and full range of physiotherapy and massage-related services by its experienced and friendly specialists can help you prevent injuries before they happen, or get you back on track as soon as possible once you're injured. 

Runners: Your Hips Don't Lie!

Are you a regular runner finding yourself with tedious pains after your runs?

Running, is known for high impact and stress it puts on your bones, muscles and connective tissue around the hip when taking part in this repetitive. It doesn’t matter what age you are, hip pain can occur in all runners. While it may start off mild, hip pain can become much more severe as time goes on if it is not treated properly. Therefore, it is important to take the proper precautions, reduce your training if you're experiencing running-related hip pain.

At the UFIT Clinic, one of the biggest groups of patients we see for injuries are competitive and social runners. Runners, more than most, have a single-minded devotion to their sport – heading out in rain or shine here in Singapore. Unfortunately, this devotion often leads to them “running through the pain” when they feel a niggle in their knees, or ankles. Eventually, this kind of attitude will lead to you ending up in physiotherapy with one of our therapists – and while we’re always happy to see you at the UFIT Clinic, we think you would probably prefer to be still out there jogging!

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So how do you avoid this fate? It all starts with your hips!

When you think about it, running is really just a series of single leg hops, over and over again. If you do not have sufficient strength and stability in your pelvis and hips, this is going to make this single leg hop action unsteady and not very powerful. If this is the case, it will make you both less efficient as a runner, and also more likely to injure yourself – bad news for any runner, social or competitive!

Why?

First, let’s discuss performance: running is about moving from point A to Point B in a straight line, as quickly as possible. Any deviation from this straight line in your body is a waste of energy – you are bleeding power. If your hip and pelvis aren’t stable, this leads to a ‘rolling gait’, and your knees pointing inwards instead of straight ahead – a loss of straight line power. Over the course of a long run, these incremental losses will add up to quite a big waste of your stored energy levels, leaving you with a less impressive run-time than anticipated.

The second issue is injuries. Without hip and pelvic stability, your knees and ankles will roll inwards with every step. Eventually, this will lead to overuse stress on the cartilage on one side of the knee, or your patellar tendon, resulting in a painful chronic injury, making running painful, leading to many physiotherapy appointments, and potentially leading to surgery.  

So how do I know if I have pelvic instability?

You can test yourself very simply.

1.     Single Leg Hop Test: One easy way is to hop up and down in front of a mirror, watching your knee. Does your knee stay in line with your toes, or rotate inwards? Does your upper body stay straight and stable?

2.     Wobble Lunge Test: If you have access to a wobble board, place it out in front of you about three feet away. Then, with a dowel across your shoulders (a broomstick will do), lunge forward, placing your lead foot on the wobble board. Again, are you able to keep your knees in line with your toes? Can you keep a strong, stable body position, or do you collapse to one side?

If your answer to either of these questions is ‘No’– I suggest you talk to a good personal trainer at UFIT, or a physiotherapist at the UFIT Clinic, before you commit to a regular running schedule. They should be able to assess your running and prescribe you some hip strengthening and pelvic stability exercises to ensure that you remain injury free, and also become a stronger, faster runner.

Do it for your running times, and do it for your knees!

If this sounds like you, come and see one of our Physiotherapists today – www.ufitclinic.com

About the Author

Declan Halpin has always maintained a strong sporting interest, and has previously worked as an Academy Physiotherapist for Crystal Palace Football Club (a professional football club in London, England), and as a Rehabilitation Coach for the Western Province Stormers Academy (a professional rugby club from Cape Town, South Africa). Declan is our Senior Physiotherapist at the UFIT Clinic heading up Singapore's only clinic that combines an international team of experts from multi-disciplinary backgrounds  to ensure that your health is always at the forefront.