Posted by Dan Swinscoe
Top 4 exercises for runners in pain
Running: a great way to get in shape or a great thing to do when you’re in shape ? The general population seems to think one thing but the fitness and rehab world thinks another. As a physical therapist with almost three decades experience I can tell you it’s the latter. A popular slogan on T-shirts of runners explains a lot, “My sport is your sports punishment.”
But despite that, people with the best of intentions go out there and take upwards of 2000 steps per mile pounding their legs with forces equal to triple body weight with each one. Or as Alwyn Cosgrove would say, “Hop on one leg 750 times. Then repeat on the other side. That’s equal to about one mile.” No wonder so many runners are sore. Each runner with aches and pains should have an evaluation to determine what he/she specifically needs to become painfree again, but there are generally consistent traits among the runners who hurt and those who don’t that are worthy of discussion.
In my mind, there are three fundamental movement skills runners need yet often lack that can be uniquely trained with one simple tool and some effort. Re-establishing these fundamentals puts the runner in a great place to be able to comfortably train again.
First, single leg balance. If you can’t demonstrate solid balance standing on one leg you can be assured that in the 1/10th second your foot is on the ground you wont be efficient with how you interact with it. Elite runners spend less contact time with the ground then their less capable comrades. That’s because skilled runners immediately control body weight when the foot is on the ground then take that absorbed energy and use it to drive the next step. Novices don’t. So instead of body weight being quickly controlled absorbed and redirected to the next step connective tissues take more of the brunt. Eventually those tissues complain and there’s your “over use” injury. A better term might be “under function” injury. Think of single leg balance as the beginners level skill and running as the advanced skill with some other steps in between.
The other essential motor skills for efficient comfortable running are good connections between the hip and shoulder via the core across the front of your body and good connection between the hip and shoulder via the core across the back of your body.
It may not sound like much, but these skills will allow you to control your landing forces in all three planes of motion. If you look at our anatomy on the front surface of the body you can see there is an orientation or line between muscles of the shoulder through the oblique abdominals diagonally to the other hip. When you look at the back side of the body you can see a similar line from the lower trap and lat of one shoulder connecting diagonally to the glutes of the opposite side. Our body is made of these muscular “slings” that criss cross the body front and back. This feature has been called the “serape effect” named after the toga like garment. Connecting the elastic energy from shoulder to hip and hip to shoulder via the core diagonally across the front and back allows the runner to efficiently use and transfer energy in all three planes when the foot hits the ground. Which is important because the forces are large and they are sudden.
That explains the three pre-requisites. The unique and simple tool to acquire them? The Ultimate Sandbag or USB.
I’ll share an example. The other day I saw a patient who had R hip pain with running. She had been getting spinal manipulations and massages for two months with minimal change. I instructed her and coached her through the exercises listed below for about 15 minutes. We then went outside and she was able to run painfree for the first time in a long time. Not everyone will have such dramatic results but they aren’t uncommon. Remember, as mentioned above, a thorough assessment is always required. I gave her one and it was clear what she needed. So that’s what we trained. Runners typically think their painful area needs direct hands on treatment by a medical professional. Sometimes they do, but not always. Sometimes the runner just needs their body to work right. To “connect” their hips and shoulders via their core. To be able to withstand the forces of running in all three planes. I like to tell people your injury isn’t your problem, your injury is evidence of your problem.
Below are some excellent exercises unique to the Ultimate Sandbag that in my opinion give most runners what they need: control over single leg stance and connection between hip and shoulder via the core across both the front and back sides of their body.
Max lunge (forward and reverse)
The “deadbug” exercise has been around a long time. However, the USB version is so much better I usually don’t even teach the original anymore. The benefit of the USB is in how much stronger of a connection it creates between hips and shoulders when you use it compared to when you don’t. When you squeeze the outside handles, tension the bag and move it through a diagonal downward motion called chopping or a diagonal upward motion called lifting you feel what I’m talking about. Squeezing something really hard makes muscles distant from your hand contract. These include core muscles. This is referred to as Sherrington’s Law of Irradiation. By squeezing so hard you essentially “tell” your brain this is important. As a result the brain tightens muscles to prepare for the expected battle. By tensioning the bag you will be using the large lat muscles on your back that connect shoulder to hip. This is further enhanced by the motion of the bag going diagonally overhead as the leg on the opposite side reaches towards the floor. By putting a band around your feet it is enhanced even more as the stationary leg has to remain solid when the reaching leg pulls against the band. After learning the USB version the original version, with nothing to hold and nothing to facilitate extra tension, feels close to a waste of time.
Bridging is another exercise that’s been around for a very long time and like the deadbug it has some value by itself just not nearly as much as when using the USB. It is a beginning way of getting people to use the glutes and learn how to extend the hip without extending the spine. By squeezing the outside handles, tensioning the bag and chopping down to each side we train the link of the shoulder and opposite hip. We can make it harder and emphasize the abs more by going overhead with the lifting pattern. We can make it harder still by doing these same motions when holding the bridge position with just the single leg. This is when you really feel what is required of you as a runner each time your foot hits the ground. Only now its happening slowly enough you can feel it and learn to control it. This is a key point as it allows awareness and practice.
Once a runner gets good at these they are likely to succeed with the next exercises described below which are more challenging because they are upright. These exercises aren’t mutually exclusive of one another so they can overlap but if someone struggles with the deadbug and bridge it doesn’t make much sense to challenge them more. I want my exercises dosed such that my patients are successful not perfect, challenged not overwhelmed. This is the sweet spot for training.
The max lunge exercise is a greater challenge than bridging and dead bugs because now we are standing and controlling full bodyweight, the USB and momentum. The USB allows us to train a challenging load in all three planes like running but with less impact forces than running. A small weight goes a long way with this exercise. With the lady mentioned in the example above it was only 15#. With this exercise you’re rotating the bag to the side of the front leg. This can be done with the moving leg stepping forward or backward. They feel distinctly different so I like to think of them as two separate exercises. I usually begin with stepping back. To me this enhances the runners ability to “feel” the ground and generate forces similar to propulsion. Especially if he/she can get in a rhythm and make it a little faster. This more dynamic version is very similar to a kettle bell swing but better for runners in my opinion because you’re using one leg at a time just like with running. Notice in the video the movements begin slowly but get faster. This exercise is dynamic and challenging for muscles but is very joint friendly.
By performing the max lunge forward your body has to learn how to handle the three dimensional challenge of landing mechanics. With running, your weight and momentum are all on the forward foot and gravity is trying to make you collapse. Muscles from the foot on up are preventing you from collapsing by decelerating those forces giving you control over your foot print so you can then propel yourself and take another step. In the max lunge the weight and momentum of the USB creates similar forces. I sometimes use this as an assessment. If you cant control these loads you will lose your balance or move the weight awkwardly not smoothly. It’s a great training tool because the feedback is obvious.
Whether you want to improve your performance as a runner or try to resolve some painful issues, these exercises with the Ultimate Sandbag are a great place to start. I hope you find them helpful.
Dan Swinscoe, MPT, CSCS is a physical therapist in Issaquah, WA and owner of Peak Sports and Spine Physical Therapy.