Part 1: My injury story

My name is Katie Balthrop and I am a runner. I’m a lot of other things too but running has been a dominant part of my identity since I was 12 years old and realized I was athletic, as long as the sport didn’t involve hitting, throwing, catching or shooting a ball of any type. One foot in front of the other? Yes please. A competitive hurdler in high school and a social runner through college, my story truly starts in adulthood where I’ve found life-long friends and the unmatched joy of burning lungs and burning leg muscles as I pushed myself to excel at longer distances.

Running has been with me through 6 relocations, career changes, 3 babies and all the ups and downs of finding a path and purpose in life. Running is my metaphor for all things; working toward goals, coaching, being coached, being a teammate, needing teammates, success, failure, setbacks, disappointment, euphoria, prioritizing what’s really important. Running is where I have had the best conversations both with myself and with other people. Running is where I find what I’m made of.

I’m also a sports scientist. I study running, strength and conditioning, injuries, recovery, programming and the art of putting it all together for other people to achieve their goals, and sometimes to keep them from doing something stupid. I own a small gym, Savannah Sport & Wellness, where I see clients of all types but specialize in runners and young athletes.

My story gets interesting in all the wrong ways around the time that we moved to Savannah in 2013. Since then, it’s been 10 years of the highest highs and the lowest lows. As I prepare for one more Bridge Run, kind of on a whim and at the gentle encouragement from my friends at Fleet Feet to make a comeback and tell my story, I reflect on events that have made me who I am and have shaped my professional career.

It’s December 6, 2014. I’m still fairly new to Savannah but I’m confidently toeing the line at my first ever Enmarket Bridge Run. I’ve never raced the bridge, but I’m not worried. At 34, I’m at the top of my running game. We’ve moved a lot, I’m starting grad school and I have 3 little kids at home, but I finally feel great and in control of my training. I’m predictable, I don’t miss a day, and I’m hitting my paces. I’m enjoying a recent 3:18 marathon PR that earned me an entry into the 2015 Boston Marathon. Best of all, I’ve met a great group of running friends in my new city that is to be our permanent home.

I’m lined up with my new friend Alyssa, the rare find of a running buddy that I can train with, then race against, and still be friends at the finish line.

The 5k is fun. A charge uphill and sailing back down, pushing the pace but chatting and admiring costumes. We shake it off, and line up for the 10k. Off we go, up, over, down, and around we go, miles pass, and we start to feel our efforts. Alyssa is fast and pulls me along. As we head back up our final climb, we realize that we are probably in contention for a top 3 finish in the overall women’s Double Pump. That last podium spot…it was going to be one of us. We charge up the final climb and roll over the crest. We stretch it out on the descent, stride for stride, breathing hard and having a great time. The sudden pain came out of nowhere, stabbing at the bottom of my right buttocks. I pulled up a bit and Alyssa surged ahead. Geez, what was that? I grabbed my right hamstrings and limp-jogged in, trying to figure out what happened but also immediately bummed that I hadn’t been able to compete for the finish line. If you look up race results from 2014, there’s my dear friend Alyssa, podium finish. My name isn’t there. No prize for 4th place.

It wasn’t like those moments you see in track where a sprinter pulls her hamstrings so severely she can’t take another step and collapses in her lane. It was like most endurance injuries: insidious, sneaky, nagging, sore, but not definitive. The more I work with runners of all ages, the more common this story becomes. It’s so rarely a major event, it’s a series of frustrating, unpredictable, tweaky and twingy moments that add up to a real problem. And so the story goes for me. Lots and lots of little mistakes that created a big, unfixable chronic condition.

Ah, hindsight. If I had stopped then and given it 6 weeks, seen a doctor, gone to physical therapy, I’m almost certain I would have healed and it would have been nothing but a blip.

In the few weeks that followed I couldn’t tell if I was hurt. Most runners can commensurate. On some days it felt fine, some days felt tweaky, and some days it hurt to run, or sit, or do much of anything. Why didn’t I stop?

The Boston Marathon.

I had qualified once before and missed it when my 3rd baby was born the week before the 2012 race. I couldn’t wrap my head around missing it again. I convinced myself I was a fast healer. Just a little hamstring pull, no big deal. I am tough. Gritty. I could dig deep.

I started training a few weeks later. It hurt. Everything was off. I switched to the elliptical and bike for long miles. It all seems so obvious now, as with most things we regret. Being stubborn is not the same as being tough and there is no such thing as a fast healer. There has never been a time where I’ve so blatantly ignored the feedback my body was giving me.

What’s more, I should have known better. I’d been a fitness professional for 10 years and was in graduate school earning my Masters of Science in Sports Medicine. My capstone project was on running gait analysis. Academically, I was living and breathing physiology, kinesiology, biomechanics, injuries, anatomy and watching slow motion videos of dozens of runners. Personally, I was, day by day, permanently damaging my hamstrings and taking from myself something that I loved as I chased a short-term goal.

Boston 2015 was a cold and rainy mess – 34 degrees and drizzling all day. The weather matched my inner turmoil. I lined up, cold and wet, determined, scared, thinking only of finishing, full of self doubt. Was the Bridge Run really just 4 months ago? I had to tell myself multiple times that I could cry or I could run but I couldn’t do both. I crossed the finish line almost 30 minutes slower than my qualifying time 18 months before. I was beat up, cold, conflicted about my accomplishment and in serious need of a hot shower and dry clothes. My legs and my spirit were shot. I’ve never been so happy to see my family walking toward me. My husband wrapped a blanket around me, my sweet kiddos hugged my knees and I collapsed on my mom’s shoulder. I didn’t run again for a very long time.

Part 2: The Importance of Running Technique and Warm-Up: Don’t Just Shuffle Out the Door.

Have you ever seen race pictures of yourself and thought, “no way, I don’t run like that!” I know I have, and I wish I’d believed my eyes before I got myself into injury trouble when I tore my hamstrings in the 2014 Bridge Run. Maybe a friend has taken videos for you and you can’t believe you’re a heel striker, or that your leg swings out kinda funny, or that your hips drop side to side. A picture truly tells 1,000 words.

You’ve read my injury story in Part 1. In Part 2, we are going to delve into some running techniques, tips and cues that I’ve developed over 10+ years of working with injured, emerging and performance-driven runners.

One question I love to ask my runners: Would you ever give a kid a basketball and say, “ok, good luck, try hard!” Of course not. Any coach would teach skills and fundamentals with ball handling and movement on the court. Think of how much practice it takes to develop basketball proficiency, let alone a high-level skill and ability.

Here’s an example that most of us can relate to: have you picked up pickleball? Yeah, me too, at least a little bit with very patient and kind partners. The few times I’ve been on the court there has been a LOT of coaching on technique and fundamentals, for which I’m grateful. What’s the point if I don’t learn the right way to play? I’ll never get better and I might get hurt.

Unfortunately, it is rare in running to begin with fundamentals, economy and efficiency, technique, foot strike, push-off, or strength. We think that humans naturally run in their best way and that we shouldn’t change a runner’s stride or gait. This is often untrue. Most of us waste energy, put undue pressure on our joints with poor form, and fail to use our powerful posterior chain muscles (glutes, hips, hamstrings) to push off and propel us forward. There ARE right ways to run, and a lot of wrong ways. Luckily the wrong ways are fixable, no matter what your age.

There are points in the running stride that determine the forces and stresses on the body` through the gait cycle. When I analyze running gait, I break it down into the following phases:

1. Initial contact to see how the runner’s foot meets the ground and how the body responds to the load and ground force reaction.

2. The position at mid-stance when a runner is bearing his or her full weight on one leg.

3. Terminal contact

4. Push off,

5. Swing

6. Initial contact again

I also look at structural anatomy to check for flat feet, varus (bow legs) or valgus (knock knees), Q-angle and hip structure, and spinal curvature. All of this information informs me about why a person runs how they run, why they might be having pain, and what we can do to help improve their running.

The most common problems are over-striding leading to a pronounced heel strike and shuffle-run pattern, hip and core weakness that lead to hip drop and leg swing, and rotation at the midsection. Some of this is fixed with cuing and practicing different techniques. Almost all running problems stem from weakness or muscle imbalances, particularly in the glutes, hip stabilizers and core. Tight hip flexors play a role, as do unengaged hamstrings. We’ll discuss strength and conditioning in Part 4 of this series.

Here are some simple technique cues to improve your running:

  1. Push-off, engage your glutes as your foot leaves the ground to help extend your hip.

  2. Push back with your elbows during your arm swing. It cues the push-off.

  3. Run “tall” without bending at the waist but lean into it. Notice if you tend to lean back and purposefully press forward with your upper body. This brings your center of mass over your feet.

  4. To help with over striding and a pronounced heel strike, work to tighten up your cadence and shorten your stride a bit. This will help your initial contact point to be under you instead of out in front of you.

Here is one of my favorite graphics illustrating typical versus ideal running form.

Three of the most essential pieces to good technique and a long running career are a proper warm-up, cooldown, and intentional, running-specific strength training.

A good warm-up should be 10 minutes or less but can mean the difference between a good run and a bad one. The point is to get your heartrate and body temperature slightly elevated, then put your joints and muscles through their ranges of motion and stretch-shortening cycles to prepare them for efficient running. The shuffle run out the door is NOT the best way to start a run! There are many drills and dynamic movements that can be incorporated, but some of my favorites are ATG lunges, A, B and C skips, high knees, butt kickers and leg swings.

Check out this video for ATG lunges: https://youtu.be/szIlTVlBDDY?si=FJ2fbsdBAc7Ey1xw

Check out this video for skip variations: https://youtube.com/shorts/QBiqiKZxuKQ?si=MDCKtRavnzwlUXnT

Changing your running form takes practice and can feel awkward at first. Have a friend take videos of your “before” and “after” so you can see how your form has improved. The more you practice the more natural it will become, and you’ll save yourself from some common aches, pains, and injuries due to bad form. Trust me, I know. After what could have been a career ending injury, I completely revamped my gait to this technically sound variation that started me on the long road of recovery and being able to run again.

Part 3: Surgery, the last option in a frustrating quest for healing.

The alarm sounds at 6 am. I tap my phone to turn it off almost immediately. I’m already awake, waiting for that audio cue. The hotel bed isn’t uncomfortable, but nerves have kept me up most of the night. I shower and quietly dress as my husband sits on the bed, waiting for me. We walk to the car without talking much and I spend the short ride struggling to get my wedding rings off. They usually stay in place and don’t slide off easily. My knuckle is raw as I finally scrape them over my finger joints. I drop both rings into the cup holder and my husband frown-smiles at me, one of those straight-lipped smiles that projects concern, not happiness. We pull into the Duke University Medical Center parking garage, one of the first patients to arrive for the day.

It’s the fall of 2018. The Boston Marathon of 2015 is a distant memory. In the three years since, I’ve been through round after round of physical therapy, injections, PRP, nerve block studies and repeat imaging. I’ve seen multiple orthopedic specialists who can’t seem to agree on a course of action. No one knows why I’m hurting so much and not getting better. My legs, my back, my SI joints are on fire all the time. Running isn’t an option. I’ve attempted to enjoy cycling and swimming. I’ve graduated from my master’s program and thrown myself into my work and the opening of my gym. I love my work and my family, but I’m desperate to feel better.

I’ve decided that surgery is my only option remaining, if only for function and pain relief. Hamstring repair surgery has become more common recently, but 5 years ago it wasn’t, so we traveled out of state to one of the few specialists in the country. My case is first on the schedule so prep starts at 6:30 am. I don’t remember much of those 24 hours in the hospital. The report from my husband included anecdotes like how many times I asked for Tylenol when anesthesia was wearing off (many), that my resting heart rate, still low from years of training, threw the nurses for a loop (is that normal for her?), and finding during surgery that one of my hamstring tendons was completely avulsed from its attachment point on my pelvis, and the other two were stretched, thin and frayed. An MRI of my other, non-operative side revealed all three hamstring tendons were damaged and frayed. These types of tendon injuries don’t heal on their own. However, my surgeon said the procedure went well and he had high hopes.

I did not recover well.

My body kicked up a huge inflammatory response which inhibited tissue approximation and therefore inhibited healing. Instead of cruising through rehab and getting back to running in 6-9 months as expected, I confounded my doctors with my body’s overreaction to the insult of surgery. With the stress of the systemic inflammation and physical therapy, and despite trying to live and work as carefully as possible, the repair partially failed. Instead of getting better, I began seeing rheumatologists who diagnosed me with an autoimmune condition that required a bi-monthly infusion to calm it down.

I felt betrayed from the inside out. The body that had always done what I’d asked of it was no longer strong, resilient or at all predictable. My mental health began to suffer. I watched my former running buddies continue to throw down killer workouts. I coached dozens and dozens of people through their workouts, training plans, sporting events and races. I could hardly stand to watch from the sidelines, especially running events. I felt like I’d lost myself in the span of 5 years.

Injury was a lonely place for me. I didn’t feel like sharing my story. My introverted nature kept me from seeking support from my friends and my running community who could have lifted me up. I retreated instead.

As life goes on, things usually come along to help balance out our priorities and sense of self. Three things happened toward the end of 2019 and beginning of 2020 as I hit an all-time low. I sought another physical therapy opinion, I found some mental health guidance, and covid-19 rocked our world. Talk about perspective. It was time for a hard reset.

Part 4: The Importance of Lifting Weights for Runners

Thoughts from a gym owner who defaults to running.

I’ve been around weight rooms since I was 13 years old and I now own a gym, so this might sound a little backwards. Sometimes, lots of times, I just don’t want to lift weights. I want to run. I don’t get the same high from squats as I do from 800 meter repeats. Sound familiar? Unfortunately, my 800’s tend to suffer (along with every other run) when I don’t do squats. What’s a runner to do? 

Research says to lift, and not just for endurance. Runners need to lift heavy for strength and power.  

I found this especially important as I climbed out of a difficult recovery from a hamstring repair that partially failed and I had to stop running completely for over a year. Strength, stability, mobility and running technique became the only way I could ever hope to run again.

Cross-training for runners is often an afterthought, or an add-on to a run, something we do if it’s raining, or pushed aside for additional miles. We might be ok, even pretty fast for a while, but skipping weights and cross training will eventually catch up to us. Many of us find this out the hard way, when our training runs and performances suffer, or we get hurt.

Lifting weights increases endurance, running economy, and sprinting speed. It balances out weaker muscle groups and creates strength and stability in our muscles, tendons and ligaments. 

There is a big myth in the running community that we should only do light weights at high reps or we’ll bulk up. This is untrue. You bulk only if you’re lifting specifically to get bigger (muscle hypertrophy). Lifting for any goal, including bulking, is an intentional combination of sets, reps, weight and rest. Changing these variables yields different results and we can use them to meet any athlete’s goals. 

When I’m programming runners, I often start with an endurance phase to build a base, much like building a mileage base, but we don’t stay there. We progress to lifting for strength and power, which is where the real improvement in running performance is achieved. Much like adding tempo and speedwork to your running training, lifting for strength and power is key to being fast and reducing your injury risk. 

I find the following charts particularly helpful when explaining how weight lifting in different combinations of sets, reps, load and rest between sets result in different physical outcomes. 

The first chart is the continuum of the different goals of weight lifting.

For example, when we lift in sets of 13-20 reps we will build mostly muscular endurance but we will see very little gain in strength or power. If we want to get big (hypertrophy) we program in sets of 7-11 reps. For strength and power, it’s sets of 2-6 reps.

The second chart is how to decide how much weight to lift for those reps and how many sets to do. If you don’t know your 1 Rep Max percentage, you can use a scale of 1-10 for perceived effort and get pretty close to the right numbers.

The final component in weight training is exercise selection. This is where I truly dial in to what my running athletes need. Not everyone needs the same exercises to accomplish their goals. In fact one person’s program rarely translates directly to another athlete. If you’re just getting started, exercises like squats, lunges or split squat, Cossack squats (lateral lunges), RDL (Romanian Deadlift/ “hinge”), step-ups, bench press, lat pull, mid-back row and shoulder press would be good choices.

I emphasize work with a flat band like fire hydrants, clam shells, donkey kicks and lateral walks. Other mat work should include bridges both double and single stance, pelvic tilt, planks, side planks, back extensions and mobility work.

Check out these resources for additional information:

Strength training for runners: Your need-to-know guide (runnersworld.com)

What are the Best Strength Exercises for Runners? (matthewboydphysio.com)

Finally, a key component to running success and something that I insist that my runners do: define “seasons”.  It’s important to look ahead at your year and plan when you’ll be racing and back your seasons up from those date(s). For example, if your “A” race is an October half marathon, your year looks like this:

January-March: Off Season: Focus on building strength and stability in the weight room, locking in technique adjustments and sorting out imbalances. Running workouts are focused on building a base.

April-June: Pre Season: Weight room workouts shift to compound and more advanced exercises, explosive power (yes, even for distance runners) and plyometrics.

July-September: In Season leading to A Race. The focus shifts to harder running workouts, technique, race strategy, fueling. Weight lifting and other gym work is auxiliary to the running workouts.

October-December: Post Season: Focus is on recovery and rest, addressing any injuries and cross training with different sports like swimming, biking and yoga. Take a break from running! Weight room work toward the end of the postseason is focused on base building and weight lifting endurance.

To learn more about strength training for runners and to get started with a personal program, please email Katie Balthrop kbalthrop@savannahsportandwellness.com or call/text 912-656-0736. 

Part 5: Back at the Bridge Run, 9 years later…

It’s December 2nd, 2023. I’m toeing the line at the Bridge Run again. It’s been 9 years since my first, (and until today, last) Double Pump where I tore my hamstring in the last downhill and suffered a long, complicated, partial recovery. I’ve avoided this race, and all races, for years. I felt like a shadow of my former self, like I’d lost an essential part of me that was racing, like I didn’t want to show up to a race when I wasn’t ready to crush it. I didn’t want to be one in the crowd. I wanted to be at the front and when I couldn’t do that, I didn’t want to do it at all. 

It’s taken a long time to work through those emotions but today I am joyful.

9 years ago I remember waking up two hours before the race with my gear carefully set out: my shorts and tank top, throw-away shirt, socks, shoes, and of course my running watch to track every second of my efforts, all laid out on the floor in the shape of the human that was to wear them. Nothing was out of place. This morning, I had pushed snooze on my alarm, haphazardly cobbled together a semi-matching running outfit in the semi-darkness of my bedroom, and dragged my 17 year old out of bed…twice…to make it to the last 5k shuttle. My watch hadn’t been plugged in all the way, so the battery was dead.

9 years ago I had ventured downtown alone, not knowing many people, looking for the one or two running friends I’d made so far in Savannah. Today, my teenager and I joked around on our drive downtown, noting with a little concern that we were 10 minutes late, charging my watch on the way to see if I could get enough juice to make it through 9.3 miles. We squeezed into a parking spot that probably wasn’t really a spot and jogged to the line for the last shuttle. No worries, no pressure, just hanging with my kid, chatting with friends we bumped into all along the way.

Over the river on Hutchinson Island we waited in our corral for the start of the race. I realized that this was a bigger milestone for me than any PR race or grueling workout. This was me showing back up, rejoining race day with no hopes of racing. As Ernie Ledesma sang the national anthem and the crowd of runners surged forward I wondered why I’d stayed away so long. Race day is euphoric whether you’re first or last.

My son John and I agreed on an 8:30 pace for the day. He is faster than me, so for him to offer to run with me felt special. We wove through the people who had lined up in front of us but started out walking or jogging. This used to bother me. “Why are you lined up in front?!” I would think to myself as I darted between humans to gain a position I wanted. This time, we casually found openings as they presented themselves, weaving back to John when we got separated. 

The 5k was purely fun. We adjusted our pace on the first climb when we fell into step with friends, talked for a minute, then kept on our way. The first time up the bridge seemed to go by quickly with all the distractions of a crowd of runners. I will always love the feeling of cresting a hill, when my legs feel the difference of the incline leveling out and I know I’ve made it through the effort. I thought I’d have to hold back on the downhills, but in the 9 years of rehab and gait retraining since tearing my hamstring, I’ve perfected my art of protecting but not braking on downhills. I felt free as a bird sailing down the bridge back into Savannah. 

The Savannah Sports Council does this race right, especially the finish line announcements and energy. You can’t help but be excited to be a part of the day when you’re running up Oglethorpe to crowds cheering, music and someone calling out individual names. We had enough time for a pit stop, to ditch extra clothing and walk up to the 10k starting line.

About a mile and a half into the 10k we were on our second climb of the bridge. John and I came up behind one of his teachers from school. In a moment that I’ll tease him about forever, he seemed to decide that it was not cool to be running the same pace as his mother and surged up the hill in front of us. She said, “well, I can’t do that” and I said “me neither”. He stayed ahead of me the rest of the race, his neon yellow shirt getting farther ahead as the miles passed. 

Until this race, my longest run had been about 8 miles on flat ground. I hit about 7.5 and my legs said, “this is when we stop, Katie”. But I remembered that old feeling and I’ve told my legs “not yet” many, many times. It’s one of my favorite feelings, digging a little deeper, pushing just a little more. I refused to look at my pace. I focused on technique, cadence, and the people ahead of me. I got passed. Twice. Oh well.

The last mile was a long one, just one foot in front of the other, steady, eyes up. I didn’t sprint at the finish. I had nothing to prove, and not much left to give anyway. How nice to hear my name called, one of thousands, but it was there on the list, still worth calling out.

So much perspective is gained when we are forced to become a new version of ourselves. I’m glad that my Fleet Feet family convinced me to give The Bridge Run another shot and to tell my story along the way. If you’ve been reading along you know it’s a long one. I didn’t shorten it for blog or newsletter length, I just told it like it was. It hasn’t been an easy road, but this race felt like I was closing the loop on an experience that has changed who I am. I’m grateful for the support of the running community and I don’t think I’ll be avoiding race day anymore. No one will remember if I win, but hopefully I’ll be able to do something bigger: help other people find their way through injury, changes, setbacks and self-doubt. 

Thanks for reading along. The 6th and final part, looking to the future of running, will come out next week.