In a separate post, I described my knee injury that kept me from running for two months earlier this year. I’ve been wanting to write a how-I-came-back-from-injury post for a while, so I’m glad I can now say that my knee feels strong. I’m ready to start real training: I’ve signed up for two half marathons in the fall, and I may run a few shorter races for fun in between.
Weekly Mileage Post-Injury
I began my return to running with a 9-mile week (3 miles x 3 days), on a flat route. I didn’t run on consecutive days, and I added 1-2 miles per week (except on the weeks I added hills, I kept my weekly mileage flat). I added uphills first because they are lower-impact. I walked downhills for two weeks, then added downhill running. As early as week 2, I designated a “long” running day each week, and I built up to 17 miles per week on three days of running a week (runs of 4, 5, and 8 miles).
Since then, I’ve been running four days per week, and my average weekly mileage has hovered around 20 (going as high as 25 and as low as 13 based on how I’m feeling and life). It’s been nice to keep my average running volume around 20 miles per week and feel myself get stronger as the weeks go by.
One KEY aspect of my recovery has been doing an appropriate warm-up before each run. I always begin my warm-up with the first two glute activation exercises described below and leg swings. If I plan to run longer or harder than normal, I’ll add the lunge matrix or do this warm-up routine. I’ve also been foam rolling my adductors before some runs when they feel tight.
As I mentioned in my earlier post, a huge contributing factor to my injury was that my glute muscles weren’t activating when I was running. I had a remarkably similar experience to this Runner’s World author – lying on a doctor’s table, unable to perform the simple act of contracting my glute muscles. I also learned that my right glute was stronger than my left.
Initially, I was given exercises that weren’t very challenging physically, but were to be performed with attention to how and when I activated the muscles involved in the exercise.
1. Prone leg lifts
Lie face-down on ground, yoga mat, whatever suits you. Contract one of your glutes (with my dead butt, this took poking my glute muscle at times). Then once the glute is contracted, simply lift the leg up off the ground 6 inches or so. It’s important to let the glute disengage after each repetition, because this is an exercise to train the brain that the glute should initiate this motion. Perform 10x per leg, 1-2 sets.
2. Glute bridges
Lie on your back with your knees bent, feet together on the floor. Contract the abs first (not too hard – about 30% effort), then the glutes. Push up into a bridge position, keeping knees and feet together. Hold for 5 seconds and repeat.
At first, I had trouble keeping my balance, which can indicate either weak hips or that the glutes are not firing. I had to be patient and really focus on the glutes, because my hamstrings wanted to do all the work. A trick that my chiro gave me to “turn off” my hamstrings was to put my weight in my heels and lift my forefeet off the ground. Because brain-training is an important element of this exercise, I was instructed not to become over-reliant on this trick. I used the heel-trick to cue my brain and body to know what the movement should feel like, so that I could perform it for the next rep with my feet flat on the ground.
To begin, I performed 2 sets of 10 repetitions. I also incorporated some hip strengthening work into this exercise by looping a Thera-band around my knees and doing bridge-clamshells. Now that 2 sets of 10 repetitions is pretty easy, I perform the second set alternating between single legs. This is really hard on the left side, so I know I still have work to do.
3. Squats and Lunges
After a couple of weeks of just performing the above exercises (in addition to cross-training, core work 3x/week and hip strengthening 2x/week), we added squats and lunges – classic lower-body exercises that seem to be good for everything! At first, doing lunges put pressure on the injured knee. I worked on this with my chiropractor, and found that the pressure was relieved if I contracted the back glute hard prior to performing the lunge motion. After trying it out, I think the lunge is a more challenging and effective exercise when I consciously engage my glutes and core before performing the motion. I began with 3 sets of 5 per leg, then progressed to 3 sets of 10 per leg. This was really easy with the right leg, less so with the left leg.When I first did a squat in the doctor’s office, my chiro noticed that I was leaning slightly to the right side (favoring the stronger glute) and my left knee buckled in slightly. She had me do squats in the mirror, watching my form carefully. I began with 3 sets of 10 and added weight once that became relatively easy. I’ve found it’s easier for me to keep good form by adding weight in front, rather than a typical back squat. I like doing squats with racked kettlebells, like this guy. Another good option is a pistol (one-leg) squat. I can’t do more than a couple of (shaky) pistol squats on my left leg, so I’m progressing by beginning in a seated position and driving up through my leg to a standing position.
If I could highlight one key thing about my introduction to lower-body strength work, it would be that my chiropractor eased me into it carefully and with attention to performing the movements correctly. It feels great to get stronger, so I’ve upped the strength training to 2-3x/week and doing more complex movements with a trainer – more on that to come!
My least favorite thing I’ve been working on is mobility. It’s not glamorous, just doing more of those not-fun things I need to be doing like foam rolling. I’ve been enjoying yoga a lot more since my injury, and I have been practicing 1-4 times per week (sometimes a formal class, other times for 10 minutes in my hotel room).
I have two new favorite mobility tricks: “foam rolling” my calves with my shin, and the “couch stretch” (it’s a long video, scroll to 2:20 for the stretch itself). The couch stretch is an awesome (read: tough) hip flexor stretch. I’ve read that there can be a link between tight hip flexors and inhibition of the glute muscles, so if you’re like me and are trying to get your glutes firing on all cylinders, this stretch could be good to add to your rotation.
I’ve never found foam rolling to be that effective on my calves, and I have found that “The Stick” is awkward to use in that area. So I loved this trick I learned at a Yoga for Runners class at Infinity Yoga, which allowed me to get into those tight spots in my calves for a little tough love. I found some tight spots I wouldn’t have even noticed foam rolling.
1. Starting on hands and knees. cross your opposite shin over the calf that you want to “foam roll.”
2. Press into your calf with your opposite shin. Move the shin around over the calf, and identify trouble spots.
3. For any spot that needs a little more tough love, position your shin over the area and lower your weight into it to create additional pressure. You can hold this position, or you can wriggle your shin around under your weight – whatever feels right!
The photos to the side illustrate each step – some days I can sit with my full body weight on my calf, other days, I can’t. I’ve found that this exercise is most effective when I do some good “yoga breathing” into my calf, and imagine the tightness melting away. Translation: breathe and relax into this movement.
Consistency & Patience
For all of the above, consistency and patience were key. Even though I was back to running a few miles per week in late March/early April, my knee did feel a bit “shaky” for a while. I tried to stay tuned in to how it felt, and definitely got a few “yellow lights” from minor pain that caused me to cut some runs short. For those of you who have experienced a knee injury, you know that recovery doesn’t happen overnight. My knee didn’t feel strong until late May/early June. I’m glad I had great resources to turn to over the course of my recovery, and I’m excited to get back to “real training” again!
Have you ever had a running injury?
What did you find most helpful in your recovery/injury prevention?