About 3 weeks ago I strained my groin doing speedwork for a 5K. I normally run 35 miles per week at moderate speed. With my Dr's o.k. to ease back into running, I have only been running about 10 miles per week at moderate speed, but experiencing some discomfort after the run. With the 5K now a week away what do you think is my best strategy for this week, moderate running or rest? Per my Dr. speed work is out of the question - but I hope to be healthy enough for a PR in this 5K.
Reply - Janet
If you're only 3-weeks post injury - it's pretty clear that your tissue is not fully healed.  Physiologically it would be pretty unlikely for the tissue to have fully healed at this point. This is backed up by the fact that even running a third of your usual mileage you're still having some symptoms.  How crucial is this 5K? Are you doing this for a paycheck? Achieving a PR in a race 4-weeks after a groin strain is pretty unlikely and you run a pretty high risk of injury in trying.  The faster you run the more force being generated by the muscles... and this could well re-injure the muscle you have that's only partially healed.  I think your best bet is to bag the 5K, get healthy and schedule yourself some serious training time to deal with the reason you got injured in the first place.  If you are dead set on doing this 5K, your strategy for the week is to do only easy pace stuff.  If your doc said "speed work is out of the question" - what makes you think that a race is a good idea?  Just keep in mind -running and racing can be a lifelong thing if you treat your body right. Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I started running this spring and had some slight shin pain at times but no big deal. I did just about everything wrong. Too much, too soon, too fast, junk shoes, you name it. The pain got worse so I took 2 weeks off and got fitted for shoes. I came back running way too much and the shin splints came back with a vengeance so I ended up taking another 2 months off. During a routine visit, I mentioned it to my doc and he seemed to think it was just "shin splints" which is consistent with my symptoms. I did a little walking and eased back into the C25K plan but now at week 4 the pain is coming back. Not as bad this time but I decided to take a break so I don't make things worse. Can shin splints or MTSS take this long to heal. It was probably due to training error but I'm just wondering if something else is causing this. I'm 6' tall approx. 180lbs, high arch and according to the running shoe store an "efficient runner" which I assume means normal pronation. I've been using a neutral cushion shoe. I'm 33. In my late teens early 20's I used to run a couple miles every other day with no problems at all and never paid attention to shoes or training plans or anything. I am 10 years older now and about 15 lbs. heavier. At this point I'm still assuming it's from me running like an idiot this summer but I can't imagine it taking over 3 months to get better. Thanks for any advice.
Reply - Janet
Unfortunately yes, it can take many months to get better if the tissue was really damaged by the continued training.  However, it could just be that you've not addressed the underlying factors yet.  You mention you got new shoes - that's a good first step.  You also mention following a more conservative couch to 5K program - also a good step.  You don't mention anything about doing flexibility or strength work though so perhaps that's a missing link?  MTSS is sometimes brought on with tightness in the calves and hamstring muscle groups.  It's easy to see why we get tight when you realize that most of us have seated jobs... which place little stretch on those tissues, and then we go out and run - which makes them stronger (and tighter).  Stretching calves and hamstrings and hip flexors several times a day (gently!) might be something to add to your routine.  Another issue is hip strength.  Again, our mostly sedentary lifestyles don't contribute much challenge for our hips so most of us lose hip strength over time.  It's subtle... but it happens.  The lateral hips in particular seem to contribute to lower extremity injuries if they're weak.  Doing exercises that work your lateral hips like lateral planks or perhaps some theraband resisted single-leg balance exercises would help.  I'd be happy to help with specifics but I'd need to know a lot more about you.  If you're interested in detailed guidance - click on the services page and then click the link at the top to bring up the Coaching Questionnaire. Copy and paste that into an e-mail or into a word document and fill it in and send it to me.  We can get started as soon as you're ready!  My e-mail is "janet at runningstrong dot com"
Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi Janet, Just wondering what your thoughts are on "shin splints" or medial tibial stress syndrome. I started running over a year ago, but have spent most of my time injured! 4 months in, after my first half marathon, I ended up with a fractured inferior pubic ramus. Diagnosis was delayed and it took a good while to be pain free running-around 5 months. Went back slowly-ish ...but was probably doing a few too many step-ups and step-jogs in the gym at the same time...and ended up with a second metatarsal stress reaction. More time off. Saw a podiatrist (under-pronating) and was given a very slow return to running plan which worked well intially. Also changed my shoes after that visit (from Nike to Brooks) to see if that would make a difference. Now I seem to have developed shin splints! They're not bad...most I get is discomfort at the beginning of the run and tenderness along the posteromedial tibia (R>L). I've taken a few days off and there's no discomfort at all now and both sides are completely non-tender. Just a kind of crepitus-like feeling if you run your finger over the anterior tibia. It will most likely come back again once I try a jog tonight though. Have been paying extra attention to stretching my calves (they're tight) and have started some anterior strengthening exercises like toe-taps and heel walking in the hope that it will help. Going to try my run in a different pair of shoes tonight to see if that helps-the Brooks seemed firmer than my previous shoes. Are any of these strategies likely to be worthwhile? I don't want stress syndrome to become more stress fractures which is why I've rested this week. Hope there's a better solution though. Thank you!
Reply - Janet
Hi Grainne, you're wise to look to other solutions for your medial tibial stress syndrome and you're wise to be conservative about your return to running in light of the fact that you have already had two stress fractures.  There's a common biomechanical thread running through your injury pattern and it makes me think that perhaps one major missing link may be your strength.  You mention adjusting shoes, and doing some stretching... but you don't say anything about doing strength work for your lateral hips and lower back.  These muscles are crucial to hip stability when you run and if they're not doing their job... then other areas have to pick up the slack. Medial tibial stress syndrome is often associated with tight calves, weak hips, excessive or poorly timed pronation and also training errors.  You've had a history of some training errors so hopefully you'll not repeat those but it's important to realize that these injuries you have had are not unrelated to each other.  I'll be happy to help guide you through this and get you back to running injury-free.  If you're interested, drop me an e-mail at "janet at runningstrong dot com".  The toe tap exercise won't hurt you but it won't deal with the underlying causes for your injuries.  let me know if I can help!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I've seen lots of somewhat confusing advice about strength training for runners and particularly how strong the quads and hamstrings should be in comparison to each other. I've read that overly weak hamstrings often lead to ACL injuries. I've also read that the quads should be somewhat stronger than the hamstrings (by e.g. 33%) In my case, I'm now doing leg extensions for my quads, one leg at a time, at 90 pounds, and hamstring curls, one leg at a time at 60 pounds. Is this a good balance, or should I try to strengthen one or the other to create a different balance to help prevent injury?
Reply - Janet
I concur... there's lots of confusing advice out there.  Partly this stems from the way in which the muscle strength was measured for research purposes... namely via an isokinetic machine called a Cybex. This machine matches the force you produce and can actually provide you with a really neat graphical printout of your "strength curve" across your entire range of motion. This is really fun stuff to look at but not particularly meaningful in the "real" functional world of activity!  Your muscles don't function in isolation so there's really not a big reason to emphasize training them in isolation.  In addition, your quads and hamstrings don't contract in a similar fashion when you run as you do when you sit on your butt and kick your leg out against a resistance - the neuromotor patterns are not the same. With that in mind the question shouldn't be "should I do more leg extensions or leg curls to affect my non-functional strength balance?" but rather "should I be doing these exercises at all?"  In my opinion, your time to strength train would be better spent doing functional exercises that have a stronger likelihood of carryover to running.  This would include things like squats, lunges, step up and step down exercises, balance and reach exercises, and hill running (the most functional of them all!).  If you're not accustomed to these more functional exercises, start gradually - they're very different in their demands than the more isolated body-building machines at the gym.  By training your muscles to work in groups, in a coordinated fashion, controlling your body weight and balancing you against the forces of gravity... you'll have a much better carryover of strength to the activity you're trainig for (which is moving in a coordinated fashion, controlling your body weight and overcoming the forces of gravity... i.e. running!)  The other up-side to this is that you don't need any expensive equipment or a gym membership to accomplish most functional body-weight exercises.  There is an introductory article on how to get started with these posted on the publications page of this website, and there are several examples highlighted in the book "Running Strong & Injury-Free".  It might be worth your time to read those before you launch into a new mode of training.
In response to your original question about quad vs hamstring strength -- yes the research shows that the quads should be stronger than the hamstrings on those Cybex machines and the numbers I recall are about what you presented.  As for weak hamstrings causing ACL injuries... I'd be just as concerned about a weak quad contributing to an ACL injury since they usually happen when the knee is in a position of flexion, abduction and internal rotation (which can be controlled by the quads).   Hope this answers your question - Janet Hamilton, MA, RCEP, CSCS

I'm 49 years old. I've been running since I was 13 (off and on) but pretty regularly since 1990. I was recently diagnosed with SI joint arthritis and told absolutely not to run on it by my orthopedic dr. I do not have arthritis anywhere else (hips, back, knees, etc.) I've been to several manual therapists that specialize in manual techniques, but they weren't able to help me (I presume because I have the arthritis, and not just hypermobile or hypomobile SI joints). I really miss running - do you know anyone that has SI joint arthritis and has continued to run? If so, how have they managed to do it? I've read stories about people with back arthritis who continue to run once biomechanically corrected. Do you have any suggestions for me? I'm almost out of hope :( Running is my life.
Reply- Janet
With a diagnosis of arthritis, there's an unanswered question of "why in that joint alone?"  The therapists that attempted manual therapy techniques - did they also teach you some strength training and stretching techniques to deal with any underlying muscle imbalances?  Did they deal with any leg length issues or biomechanical issues in your lower legs? If you have a leg length discrepancy or perhaps pronate more on one side than the other - that can place additional load on the SI joint and keep things flared up.  If you're able to walk without pain, perhaps that would be a good place to start.  I know runners don't like to walk, but sometimes it's a good way to keep the rhythmic and biomechanically similar motions going on, without the additional impact and stress of running.  Perhaps you could talk to your therapist or orthopedist about doing some cross training in the pool? That sort of depends on whether your SI joint is hypo mobile or hyper mobile.  Obviously your long term health has to be your first concern. That means keeping your body flexible and strong, supporting your feet with the right shoes, and making sure you maintain as much activity as you are able to without causing symptoms.  Yours is a very challenging diagnosis - deal with as many aspects as you can and perhaps things will settle down.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor