Common Injuries • Shin Splints • Medial Tibial Stress Syndrome • Stress Reactions

• Stress Fractures • Achilles Tendinopathy • ITB Friction Syndrome

• Patellofemoral Pain Syndrome • Plantar Fasciitis • Hamstring Strains • Low Back Pain

The Bad News Chronic, Overuse Injuries:

•Repetitive tissue microtrauma Ex: Wolfe’s Law Tensile and Compressive Forces •Reinforced malalignment; dyskinesis •Volume/intensity overload •Lack of rest and/or periodization in training cycles •Improper recovery (nutrition, sleep, time off, cross training, ect.)

Contributing Factors 1) Genetics 2) Mobility 3) Strength 4) Biomechanics 5) Training style

The Good News Many Causes = Many Solutions Address mechanics and training

Improved performance

Increased training efficiency

Decreased time-loss due to injury

Increased availability of training time

“[People] are a system of pulleys and levers, muscles and tendons that move those parts, and a brain to process and refine the reflexes and control the limbs. Even with all this variability, good running form should still play by a few rules” –Jay Dicharry, Anatomy for Runners

Keys: Mobility, Stability, and Training

Mobility, Stability, and Training Potential Problems: - Genetics - Mobility - Strength -Biomechanics

Viable Solutions: - Maximize natural abilities - Flexibility - Balance, Coordination, and Endurance - Stride

- Training Style

- Optimal Training Program

Mobility So I need to stretch more…?

Mobility: Functional ROM • Ability to effectively pass through a functional range of motion • Active and Passive ROM Can you get your leg behind you? – Hip Extension – Ankle Dorsiflexion – 1st Metatarsal Flexion

Why Hip Extension? Tight Hip Flexor Muscles Contribute to:

• • • • •

Increased Anterior Pelvic Tilt Increased Lumber Lordosis Shortened Spinal Erectors Inhibited Gluteal muscles Lengthened and overworked Hamstrings • Lengthened Abdominals • Center of Mass shifts • Alterations in landing mechanics Neumann, D. Kinesiology of the musculoskeletal system

Examining Hip Extension • Passive Assessment ex: Thomas Test

Biel. Trail Guide to the Body

Active Assessment

Mobility: Stretching Problems • Post-activity stretching vs. post-activity socializing • Not addressing intended tissues – Ex: Gastroc but not Soleus – Ex: Quads but not Hip Flexors

• Poor form – Ex: Rounded Trunk for Hamstring

• Insufficient duration

Mobility: Stretching Tips • • • • • • •

Make it count Demonstrate and cue the athlete Educate on methods Longer Holds, 30-40 sec x 4 sets in elastic range 8-10 wks for lasting changes Foam Roller, Ball PNF

Mobility Activities for Runners • Deep Lunge Stretch

Mobility Activities for Runners • Bent and Straight Knee Calf Stretches

Mobility Activities for Runners • Foot and LE Mobilization

Mobility Activities for Runners • Eccentric Heel Drops

Mobility Activities for Runners • Self-Massage

Mobility Activities for Runners • Foam Roller

Can You Spot Any Runners Who May Have HF Deficiency?

Stability But I do abs every day...

Stability: Strength and Support for the Task at Hand • Ability to support body throughout the repetitive phases of running • Balance, Coordination, and Endurance – LE, Core, Glutes, Hip Stabilizers

• Reinforce the Framework for Movement & Energy Translation – Foot and Ankle

Neuman. Kinesiology of the musculoskeletal system : Foundations for physical rehabilitation

Running = Series of Single Leg Hops

Photo Credit: Tom Connelly

Lower Extremity Stability • Single Leg Balance test

Stability: Balance & Coordination • Inability to hold position statically → inability to support body during dynamic SL stances of running – Poor energy transfer during push-off – Accessory motion

• Unstable Base of Support

Stability: Coordination

• Can you move big toe independently? • Can you move toes at all?

Stability: Coordination & Strength • Great Toe acts to support balance – Assists Push-Off – Helps direct arch

• Foot and Ankle forms the lever arm for converting PE to KE

Stability: Strength & Endurance • • • •

“Core Strength”: More than just a 6 pack! Stabilize vertebral bodies Absorb and disperse force Can fatigue abdominal movers quickly – – – –

Ex: ~2mins (PRT) 10k ~30min 1mi ~4-6min Lacrosse game ~90mins

Stability Activities for Runners • Single Leg Balance exercise: – Stand Tall – Shoe Off – Neutral Spine with core engaged – Hold for time – Can add motion with increased proficiency

Stability Activities for Runners • Big Toe/Little Toe Raises: – – – – – – –

Start seated Lift GT and hold Relax foot Lift smaller toes Can assist initially Assist and release pressure Progress to alternating holds – Progress to standing

Novel Balance Training Method: StabilityShort Activities for Runners Foot Exercise – Start seated with foot on floor – Draw down and back with 1st metatarsal jt – Do not curl toes or roll foot/knee out – Progress to standing

• Stabilizes Arch • Preliminary evidence shows promising results in CAI patients

FAAM Sport Score (%)

• Short Foot Exercise:

Stability Activities for Runners • Muscle Groups to Remember: – Glutes! – Hip Abductors, Adductors, and Rotators

• Eccentrics! • Resistance Training – Hypertrophy, General Strength, Speed

• Plyometrics – Improve Neuromuscular Control and Power

• Hurdle Mobility

Stability: Strengthening Problems • Cheating the exercises • Fear of weight lifting – Increased size – Increased weight – Stygma

• Too much, too soon – Attempt too many new activities at once – Attempt complicated movements before sufficient strength in basics

• Miss muscle groups

Stability: Strengthening Tips Stability: Strengthening Tips • Master basic movements before complex ones – Make no assumptions – Don’t reinforce poor techniques and habits

• Don’t forsake form and control for heavy weights, high reps, or long holds • What does “correct” form and activation feel like? • Make sure local stabilizers “turn on” before movement and stay engaged throughout – Ex: Trunk Stabilizers, Glute Max – Endurance events require muscular endurance of stabilizers

• Educate and moderate in regards to lifting volume • Balance, Coordination, Endurance-Remember the little guys! And Glutes! And Eccentrics!

Acute and Chronic Injuries • Strengthening for an acute injury may not be indicated • Seek help from a medical professional

Training If I run more miles, I will become better at running…

Training Part 1: Basic Biomechanics Running Motion = Pendulum Running Energy = Loaded Spring

Flight

Initial Contact Mid-Stance

Toe-Off

Swing

Basic Biomechanics • Optimal Running Economy: Fastest speed using the least amount of energy • Smooth pendulum – Even leg swing front to back – 30-40% of time in stance, 60-70% in swing/flight

• Maximize our “spring” through efficient energy transfer – Loading phase: Initial Contact to Mid-Stance – Peak force at Mid-Stance – Mid-Stance to Toe-Off, energy is released

Basic Biomechanics • All runners experience high loads, Ground Reaction Force, during gait • GRF can be 2.2-2.7x BW – Higher for sprinters

• Poor attenuation of load, steep loading curve (high rate in short amount of time) combined with high training volume leads to injury – Ex: Stress fractures

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Dicharry, J. Anatomy for runners

Landing closer to Center of Mass decreases Loading Rate

Common Errors in Biomechanics • Poor hip mobility • Poor stability – Strength – Control

Common Errors: Overstride • Landing too far in front of COM • Prolonged Stance Phase • Overstride – Decreased efficiency, increased effort – Longer lever arm – Pendulum shifted forward – Possible braking forces – Increased time on ground and GRFs

Common Errors in Biomechanics • Why? – Trying to make up ground – Insufficient neural control • Cadence • Limb weakness • Habit

– Postural weakness

Common Errors: Prolonged Stance • Can look like plodding, heavy running, or sitting • Too much time on the ground

Tips for Training Biomechanics • Am I spending too much time on the ground? – Check cadence (steps per min) • • • •

Mid-way through “long” run 90+ ideal 80s average runner; look to improve 60-70s

– Work on stride and form in short intervals – Aquajogging, pool drills, and bike

Tips for Training Biomechanics • All sports skills require practice. Expect to practice changes to poor running habits! – 4,000-6,000 steps to change muscle memory – Free investment in health, safety, and fitness

Training Part 2: Exercise Prescription • Appropriate: Target individual or group with similar goals • Maximize individual talents and genetic potential • Graduated: Allow enough time to reach training goals • Account for changes in frequency, intensity, and duration – 10% rule

• Document: – Pre-planned workouts – Can track past

Exercise Program Pitfalls • Not quantifying training volume or duration – Ex: Long run – Cross training – Undefined “workout”

• Improper recovery – Nutrient timing – Nutrient type and amount – Sleep

BLUF • Injuries (and poor performance) come from overloading tissues • Mobility, Stability, and Appropriate Training – Enough motion to get leg behind you – Enough kinesthetic control to make use of stored PE and stability to transfer to KE for next step – Strength and power to drive body up and forward – Practice optimal biomechanics – Graduated, targeted exercise plan

References: •

Biel, A., & Books of Discovery. (2010). Trail guide to the body (4th ed.). Boulder, CO: Books of Discovery.

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Chang YH, Huang HW, Hamerski CM, & Kram R. (2000). The independent effects of gravity and inertia on running mechanics. The Journal Of Experimental Biology, 203, 229-38.

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Clark, N. (2003). Nancy Clark's sports nutrition guidebook (3rd ed.). Champaign, IL: Human Kinetics. http://catdir.loc.gov/catdir/toc/ecip043/2003009149.html

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Dicharry, J. (2012). Anatomy for runners : Unlocking your athletic potential for health, speed, and injury prevention.New York: Skyhorse Pub..

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Dicharry, J. Clinical Gait Assessment. Medbridge. https://www.medbridgeeducation.com/courses/details/clinicalgait-assessment

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Drewes, L. K. (2009). Effects of rehabilitation incorporating short foot exercises on functional outcomes for chronic ankle instability.http://wwwlib.umi.com/dissertations/fullcit/3447197

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Neumann, D. A., & Rowan, E. E. (2008). Kinesiology of the musculoskeletal system : Foundations for physical rehabilitation.St. Louis, Mo.: Mosby.

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O'Connor, F. G., Wilder, R. P., & Nirschl, R. (2001). Textbook of running medicine. New York: McGraw-Hill, Medical Publishing Division. http://catdir.loc.gov/catdir/toc/mh021/2002275392.html