When I was in my early 20s and living in New York City, I often used to sleep in my running clothes to buy myself more shut-eye before rolling out of bed. I was usually successful, getting out the door within half an hour, sometimes even in 10 to 15 minutes if I didn’t down a cup of coffee first. Now, at 36, I find that I need at least an hour to not only wake up and pace myself with that coffee… but to also get in some prehab exercises.
I recently ran my first Boston Marathon, after a solid couple of years of improving my marathon time, with no major injuries. However, I had been feeling like my legs were dragging on most of my very easy runs both before and after the race. I took more than two weeks completely off after the marathon, expecting to feel fresh and ready to go once I got back into it. Instead, I felt exactly the same.
To address my heavy legs issue, I scheduled a tune-up with a highly recommended exercise physiologist thinking he’d help to flush my legs out and I’d be good to go. Instead, I got a deserved lecture about all my lower-body weaknesses and went home with homework in the form of regular prehab exercises.
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I’m about two months into my new prehab routine and while I wouldn’t say I’m good as new, I have already noticed a difference in how my legs feel in my daily runs—and my normal easy paces are slowly coming back.
So what is prehab? I asked a few experts to break it down. Here’s how you can implement prehab into your routine to keep injuries at bay and your body performing at its best.
What exactly is prehab?
According to Jessica Mena, D.P.T., C.S.C.S., a physical therapist in Los Angeles and an RRCA-certified coach, the term “prehab” is typically used to describe a tailored strength program created by an expert, such as a physical therapist, exercise physiologist, or chiropractor for injury prevention. (As you can see, it’s a play on rehab, but before you’re injured.)
Prehab can help you fine-tune and correct imbalances if you’re found to have certain weak points (which virtually all athletes do), like your hamstrings and calves, which can lead to issues like tendinitis or plantar fasciitis.
“Everyone, including runners, has an imbalance and you might be asymptomatic where you’re not having issues,” Mena explains. “But the whole goal is to find these weak points and try to optimize them so that you don’t develop an issue down the road.”
Unsurprisingly, many runners find themselves in the predicament where they’ve gone so long without doing any prehab work that they’re deep into muscle weaknesses and imbalances, and this doesn’t mean that you’re a poor athlete, says Athena Farias, an exercise physiologist, RRCA-certified coach, NASM-certified personal trainer based in San Antonio, Texas. That’s why she takes a positive approach with the terminology she chooses when prescribing a program after putting the athletes she coaches through a movement screen to identify existing weaknesses.
“When runners hear the words ‘corrective exercises,’ it can make them shut down,” she says. “But really, it’s just movement prep to get your body warmed up and get your muscles ready for what’s about to happen with the impact and load on the muscles, bones, ligaments, and tendons [during running and race training].”
Is prehab more important as you get older?
Unsurprisingly, the majority of runners who come to the realization that certain weaknesses are catching up with them tend to be those nearing or past master’s status. And research shows that older runners are more prone to frequent injuries and may take more time to recover.
“Physiologically, as we age, our muscles and tendons also change—not only are we losing muscle mass, but our tendons also lose their elasticity and strength leading to a decreased snap and power,” says Ian Nurse, D.C., a chiropractor and owner of Wellness in Motion in the greater Boston area. “Supplemental strengthening and regular bodywork from massage becomes even more crucial to keep the tissue active and strong, as well as healthy through increased blood flow.”
However, this isn’t always tied to actual age. Mena says it may also be tied to how long you’ve been running. Research also suggests how many miles you clock may play a role in injury risk, though numbers differ between men and women. “The longer you’ve been putting miles on your body’s muscles and tendons, the more you have to be diligent about doing the small things,” she says.
That’s why prehab is something that becomes important to prioritize, along with other aspects of your lifestyle, such as addressing stress and getting quality sleep, Nurse says.
“Overuse running injuries are usually the product of multiple factors including many that people don’t feel are running related, [and instead] occur when the overall load placed on the body exceeds its capacity,” he says. “What many don’t realize is that load and capacity consist of many factors such as sleep, diet, and stress, in addition to strength, flexibility, and tissue health.”
What type of provider should you see for a prehab program?
It’s easy to get overwhelmed by the different types of specialists out there and you’re probably wondering if you should seek out a physical therapist, sports chiropractor, or exercise physiologist.
“If you’re looking for more manual treatment of the muscles (including myofascial release, such as massage) or treatment of joint restriction/dysfunction, you should see a sports chiropractor. If you’re looking for a comprehensive rehabilitation plan to address a musculoskeletal issue and need continued instruction/observation through the plan and its exercises, see a PT or physio,” says Adolfo Liu, a chiropractor at Avanzaré Chiropractic Sports Therapy in San Francisco.
“In my opinion, there is only so much one can do on a foam roller or with a massage gun. It’s important to have a trained professional also assess and treat an injury or potential injury,” Nurse says.
When to see a physical therapist
You used to need a referral from a physician before seeing a physical therapist. In the U.S., all 50 states now have direct access, which means a physical therapist can evaluate you and begin a treatment plan without that first step, though some states have limitations.
However, physical therapists, like Mena, often see patients who are already injured and in pain, she says.
“Your first plan of action should always be to see a physical therapist any time there’s an ailment or concern,” Mena says. “But if you want to get assessed for a tune-up [even if you don’t have aches or pains], they are also helpful because you’ll get a plan right off the bat in terms of exercises, and we will look at your gait, mobility, and strength, which a chiropractor or a performance or strength and conditioning coach might not.”
When to see an exercise physiologist
According to Farias, an exercise physiologist focuses on creating personalized physical fitness plans and goals, whereas physical therapists focus on helping patients learn or recover specific mobility functions as part of rehabilitation from injury.
Many exercise physiologists, such as Farias, work closely with physical therapists, and have patients come to them after initially working with a physical therapist. As such, they can be a good resource whether or not you’re already injured, especially if you are dealing with an ailment but have found that local physical therapists in your area are booked for weeks, Farias says.
“I’ve had athletes roll their ankles but haven’t been able to get in with a PT for several weeks,” she says. “In these cases, I can give them some exercises to do in the meantime while still staying within my scope of practice.”
Many physiologists like Farias are also running coaches, which means they are unlikely to take the approach of telling you that you need to stop running, as some medical professionals are still in the mindset of doing, she says. “As they say, ‘motion is lotion,’ and with a proper exercise plan, many athletes are able to continue to run without slowing down [literally or figuratively],” she says.
When to see a chiropractor
As medical specialties have evolved to overlap in techniques, so have many chiropractic clinics, including Nurse’s, which includes a variety of wellness disciplines from physical therapy, massage, acupuncture, fascial stretch therapy, podiatry, nutrition, and sports psychology, all of which play key roles in prehab care and rehabilitation from injuries, he says.
As for chiropractors in particular, look for those who are soft-tissue focused with active release techniques or Graston Technique (a rehab strategy that uses metal instruments to enable the treatment of scar tissue and fascial restrictions) certifications. This makes them an ideal resource when dealing with injuries like iliotibial (IT) band syndrome, hip flexor strain, glute strain, runner’s knee, shin splints, Achilles tendonitis, and plantar fasciitis.
“When you are looking for a practitioner, make sure you find someone that has many tools in their toolbox,” Nurse says. “As a soft-tissue-focused chiropractor, I see runners for both preventative maintenance as well as acute/chronic injuries.”
What prehab exercises should you be doing?
As mentioned earlier, there is no one-size-fits-all approach to prehab, even if virtually all of us should be doing it. Generally speaking, however, core and hip strength-based exercises are what Liu sees most runners are lacking. The below three exercises are what he would consider to a good starter pack:
Mena also emphasizes that most athletes have lower-body weaknesses and need to work their glutes, hips, adductors, hamstrings, and calves. Those are the little things people hate doing, but they keep you balanced, she says.
Mena’s go-to prehab exercises include:
“Glutes are notoriously weak in runners and as they add to both propulsion and stability, they are incredibly important,” Nurse adds. He typically recommends the following exercises, performed using just body weight at first and then after a few weeks of building proper form and strength, adding bands:
- Monster walks
- Clamshells
- Lateral leg raises (performed lying on side)
- Fire hydrants
While most prehab exercises can be done at any time, there are dynamic exercises that Farias recommends doing immediately before a run to prime your body for what it’s about to do. Some examples include:
- Butt kicks
- High knees
- Leg swings
Contributing Writer
Emilia Benton is a Houston-based freelance writer and editor. In addition to Runner’s World, she has contributed health, fitness and wellness content to Women’s Health, SELF, Prevention, Healthline, and the Houston Chronicle, among other publications. She is also an 11-time marathoner, a USATF Level 1-certified running coach, and an avid traveler.
