You Are Running A Hilly Race Course, and You May Just Get Hurt

by Eric Oliver, PT, Founder, certified running coach


Harbingers of spring in Cincinnati include the usual—temperatures in the 50’s, flowers making their way up from the ground, St. Patrick’s Day, and sunlight when driving home from work. Another sign of spring, specifically for me, revolves around this coming Sunday. This weekend is the unofficial start to road running race season with the city’s first big race, the beloved Heart Mini races. This Sunday morning, along with the smell of spring in the cool air, we will feel the collective breaths of hundreds of runners tackling the oft-underestimated course that is the Heart Mini Marathon and Half-Marathon. This is a hilly course, and time and time again we see a swath of injuries that proliferate from this weekend. For those using this race as preparation for the Flying Pig, an injury or start of a nagging ache after this race can derail your training plans.

I’ve been helping runners rehab from injuries for well over a decade, and the predictability of injuries or nagging aches comes without fail after the Heart Mini race weekend comes and goes. There are three main reasons for this, and in order to help keep you from getting injured I want to bring attention to these common mistakes along with some tips that will help in keeping you from developing knee, shin, foot, or hip pain.

The top three most common mistakes that contribute to develop pain while running a hilly race include:

You underestimate the race course. This race course is quite hilly. Hills will not only challenge your cardiovascular system, but they will stress your musculoskeletal system (bones, muscles, tendons, ligaments, cartilage). Any flaws in your strength, movement, posture, and running mechanics will be exposed during this race as you run on these hills, especially as you run downhill. Hamstring (back of thigh), calf, and gluteal pain can arise from running uphill in the presence of movement and strength deficiencies. On the flip side knee, foot, shin, and quadriceps (front thigh) pain can arise from running downhill.

You overestimate your fitness. It’s easy to get caught up in the excitement of this race. The adrenaline is infectious. Before you know it you could be running much faster than what your training dictates. If you find yourself doing this you’ll feel good at first, but that feeling is fleeting if you aren’t fit enough to sustain that faster pace. Running faster requires more energy and more muscular effort. Additionally, running faster exposes your body to more forces, and if you’re not economical in your movement these extra internal and external forces will stress your tissue beyond its resilience capacity. The threshold at which tissue can no longer handle the stress is different from person to person, and as you approach that threshold you are playing a risky game of testing your tissue’s integrity.

You come into the race underprepared. If you think you can run 1 - 2 times per week, neglect your long runs, avoid hills in your training runs, or depend on general athleticism in tackling this course without some sort of discomfort you are grossly mistaken.

To be clear, not everyone who falls into one of these types of mistakes is guaranteed to end up with an injury. Nor am I implying that this is a dangerous race course. Rather, the point I’m wanting to get across is that due to the challenging nature of this course, making any of these mistakes can increase your susceptibility of developing musculoskeletal aches and pains, of which we see year after year in our physical therapy clinic.

So how do you adjust your race day strategy to have a successful race that is free from signifiant injury?

Manage these hills like a boss. When running uphill slightly lean your body into the hill. This will help to minimize the strain of running uphill by limiting the over reliance of the hamstrings, calf, and small hip muscles to power you up the hill. Proper technique when leaning into the hill is to lean from the ankles and not from the waist. To practice this technique stand in place on a flat surface and lean forward 2-3 degrees by pivoting from the ankles. If you do this correctly you will feel your bodyweight shift past your toes, and your toes will slightly grip the ground. Proper posture during this forward lean will allow you to draw a straight line connecting your shoulder, hip, knee, and ankle while leaning your body forward. Additionally, when running uphill think about pushing into the ground with each step and maintaining short, quick steps. Lastly, if your heart rate starts to spike, slow your pace and don’t be too proud to walk if you need to. See video demonstrations of uphill running technique on our Instagram page here.

Running downhill magnifies the forces that are transmitted into your body which places added stress on your bones, muscles, tendons, ligaments, and joints. When running downhill, don’t overly reach your foot forward with each step. Rather, take quick steps (high run cadence). This will help to ensure that your foot strikes the ground just in front of your hips or underneath the hips rather than far out in front of you. Running downhill with pace is a skill, and if you are not accustomed to running a fast pace downhill then slow your running pace without sacrificing the high run cadence. If you slow your running pace AND slow your run cadence you will experience a much harder foot strike which can be damaging to your body, particularly your foot, shin, and knee.

Check your ego, and run smart. To control your pacing, try to rely on either your run watch (to monitor pace or heart rate) or your rate of perceived exertion (a rating system that allows you to run by “feel”). If running with your heart rate monitor or gps watch, stay within the training zones in which you have practiced. If running by “feel” (my recommended strategy) make sure to run at a pace that still allows you to talk. For those who are experienced or who are racing the other competitors, your strategy will include racing in effort zones that range from labored breathing with moderate difficulty talking to significant difficulty talking.

Before the race starts, adjust your expectations and give yourself some grace. Be honest with your preparation for this race. Have you followed a running program that progressively increased your volume of running? Have you trained on hilly routes? Did you run more than 2 - 3 times per week in your lead-up to this race over an appropriate timeframe? If you answer “no” to these questions, then I recommend that you really listen to your body during this race. Start the race conservatively paced. Don’t get out of breath too soon. When faced with a difficult hill climb, significantly slow your pace or walk up it. Don’t charge down the hills in order to make up for lost time or to show off. Don’t ignore pain or limping. If you feel pain or start limping, slow your pace, walk, or stop at a medical tent to get checked. Lastly, don’t get frustrated with yourself. Rather, enjoy the moment, celebrate the fact that you’re out there participating in one of Cincinnati’s most challenging races, smile at the people cheering for you, and raise your arms and head when you cross that finish line no matter how long it takes to get there.

Again, the Heart Mini weekend is a fun harbinger of spring for Cincinnati’s runners. I love the atmosphere and appreciate the challenge of the course. If you respect the course, race within your limits, and respect your body’s ability you will have a memorable experience and hopefully find yourself free and clear of an injury.


About the Author:

Eric is a physical therapist and the founder of Beyond Exercise, a health and fitness business that specializes in physical therapy, sports performance, and integrative health solutions. Eric is a certified running coach with USA Track & Field and the Road Runner’s Club of America. One of his specialities is in rehabbing and developing running athletes. Eric is also the director of BE Racing, an elite amateur racing team comprised of runners, triathletes, and cyclists in Cincinnati.