Updated: Jul 20
Every runner wants to be bullet-proof and injury-resistant.
But you MIGHT be flirting with danger if you're ramping up the miles.
Because you know what *could* be lurking over the other side of that high-mileage hill…
Old nagging aches and pains.
But these DON'T have to be inevitable, even with HIGH MILEAGE.
Let me give you the unsexy answer RIGHT NOW: Do Your Prehab.
the fancy massage guns
and squeeze cold compression leg tubes (Normatecs)
...are definitely cooler, sleeker, sexier looking because that's what "recovery is supposed to look like!"
I'm going to break the ice right now; not even going to make you scan the blog post or fast forward through videos: those are JUST TOOLS.
Helpful recovery tools, but only tools.
No amount of frigid water or vibrating tools are going to save you from injury.
Only YOU CAN.
And you do that…with prehab.
Let's dive in.
WHEN IS AN EXERCISE "rehabilitatative" VS. "preventative/prehab"?
If you're in the REHAB stage or have ever been, then you know the exercises looked…different.
Purpose of the REHAB STAGE:
You're typical unable to run because you're limited by pain and tissue tolerance
This means a recent injury or a chronic injury requires re-modeling
(aka the tissues haven't healed correctly often at a cellular level, spanning from collagen matrix to muscle fiber)
Tools you might have used to help this healing process:
blading/scraping with a metal tool
BFR (blood flow restriction) which targets muscle fiber
"stimulates muscle protein synthesis, altered gene regulation of muscle satellite cells, and increased muscle fiber recruitment, ultimately resulting in improved strength and endurance"
Exercises typically look "easier" and you use a bunch of therabands, looped resistance bands, lying on a mat doing exercises that are probably boring
EXAMPLE of REHAB Exercise: double leg glute bridge or a SL (singe leg) bridge (<-- watch how this exercise changes down our lists!)
You're NOT meant to stay in the rehab stage forever!
If you've ever gone the full course of physical therapy, then you know the exercises get harder.
Congrats, you've entered the...
Purpose of the Preventative STAGE:
Keep the improved mobility and strength you've worked so hard on!
Maintain the neuromuscular gains/improvements you *might not* have known you made
Stay and injury! pain free
Did you know: your preventative stage IS your PREHAB.
But it's ONLY the beginning.
Here's how you know you're exercises meet the bare minimum requirements of the PREHAB STAGE:
These exercises are often the last exercises a runner was doing in the clinic, typically considered more difficult, but can still feel a little generic
Can still include resistance bands, now maybe some free weights, more load
Can still include home mobility/recovery tools (theragun, hyperice-normatec, red light etc)
EXAMPLE OF PREVENTATIVE/PREHAB exercise: SL glute bridge with the front foot elevated on a step, box, etc
If you're noticing that preventative stage the prehab stage are a little fluid…you'd be right.
But let me spill some tea…
Banded exercises are probably NOT enough for long term PREHAB (aka you're regular strength training).
Here me out.
You went to PT to get rid of pain and get back to running.
You started with easier exercises that maybe weren't "so easy" because pain sucks and it limits what you can do.
You progressed to harder exercises… at the time.
But after a couple weeks, you noticed something majorly important.
They got EASIER!
You rose the challenge of hard exercises.
And conquered it.
If you were to only do those exercises forever and ever with the same resistance, reps, everything…
they would only get EASIER, not harder.
This is the major mile marker that most runners miss.
Your PREHAB MUST BECOME RUNNING PERFORMANCE.
You NEED to level up.
You need to push those prehab exercises into the uncomfortable zone…again.
Because that's how you got stronger in the first place.
Here's my soap box boiled down to 5 words…
TRUE PREHAB is RUNNING PERFORMANCE.
But what the heck does that even more or look like?
Purpose of Running Performance:
to INCREASE and improve your strength, power, and neuromotor control in dynamic and explosive/reactive ways to improve your athleticism.
For runners this (usually) means doing hard exercises so you can run faster.
What Running Performance "prehab" looks like:
Very sports performance-y; "looks cool" because the exercises begin to emulate your sport (running) more
Starting to get serious and use some serious weights like dumbbells, kettlebells, barbells, squat rack, battle ropes, sleds (aka "cool gym toys")
Exercises can be based off of your preventatives ones!
The KEY: they're typically HARDER, heavy, and you're definitely working!!
EXAMPLE of PREHAB RUNNING PERFORMANCE exercise:
SL bridge with one arm chest press
OR SL bridge with weighted hip thrust
OR slide bridge with front foot elevated on the edge of a step and you power up/move FAST into that hip extension/top of the bridge for speed
Through all of these different stages, can you see how we took the humble glute bridge/butt lift/Beyonce exericse and progressed it, gradually turning it into something more performance based?
You're current prehab exercises aren't necessarily "wrong", but they could be progressed and made better so YOU can achieve you're ultimate goal of running better, stronger, faster, without injury.
SORRY, NOT CONVINCED. HOW ARE MY CURRENT EXERCISES NOT GOOD ENOUGH?
You love your ride-or-die strength circuit because it's worked for you for years.
(that's ok! Don't fix what ain't broke.)
TRUE TALK: But if you're ever looking to level up your running, you're strength training/running performance/prehab (more of the fluid thinking) MUST level up, too.
Let's say you want to improve running economy (how efficient you are running from an energy perspective).
You and your strength/prehab circuit needs to do 3 things:
Maximal Strength Development
Defined: make muscles stronger/bigger
Exercises: Barbell (BB) deadlift, RDL, Bulgarian split squat, pushing a sled
Explosive Strength Development
Defined: Quick, fast, powerful movements
Exercises: high effort box jumps, BB clean, OH push press
Reactive Strength Development
Defined: Jumping, plyometric exercises that improve speed, make you a faster runner
Exercises: explosive SL step up, hurdle hops, pogo jumps
Does your circuit pass this test? (be honest with yourself)
Does it work those 3 categories? (it be missing one ;) )
If your strength circuits do NOT incorporate all 3 of these, you'll still improve your running economy, but wouldn't you like to take all the possible "short cuts" to make that happen as fast as possible?
(note: the exercises listed above are just examples; I couldn't possibly list EVERY exercise.)
BUT I LIKE MY EXERCISES. JUST TELL ME HOW MANY REPS/SETS I SHOULD DO.
If you're determined to just give your current strength workout a face lift with a reps and sets change-up...
that's an excellent place to start.
Just remember, there's a lot "it depends".
typically low load, moderate number of reps 10-30
exercises performed every day (maybe multiple times day)
GOAL: make pain stop; gently make the tissue more tolerant to doing hard things, get the entire muscle team on the same page again
PREVENTATIVE/BEGINNING of PREHAB loads/frequencies:
Load can vary from body weight, resistance bands, to using light-medium free weights like dumbbells
2-3x a week (maybe 1x a week depending on where you're at in a training cycle)
Typically interpreted as strength-endurance: 40% 1RM, reps of 20-30, none to very minimal plyometrics
RUNNING PERFORMANCE PREHAB frequencies:
Consistently using weights, doing hard things (generally steering away from only body weight exercises-there are exceptions! Push ups, lunges, pistol squats)
2-3x a week (obviously 1x a week during taper)
"the most common prescription of intensity or training load for concurrent resistance training exercises with the goal of max strength development ranged between 2 and 6 sets of 3-10 reps per exercise at loads greater than 70% 1RM."
ranging from 70%-85% 1RM, sets could look like 5x5, 3 sets of 5-6 reps, etc
Very simplified version: find a heavy weight that limits you're ability to do only 5 reps at a time.
"Why did my PT tell me to do this rehabilitative exercise multiple times a day every day compared to when I strength train I only do it like 2x a week?"
Would you say you've trained adequately for your marathon if you've only run 2x a week?
I want you to think of LIFE, everything you do in a DAY.
How many times you get up from a chair or out of a car
pick up/lift a kid or a pet
wrangling a kid into a car seat or a running stroller
unload the dishwasher
reload the clothes dryer
mow the lawn,
wash the car
ALL THAT could be IN ONE SATURDAY!
THIS IS A MARATHON OF LIFE.
Don't get sucked into the trap of expecting your pain to go away, cranky tissue to heal, and to never get injured again with ONLY 3 sets of 10….2x a week.
Do you see the discrepancy?
The reason PTs suggest you do rehab exercises multiple times a day can be:
to keep you pain free during this marathon of life
help the injured tissue heal faster so you don't have pain so you can get back to running, etc
to create a neuromotor change and for this change to stick, it often requires MULTIPLE repetitions (it would be like teaching you quantum physics one time and expecting you to remember everything. Our brains often need repetition and so do our bodies)
Eventually, AFTER FORMAL PT, you CAN drop down to 2x a week because you're body has demonstrated at that point the ability to hold onto whatever strength/correction we were looking for/you're not in pain
Never forget: your body is strong.
You're not fragile.
And it's ok for certain muscle groups to need a little "recalibration" once in a while.
You're body has gone through a lot and it's still enduring a lot.
And prehab is how you keep it going.
Don't forget: prehab can take a LOT of different forms!
Especially if you've struggled with tight or achey hips.
You might fine that hip flexor stretches work great for your running friend, but they're straight dumpster fire garbage for you.
They just don't work.
You might need a hip program geared more towards:
Restoring hip JOINT mobility
To create space to activate your glutes
Which then can be strengthening to their fullest potential
ALL…in order to finally unlock tight hips and cranky, achey hip flexors.
It all flows together.
By the way, if this is you, you're going to want to check out my workshop STRONGER GLUTES.
(It's this road map to a tea and you'll never have to worry about tight hip flexors or wonder if you're glutes are turned on ever again)
Until next time running fit fam…
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
P.S. Looking for somewhere to start with prehab/strength exercises? Grab my FREE strength guide for runners HERE!
Barrie, B. (2020). Concurrent resistance training enhances performance in competitive distance runners: A review and programming implementation. Strength & Conditioning Journal, 42(1), 97-106.