injury prevention

Injury Prevention with Physical Therapist Kaci Lickteig, DPT


By CTS Coaching Staff

A great physical therapist can be an important part of an athlete’s support network, not only because they can help you return to training and competition following a serious injury, but perhaps more importantly because they can help keep small issues from becoming serious injuries in the first place! We asked Kaci Lickteig, a Doctor of Physical Therapy (DPT), what she wishes athletes would do to take better care of themselves before they step into a PT’s office.

If Kaci’s name sounds familiar to the runners in our audience, that’s because Kaci won the Western States Endurance Run and was Ultrarunning Magazine’s Ultrarunner of the Year.  The “Pixie Ninja” is a CTS Athlete coached by Jason Koop, author of “Training Essentials for Ultrarunning.” And if you’re not a runner, you should still keep reading, because Kaci has advice for cyclists, triathletes, and other endurance athletes, too.

CTS: What do you wish 40+ runners would do to help them continue running pain-free for years to come?

Kaci Lickteig: I wish 40+ runners would maintain a good strength and stretching routine. I believe as we age it is important to keep our bodies strong and flexible. I have seen numerous people over 40 get injured due to weakness and inflexibility that causes stress and strain on tendons, ligaments, and muscles.

As we age, the body reduces the ability to maintain muscle and flexibility. It goes to the concept of ‘you either use it or you lose it’. Incorporating a strengthening routine 2-3 times a week and having a stretching routine after each run is all it takes. It doesn’t have to be long or elaborate. The main goal is to target an exercise for each large muscle group. You just have to make it a priority to be a part of your workout routine. I want to see everyone 40 and older running strong and injury free for years to come!



CTS: What do you wish young women would do to prepare themselves for an injury-free adulthood?

KL: I believe young women should prepare themselves by working with coaches and finding a way to incorporate a good pre-sport warm up. This allows both the muscles and nerves to start firing and communicating properly, so they decrease the risk for injury. I would recommend an easy warm up, such as jogging for 10 minutes, to increase heart rate and to get the blood moving throughout the tissues. Adding in some dynamic stretching and plyometrics is also good to include after the initial jogging is done.

Additionally, a post-sport stretching routine is a good idea. It allows the body to recover faster after a workout. Adding in sport-specific weight training can be helpful to maintain good joint stability and strength of muscles, tendons, and ligaments to decrease fatigue and instability related injuries.


CTS: Is there anything universal that you wish all endurance athletes would do on a daily or weekly basis?

KL: To sustain longevity in endurance sports, I wish all endurance athletes would incorporate more rest in their training. Rest is vital for recovery, and it is by far the hardest part of being an endurance athlete. We are not wired to want to rest, but without it there is no way to become a better athlete. Rest comes in many forms.

Daily we should be aware of how much we are ‘on the go’. Life is busy and we become so involved with everything going around us that at times we forget to take care of ourselves. Simply setting aside 15-30 minutes in the day to stop what you are doing and disconnect from social media and everything the day has thrown at you is healthy. It can boost your mood and make you feel refreshed.

Weekly resting is also important. I was once a believer that I didn’t need to take a day off from running. I thought that ‘more is better’ and resting would lead to detraining. I have come to find those beliefs are absolutely wrong. Taking a rest day, meaning NO running and only light and easy cross training if you must, is when your body heals and rebuilds to become better and stronger. The body requires stress to break down tissue and rest to rebuild the tissue. If you constantly stress the body and break it down day after day something is bound to break. That can be your physical body or it can be your mental state of mind. Being proactive and allowing a true rest day will help you to stay in the sport longer… and you’ll enjoy life more, too!

kaci lickteig ws100 2018

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CTS: What’s the best thing an ultrarunner can do to stay out of a PT’s office?

KL: The best thing ultrarunners can do to stay out of a PT’s office is to listen to their bodies. As athletes we are more tuned in to our bodies than non-athletes, but we do not need to take the mantra “no pain, no gain” literally. Pain comes in many forms. I tell ultrarunners to let pain be your guide. For instance, if an ultrarunner tells me they are having pain when they are running I ask the following questions in the process of deciding the next course of action. The examples below certainly don’t fit every case; I’m including them here for illustration.

Question 1: When do you have the pain?

Example answers: Before the run, during the run, or after the run extending into the later part of the day.

  • Green Light: Pain doesn’t cause limping or compensation when walking/running or daily living. Pain that goes away during the run or becomes less apparent.
  • Red Light: Pain that causes limping or compensation when walking/running or daily living. Pain that becomes worse with activity. Pain that last several hours or longer after completion of the run.
Question 2: How long does the pain last?

Example answers: The first few minutes of a run, the entire run, during the run on occasion, all of the run and then after, into the next day, etc.

  • Green Light: Pain diminishes after the initial warm up. Pain that doesn’t cause compensation when running.
  • Red Light: Any pain that lasts throughout the entire run, becomes worse throughout the run, and definitely if it lasts into the night and following day.
Question 3: Describe the pain.

Example: Sharp, throbbing, dull, achy, burning, stabbing, electric, etc.

  • Green/Yellow Light: Dull and achy pain usually can be worked through. Most of the time it is muscular and will improve after warming up the muscles.
  • Red Light: Any sharp, throbbing, burning, stabbing, and electric pain. Those are more serious and can be huge red flags indicating something more is wrong. Those kinds of pains are ones you do not run through and should rest and see if they subside. If not, you may need to see a doctor or PT.
Question 4: Does the pain increase, stay the same, or decrease throughout the run?
  • Green/Yellow Light: Pain that decreases or or stays the same may be okay to run through. However, go back to the questions above and make sure it is safe to run through.
  • Red Light: Any increase in pain should be a red flag and something you should not run through.

Overall, remember that rest days and generalized training days are just as important as sport-specific workouts. Be sure to include them in your routine in order to stay injury free and out of my office!


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CTS: What exercises or stretches do you wish adult cyclists would do when they are off the bike?

KL: I recommend a good overall body stretching routine for cyclists, to maintain their range of motion and prevent injuries. When you are cycling the body is in a compact form and rigid for the most part of your ride. You use the same muscles repeatedly for a given amount of time. All the posterior muscles in the back are extended while the anterior muscles are in a flexed position. Also, the head is commonly in extension causing the neck muscles to be strained.

Stretching and AROM (active range of motion) exercises are simple and easy to do and do not take too much time. Here is a sample of a good stretching/AROM routine you could do. Starting from the head down.

  1. Neck flexion/extension stretches: 5 x 10 second hold
  2. Neck lateral side stretch:  5 x 10 second hold
  3. Neck rotation stretch: 5 x 10 second hold
  4. Shoulder rolls forward/backward: 20 forward/20 backward
  5. Across arm stretch: 5 x 10 second hold
  6. Doorway stretch: 3 x 20 second hold
  7. Lying extension pushup: 3 x 20 second hold
  8. Kneeling lumbar flexion: 3 x 20 second hold
  9. Hamstring stretch: 3 x 20 second hold
  10. Quad stretch: 3 x 20 second hold
  11. Calf stretch: 3 x 20 second hold
  12. Ankle AROM circles: 20 times both directions


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Comments 25

  1. Never done stretching. We have to keep some tension on tendons/muscles for a SnapBack. Isn’t it in the bs side giving stretching credits for recovery? I’m 50. Maybe I’ll add some strength exercises, maybe…

  2. Not that Kaci needs any affirmation from me, but like the 72 year who commented earlier, experience is a great teacher. I’m 62, have incorporated stretching and rest days into my weekly routine for several years now, and it has preserved my ability to stay in the game. All credit to my wife, who just happens to be a PT as well. I was smart enough (for once) to follow her advice.

    Prevention is the name of the game. You’ll never be bulletproof, but you’ll have a better than not chance of staying in it and staying stronger, for longer. Ask the 30 somethings who keep getting thrashed by the “old dudes”.

  3. All great advice. I recently had emergency abdominal surgery and started back running my 4 miles a day after 5 weeks of rest. It just takes time to get recover which is difficult for me. Here is the funny thing…one day I was running South on my trail and I think it was you running North? At my turn around point, I was thinking I’ll catch up to the cute woman I just passed…lol, I was running at a decent pace and was left in the dust. So, keep your eye out for the bearded runner…I’ll say hi next time we cross paths lol.

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  5. Great a advice Kaci. I began running when I was 14 ( back in the day when I was speed skating) and now, at 72 I’m still at it largely because I had good advice from the beginning about strength training and stretching from coaches and PT’s. Everything you provide here is in harmony with what I have taught by others and that other teacher called “experience”. Glad you are healthy again and thank you.

  6. For a short article there is actually a ton of usable and applicable information here, it would be impossible to detail to many specifics in a short space. This is one of the best articles I’ve read with a combination of brevity, clarity, and actionable information.

    1. Great advice Kaci! Thanks for sharing! I always need the reminder about strength and warm up and cool down and stretching being so important for those of us over 40! Keep up the great work!

  7. Maybe not, but we all need reminding sometimes and I know many new ultra runners who look for this type of information. Let’s stay positive and supportive! 🙂

  8. The one thing that I would add about pain is this – where is the pain? If it’s muscular, light workouts will actually speed up the healing process. If it’s in the joints or connective tissues (ligaments and tendons), I would be very wary and try to address the problem immediately, or even refrain from running until it passes.
    I totally agree with the recovery – exercise actually destroys muscle, it’s the recovery process that rebuilds muscle. Once you start thinking in this frame of mind, you can really appreciate the rest periods. After a really big effort, some total rest is needed. After tough workouts, or on a weekly basis, I prefer active recovery – keep the body moving without impact or strain (walking, swimming, biking, etc., without real effort)

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  10. I liked everything Kaci said. I’m a 51 year old ultrarunner and PT, so when I asked myself this question before reading Kaci’s answer, my answer was ICE. When I am training hard, I will bring a baggie or 2 of ice and an Ace wrap to my run and put it wherever I’m sore. I do this even when nothing is giving me any issues. It works great. Throw it on, drive home and your done. I loved what she said about pain too. I would add a caution because I frequently hear runners talk about taking pain killers after training. You can’t listen to your body if you are masking the pain. PoDog Vogler

    1. Absolutely! Great advice on the ice. And yes, pain killers and anti-inflammatory medications should be used with extreme caution. Thanks for the added tips.

      1. Plus I have read that nonsteroidal antiinflammatories like ibuprofen or naproxen actually impead the training response (increased strength and endurance) while alleviating pain. Exercise makes you tired, sore and exhausted; recovery makes you stronger, increases endurance and refreshes.

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