RPM Physiotherapy

Category Archives: Running

Running Mistakes to Avoid

While August is often dominated with back to school excitement, there is another group of people giddy with anticipation for September……..runners!


With the height of Fall race season being October, many runners start to prepare towards the end of August for upcoming races. Whether you are running your first race or are a veteran runner aiming for a personal best, you are probably building your distance, incorporating speed work and strengthening on hills.


The return of race season is also high season for overuse injuries. Excited to hit the road, many runners go out too quickly, do too much and neglect the importance of a balanced workout regime.


After years of treating disappointed runners who have had to forego a race or who did not achieve their goal because of injury, I noticed the following to be the main contributors to overuse injury in runners.


Going out too quickly


Whether it is distance, intensity or speed, your build should be gradual. Consider using the rule of 10%. If your longest run on week one of training is five kilometers (km), the next week’s long run should only be 10% more or 5.5 km. Your body needs time to adapt and progressing too quickly can add stress that your muscles and joints are not prepared to handle.


Old running shoes


One of the biggest draws for running is that you only need a pair of shoes but they should be good shoes. We suggest replacing your shoes every six months or 500 km, whichever comes first. That might seem like a high turnover but during that time the material that supports your foot and absorbs shock degrades.


To get the most out of your shoes, make sure you are fit by someone who has been trained in shoe fitting that includes watching you walk and stand. Consider buying two pairs and rotating them if you intend to run on back to back days.


Forgetting to stretch


While it may be tempting to go straight from your run to the shower, 10 to 15 minutes spent stretching afterwards can help realign muscle fibres and promote recovery. Ideally you should do a warm up including dynamic stretching and follow your run with sustained static stretches held for a minimum of 30 seconds.


Only running


While it makes sense that you need to run as part of your training, many runners fail to include flexibility or strength training for fear it will make them slower or they think it is not sport specific.


Engaging in cross training not only improves your running technique, it increases your power, speed and gives you the strength to conquer varied terrain. The other benefit of cross training is that it reduces the strain on your running specific muscles, decreases the amount of impact on your joints and overall helps to prevent injury.


Running Loops or Unidirectional Tracks


Running one way can be a serious disadvantage. If you run on the road, you might have realized that most city streets are sloped for drainage. If you run in a loop you put uneven forces through your legs if you continuously stay on one side of the road. To even things out, run the first half of your run in one direction and then turn around and run home following the exact same path.


If you run on a track to train, it is also important to change directions. Always circling the track in one direction means that you consistently push off one the corners with one leg creating an imbalance not only through the lower legs but also the hips and low back. Most tracks will change their direction of use on different days of the week. Make sure you train equally in both directions to prevent injury.


Not hydrating enough as the weather gets cooler


People are generally quite good about hydrating in hot weather but sometimes feel it isn’t as necessary as temperatures drop. Regardless of temperature, good hydration is essential before, during and after your run. It helps to dissipate core heat and prevents spasms and cramps. Research suggests that for exercise under 3 hours water should be sufficient but you should consider something that helps with electrolyte replacement for longer workouts.


A great test to know of you are hydrating enough is to observe the colour of your urine. If you have consumed enough fluid, your urine should be close to clear in colour. The only time it should be darker if you are properly hydrated is when you first wake up in the morning.


Assuming it will get better on it’s own


Pain is your body’s way of letting you know that something is wrong and shouldn’t be ignored.


Delayed onset muscle soreness is a normal adaptation to an increase in training intensity, duration or frequency. It commonly last 48 to 72 hours and rates lower on a pain scale of 1 – 10. The nature of the pain should be dull and muscular in nature.


If you experience more intense pain, pain that prevents you from sleeping, sharp, shooting or electric pain or something that generally just doesn’t feel right, don’t hesitate to get it checked out. Studies show improved recovery with early intervention but if you wait it out and potentially make it worse, you may compromise your running season.


I actually advocate preventative treatments for all of our clients but especially our athletic clients. It is a great way to identify a problem before it becomes an injury and ultimately keeps your season on track and your money in your wallet.


Happy running everyone.

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Everything Worthwhile Takes Time

This morning when I woke up, this picture from two years ago was in my newsfeed. I got so excited because I remember the exact feeling I had when I saw this picture for the first time. We were going my husband’s colleague’s wedding and I had rented this beautiful designer gown and literally squealed with joy when I saw the size on the tag. I had been working out really hard and eating well since having my daughter and this was the first time I saw an image of myself and felt genuinely happy with how I looked. I actually remember my eyes welling up with tears from the pride of feeling all those days of hard work had finally paid off.


So today, less than three months after having my son, and not exactly thrilled at the prospects my closet held as I got ready for a meeting, I again got really excited again seeing this picture because I knew I was on my way to that feeling again. I quickly did the mental math in my head. My daughter was born in late December and this was early June, so it would have taken me about 6 and a half months to get to this point.


Wait a second……that is not a 6 month old I am holding in my arms, it is a toddler. OH SNAP. THAT IS NOT 6 MONTHS POST….IT IS 18 MONTHS POST!!!!! All of a sudden my stomach sank and my eyes welled up for another reason.


I’ve never been too concerned with the concept of skinny. I do however love the feeling of fit. I am a self described fitness addict and I adore seeing the results of hard work. I loathe not feeling like myself in my own skin. However in this world of silver bullets and instant gratification it is easy to forget that the real game changers are persistence and time.


I’ve seen it a million times over in my practice when patients give up on their sessions because they don’t feel they are getting anywhere. I know from experience and often tell them it takes 14 to 16 weeks to see change. That change may not be monumental change either. It might be a small change or a change only noticeable to those who know you well. The point is, the photo this morning gave me my own reality check.


This is achievable but it is going to take time. Beating myself up about it won’t make me feel better and it won’t speed up the process.
With that in mind I stripped down to my underwear and took another photo. A before photo. Then I went downstairs, made a spinach and strawberry protein shake, grabbed my running shoes and headed out the door.


If you’ve enjoyed this post and would like to learn more about living a happy and healthy life, you can subscribe to our newsletter or follow us on facebook, Twitter or Instagram.

Melanie Stevens Sutherland

Clinic Director / Registered Manipulative Physiotherapist HonsBKin, MSc(PT), FCAMT

Melanie is a graduate of McMaster University and brings 13 years of experience as a sport physiotherapist to RPM. She has enjoyed a long tenure working with active populations at prestigious sport medicine clinics. Past clients include Provincial, National and Olympic level athletes as well as members of the National Football League, the Canadian Football League, the Ontario Hockey League, the American Hockey League, the National Lacrosse League and Major League Soccer. She has also worked extensively with elite level endurance athletes. She enjoys treating all patients with orthopaedic concerns and is passionate about preventing injury and illness through healthy lifestyle. As a new Mom, her most recent area of interest is working with pre- and post-natal women to manage pain associated with pregnancy by helping restore their core strength.


The HOW and WHY of ‘Pulling’ Your Hamstring … Again

The HOW and WHY of ‘Pulling’ your Hamstring again

        I know it’s early but summer-time is ramping up, and with that you have committed to one or more of the following:

  1.     Spending an extra (possibly dreaded) one-to-two hours with your co-workers per week playing beer-league softball
  2.     Sweating-it-out with the TRIBE crew for the first time at RPM
  3.     Unexpectedly chasing your children around the yard and park
  4.     Watching your child chase around a soccer ball… give me a second to make sense of this one…

        Whatever it may be, for some reason you, or your child, returns to your beloved activity and somehow manages to ‘pull’ that hamstring again. And no, it’s simply not because you are older (well, maybe it is a little bit) or less flexible. There are many reasons why, and many ways to avoid this common injury, so let’s get to it!

What is a recurrent hamstring injury and when does it happen?

        It is exactly as it sounds, a hamstring muscle strain injury occurring greater than one time on the same leg and muscle. Hamstring injuries in general account for 12-15% of all sport-related injuries, with re-injury rates reported as up to 40%. Subsequent hamstring injuries often are associated with greater injury severity and recovery time in comparison to the first injury, meaning you miss out on more ‘fun’.

        Common sports and activities that lend themselves to this type of injury include high-speed sports and those involving rapid acceleration and deceleration (think running to first base in softball, flag football, sprints). Additionally, jumping and kicking activities also put the athlete at higher risk (think soccer and track and field sports). Does your weekly fitness routine include any of these elements? Add that to the list.

What puts us at risk?

        Please allow me to delve a bit into what current research tells us. There is no gold standard at this time to classify risk of injury, but the evidence does suggest the following:

      Previous hamstring injury increases risk of re-injury (within 2 years of the first injury) to 13- 63%.1 This is probably the most obvious risk factor but also most important to the clinician in developing a progressive program for the athlete to reduce the risk of future injury.

      Previous anterior cruciate ligament (ACL) reconstruction on the same leg as the initial hamstring injury increased re-injury risk (up to 66%).1 This would be more relevant in soccer players, and even-more-so female soccer players.

      Thigh muscle imbalance (quadriceps to hamstring strength ratio).2 Conflicting evidence here. The general idea is that our hamstrings (muscles in the back of the thigh) need to be able to decelerate the action of the quadriceps (muscles in the front of the thigh) efficiently, which requires both strength and muscle contraction timing.

      Age.1,2 Again, conflicting evidence here. If there is an increased risk it is not as relevant as the above factors… so don’t sweat it, age is just a number.

      Improper warm-up. I’ll be honest, I didn’t find this in my literature review, but anecdotally I have re-injured my hamstring when returning to the field ‘cold’.

So what would we be looking for?

        Coming in for a detailed biomechanical assessment will bring you one step closer to avoiding re-injury. Special attention will be paid to the pelvis, hips, and knee given that the hamstring muscles directly affect these areas of the body. Additional evaluation of the foot and trunk is also relevant. Highlighting and resolving biomechanical and strength deficits is something that can’t be done by reading this blog, so please use our expertise appropriately.

And how would we treat this?

        Most importantly, every rehab and prehab program is client specific and goal-directed. What we discover in the assessment, in conjunction with your goals, will mold the treatment plan. If there are clear limitations in strength or range of motion (i.e. at the hip, knee, pelvis, or lumbar spine) then these need to be addressed. If a warm-up wasn’t included (shame on me), then education around this is required.

        But out of interest, what does the evidence suggest? Interestingly, more evidence is coming out that suggests that agility and stabilization training should be included in the treatment plan (with a reduction of re-injury to 7.7% from 70% when compared to a rehab protocol aimed at leg strength and flexibility).3 What does this mean? It means that we need our core muscles to work like core muscles (provide STABILITY and transfer POWER to our limbs), and we need our thigh muscles to fire in a coordinated fashion when we accelerate, decelerate, or change directions in sport. If we have a weak core, control of our hip and pelvis will rely more on muscles such as the hamstrings and quads (which were designed to MOVE our thigh and not stabilize our thigh).

        Lastly, progressive return-to-sport is a critical conversation that needs to occur between the practitioner and you, the athlete. The athlete should be able to demonstrate all skills of their sport before returning to play, have returned to the appropriate level of conditioning to perform, and should likely be able to participate in a team scrimmage in sports such as soccer, symptom-free. It becomes more complex when there are financial incentives (i.e. paid gym membership, elite sport) or upcoming tournaments/games with organized sport.

        Thanks for sticking it out! If you have any questions, please comment below.


If you’ve enjoyed this post and would like to learn more about living a happy and healthy life, you can subscribe to our newsletter or follow us on facebook, Twitter or Instagram.

Jordan Fortuna

Registered Physiotherapist

Jordan is a graduate of the University of Toronto Physiotherapy program and has since been practicing in orthopaedic settings. He has developed an interest in sports physiotherapy through his many years as an athlete, participating in baseball, golf, snowboarding, and more recently rock-climbing, cycling, and strength training. He has worked with a variety of clientele including athletes from disciplines such as competitive dancing, running, rock-climbing, and mixed-martial arts, as well as non-athletes of a wide age range and ability. Regardless of activity level, he is dedicated to improving mobility, optimizing function, and strengthening to help achieve your goals through the use of manual therapy and individualized exercise prescription. He also has additional training in acupuncture and sports taping.



  1. de Visser HM, Reijman M, Heijboer MP, et al. Risk factors of recurrent hamstring injuries: a systematic review. Br J Sports Med 2012; 46: 124-130.
  2. Freckelton G, Pizzari T. Risk factors for hamstring muscle strain injury in sport: a systematic review and meta-analysis.Br J Sports Med 2013; 47: 351-358.
  3. Sherry MA, Best TM. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 2004;34:116–25.


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