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As we enter a new lockdown, with gyms and swimming pools closing again, more and more new runners have taken to the streets. In the first of this series focused on the prevention and treatment of running injuries, Physiotherapist Ruth Ashton looks at how runners can prevent injuries by identifying vulnerable muscles through an easy Movement Control Assessment.

About Ruth Ashton

Ruth operates a split post working both in management and covering a clinical caseload. She has a special interest in tendinopathies, running related injuries and post-surgical rehabilitation. She completed an MSc in Sports and Exercise Medicine and has post graduate training in acupuncture, Pilates, manipulative therapy, women’s health and aquatic therapy.
View Ruth Ashton’s full profile

As a frequent runner, I have noticed a significant increase in the number of people out running since March last year. In our current situation it’s completely understandable.

As well as beating the boredom of spending more time inside, running is fantastic for building strong bones, strengthening muscles, improving cardiovascular fitness, burning calories and helping to maintain a healthy weight. Running also improves the quality of our emotional and mental wellbeing, promoting both sleep quality and concentration levels. 

In fact, evidence from a 2019 study published by researchers at UCL showed that novice runners completing a marathon saw improvement in MRI scores for the two main weight-bearing knee compartments.

This is the most robust evidence to link marathon running with knee health, and turns previous predictions that running can ‘damage your knees’ totally on its head!

However, since the human body needs time to build muscle and connective tissue resilience – as well as adapt to the new load that running places on it – anywhere between 65-80% of runners acquire an injury every year. 

Poor running biomechanics, equipment errors and training errors are just some of the factors that can lead to injury, with one of the most common being ‘runner's knee’. Runner's knee is a non-specific term that refers to pain that typically starts anywhere in the knee during a run.

Although this injury can be managed by reducing aggravating movements and taking anti-inflammatories, an easy Movement Control Assessment can help runners identify weaknesses in their ankles and hips, to prevent ‘knock on’ injuries in other parts of the body such as the knee.

1. Discover your ankles’ range of movement and detect tight calf muscles with the knee to wall test

Reduced ankle range of movement (a result of tight calf muscles or a stiff ankle joint) can limit your ankles’ ability to shock absorb, leading to additional forces transmitted to the rest of the body, including the knees, hips and back.

One quick and easy way to check and compare your ankles’ range of movement is to perform the knee to wall test. 

The knee to wall test

First, touch your knee to a wall. Next, slowly move your foot further away from the wall until you reach a point where your heel is about to lift. Measure the distance from your toes to the wall to find your knee to wall measurement.

If after comparing both ankles you find that one ankle has a reduced range of movement, it may be beneficial to perform calf stretches to increase your ankle range of movement.

2. Identify weak hips with a single leg squat test

If you are weak in your gluteus medius (a muscle in the hip) then you might find that your knee tends to drift inward when performing a single leg squat test. A weak gluteus medius puts additional load on the knee cap (also known as the patella-femoral joint or PFJ).

One way to test this movement control at home is with a single leg squat test.

Single leg squat test

While standing in front of a mirror, squat using one leg only and check if your knee is following the line of your second toe. If your knee is moving inside of this it may indicate that you have reduced strength in your gluteal muscles. 

3. Test the strength of your quadriceps with a single leg sit-to-stand test

Another important muscle group for supporting knee caps during the early landing phase of running is the quadriceps (the big group of muscles at the front of your thigh).

One way to test the strength of these muscles at home is with a single leg sit-to-stand test. 

Single leg sit-to-stand test

Try to stand up from a chair just using one leg and compare the strength of the right and left leg and ease of performing this movement to identify weakness in the quadriceps and gluteal muscles.

Further information

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