An Interview with a Physical Therapist

While running is a great way to stay active and healthy, running can also be hard on your body. If you’re running on the sidewalks, road, or even treadmill, the pounding on the hard surface can be tough on your bones and joints. Plus, running places a lot of strain on your muscles and tendons in general, and if you’re not taking action to stay healthy you could be at high risk of an injury.

I routinely see a physical therapist to take care of my aches, pains, and injuries that come with running.  Seeing a PT regularly also helps keep my serious injuries at bay as he treats minor things before they become major and keep me from running. Dr. Mike Pavlak and Dr. Tim Pavlak of Physio Orthopedics and Performance in Akron have been my go-to’s for all my running related issues during my years of collegiate competition and after.

Both doctors sat down virtually with me to chat about common injuries, preventative measures, and strengthening options. Check out this article to see some common questions answered, and then go see them or your local PT to give your body the treatment it deserves!

When looking at runners, is there a common cause for injury you see most frequently--such as lack of stretching, weaknesses, inefficiencies, or is it a pretty even spread?

Dr. Tim: When you look at research, there is no article that says stretching prevents injuries. You need the range of motion that is necessary for your sport and that’s it.

The number one thing we see in runners is an asymmetry—something being different on one side of your body versus the other, and it almost always goes back to being hip related. Running is a straight-line sport, so the side-to-side muscles that give you stability don’t get strengthened as much from running. You see this more in road runners than trail runners, as trail running gives you more opportunity to strengthen stabilizing muscles.

So is there a really common injury you see among runners that is easily preventable?

Dr. Mike: One thing we saw during coronavirus among runners but is really work related was a lot of neck or low back tension just from sitting too long and then trying to jump out and do a run with no warmup.

Dr. Tim: Looking at just runners, IT band syndrome (which is related to lateral stability), glute med. syndrome (which is also related to lateral stability), and then achilles tendinitis and plantar fasciitis (which is more related to the calf complex, poor shoe choice, and poor movement patters). In newer runners it’s all shin splints because they’re not used to the mileage. Serious runners often deal with overuse or have a weakness they didn’t realize was underlying. That’s why we focus a lot on preventative care.

So how important is it to have that pre-run warmup routine?

Dr. Mike: I would say dire. It’s really common for people to come in and say that on their runs they feel bad for about a mile and then start to feel better—because their muscles are finally warmed up after that mile. This could be easily improved by supplementing with a warmup routine. Just stretching before a run really doesn’t do anything to prepare you; warmups should be activation based so your muscles are firing and ready before you run. That way the muscles used for running are warm and ready to do what you need them to.

What are a few examples of some warmup drills you definitely recommend?

Dr. Tim: Hip mobility is great as a warmup and should ideally be done as a strength routine around 3 times a week. So clam shells, monster walks, and other banded exercises are all great. As mentioned, a lot of problems for runners come from weak hips and glutes.

Another good daily thing is foam rolling after you run. This is a big deal because your body is in sympathetic mode with lots of blood flow, and if you don’t take the time to roll out and cool the muscles down after activity then they’re staying activated. Then when you go and sit at work or wherever they’ll just get really tight.

Dr. Mike: Also going with the hip stability work—it’s important to do a good job of taking care of the big three joints when it comes to running—the ankle, knee, and hip—and if you take care of the hip and you take care of the ankle, the knee is usually safe. If someone is having knee problems, it’s often coming from a lack of stability at the hip or a lack of mobility down at the ankle. That’s why it’s important to be warming up and cooling down the ankle and the hip; so doing the hip stability work and then adding in some toe walking and calf exercises to activate the ankle is a great way to keep the knee healthy.

What if someone wasn’t able to avoid injury—what are some of your favorite cross training activities to stay fit until they’re able to run again?

Dr. Mike: Aqua jogging is a great way to maintain cardio fitness and muscle memory. If you’ve got a load related injury then that’s a great option for you. Just throw a belt on for floatation and stay upright maintaining the pumping motion of running.

Dr. Tim: Aqua jogging is good and even just swimming is great. You’re using completely different muscles, you’re unweighting joints, you’re not getting irritation from load bearing surfaces, you’re getting core stability and movement at the hips. But it also comes down to what you have available.

Are there any weight training exercises you think all runners should be doing for both staying healthy and improving performance?

Dr. Mike: Single leg work and posterior chain work are what’s biggest. There’s no double-legged stance in running, so single leg activities are really helpful.

Dr. Tim: Single-leg deadlifts with a kettle bell or dumbbell, a kettle bell swing, Turkish get-ups, and then chin-ups and push- ups. If you’re doing all of these you’re good to go.

Dr: Mike: you don’t even have to pay for a gym membership then, just get a kettle bell!

My recommendation—see a PT and do preventative activities before an injury. Whether you’re a runner, walker, or just active person in general, your body is doing a lot for you. Give it the care and maintenance it deserves so you can keep doing what you love!