As a physical therapist based in Salt Lake City, UT, Abby has extensive experience working with athletes to prevent and treat injuries. But her passion for helping people stay healthy extends beyond just sports performance. Enjoying the mountains is everything to Abby, and she wants to share this by helping people participate in the activities they love without being hindered by injury. In this blog post, Abby will be sharing tips on how trail runners can reduce their risk of injury, with a focus on common injuries such as patellar tendonitis, runners knee, achilles tendonitis/tendinopathy, stress fractures, and plantar fasciitis.

1. Warm-Up Before Running: A proper warm-up is essential before any physical activity. A good warm-up will increase blood flow to the muscles, loosen up the joints, and prepare your body for exercise. A proper warm-up should include dynamic stretching exercises that focus on the muscles most used in running, such as the quadriceps, hamstrings, calves, and feet (for some ideas about dynamic stretching, check out my blog about warming up for skiing).

2. Strength Training: Strength training can help prevent injuries by improving the strength of your muscles and stability of your joints. Runners should focus on exercises that target the lower body, such as lunges, squats, calf raises, and intrinsic foot muscle strengthening exercises. Specific focus on the hamstrings and glutes should be taken into account to improve power and reduce overuse injuries. Incorporating a greater amount of single leg vs. double leg exercises while focusing on form will help you reduce compensation patterns. For optimal outcomes, strength training should be done at least twice a week.

Some specific exercises include the following:

• 3x30 seconds: Towel Scrunches
• 3x10: Arch Lifts
• 3x12 each: Single Leg Squats
• 3x12: Sumo Squats
• 3x12: Romanian Dead Lifts
• 3x12: Explosive Lunges (or lunge jumps)
• 3x30 seconds: Copenhagen Side Planks
• 3x20: Calf Raises on an elevated surface

3. Wear Proper Running Shoes: Wearing the right shoes is crucial for runners who are looking to spend time exploring the mountains. Proper running shoes provide support and cushioning to the feet, reducing the stress on the lower extremities. It's important to choose shoes that fit properly and are appropriate for your foot type and running style. If you have a wider foot, respect this and find a shoe with a wider toe box to accommodate it and reduce the risk of Morton’s Neuroma formation, this also applies to people with bunions or other foot deformities (skier’s I’m looking at you and your 6th toes). In addition to finding shoes that are comfortable and fit you well, if you are trying to switch to a new style of shoe make sure you gradually work into it, ensure that if you are changing the drop of your shoe that you wean out of your old shoe as you train your body to the different demands of the new shoe. If changing from a traditional running shoe to a Zero drop shoe, make sure to do a series of calf stretching prior to every run to establish baseline ankle flexibility required for this style of shoe. Many running shoe stores give you the chance to try shoes for a week or two prior to returning them. I highly suggest you do this if you are going to wear a new type of shoe for running >20mi/week. 

4. Gradually Increase Mileage And Intensity: It's important to increase mileage and intensity gradually to give the body time to adapt. Sudden increases in mileage or intensity can lead to overuse injuries. A good rule of thumb is to increase mileage by no more than 10% per week.

5. Reduce Stride Length And Increase Cadence: Many of the injuries that runners experience are due to performing too long of running strides at too slow of a cadence. Running speed is the combination of Cadence and Stride Length. You can maintain your same speed by increasing cadence and slightly reducing stride length which reduces load through the muscles and tendons as you run, therefore reducing the risk of overuse injuries. 

6. Listen To Your Body: It's important to listen to your body and take rest days when needed. Rest days allow the body to recover and prevent overuse injuries. If you experience pain or discomfort while running, it's important to address it promptly to prevent it from becoming a more serious injury.

7. Specific Injury Prevention Tips:

• Patellar Tendinitis/Tendinopathy: To prevent patellar tendinitis, runners should focus on strengthening their quadriceps muscles and increasing glute activation, which help support the patellar tendon. Incorporating eccentric exercises, such as squats and lunges, and ensuring adequate quadricep muscle flexibility can help prevent patellar tendinitis.
• Patellofemoral Pain Syndrome (i.e. Runners Knee): To prevent patellofemoral pain syndrome, runners should focus on strengthening their quadriceps and hip muscles. It's also important to wear proper footwear that provides adequate support to reduce pronation and cushioning to reduce impact. Runners who are experiencing runner’s knee should take a minute to review their running technique and ensure that they aren’t allowing any cross over gait (when their feet cross over midline with each strike) or knees collapsing in during impact. 
• Achilles Tendinitis: To prevent Achilles tendinitis, runners should focus on strengthening their calf muscles to increase dorsiflexion and incorporating heavy load exercises to improve tendon tissue resilience. It's also important to stretch the calf muscles regularly and gradually increase mileage and intensity.
• Stress Fractures: Avoid stress fractures by gradually improving running volume by about 10% per week. This also includes when transitioning from treadmill work in the winter to hard ground or pavement/concrete running. Make sure you have appropriate footwear and are getting adequate calories to maintain your active lifestyle. 
• Plantar Fasciitis: To prevent plantar fasciitis, runners should focus on stretching their calf and foot muscles regularly. It's also important to wear proper footwear that provides adequate support and cushioning, especially for those with flat feet or high arches.
  

Living an outdoor lifestyle can be incredibly rewarding, but it also presents unique challenges when it comes to staying healthy while enjoying the outdoors. As someone who values this lifestyle and works with clients who share this passion, I am committed to helping people stay healthy and active in these environments. By following these injury prevention tips and taking steps to care for your body, you can continue to enjoy all that mountain living has to offer.

Check out Abby's PT site: https://progressionphysicaltherapy.com/