DEAR MAYO CLINIC: I am 42 and training for my first marathon. During my longer runs I have pretty significant hip and knee pain. Some runner friends advise that I just stretch more, and others say I need to do exercises to strengthen my ITB. What can I do to alleviate the pain? Is it safe to run with these issues, or am I doing lasting damage by continuing to train?
ANSWER: It may be okay to keep running. But to avoid injury, it’s important that you address the problems you’re having on your long runs. It’s likely that stretching and strengthening will help to relieve the pain. It would also be valuable to have your footwear and running cadence assessed to see if they could be contributing to your discomfort.
Proper stretching is an important part of any exercise program. It can increase flexibility, improve your joints’ range of motion and reduce the risk of injury. For runners, stretching the quadriceps, hamstrings and iliotibial (ITB) is particularly important to help avoid the type of hip and knee pain you’re experiencing.
Your quadriceps muscle runs along the front of your thigh. The hamstring muscle is on the back of your thigh. Your ITB is a band of tissue that runs along the outside of your hip, thigh and knee. To learn specific techniques that effectively stretch each of these muscles, talk with a physical therapist. Suggestions for basic stretches are available from Mayo Clinic’s website at www.mayoclinic.org.
Don’t stretch a cold muscle. Instead, before you stretch, warm up with at least five to 10 minutes of light activity, or wait to stretch until after you’ve completed your workout. Hold your stretches steady, without bouncing. You shouldn’t feel pain as you stretch — only light pulling. Hold each stretch for about 30 seconds.
Along with stretching, you may also be able to help ease the pain you’re feeling by working to strengthen your hip abductor and extensor muscles — the gluteus medius and the gluteus maximus. Increased strength in these muscles can help provide an extra measure of stability and support to your body when you are running. Again, working with a physical therapist you can learn strengthening techniques that target these muscle groups.
The way you run and what you put on your feet while you’re running can make a big difference when it comes to avoiding injury and staying comfortable throughout a run, especially when you’re going a long distance. When choosing a running shoe, comfort is the most important consideration. Correct fit and support also are key. Replace your running shoes when they lose their ability to provide proper support and become uncomfortable.
Running cadence is how often your feet touch the ground when you run. The right cadence varies somewhat for each runner. If your cadence is too fast or too slow, you may be increasing your risk for injury or pain when you run.
A sports medicine specialist can evaluate your cadence, as well as your overall running form. He or she may be able to help pinpoint other areas of concern that could be contributing to your hip and knee pain, too. Such a specialist also will be able to provide you with the right rehabilitation program to decrease your risk of injury, as well as increase your performance. — Jeffrey Strauss, D.P.T, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.