[Case Study] How to Run Pain-Free

Research has shown that as many as 79% of runners get injured at least once each year. Think about that number for a moment. Nearly eight out of every 10 runners will be injured once every 365 days. Trainers typically focus on biomechanical aspects such as foot strike and running gait, but that’s not the first place we should look to prevent injury.

In my coaching experience, there’s often a much easier solution: Better training. Runners who progress their training volume and running speeds at a pace that their body is not ready to handle are at a much higher risk for injury than those who take their time with a well-thought-out program.

Today, I want to share the story of Zianne Lemke and how we took her from being unable to run across the street without pain to running continuously for nearly 60 minutes, in just over 12 months. A slightly different approach than most but one that will enable Zianne to run with a smile on her face for many years to come.

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The Case Study:

Name: Zianne Lemke
Age: 53
Country: USA
Occupation:
Running Capability Prior: Not Possible Due to Knee Pain.
Running Capability Now: 60 Minutes Pain Free.
Time to Achieve: 13 Months

As Zianne started her coaching program in May 2019, one of her goals was to get back into running, which she had been unable to do for many years. The only thing we promised was to let her assessments do the talking It’s important to assess prior to starting a running programs to get the overall picture of your four main areas of fitness: Health, movement, strength and cardio. Sometimes it isn’t possible to return to running pain-free because of underlying issues, so please don’t think of this as a miracle cure. What we’ll outline below is an approach that worked for Zianne, that might possibly work for you or someone you know.

  • Average Daily Steps: 15,012
  • Waist-to-Height Ratio: 0.53
  • Single Leg Balance: Left = 1 Minute | Right = 20 Seconds
  • Standing Toe Touch: No
  • Sitting Toe Touch: No
  • Straight Arm Plank: 2 Minutes = Yes
  • Glute Bridge: 2 Minutes = Yes

Let’s discuss her strength tests first. Zianne could easily complete the plank and glute bridge tests, which showed good basic muscular endurance in the core and glutes. Strength in these areas is an absolute requirement for us. A strong core increases stabilization in the torso, improves balance, and helps the body work together to prevent any excess energy expenditure.

In terms of the glutes, “Strong glutes make everything better,” as my good friend Perry Nickelston says. Weak glutes are often a major cause of knee pain, something that Zianne was suffering from, even though she was able to complete the glute bridge test successfully. We see so many people start running who struggle in these areas. We need this foundational strength work.

Moving along, Zianne was walking a lot each day and had been doing so consistently for many years thanks in part to her job. We were more than happy with this number. A lot of new runners have extremely low daily step counts and taking the time to walk more often and for longer durations is so important. You can’t run before you walk! However, Zianne scored poorly on the waist-to-height ratio, single-leg balance, and our basic mobility clearance tests. Addressing these areas was where Zianne’s journey really began.

Stage 1: Weight Loss

Every time your foot hits the ground when running, you experience a force of 1.5 to 3.5 times your body weight, increasing to a staggering 5.5 times your body weight when sprinting. Waist-to-height ratio is a litmus test to see if it is safe for your body to support that force. For those unfamiliar with this measurement, your waist-to-height ratio is calculated by dividing waist size by height, in either inches or meters.

If your waist measurement is less than half your height, or under 0.5, you’re likely not at risk for obesity-related disease and it’s likely safe to run. If you have a waist/height ratio over 0.5, we see this as a significant risk factor to long-term health and performance. It does not mean we don’t see you running ever; it is merely a safety measure to ensure that when you do start, you’ll enjoy years of pain-free running ahead.

Because Zianne’s score was above 0.5, our first goal was to help her lose weight through a mixture of strength training, good eating practices, and alternate aerobic activities. We wanted to build strength in her joints and ligaments so that she could better withstand the force when she returned to running and also increase her aerobic capacity so that when it was time to run again, she had an enjoyable experience not an arduous one.

Zianne’s Waist-to-Height Ratio Chart

Stage 2: Addressing Single Leg Balance

The single leg balance test tells us a lot about your proprioceptive awareness underfoot. Proprioception is the sense that lets us perceive the location, movement, and action of parts of the body. It enables us to judge limb movements and positions, force, heaviness, stiffness, and viscosity. It combines with other senses to locate external objects relative to the body and is closely tied to the control of movement. How many people do you know that have sprained, rolled, or broken their ankle during running? If the foot cannot feel or sense danger while running, you are considerably more likely to roll and injure your ankle.

Zianne’s Single Leg Balance Chart

Stage 3: Improving Thoracic Mobility

The standing and sitting toe touch tests give us a quick idea of whether you have either a stability problem or a mobility problem. If you’re unable to touch your toes in both positions, it’s a mobility problem, as was the case with Zianne. On further investigation, we discovered she had significant restrictions in her thoracic spine.

When you walk or run, your thoracic spine is supposed to rotate. Most people who don’t rotate in the thoracic spine end up with too much motion up in the neck or down in the lumbar spine and hips. The thoracic spine is designed for rotation. It’s supposed to rotate more than your lumbar spine but in most people it’s the opposite. Our modern lifestyles often lead to posture that feeds thoracic spine dysfunction, like hunching over your cell phone or rounding your shoulders at a desk. These movements increase your thoracic curve which makes efficient rotation damn near impossible.

Good running technique depends on good posture and good posture depends on the thoracic spine. A healthy thoracic spine allows just the right amount of rotation through the entire spine to promote efficiency. When the thoracic spine is immobile, this area of the back and spine—and all of the associated muscles— will not function efficiently, or at all in some cases. This has a trickle-down effect through the entire body, leading to poor biomechanics and increased injury risk.

With Zianne, even though she passed the 2-minute plank test, good core function is a primary contributor to thoracic spine rotation. The two go hand-in-hand. We assigned her core work that integrated with other parts of the body to improve her posture and thoracic mobility. We didn’t focus specifically on hamstring flexibility or strengthening. That isn’t what we’re looking for in the toe touch tests; we’re trying to see if the hamstrings let the abs do the work they’re supposed to. As soon as her core started to fire the way it supposed to and her thoracic rotation improved, so did her toe touch tests. In a matter of months, they went from being a no to both being an easy yes.

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Lessons You Can Learn from Zianne

We see running as a key to a lifelong pursuit of happiness. Therefore, we want to prepare our bodies accordingly so that we can keep running well into old age. We didn’t begin any running protocols with Zianne until we fixed the issues listed above, and we only began with a simple walk/run workout of one minute on, four minutes off for a period of 20 minutes, gradually increasing this to 60 minutes over a four-month period. Her body needed to adapt to its newfound changes and also learn to cope with the force of running.

Zianne’s Thoughts

“I have been working out with Josh Kennedy and Strength Matters for about a year. I decided to try the program because I was feeling uninspired in fitness and was also feeling just plain old. I’m 53 and I’ve always enjoyed moving. I’ve had issues with knee pain for years, but it was trouble with back pain that lead me to seek help with my workouts.

My goals were not huge. I just really never wanted to feel my back go out ever again. I wanted to be able to run but I didn’t think it would ever be possible for me because of the knee pain. Over the years I had seen doctors and had rounds of physical therapy with no help for the pain I experienced in my knees. I decided running wasn’t going to work for me. I could walk and that was good enough for me.

To my surprise I saw quick results in how I felt and moved at the beginning of my programming. I love the testing part of the programming where you can see and measure improvements. With the combination of strength and mobility workouts I was feeling so much better and more importantly to me, moving without pain.

After a few months of training I decided to just try a little one minute jog with my walk and to my great surprise, I was able to do it without pain. I am currently at a point in my life now where I can say I am a runner again. I can do it and I can do it without pain. I really am so very excited about it. When I first started, I didn’t think it was possible. I couldn’t run across the street without hobbling. I was wrong. It is possible and I am so excited about it. I can run again!

Strength Matters has given back to me something I enjoyed very much as a younger person. I never thought at 53 I’d start running again.” Zianne Lemke, everyday athlete.

Credits

This article first appeared in Issue 2 of Fit Over Thirty Magazine. If you’d like to get our very best content, delivered to your door every month, and be at the forefront of high-performance living, we recommend you upgrade your membership today.

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Is Running Supposed to be Painful?

No. If you're running whilst in pain, particularly if you're a beginner, there's something seriously wrong. There could be several reasons for this, however, more often than not, it's because your body isn't ready to run just yet. Try walking more, and walking for speed first.

What Makes Running Easier?

Most people have never walked 5km, yet they start jogging 5km almost instantly. Build up your aerobic base first by walking more, and running at a lower heart rate.

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[Case Study] How to Run Pain-Free
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[Case Study] How to Run Pain-Free
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We share the story of Zianne who came to us wanting to get back to running pain-free. Here's the exact steps we took to help her achieve that!
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Strength Matters
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