Runner's Guide to Healthy Running

Runners Guide to Healthy Running

By Dr. Sarah R. Hnath PT

Running is great for getting in shape and relieving stress, and with this gorgeous weather and fall races coming up, it’s a great time to get outside and start racking up the miles. But the last thing you want with is to be sidelined by an injury. So what’s the best way to run without limitation and decrease the risk of injury? It’s a combination of training correctly, balancing strength and mobility, getting proper nutrition and allowing for adequate recovery.

Concentrate on Proper Technique

Traditionally, training for runners consists of increasing training time and distance for optimal performance, but no

attention is paid to mechanics, Faulty body mechanics can result from lack of knowledge of proper skill &

technique, muscle weakness, imbalance, and/or tightness.

For starters, positioning is key. Important things to think about when running is to start with & maintain perfect

posture with an upright head, relaxed arms and no bending at the hips. Starting and maintaining this position

while running is vital to running with correct technique, once positioning goes, so does ones running performance. 

Once you start running with the right position the next step that follows is a “fall” or “forward lean” in the correct

position. One common error runners make is bending at the waist instead of maintaining good posture, this can

lead to over use of the hips and knees and lead to injury. One tip to remember to avoid this faulty pattern is to

lead with your hips instead of your head and upper body. 

The final piece of technique for optimal running is your leg pull. As you maintain good posture and fall forward you will need to lift the foot off the ground to move forward (and not fall on your face!), your leg should look like a figure 4. It’s important to make the hamstrings, the muscles in the back of your thighs, do the work here. With this piece of running technique you should notice that after you pull your leg and your foot hits the ground, the forefoot will strike first. When the heel strikes first, increased force goes through knee, which is a prevalent problem area for many runners, especially women. Conversely, evidence shows that when you land with your forefoot first, there is less lower leg pain and pressure when using this technique. 

This can be a lot of information to digest and difficult to change, especially for those runners that have been using improper technique for years. A good place to start is to have a physical therapist, coach or even a friend video tape you while running and look to see where you are now and identify any major problem areas. Some questions you may want to ask yourself are: Is my posture good? Is my head upright? What is going on at my arms? Am I bending at the waist? What are my legs doing? Can I see a figure 4? Where does my foot land? 

Embrace Strength and High Intensity Interval Training

One aspect of training many runners, weekend warriors and seasoned marathoners alike, tend to avoid is

strength and high intensity interval training (HIIT). Strength training & HIIT is one of the most important things a runner can do. As previously discussed, proper technique is vital for efficient running and injury prevention. In order to maintain good posture, attain a forward lean and pull with your hamstrings one requires strength in all major muscle groups.

Current research shows that less is more. The best running performance comes after short duration, high intensity strength training as opposed to increasing time and distance. In one recent study, short-term plyometric or explosive strength training improved the energy expenditure (running economy) of moderate and long-distance

runners without sacrificing performance. Not only does short duration, HIIT improve strength to

help attain proper technique, it increases the amount of power one has to propel themselves forward. Additionally, it's much easier to maintain optimal positioning for a shorter period of time than a long duration, meaning improved performance and less chance for injury. 

So how do I implement this kind of workout into my schedule? For starters, this approach will open up your

schedule tremendously! Instead of spending hour upon hour trekking along on a treadmill or at the track working

at 60% of your max effort, you can take 15 minutes to perform a high intensity circuit of exercises such as sprints,

squats and lunges at 100% effort and really get more bang for your buck! The important thing to remember is use

good technique with ALL exercises you do in order to get the most out of it and prevent injury. Other important tips for runners is to put variety in your routine from 20 meter sprints to 800 meter runs, give your body adequate rest time whether it’s taking a day off or working rest into your routine (example: sprint 30 seconds, rest 30 seconds 15 times), and push yourself to your max effort to improve and see positive change! 

Work on the Core

So we’ve discussed the importance of technique and strengthening muscles such as your hamstrings, but did you

know a strong core is important too? Studies have shown that distance runners improve their efficiency and time

to exhaustion with a mix of strength training and core-specific training. 

Core and total body strengthening is especially important for female runners. Women undergo changes during

and after pregnancy, menopause, and throughout the lifespan that can lead to issues such as low back, pelvic &

knee pain, urinary leakage and more due to muscle weakness. 

Core stability is one of the main areas I focus on with all my clients. My biggest piece of advice for women and men alike when it comes to core strengthening is to make sure to include all aspects of the core: pelvic floor, transverse abdominus (deep abs), multifidi (small muscles between your spinal segments), and believe it or not, your diaphragm. Some good activities to include are Kegels, planks, and work on breathing with your diaphragm. Check out my article on the core and how to use it for more details!

Warm up with Dynamic Stretching

One of the most common questions I hear from runners is how to stretch before running to improve

performance and avoid injuries. The short answer is, don't. 

Many runners were taught to do stretches while staying stationary, but new evidence indicates caution. This sort of “static stretching” should generally be avoided prior to a run unless combined with a proper warm-up because it can actually have a negative effect on maximal muscle strength and performance. 

The best way to get ready for a run is a good warm-up and a bout of dynamic stretching, according to the latest research. In addition to performing a proper warm-up and dynamic stretching before running, once you’re done, myofascial release (MFR), a manual technique, should be implemented into your program. MFR helps improve mobility of muscles and connective tissue around the muscles, bones and joints called fascia. MFR has been shown to decrease fatigue and soreness and significantly improve pain better than just stretching for common conditions in runners such as plantar fasciitis and runners knee. Having good mobility is also important for maintaining good posture and technique with running and other physical activities. 

A great way for runners to apply these mobility tools is to set aside time before and after runs and workouts

to warm up with a light jog, jumping jacks, jump rope, or anything else that will get your blood pumping, perform

some dynamic stretches such as high knees or butt kicks, and use tools like foam rollers & lacrosse balls to

perform self MFR on common problem areas like the IT band, hip flexors, glutes, calves and plantar fascia (sole

of the foot). 

For more specific mobility for better performance you can schedule an appointment with me in which I will perform manual techniques including myofascial release, active trigger point release, joint mobilization/manipulation and more! My goal is to advance my clients' wellness and take a proactive approach to overall health & well-being. I am dedicated to helping you get the most out of wonderful physical activities such as running and feeling good while doing them.

Proper technique is not something that can be changed overnight, it requires learning the proper skills, drills and

running body mechanics from an expert and gradually implementing them into your running program in order to

prevent injury and get the best results. I’ll assess your current running form, hone in on areas that need

improvement and teach you drills, skills and more to correct those problem areas.

1. M. Wunderlee. (2014). Direct Communication. CrossFit Endurance Seminar. Bellmore, NY. 
2. D.L. Goss and M.T. Gross. (2013). A Comparison of Negative Joint Work and Vertical Ground Reaction Force Loading Rates in Chi Runners and Rearfoot-Striking Runners. Journal of Sports and Orthopedic Physical Therapy; 43(10);685-692.
3. A.R. Diebal, R. Gregory, C. Alitz, P. Gerber. (2012). Forefoot Running Improves Pain and Disability Associated with Chronic Exertional Compartment Syndrome. The American Journal of Sports Medicine; 40(5);1060-1067. 
4. P.U. Saunders, R.D. Telford, D.B. Pyne, et al. (2006). Short-Term Plyometric Training Improves Running Economy in Highly Trained Middle and Long Distance Runners. Journal of Strengthe and Conditioning Research; 20(4);947-954.
5. O. Storen, J. Helgerud, E.M. Stoa, J. Hoff. (2008). Maximal Strength Training Improves Running Economy in Distance Runners. Medicine & Science in Sports & Exercise; (40)6;1089-1094.
6. K. Sato & M. Mokha. (2009).  Does Core Strength Training Influence Running Kinetics, Lower-Extremity Stability, and 5000-M Performance in Runners? Journal of Strength and Conditioning Research; 23(1);133-140. 
7. L. Simic, N. Sarabon, G. Markovic. (2012). Does pre-exercise static stretching inhibit maximal muscular performance? A meta-analytical review. Scand J Med Sci Sports. doi: 10.1111/j.1600-0838.2012.01444.x
8. T.J. Herda, J.T. Cramer, E.D. Ryan, et al. (2008). Acute Effects of Static Versus Dynamic Stretching on Isometric Peak Torque, Electromyography, and Mechanomyography of the Biceps Femoris Muscle. Journal of Strength and Conditioning Research;22(3);809-817.
9. K.C. Healey, D.L. Hatfield, P. Blanpied, et al. (2013). The Effects of Myofascial Release with Foam Rolling on Performance. Journal of Strength and Conditioning Research;28(1);61-68.
10. R. Renan-Ordine, F. Alburquerque-Sendin, D.P. Rodriques De Souza, et al. (2011). Effectiveness of Myofascial Trigger Point Manual Therapy Combined with a Self-Stretching Protocol for the Management of Plantar Heel Pain: A Randomized Controlled Trial. J Orthop Sports Phys Ther;41(2)43-50. 

Urinary Incontinence: A Laughing Matter — Or Maybe Not

Urinary Incontinence: A Laughing Matter — Or Maybe Not

By Dr. Sarah R. Hnath 

According to the United States National Institute of Health (NIH) there are over 13 million cases of incontinence in the U.S. alone! This is a huge problem & means it’s time for a little potty talk!

Do You Ever…

• …worry about laughing too hard in the fear of leaking a little pee? 
• …skip your workouts because you’re sick of peeing your pants? 
• …fear getting on a trampoline with your kids because it’s too much for your bladder to handle? 
• …lose sleep because you wake up during the night needing to pee?
• …create a detailed map of every bathroom and an exit strategy in place every time you leave the house? 
• …get yelled at by your family for stopping the car every 30 minutes to go to the bathroom?

If you said ‘yes’ to any of these questions, then you my friend may being dealing with a very common problem called urinary incontinence. 

But It’s Normal, Right?

Often times women make comments such as, “oh I had kids, it’s normal to leak a little pee when I sneeze” or “I make sure I go to the bathroom every I time I leave the house so I don’t have to worry”. If any of these scenarios describe you or someone you know, I’m sorry to break it to you but this is NOT normal and can be a sign of urinary incontinence. It’s NORMAL to pee once every 2-4 hours, it’s NOT normal to pee 15 times a day. It’s NORMAL to be able to do the activities you love worry-free, it’s NOT normal to avoid running, jumping, Zumba and fun girls nights out because you’re worried if you move too much or laugh too hard you might pee your pants. 

How and Why Does This Happen?

If this is hitting close to home you may be asking yourself, “why is this happening to me?”. This is not a freak accident, and you are certainly not alone. Urinary incontinence is a muscle issue that afflicts as many as 1 out of 3 women! The bladder (and the rest of your pelvic organs) are held up by a group of muscles called, the pelvic floor. When these muscles don’t work properly it’s called pelvic floor dysfunction and can lead to a slew of problems, a major one being urinary leakage. 

Incontinence and pelvic floor dysfunction can result from a number of reasons. The most common reason is pelvic floor muscle weakness which can be caused by pregnancy & childbirth, surgery & other medical problems, poor posture & bad habits, changes due to menopause, and a lack of exercise. Another very common reason for women who develop incontinence is a lack of muscle coordination and improper breathing. In this incidence a woman (or even a man — yes, men have a pelvic floor too!) may actually have a strong pelvic floor, however, does not coordinate her (or his) muscles & breathing properly with activities such as exercise and heavy lifting. This lack of coordination can lead to an increase in the amount of pressure and force inside the abdomen (intraabdominal pressure) and put so much force on the pelvic floor that one can still end up leaking urine. One more cause of incontinence can be actual damage to the pelvic floor. The pelvic floor can go through events such as childbirth, surgery or cancer & radiation. These traumatic events can cause physical damage such as scarring or tearing to the muscles, nerves and surrounding tissue.

Good News…There IS a Solution!

There is good news ladies (and gentlemen)! These incontinence problems caused by pelvic floor dysfunction can be helped with the right women’s health/pelvic floor physical therapist and the willingness to work hard to overcome this leaky issue! 

A physical therapist trained in pelvic floor dysfunction can do an external and/or internal assessment of your pelvic floor strength and integrity as well as a total body assessment of strength, mobility and function in order to find out exactly what is contributing to your pelvic floor dysfunction and come up with a plan to help you overcome it! These women’s health specialists can then teach you how to get your pelvic floor stronger, how to properly perform what many know as “Kegels” (which believe it or not, most people do this exercise wrong), how to coordinate your pelvic floor with other muscles, use highly effective training tools such as biofeedback, instruct you in the best breathing techniques to decrease intraabdominal pressure, how to improve your posture & kick bad habits, and they can also implement skilled hands on techniques to improve mobility of your pelvic floor and surrounding muscles & joints.

To Pee, Or Not To Pee…

So what now? If you are dealing with any of the issues we discussed it’s time to take control of your floor! One great place to start is filling out a bladder diary. This tool will help you take a deeper look at your voiding habits including how frequently you’re going, whether you are going at night, determine any leakage, and see how much and what kinds of fluids you are getting in your body. The next step is to find a physical therapist that specializes in pelvic floor and women’s health, a personal trainer for your pelvic floor if you will! If you are in the greater New York City area you can contact me (Dr. Hnath) and I’d be happy to help you get back to living your life. If you unfortunately aren’t in the area, you can look up a women’s health specialist online on the American Physical Therapy  Associate Section on Women’s Health website. 

Don’t wait, address this issue sooner than later and kick incontinence to the curb!

“Getting Down to the Core of Things”

“Getting Down to the Core of Things”

By Dr. Sarah R. Hnath PT

In lieu of my blog title, “Common Core”, I decided my first blog post should be about the ACTUAL core, a part of the body that many people refer to but few actually understand. 

The common core question

Time and time again I meet patients, clients, fellow gym junkies, and even many trainers and fitness professionals who ask, “what is the best way to strengthen my core?”. 

My first response is of course, a pop quiz. I typically ask, “what do you think your core muscles are?” The responses I get may vary a little but they tend to be the same, “your abs?”, some may even go as far as including the low back as well. Close…but no cigar. 

So, what makes up “the core”? 

The core is actually a group of 4 muscles, that believe it or not, does NOT include “the abs”, or at least the typical “6 pack abs” that most people refer to. The muscles that comprise the core are:

• The Diaphragm
• The Transverse Abdominus 
• The Multifidi 
• The Pelvic Floor Muscles

I refer to these 4 muscles as “the building blocks” of all movement. Without proper use of ALL core muscles and good strength & coordination with activity, people are setting themselves up for injuries and conditions such  as low back pain and incontinence as well as missing the key component to better movement and performance.        

How do I know I’m using the right muscles? 

Learning how to use these muscles means starting with the basics. Like I said, they are “the building blocks”, without a good foundation all other exercise is a waste of time because you cannot…I repeat…you CANNOT do any movement properly without having good core strength and coordination. Without good core stability and awareness you are (a) setting yourself up for injury, (b) not getting an optimal muscle contraction with other activities, and (c) missing out on your best performance potential. Starting with the basics may be slow and feel too easy, especially for my fellow CrossFitters and intense exercisers, but I cannot stress the importance of building a strong core and learning how to properly use and coordinate your core muscles, especially if you want to PR! 

Here is where you start: 

• Stop breathing with your chest and learn how to breathe with your diaphragm.  — Your diaphragm is actually supposed to do 80% of the work when you breathe. When this doesn’t happen you limit the amount of oxygen your lungs can inhale and subsequently make is more difficult for the rest of your muscles to get adequate oxygen. Not to mention, when you breathe with your chest your ribcage and neck muscles get over worked and are more likely to be tight and possibly cause pain. A simple way to practice how to use your diaphragm is to lie down, place 1 hand over your abdomen (just below your ribcage) and the other hand on your chest. Take a slow, deep breath into your nose and allow your abdomen to expand. You will know you’re doing this right if the hand over your abdomen rises before the hand over your chest. If this did not happen you have some work to do. Slowly, exhale through your mouth and let your abdomen deflate. Repeat. Practice doing this type of breathing regularly, using your hand placement to make sure you are using your diaphragm and not over using your chest and neck muscles. 

• Do your ‘Kegels’ and do them the right way. — The pelvic floor muscles are probably one of the most important yet severely under-recognized group of muscles. This muscle group holds your organs in place and without them we would all be wetting our pants, our organs could LITERALLY be hanging out, and we would not be able to do most activities without major issues. The pelvic floor muscles are located internally making it difficult to know whether we are engaging them and whether we are doing it properly. Because these muscles are not visible externally, the best way to exercise them is by using cues. Ones that tend to click for many of my patients and clients are, “pretend like you’re stopping the flow of urine”, or for the men, “pretend you’re walking in cold water”…yes…men have a pelvic floor too! It is also important to incorporate the diaphragm breathing along with ‘Kegels’, holding your breath actually can increase the amount of pressure and stress on your pelvic floor. Take a long deep diaphragm breath and as you exhale engage your pelvic floor and hold it for about 5 seconds. Repeat. Practice these throughout the day and incorporate the pelvic floor into every day activities like walking and exercises such as squats. 

• Wake up your deep abdominals. —  Your transverse abdominus is the deepest layer of your abdominals and it is meant to act as a brace, your internal girdle if you will, and provide support to your trunk. Many low back issues can actually be avoided and/or managed by having a strong transverse abdominus. The problem is most of us don’t use this muscle when we work on strengthening our abs and we lack the strong foundation we need for more vigorous exercise and activity. The best place to start is to first learn how to find the muscle and use it. You can feel your transverse abdominus by lying down on your back with your knees bent, place your hands on your hip bones and slide your hands down and in approximately 1 inch. Cough. That muscle that kicks you is your transverse abdominus. Next, you want to engage that muscle by gently pulling it inwards as your belly button gently pulls towards the spine. Your pelvis should not move. It is a very subtle movement. Just as you did with the pelvic floor, you want to coordinate this muscle contraction with your diaphragm breath and engage the muscle during exhalation. You can even go as far as to engage your transverse abdominus along with your pelvic floor, these muscles help each other recruit. Add this exercise to your every day routine and along with all your daily activities. 

• Keep your spine in check. — Your multifidi are muscles that attach between your spinal segments and provide stability and support to the spinal column and allows the different vertebrae to work more efficiently. A good way to stabilize the your spine using your multifidi is to go into an all 4’s position (arms straight, bent knees) and move your spine up and down until you are in a flat position, like a table top. Maintain this position like you are balancing something fragile on your back (I like to think of my favorite glass of wine) and slowly lift your right leg without letting your trunk move. Return your leg and repeat on the left side. Continue to alternate sides for 3 sets of 10. Think of using these muscles with activities from squatting and lifting to sitting and working at a computer.
How do I know I’m Using My Core Properly?


Although it seems as easy as, “just engage these 4 muscles”, it’s not. For many of us have spent most of our lifetime NOT using these muscles, compensating and developing bad habits. In order to learn how to properly use these muscles and integrate them into everyday activity it’s important to consult and seek guidance with a professional that is a human movement specialist. Especially as a pelvic floor specialist I have a thorough understanding of the core, how to use it and how to teach my clientele to incorporate this knowledge into everyday activity.