Pilates and Rehab for Runners

James Wilson and Rohan Singleton

BIM Northcote
 A Quick Recap…
• Why do runners get injured?
1. Tissue overloading (training errors)
2. Extrinsic factors (running shoes, surfaces)
3. Intrinsic factors (biomechanical, muscle
dysfunction, tissue frailty)
A Quick Recap…

Stress on
Tissue

Intrinsic Extrinsic
Factors Factors
Tissue Overloading
 General R4L Management Advice
1. Surround yourself with the right people: to treat runners well, experience running
2. Your body will adapt:Integrate new stimulus slowly
3. Cadence 170 to 190
4. The Kenyan Surface: Best surface is firm irregular
5. Warm Up’s: Increase body temp with 15-20min jog +/- funcitonal ballistic stretches
6. Stretching: Only if running biomechanics are altered by a
shortened muscle
7. Specific stabilisation, prop and strengthening programs:
Pilates and traditional exercises
8. Regular Massage and Self Myofascial Release: Spikey balls, foam rollers, weekly
massages ideal
9. Cross-training: People who’s only sport is running are more often injured than those
who practice another sport.
10. Complete rest is rarely the best treatment: Safe cardiothoracic exercise will decrease
recovery time
11. Eat well, Sleep well
Questions??
 Today
1. Types of Runners
2. Rehab and strengthening for Runners
• Assessment
• Mobility and Stretching
• Rehab phases 1-3
• Running Drills
3. Pilates for Runners
 Type of Runner
• Jogger/Novice: focus on body awareness,
posture, efficiency
• Runner/Expert: Fill holes in training, what
other training are they doing?
 Screening Assessment
• Posture
• Balance – eyes closed >30seconds – foot contact OR head turns
• Squat
• Single leg squat 6/6
• Hop
• Toe Yoga
• KTW - >12cm
• Big toe mobility > 30 degrees in DF
• SLHR – 20 – 25 (rec athlete), 25-30 (marathon runner), >30 (professional).
• Modified Thomas > 15 hip ext, 0 ab/add
• Internal Rotation > 30 degrees
• Hamstring Length > 70
• Single leg bridge - glutes, pelvic control.
• Thoracic Rotation = 90 degrees
• Any pathology related tests
 Single Leg Squat
• Everyone starts with 6/6.
• 6 reps each leg
Deductions Scored Criteria Implications
-1 Loss of foot Foot stability
contact
-1 Trunk Shift Hip or Foot
-1 Pelvic control Hip
-1 Knee control Hip
-1 Hands off hips Gross instability
-1 Loss of balance Gross Instability
 Common Issues
• Feet • Thoracic
– Poor stability - Poor Mobility
– Poor mobility – big toe, ankle
• Knees • Posture
– Decreased mobility (hip + - Kyphotic (mid – lower thoracic)
knee – hamstrings) - Ant tilt pelvis
– Poor control (hip/glutes)

• Hips/Pelvis • Balance
– Decreased mobility - Decreased balance
(extension)
– Poor lumbo-pelvic control
 Mobility, Muscle Length &
Stretching
• Only stretch if the muscle is short for
necessary movement!!
• Massage and mobility work for tight,
tender, muscles
 Mobility
• Mobilise scar tissue and trigger
points.
• Hamstrings
– Spikey ball
• Glutes
– Spikey ball
• Feet
– Small Spikey ball or Hands
• Calves
– Calf smash –foam roller
– Spikey ball
• Foam Roll
– Quads, ITB, Thoracic.
 Muscle Length and Stretching
• Don'ts
– Stretch before activity
– Stretch a muscle
because it feels tight
– Stretch gastrocs
• Do’s
– Stretch a short muscle
– 3-5 mins/day 10-12
weeks.
 Muscles
Hamstrings Psoas
 Rehab
• Goals
– Move right
– Get strong
• Phase 1 – Motor Control (Rewiring)
• Phase 2 – Strength
• Phase 3 – Spring (plyometrics)
 Motor Control (rewiring)
• Lumbopelvic
• Hip Extension &
Glutes
• Posture, Balance &
Feet
 Hip Extension + Glutes
Exercise Goals Target Reps
Clams Glute (ER) 100 Daily
Pigeon Hip Ext Isolate Hip Ext 2 x 20
4PK Leg Extension Hip Ext, Postural Control 50 reps
Marching Bridge Glutes (All), Hip Ext 3 x 20
Knee to Chest Bridge Hip Ext, Glutes 3 x 12-15
Chair Squats Motor Control 3 x 10
 Posture, Balance & Feet
• Posture is vital for correct running form
Eg. Forward lean – can directly lead to overstriding
(head chasers)
• Balance
– Running entirely involves single leg stance, need
good balance for efficiency and stability
• Feet
– Big Toe is crucial for providing dynamic stability
during stance and push off
 Posture, Balance and Feet
Exercises Goals Reps
Big Toe Isolation Initiating Big Toe Mvmt 3-5min, 1-2/day.
Toe Yoga Foot Coordination 1-2 mins, 3-4/day
Balance Balance, Foot Control 30 secs – throughout day.
Barefoot Squats Posture, Hip, Knee + Ankle 2 x 15
Reeducation
Front Squats Posture, Hip, Knee + Ankle 2 x 15
Reeducation
Overhead Squats Posture, Hip, Knee + Ankle 2 x 15
Reeducation
 Strength
• Needed for stability, efficiency and speed.
 Strength – Beginner/Intermediate
Exercise Goals Target Reps
Rocker Board Foot Strength, Balance 2 x 20
Rocker Squats Multiplane Stability 3 x 10
The Walks – Crab, Wet Glute Strength 10m up and back
Pants, Waltz
Hip Hike Glute Strength 3 x 10
Swiss Ball Bridge and Curl Hip Ext, Glutes, Hamis 3 x 12-15
Swiss Ball Pike Core 3 x 10
Swiss Ball Rock n Roll Dynamic Core, Balance 3 x 30sec
Swiss Ball Leg Ext Postural Control 3 x 8 each leg
Arabesque Glutes, Postural 3 x 10
Twisting Lunge Rotational Stabilistaion, 3 x 10 each leg
Glutes
 Strength - Advanced
Exercise Goals Target Reps
Swiss Ball Russian Twists Multiplane core and hip, 3 x 8 each leg
obliques
Swiss Ball Torso Rotations – Postural, Rotational control 3 x 20
Kneel or Standing
Swiss Ball Running Man – Postural, Rotational control 3 x 30 secs
Kneel or Standing
Rotisserie Chicken Rotational Hip and Core 3 x 10
control
Swiss Ball Plank with Running Core and Rotational 3 x 10
Leg Stability
Lleytons Gluteal and Core control 3 x 10
(single leg stance)
 Spring
• Muscle Elasticity and
energy return
• Ability to use the
muscle strength more
efficiently
• A big spring is stiff and
capable of delivering
incredible force in a
short period of time
 Spring

Exercises Goals Reps

Squat Jumps Absorb stresses, explosive 10 – 30 jumps
force
Lateral Jumps Lateral stabilisers at 3-4 x 10
Increased intensity
4 Square Lateral stabilisers, explosive 2-6 x 10 sec
force
 Your Turn…
Type Exercise
Hip Extension and Glutes Pigeon Hip Ext
Chair Squats
Knee to Chest Bridge
Posture and Feet All 3 Squats
Strength Beg/Int Rocker Board
Swiss Ball Leg Ext
Twisting Lunge
Strength Adv Torso Rotations
Lleytons
 Running Drills
Exercises Goals Reps
Heel Lift Drill Dynamic glute, hamstring 2-3 minutes
recruitment
Metronome Jump Rope Cadence 5 – 10 mins
Run Away Drill Posture, Glutes 3 x 45 secs
100 Ups Balance, Stability, Posture 100
 Role of Pilates for Runners
• Increased body awareness
• Increased efficiency – eg.lumbo-pelvic
stability, scapulo-thoracic stability
• Good posture
• Increase/maintain LL strength
• Increase/maintain joint mobility (eg. Hip,
thoracic, ankle)
 Pilates for Runners: Target Areas
1. Lumbo-pelvic stability
2. Scapulo-thoracic stability
3. Hip/Knee stability
4. Gluteals
5. Abdominals/Hip flexors
6. Hamstrings
7. Adductors
8. Thoracic and spinal mobility
9. Hip mobility
 Pilates for Runners: Other
considerations
1.Balance
2.Breathing control
3.Feet
4.Jumping training
 Lumbo-Pelvic Stability: What are
we looking at?
• Extension control
• Rotation control
• Lateral stability
• Hip/Pelvis dissociation
• Balance between
slings
 Lumbo-Pelvic Stability
Exercise Equipment Variations
BKFO Foam Roller +/- Arms
Leg lifts Foam Roller +/- Arms
Hip twist 90/90 Mat Leg extensions, +/- arms
Footwork – Single leg Reformer Chi ball, +/- arms
Sleeper (bottom leg straight) Reformer Turn out
Sleeper in strap Reformer Turn out, Straight leg, Bicycle
Feet in Straps – Plies’ series Reformer Sgl crossover – Sgl same
side. +/- chi ball pelvis, heels
100s Arms Reformer Sgl leg ext, Ball bw heels and
curl ups (Dbl leg)
Side Knee Stretch Reformer
Stand Knee Stretch Reformer Double leg, Single leg
Scapulo-Thoracic Stability (Posture)
• Scapula posture
• Thoracic and ribcage posture
• Importance of landing under centre of
gravity
• Arm drive (counterbalance)
Scapulo-Thoracic Stability (Posture)
Exercise Equipment Variations
Supine scap series Foam Roller Scap isolations
eg.OH Arms +/- weights Pec stretch
Toy Soldier
Bow and arrow Reformer Box, low kneel, high
kneel
Triceps dips Chair +/- stick
Reverse frog Chair
Snake Reformer
 Hip/Knee Stability and Gluteals
Exercise Equipment Modifications
Sleeper/ Sleeper in Strap Reformer Turn out, straight, Jump Board
Scooter Reformer Discs, running man, rotations
Reverse scooter (strap) Reformer
4PK leg press Reformer Jump Board
4PK strap (quadruped) Reformer/Box
Standing Ab/Adduction Reformer Squat
Lunges forward, backwards Reformer Rise, rotations
Stand leg press Chair Discs, rise, turn out, cross over
Lunges Chair Discs, rise, one leg, pulses
Donkey Kick Trapeze Box
 Hip Flexors/Abdominals
Exercise Equipment Modifications
Reverse Abdominals Reformer Double, single, speed
Pike Chair Doubles, Plies’, singles
(pistons)
 Hamstrings
Exercise Equipment Modifications
Bridging Reformer Double, single, plies’, arms
in air
4PK (quadruped) hip Reformer
extension strap
Sleeper in strap with leg Reformer Bicycle
straight
 Adductors (AOS)
Exercise Equipment Variations
Plies’ in straps Reformer As previous
Jumping in plies’ Reformer Ball
Sideways leg press Chair Discs, rotations
Sideways lunge Chair Discs, rotations, Mid range
pulses, lift and hover
Pike in plies’ Chair +/- Stick
Star on trapeze Trapeze Knee, Foot
Star mat Mat Knee, Foot
 Thoracic and Spinal Mobility
Exercise Equipment Variations
Bow and Arrow stretch Mat Book openers with weight
Barrel extensions Barrel Arm circles
Barrel port de bras Barrel Add flex/ext
Mermaid Reformer/Trapeze
Trapeze swan + duradisc Trapeze Singles
Kneeling Cat Stretch Trapeze +/- rotation
Standing Cat Stretch with Trapeze Arm off at either end
Rotation
 Hip mobility
• Hip ext independent of lumbar
• Hip flex without post tilting

Exercise Equipment
Kneeling splits Reformer
Standing splits +/- arms Reformer
 Balance
• Incorporating
duradisc/rotator
disc/wobble boards
• Look at balance in rise
position
• Maintaining stable
gaze/head movement
• Firm surface ideal to be
functional
 Breathing Control
• Want diaphragmatic breathing
• Apical breathing = inefficient
• Ability to dissociate breath from movement
 Jumping Training
• Noise (Ground reaction forces)
• Foot placement and articulation
Jumping Exercises
Footbar – dbl, sgl, crossovers
Plies'
Sidelying
Quadruped
Goals
Control ground reaction
forces, lumbo-pelvic control,
leg alignment
Anterior oblique sling
Gluteals, hip rotation control
Hip dissociation, stance leg
control
 Your Turn…
Type Exercise
Lumbo Pelvic Foam Roller
Sleeper
Knee Stretch’s
Scapulo Thoracic Tricep Frog
Snake
Gluteals Rev Scooter
Donkey
Mobility Trapeze Swan
Kneeling Splits
 Questions?
“There is no drug, in use or being
developed, that shows as much promise to
bring health to users than a sustained
physical activity program.”
– Walter M Bortz (MD)