Never too fat to run
September 27, 2011 9:55 AM   Subscribe

What can I do to strengthen my knees and ankles to lesson the likelihood of a running injury?

Having hit my first two fitness goals (Don't gain back any of the weight I lost while I was pregnant and get my cholesterol & blood sugar into normal levels), I'm now training for a sprint triathlon. I have a year, and I suspect I'll need every day. But while my swimming and biking training is going really well and I'm making a lot of progress, my running training is hampered by my weight and its effect on my knees and ankles.

I weigh 235 pounds and I'm 5'2". Despite good, varied, high-intensity workouts 5 times a week and controlling my calories and carbs, the weight is not coming off very quickly, for what we're pretty sure are complicated endocrinological reasons, including low thyroid, sleep deprivation, nursing, & others. I'm doing c25k and I LOVE it, but every time I try to move from week 1 (alternating 60 seconds of running with 90 seconds of walking) to week 2 (90 seconds of running and 2 minutes of walking), my knees and ankles begin to hurt.

Are there strength training or other exercises I can do to help my knees and ankles be up to this task? I have a team of dedicated professionals working with me on my fitness, so unless you're one of them, please don't tell me that if I just do XYZ I'll lose weight and then I'll be fine. I need strategies to make it possible to run at the weight I'm at now.
posted by KathrynT to Health & Fitness (35 answers total) 38 users marked this as a favorite
Best answer: What kind of shoes are you wearing? That'd be the first place I'd start looking. (You'll probably get a bunch of conflicting advice about what kind of shoes are good for you, of course, but if you're wearing broken-down old shoes or shoes not designed with running in mind, that may be a chunk of it.)

There are also gait issues (that go with the shoes.) Midfoot striking and barefoot-style shoes solved my knee problems, and I'm not all that much lighter than you are. Worth looking into, at least.

Even then, I can't train on hard surfaces - I can run a 5k every few weeks on asphalt, but if I'm running three times a week, I need to be running on dirt. Jogging on the sidewalk hurts way worse than jogging in the street.

And part of it is just flat an issue of time. Your bones and tendons take longer to adapt to stress than your muscles do. Not pushing it too hard is always a good plan with running - I know way, way too many people who trained too aggressively and sidelined themselves with stress fractures or tendon issues.
posted by restless_nomad at 10:03 AM on September 27, 2011 [1 favorite]

Response by poster: What kind of shoes are you wearing?

Brand-new Brooks running shoes with a post to help correct my pronation issues. I used to have fancy orthotics, but they were KILLING me while running (hurting all the way up into my hips) so I took them out. They were also fitted when I was newly postpartum, so God only knows how different my joints are now. My gym sadly doesn't allow barefoot shoes, although maybe I could petition them for an exception.

I am being super careful not to push it. I keep telling myself I get way more exercise doing c25k week 1 than I do sitting on the couch icing my knee. A bad joint injury at this point would be really horrible.
posted by KathrynT at 10:08 AM on September 27, 2011

Best answer: Yeah, just anecdotally, I had pronation issues that uber-supportive running shoes and/or orthotics sort of mitigated, but barefoot shoes actually fixed. (Well, they fixed the pain - presumably I still pronate, it just no longer causes a problem.) You can get something like Nike Frees, too, that are "barefoot-style" (and worked fine for me) but look like normal shoes and don't leave your toes hanging out.
posted by restless_nomad at 10:11 AM on September 27, 2011

There are definitely exercises you can do to strengthen muscles around the knee, and reduce likelyhood of injury: Here are some knee exercises using your own body-weight. Your gym also has machines you can use - have a session with a trainer or a friend who knows what they're doing show you how to do them safely.
posted by canine epigram at 10:12 AM on September 27, 2011 [4 favorites]

I started the Couch to 5K by running on an indoor running track (made from a special surface) at a gym - it seriously revolutionised running for me. The first time I ran outdoors (at about week 5 or 6 on the program) on footpaths and asphalt, I was in a lot of pain. I have finished the program now and I am working in more outdoor runs, interspersed with runs on the running track, and that seems to be working to strengthen those muscles. Can you look into gyms in your area that might have similar tracks? Normally big university gyms, or larger YMCAs have them.

Another exercise that I found seemed to result in twinges in the same muscles are single leg step ups (I think that is what they are called, where you are on a box, doing like a one lef squat, and you keep you other leg down, trailing and not supporting weight) so I try and incorporate those into my routine (even though I hate them!) to strengthen those muscles

Good luck!
posted by unlaced at 10:13 AM on September 27, 2011 [1 favorite]

You may want to look into something like ChiRunning.

I found it useful not so much in terms of following the specific techniques exactly but more so for its focus on being mindfully aware of your form.

Running is a puzzle. It's great, gosh do I love it. Good luck with your race!
posted by dyobmit at 10:23 AM on September 27, 2011

This is probably not what you want to hear, but running may not be a possibility for you right now due to your weight. It is promoted a lot as the ultimate fitness activity, but for larger frames and overweight people it's a pretty awful choice. Extra weight puts a ton of stress on the body and its joints, and unless someone has a background in athletics most people, overweight or no, have pretty terrible running form that exacerbates the joint and pain issues.

Issues with your ankles and knees aren't due to a lack of muscle development per se so much as your body's tendons and joints have not adapted to the force you're putting on them while running. You may also have mobility issues that are wreaking further havoc. If you're set on running, I'd try these strategies:

- Make sure you're doing mobility work--Google "dynamic stretching" and "mobility exercises" for your hips and ankles
- Stretch your calves--tight calves can cause ankle issues and shin splints
- Ramp up a lot slower on C25K--maybe taking 2-4 weeks per week rather than just one
- Run on soft surfaces, grass or trail running (pavement is TERRIBLE)

Specific strengthening exercises (but recognize that they're not going to make up completely for the above):
- Tracing the alphabet with your toe
- Walking barefoot - The best method, bar none, for ankle stability is walking barefoot every chance you can get. Wearing shoes weakens the muscles of our feet and ankles, causing undue stress on the ankles, knees, and all up the lower body.
- Foot strengthening exercises
- Strengthening your VMO (vastus medialis oblique). There are a billion exercises for this online, I like one legged step-ups on a small step. VMO is only active in the last 30 degrees of leg extension so you preferably use a shorter step to focus on its contraction*

If I were you I'd hold off on the running and try biking, rowing, anything else that doesn't put as much stress on your body until you drop more weight.

*though one-legged strength work through a larger range of motion is great for a whole host of other reasons and should be incoporated into your programming)
posted by Anonymous at 10:23 AM on September 27, 2011

Response by poster: If I were you I'd hold off on the running and try biking, rowing, anything else that doesn't put as much stress on your body until you drop more weight.

There's really no guarantee that I'm going to drop the weight at all. I've learned the hard way that making plans for after I drop the weight is a sure-fire way to ensure that they don't get done. I'm trying to work with the body I have. I'm not so much focused on RUNNING! but I really want to do this triathlon, and running is a part of that.

My Y does have an indoor springy track; it's tiny but I could definitely give it a shot.
posted by KathrynT at 10:32 AM on September 27, 2011 [2 favorites]

I've got chronically shit ankles. Like, bad bad bad. It started when I was a child and viciously dislocated an ankle and tore my achilles. Now, as an overweight 31 year old who plays 5 soccer seasons a year, I was continuing to wreck them at least once a year. My problem is that I over pronate, or roll my ankle to the outside. I'm also pigeon toed, which I think exacerbates the issue. I did not go to a PT or an OT (honestly, I think I've got gait issues associated w/ minor scoliosis too), but I DID try a bunch of exercises recommended by a couple I know from soccer. Really, it was bad. Every single soccer game I was hurting.

Then an athletic trainer told me to watch youtube videos on "basket weaving" my ankle. I started to do this, and HOLY CRAP has it made all the difference. I do this and I can't roll it. I can't over extend it. I'm faster, more confident, have quicker acceleration, and I'm not afraid of quick turns and whatnot. I do both ankles, which takes me exactly 1 roll of athletic tape per game. I intend to bulk-buy on amazon/ebay for next season.

Anyway, this is NOT a day-to-day solution, however I recommend it for the day of your event. Watch several videos to make sure you understand the concept. Changed my life it did. Try it a couple times before the big day, because I GUARANTEE you'll go too loose the first time and too tight the second time. You'll find the sweet spot on your third or fourth wrap.

How to basket weave your ankle. I find this one to be the most clear, however I don't spray and cushion before I tape.
posted by TomMelee at 10:34 AM on September 27, 2011 [6 favorites]

I developed chondromalacia patellae by running. I might could have avoided the injury (and subsequent PT and surgery) by strengthening my adductor muscles.
posted by workerant at 10:34 AM on September 27, 2011

Stairmaster and hiking up steep mountains worked for me
posted by KokuRyu at 10:34 AM on September 27, 2011

My Y does have an indoor springy track; it's tiny but I could definitely give it a shot.

Definitely give it a go! The track is short at my gym too (125m) but I found it was actually quite good whilst doing the C25K - I didn't get bored running in circles, because I was concentrating on just getting through! Now that I can run consistently for a longer time, it is a bit boring, which is why I wanted to work up to running outside. I also live in a climate where there will be lots of snow on the ground soon, and the indoor running track is going to be infinitely appealing again I think!
posted by unlaced at 10:39 AM on September 27, 2011

Best answer: A lot of knee pain can be mitigated through strengthening your hips. Specifically, you want to do exercises that strengthen your hip flexors and abductors.
posted by atomicstone at 10:51 AM on September 27, 2011

For knee issues, strengthening your glutes by doing clams may help. (They're the main exercise my physical therapist recommended when my knees started to bother me.)

Is physical therapy an option for you? I've found it invaluable, and a good PT should be able to figure out what's causing you pain and give you targeted exercises, with far better accuracy than we can.
posted by asterix at 10:52 AM on September 27, 2011 [1 favorite]

Best answer: I'm a barefoot running fan myself, as it resolved my own knee issues. (And some other weird stuff that had started happening too, like IT band problems.) My version of "barefoot" is my Nike Frees, or my Merrell Barefoot Pace Glove. You need to land mid foot or forefoot, with said midfood or forefoot coming down right under your body. Don't rush it.

Speaking of not rushing it, I'd stick with the first week of couch to 5K for the foreseeable future. There is no shame in going at your own speed when you are becoming a runner.

Have fun. There is nothing quite as wonderful for your spirit as well as your body as running.
posted by bearwife at 10:55 AM on September 27, 2011 [1 favorite]

"You'll probably get a bunch of conflicting advice about what kind of shoes are good for you"

I'll field this! I thought my knees couldn't stand up to running until I started wearing Sanuks all the time. They're basically sandals, so you're running barefoot except for half an inch of foam. You land on the front parts of your feet and the force isn't sent straight to your knees.
posted by fraac at 10:57 AM on September 27, 2011

If you have access to a clay track or even a beach, you might find that running on softer uneven surfaces are less painful. Sidewalks and city streets are ghastly for running.
posted by elizardbits at 11:04 AM on September 27, 2011

Best answer: I am also a heavy woman who recently did my first sprint tri (awesome!), wear Brooks (for years now!), and am doing exercises to prevent injury when I run. I'm working with a trainer at my Y, and he has me doing "prehab" exercises and stretches.

Clamshells (above)
Bridges (the glute exercise on your back where you lift your hips)
Bicycles (the ab exercise on your back)
Side planks (I do them with the top foot in front of me on the ground for support)
Adduction machine

Quad stretches
Calf stretches
Achilles stretches
IT band and glute stretches on the foam roller

One of things he's done that was helpful was test my strengths to see where I'm imbalanced - like many folks I find clamshells easy and the adduction machine hard. My back was weaker than my abs (thanks, gym classes!). And we're trying to address those imbalances. If you can get a few sessions with a good trainer, that might really help, or even if you can go to a few classes at the Y you may pick up some good tips.

Otherwise - walk, run on something squishy, do strength exercises, and ease yourself into this stuff. And best of luck - fitness really can be fabulous!
posted by ldthomps at 11:18 AM on September 27, 2011 [2 favorites]

There's nothing about the C25k interval-style of training that you can't do on a recumbent bike. If that's a style that works for you then you might consider it till you get a few weeks in and either drop some pounds or at least develop some of the smaller support muscles and tone that might help you hurt less.

Depending on the equipment you have at that Y they may have bikes with heart rate sensors and interval programs. Drop the $25 for the sensor and let it do your interval setting for you. The more recent ones even factor in your weight as well as age to set an upper heart rate bound that'll be safer and more achievable.
posted by phearlez at 11:57 AM on September 27, 2011

Good form is imperative. If your joints hurt after running, your form isn't right. Your muscles should be absorbing the impacts, and they are what should be sore after running. How to get good form: watch an animal run. Look at the physiology of their legs. When they run, their "heel" never even touches the ground. Their legs push backwards with their toes, then tuck up and push backwards again.

Combined with some strength training.
posted by gjc at 12:05 PM on September 27, 2011

According to my podiatrist, I have shortened heel chords, which cause chronic tendinitis in my feet when I try to run. This swelling is alleviated for me by ice-bathing my feet/ankles 10 minutes prior and 10 minutes after running. I cannot recommend this highly enough if you are anticipating stressing your ankles.
posted by yoyoceramic at 12:06 PM on September 27, 2011

I'd second the recommendations toward minimalist running shoes and mid-foot striking. I have a friend, a former Olympic team member, who had lots of problems with the immediate re-emergence of old injuries to her feet, ankles, knees, etc. when she returned to running after two pregnancies. I believe she's now running in Vibram Five Finger Bikilas, and has had pretty good luck thus far; I think she's actually going to try full-on barefoot running soon.

If you're skeptical and/or interested in barefoot running, here's a really cool video explaining the science behind the idea.
posted by EKStickland at 12:09 PM on September 27, 2011

Have you tried just icing your sore areas after each run and seeing if the pain persists on the next run? I started running at about 190lbs and I had ankle and foot pain quite often, but the more I ran and got comfortable with the act of running, I started to feel better and was able to complete 2 half marathons less than a year after completing the C25k plan.

Pain isn't *always* an indication of injury, sometimes your body just needs to adjust. (within reason, of course)
posted by CorporateHippy at 12:22 PM on September 27, 2011

Walking lunges
Calf raises
Something to recruit the sides of your calves/shins (like, I brush my teeth balancing on alternate legs - or, you know, yoga).
posted by Pax at 1:11 PM on September 27, 2011

Row, swim and machines. But if you want to really lose weight...lift weights and lots of them. Not necessarily heavy weights, but work those muscles. I prefer to focus on my biggest muscles...they will use more calories.
posted by swmobill at 2:41 PM on September 27, 2011

Aside from raw strengthening, look into a "wobble board" for balance.

Protecting your joints in part means being able to quickly adjust your balance and prevent things from rolling out the wrong way, or, if you're going down, going down with some choice in the matter instead of taking in the joints.

Strong muscles also need to be trained to react quickly to random changes, to get the full benefit.
posted by yeloson at 3:26 PM on September 27, 2011

I found running on a tiny track to be AWFUL for my knees; the tight turns were murder. I also really hurt my foot running barefoot-- believe the experts who tell you to work up to it gradually. No matter how awesome you might feel the first few times! I did find either calf raises or stair climber to help my running. I also find that swimming is great for my cardio health and really helps my running-- and biking helps my leg strength, and thus my running. So tri training should be awesome for you!
posted by instamatic at 3:51 PM on September 27, 2011

Best answer: I think you've probably had a tonne of advice for physical stuff in this thread already - as a seasoned runner I think most of it is reasonable (though just be careful, barefoot running is very flavour of the month, but it's not necessarily for everybody; a lot of the great things about barefoot (high cadence, small steps, mid/forefoot landing, slight lean from hips etc) can be incorporated easily and well into non-barefoot running and if biomechanically you're not suited for it, that can be the safer option. Either way, Nthing stay off the pavement [treadmills are not a crime!] and stretch stretch stretch those calves!), but I thought maybe some mindset advice might help, too.

Running is a long game, and gains - especially when you're starting out and desperately training those ligaments and tendons to toughen the hell up - can be frustratingly slow at times, especially when your aerobic capacity starts to exceed your physical capacity (sounds like you're getting quite close to this stage if not already there). Firstly I would say; this is all perfectly natural and anyone long term runner and any stage knows how you feel and experiences it.

Secondly, I applaud your instincts to be careful and protective of your body. It's easy for runners and running culture to get a bit gung-ho about shit and take it from me: winding back a bit is a lot better than eventually having to take six months off.

Thirdly, something that I've personally found helps me to stop focussing on my short term frustrations is rather than think about where I want to be, and how I'm not there yet and getting there so.... slowlllllly. I think about where I'm going to be in six months time - if I just follow my conservative training program to the letter. By doing that, it's almost like a license for me to enjoy myself a bit more on my runs and not stress out so much if I don't feel like my heart rate is high enough or whatever. Because I'm gonna get where I'm going where I feel like puking after the run or not. So why not smell the roses?

This only really works when I have a proper training plan, and I stick to it. For me, if I go off-plan I have a tendency to push myself too hard, too fast, and I end up getting hurt. Don't be me! The other thing I have a tendency to do is run too fast, based on speeds I was clocking at the absolute zenith of my fitness. This also results in injury. Take your time.

Good luck! You'll get there, I swear.
posted by smoke at 4:52 PM on September 27, 2011 [5 favorites]

Best answer: Lot of advice here, but smoke's advice to take the long view is a really good one, methinks.

The Couch to 5K training program is 10 weeks from start to finish, and you've got a year to get ready for your tri. You don't have to do everything all at once. For the next six months at least you can bike and swim to your heart's content, do great things to your cardiovascular system, keep steady with your diet (and maybe wean by then? who knows), and just keep keepin' on with week one. Maybe once a month try bumping up to the week 2 routine and see how it feels. If in 6 months time you're not at a place where it's coming together, you've still got plenty of time to try the suggestions above.

And if it still doesn't work? Don't beat yourself up. You can still end a sprint tri with a 3 mile walk. Or with 3 miles of alternating 60 seconds of jogging with 90 seconds of walking. I have done both of those things, and guess what? I still finished, and I still freakin *rocked*. As you do too, sister, and as you will.

Keep up the great work!
posted by Sublimity at 5:47 PM on September 27, 2011 [1 favorite]

I found running on a tiny track to be AWFUL for my knees; the tight turns were murder

Seriously seconding this. Aside from being really hard on the knees in general, it also stresses your legs unevenly.

Personally, I would recommend only running outdoors, on good surfaces (grass and dirt is best, asphalt ok, concrete is a no-no). Yes, this sucks in the winter (really hard on the lungs, in particular), but it's worth it to avoid knees problems.
posted by Dr.Enormous at 6:05 PM on September 27, 2011

Response by poster: I would love to be able to run outdoors. Sadly, the great outdoors doesn't come with child care, and my husband works very long hours. I'm not going out running at 10PM in January when it's sleeting outside. I'm making plans to transition from indoor training to outdoor starting next late June early July, but it's simply not feasible before then.
posted by KathrynT at 6:21 PM on September 27, 2011

Whatever you do make sure you get have rest days to allow your body to heal between your running days. That is super important.
posted by tarvuz at 7:51 PM on September 27, 2011

My understanding is a lot of joint pain from running is caused by overusing one set of muscles (the ones you use while running) and not developing the other muscles in your leg, so I think your instinct to do strength training exercises is right on. I injured my knee when I first started running by doing too much too quick. I didn't think I'd ever get over the knee pain, but one thing that worked for me is a yoga practice. Yoga strengthens a lot of muscles that don't get used otherwise and that promote healthy joints. It also complements running (and other endurance activities) very well, because it helps you get in the zone and learn how to cope with the tedium of doing a single thing for an extended period of time.

After starting a yoga practice and gradually building up my running intensity and distance (not increasing either by more than 10 percent a week), I was able to run three half marathons in six months with little to no knee pain. I also wear barefoot running shoes, but mostly because I think they're fun. I think the other things made more of a difference. Good luck.
posted by ultraviolet catastrophe at 9:40 AM on September 28, 2011

Response by poster: I've marked a bunch of best answers. Thank you, everyone.

I'm going to talk to my doctor and my trainer about the Frees, and my trainer helped put together a strengthening and stretching routine for me. The tiny springy track was AWFUL, I was aching before I'd done a quarter mile on it.

But it turns out that if I just slow down my jogging pace, I can do week 2 with no problems at all. None. Mind you, the new jogging pace is VERY slow, but I'm putting an incline on the treadmill so that I still get a cardio workout from it. Slow running is more exercise than sitting on the couch with an ice pack on my knee, after all, and slow progress is still progress.
posted by KathrynT at 3:17 PM on September 30, 2011

Passing info from my running mother - try a glucosamine sulphate supplement to help with strain on your joints, dosage 1500mg / day (only effective at that dosage).
posted by paduasoy at 2:53 AM on October 6, 2011

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