Final week, first injuries...

So as we enjoy our final week of rest and taper after 4 months of training in readiness for Sundays marathon, we suddenly have numerous injuries between the 6 of us (all ladies). These are all common injuries to runners so worth some detail about each and how to manage them:

1. runners knee - 4 out of 6 of us have this

2. sprained ankle and foot - 2 out of 6 of us

3. achy lower back - 1 out of 6 of us

(Statistically 50% of runners incur injury during the year so we've not done too badly!).

First up: Runners knee (ITB Syndrome) - it can start as a burning sensation on the outside of the knee. If left untreated it can worsten such that walking downstairs can be painful with every knee flexion. Runners knee can also be a term used to describe general front of knee pain and lateral knee pain.

It is caused by repeated overuse of the muscles and their tendon insertions on the outside of the knee and specifically the insertion of the IlioTibial Band (ITB) into the lateral epicondyle of the tibia. The ITB is a thick wide sheet of connective tissue deep fascia that wraps around the outside of the thigh arising from the tensor fasciae lata (TFL) (which is in the location of a front pocket in a pair of jeans!) allowing it to function as an abductor (leg out to side), medial rotator (turn leg in) together with the medial hip rotator gluteus medius. When the knee flexes the ITB insertion moves posteriorly over the bony ridge of the lateral epicondyle of the femur, then when extended it moves anteriorly and if it's too 'taught' it will cause friction, inflammation, irritation and pain.

Any weakness or imbalance of any of these muscles, fascia or soft tissue structures or indeed any pelvic instability can result in the knee 'dipping' in when running - this is particularly noticable when runners begin to tire. The reason for mentioning that we're all ladies running is that women have more of a Q angle than men due to having a wider pelvis the knee naturally comes to the centreline at more of an angle, it seems to me that runners knee is more prevalent in women due to the increased 'knee-dipping' but that's just my thoughts.

Once you have runners knee or ITBS (ITB Syndrome) treatment involves the RICE principles ie rest, ice, compress, elevate, and taping is very effective as it helps to lft the fasical layers whilst also compressing the inflammed area. Massage is also great for treating the whole ITB and underlying structures the vastus lateralis to the front and hamstrings to the back, massage promotes blood flow to the tissues and can help to minimise scar tissue and the long-term recovery / dysfunction.

However, prevention is better than cure and therefore if you can do work to strengthen the muscles used to stabilise the pelvis specifically gluteus medius, you will go longer before ITBS becomes a problem if at all. There is a balance between medial rotation and lateral rotation - the lateral rotators being the piriformis group which you will definately be able to locate and feel if you lie on your back and cross one ankle over other leg bent knee and bring that knee to chest you will feel the lateral rotators deep to the gluts.

Exercises: Side lying clam, side lying lateral leg raises, circles and kicks foward and pack whilst maintaining pelvic stability.

Combine this with exercises for strengthening your main hip extensor ie gluteus maximus and you'll ensure your 'bootie' really is your powerhouse and you won't get other muscles trying to compensate as hamstrings and calves often pick up the slack where glux max isn't firing first or strongest.

Exercises: Squats, lunges, and single-legged variations all work. Shoulder bridges lying on your back and squeezing the gluts to hold the pelvis up, and progressing to include single alternate leg lifts.

Now if we add to that core strength to ensure we maintain form throughout our running particularly when we begin to tire andthe body starts to fold at the pelvis which has repercussions up the body aswell and down the body, you will find that you maintain better alignment generally but particularly knee tracking which will help you to run further, and without injury.

Exercises: Planks, Side planks, Abdominal crunches and with a twist and / or leg lengthening away, superman.

In fact all of the above exercises are pilates exercises of a sort; pilates being about core strength and endurance, posture and alignment. A good class will take you through a range of exercises that work the whole body and will include variations of all of the above plus a load more, with the addition of stretching for flexibility, mobility

and correct breathing and cues on how to engage your core effectively.