Running away from injuries

Lisa Zeman, a physical therapist who specializes in running injuries at St. Paul's Regions Hospital, stepped in front of a throng of runners Saturday morning and announced, "I hope I never see any of you again."

She wasn't being rude. She was being practical. Exercise-related injuries are skyrocketing, and runners are leading the way. The hospital saw an 86 percent rise in patients with running injuries in 2011 over the previous year. The numbers are enough to stop you in your tracks: 50 percent of recreational runners experience at least one injury a year, said Dr. Heather Cichanowski, and 60 percent of those injuries are caused by training errors. Factor in running's popularity -- 49 million Americans do it -- and there's a whole lot of limping going on.

"When you're talking about millions of participants, these numbers get really high," she said.

One solution is to stop the injuries from happening in the first place. In hopes of doing just that, the hospital's Rehabilitation Institute and HealthPartners' Orthopedic and Sports Medicine program kicked off the outdoor running season with its annual Run Injury-Free Seminar.

"Sports medicine has to become more about preventing injury instead of reacting to it after it happens," Cichanowski said.

The seminar attracted both relative newcomers and people who have been running for decades. Kris Miller of West Lakeland Township is one of the latter. She's been a runner for "36 or 37 years," during which time, she said, she's had just about every injury. She went to the seminar "looking for ideas that will help me minimize those injuries." On the other end of the spectrum, Tracy Yoder of Hastings started running two years ago as a way of getting back in shape after a pregnancy. So far, her running has been largely injury-free, but "I want to be proactive" about keeping it that way, she said.

There is no one-size-fits-all remedy. "There are too many variables" in terms of causes, Cichanowski said. "And on top of that, it varies from person to person. But there are tools you can use to help keep yourself injury-free."

They include:

Focus on form. Those over-padded heels on your running shoes might lead you to conclude that you're supposed to reach out each stride as far as you can and land on your heels, but that's wrong. The current thinking is that you should shorten your stride and land on the balls of your feet.

When your foot hits the ground, your heel should not be forward of your knee. If your stride extends too far, the heel absorbs the entire force of the landing, energy that it dissipates by sending it up your leg to the knee, which, because it's overextended, is in a bad position to take the hit.

A quick way to break the habit of over-striding is to get on a treadmill and increase the angle of the bed. Your stride will naturally shorten to help maintain balance, Zeman said.

You also want to be aware of your posture so that your weight stays centered. "Keep your head up by looking 30 to 40 yards ahead of you," said physical therapist Amy Hawks. Another thing that can affect your balance is an asymmetrical arm swing in which your dominant arm moves more, she said.

Use a running partner to check these things, she said. Run directly toward them, directly away from them and then past them at a 90-degree angle. Have them check your posture, stride length, arm swing and hip rotation (too much causes your foot to cross beyond the midline of your body, another no-no).

Analyze your aches. The decision whether to push through pain is one of the most difficult ones that recreational athletes face. The seminar offered a basic guideline: If the pain doesn't cause you to alter your running, you can keep going. But if it forces you to change the way you run, including the length of your run, or if it starts to interfere with normal daily activities, stop.

Overuse is the primary culprit, Zeman said. "Injuries occur when the load exceeds the body's ability to recover," she said.

Cross-training is the easiest way to avoid overuse injuries. It enables runners to increase overall activity levels while resting many of the muscles that are stressed during running, said physical therapist Rhoda Breakfield-Uggen. While most runners focus on aerobic conditioning -- biking and swimming are the most popular -- she also suggested using non-running days to work on things that will help your running, like improving flexibility and core strength. "Then you can go run happy," she said.

When aches do crop up, remember that the location of the pain is not always an indication of where the problem is. For instance, that pain in your knee could be coming from weak hip muscles that are throwing off your balance.

"People will put on a knee brace, which helps for a while, but six months later the knee hurts again -- or maybe now the other knee hurts," Cichanowski said. "You have to address the underlying biomechanics. The brace treats the symptoms. It doesn't do anything about the cause."

Do the prep work. There are two basic types of stretches: those you do as a pre-run routine to loosen up your muscles, and those you do on a regular basis to increase your flexibility. In both cases, start slowly, focusing on form, and then increase the number of repetitions and/or range of motion as you become more comfortable.

"Always work within the tolerance of your body," advised physical therapist Laura Kramer. "You should be listening to your body as you do this."

Some runners prefer yoga, which can serve both as stretching and a core-strengthening exercise. Physical therapist Dawn Altstatt, who has been running for 18 years and practicing yoga for 12, does short yoga routines on the days she runs and long ones on her off days. She focuses on poses that work the glutes, hips, lower leg and foot muscles as well as hamstrings and Achilles tendons.

Hard-core runners are devoted to their running regimens. They need to be just as dedicated to preventive exercises, Cichanowski said.

"You need to do them daily," she said. "They should almost be like brushing your teeth."

Jeff Strickler • 612-673-7392