1. Biomechanical Assessment and Treatment of Running Injuries Created by Francine Eastwood BScPT, ART Provider ®, Founder of PSI Runner’s Clinic, Senior Clinical Leader PSI Sports Medicine Centre, 1000 Palladium Dr., Kanata, ON. www.psiottawa.com Picture of elite African distance runners
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13. Running Form the good, the bad and the ugly Runner #1 – The elite model style Runner #2 – The jogger style Runner #3 – The peculiar style
21. Injuries and Biomechanical Flaws my observations…. Injury Potential Stride Flaw Correct form PFPS ITBS IR Femur during contact and support phase Pelvic drop (opposite) “ keep knees apart” cadence/MFS strength glute med/ tone adductors ADD Femur during contact/ feet cross over midline/ whip “ Run with line between feet” “ Drive from hip not foot” – as if running through tall grass “ good arm carriage”
22. Injuries and Biomechanical Flaws Injury Potential Stride Flaw Correct form/strength vs. length Plantar Fasciitis/ AT Amount/duration of pronation, lacking dflx ( foot ER) “ push with big toe” cadence, heel strike +/- dflx ROM, ecc calf Shin Splints Stress # As above + Loud/slaps (fatigue) Heavy heel strike, lands far in front plumb line (inc GRF) “ Soft strike” MF strike, land with foot underneath body LEAN + cadence Minimalist shoes if anterior HS strain Overstride, land with foot far in front, pull type gait, slow cadence, overleans, stiff L/S Upright + cadence Avoid trunk rotation MF strike, look at L/S
40. Acute vs. Chronic PFS (load) Neuro-proprioceptive taping; myofascial release Of lateral structures Glute strengthening; Eccentric loading – step down Change running form ITBS (Repetition) Neuro-proprioceptive taping; myofascial release of lateral structures; AP fat pad; foam roller; Glute strengthening; single leg squats; hip hikes; airplane ex. Interval running AT (load) Unload (heel lift; no hills/speed); protect (friction) Calf stretching if needed AP; US; ART Eccentric loading; Return to run (run often/daily) MTSS (load) Unload (no hills/speed) Myofascial release; US; AP; Taping Eccentric loading; IMF strengthening; calf stretching as needed
Editor's Notes
Thank you for inviting me to do this presentation. As a runner and a PT I have naturally been interested in treating long distance runners and it’s with this love for running that I have focused much of my spare time on learning more about running mechanics Because after all, the joys of running are certainly not limited to the talented but available to everyone! Here is Renata and myself at the Ottawa Marathon… and might I add that she came in 7 th in her age category with a 3:37 finish time….
Many people say that running is simple, you just go out and do it, right? What “feels” natural is not necessarily what is most efficient. A runner might adopt a certain style based on training, compensations for injuries, innate athleticism…. Sahrmann: repeated movements alter tissue characteristics which eventually change the pattern of mvnt and IF less than ideal, can cause injury/impairments
Speed… what we all want. Is determined by 1 Cadence and 2 SL Cadence is the number of steps per minute SL is the distance from IC of same foot (L to L) like in picture here. Optimal Cadence has been studied… it was determined to be most economical from 168-180 steps/min (which if you are like me, you just count the strides – which is how many times does the R foot hit the ground/min = 84-90) This cadence was for speeds from 5-10 mph Elite runners are running from 10-13mph and their cadence is only slightly faster, from 180-184steps/min Cadence is the one set at a constant and stride length is the one which changes with different speeds. 1.40-1.50 strides/second 84-90 strides/min) novice runners 1.51-1.53 strides/second (90-92 strides/min) elite runners 2-2.5 strides/second = 120-150 strides/min Sprinting : short distances/ greater than 10mph (Mulligan E.P., 2004) 240-300 steps/min (120-150)
Even though using a treadmill is okay to study running (a number of researchers have concluded that the TM is an acceptable tool for studying running – Schache A.G. et al 2002) There are some important differences In General, on a treadmill, a Runner adopts a more secure running pattern. There is a DECREASE in… step length, contact time, vertical displacement There is an INCREASE in…cadence/ forward lean EMG…. In conclusion, a runner looks better in a controlled setting like a treadmill. I don’t like to rely on the treadmill only when assessing a runner, particularly a runner who doesn’t ever run a TM ****** Increased work of Biceps fem (contact +early swing) Decreased work of Rectus fem No difference with Soleus, Gastroc, Glut Max
RE is important because In elite or near-elite runners with a similar VO2 max, RE is a better predictor of performance Running economy is a bit like fuel economy…In cars…..It’s the fuel cost at submax speeds… in humans it’s the energy cost (O2) at a submax speed. 2 different runners the same VO2 Max, same speed and weighing the same might have 2 very different O2 consumption rates. The one who uses less is more economical. RE: determined by measuring the steady-state consumption of O2 and the respiratory exchange ratio. Runners with good RE use less energy therefore less oxygen than runners with poor RE at the same speed. elite runners are more biomechanically efficient than their nonelite counterparts. Programmed to Run Miller, Thomas Miller, 2002
All of the biomechanical factors influencing running economy are still unclear and somewhat contradictory. But Basically, running is a sagitall plane motion….unless we are talking hills... Therefore, if you minimize the Up and Down, side to side and rotation, you should have a more economical stride. Cavanaugh's work in 1982 showed that it was better to run at one’s own chosen stride frequency and stride length. – study done with elite runners. In 1994, Morgan et al published a study concluding that there was a decrease in aerobic demand when changing to an optimal stride length in more novice runners who exhibited uneconomical stride lengths. relative level of muscles activation (Voigt et al.,1997) At higher speeds: plantar flexion during foot removal (Williams & Cavanaugh, 1986,1987) Recent studies showed a difference in pose method – effective in reducing stride length, reducing V displacement yet also Decreased running economy by 8% (only 8 sub-elite triathletes per group – 1 of the least experience ones showed increase in economy after pose – he ran with slowest cadence-78-84) Other studies have shown: Ground contact time was the only factor which correlated significantly with both running economy and max running speed (Nummela A. 2007-Aug.)
Efficient movement being the target for all athletic movement. Why Video Analysis : Objective gait analysis Able to slow down motion and freeze frame Good visual feedback for runner How: Observe runner on TM at 1% incline and allow > 4 min warm-up Big picture 1st, rhythm and symmetry, cadence Videotape or view Right, Left, Back Front + outside
Short contact time: Important measure of dynamic stability (Walsh, 2005) Lean allows gravity to help propel you forward Avoid high breaking forces shown in heavy heel strikers cadence– (like rpm on bike) Land nearly flat-footed underneath a slightly bent knee (Miller, 2002)
Too much dorsiflexion due to improper knee flexion I Swing: Iliopsoas –conc. hip flex; TFL – coupling with hip abductors to stabilize stance limb After IC -(concentric HS and Glut Max.)
Adductors work in concert with Int Oblique and opposite Ext Oblique to stabilize body on top of stance leg, rotate pelvis forward. Max Hip adductor activity just prior to IC and increases with speed as base gets narrower Pronation is not a dirty word: (shock absorption mechanism) In this picture, the angle you see measures Calcaneal Eversion… not actual pronation. The software I use is not that sophisticated but it’s enough to see what is good and what is really ugly….
Running is like 2 pendulums R arm with L leg. Therefore one can cue with the arms to get the legs to do something…. Arms: compact “hips to tits” ~ 90 degrees – seemingly always extended Drive backwards and recover forwards
Running injuries – 80% are caused by overuse/ misadaptation… Therefore, how do we prevent these injuries? You need to quantify and monitor the loading on the msk-skeletal system.
You can prevent 80% of injuries by applying a gradual daily load to the tissues. The body will adapt itself as long as the applied stress is not greater than the body’s capacity to adapt. Mechanical Stress can be quantified. It increases as our tissues are subject to more impact/load. It is not the same as physiological loading (cardiovascular loading). You can find this chart at the running clinic website. It is an essential tool for clinicians.
We know there is no direct link between biomechanical peculiarities and injuries, however, when joints and muscles are in compromised position, they will work harder. If they are working harder, they will incur an overload much quicker. Same goes for running with a slow cadence, it increases impact therefore increases total loading. This is where I find the link between overload and biomechanics exists.
ADAPTATION - MUST DO PRIOR TO D/C
PROGRESS SLOWLY!! SPECIAL ATTENTION TO PATIENTS WITH CHRONIC PROBLEMS OF THESE STRUCTURES!! CUSHIONING SHOES HAS PERHAPS CONTRIBUTED TO A HIGH INCIDENCE OF KNEE INJURES WILL THE MINIMALIST SHOE CONTRIBUTE TO A HIGH INCIDENCE OF AT/CALF/FOOT INJURIES? Since 80% of all injuries are load related, this could be the case.
Go on google and research your injury or ask your running friends how to treat it.
So what does all this mean in a race – what everyone wants to know after all the studies are done is performance, performance…will this improve my performance?? Well, this recent study looked at…. Foot strike patterns during an elite ½ marathon The percentage of RFS increases with the slower running speed; conversely, the percentage of MFS increases as the running speed increases. A shorter contact time and a higher frequency of inversion at the foot contact might contribute to higher running economy. Conclusion: A shorter contact time and a higher frequency of inversion at foot contact might contribute to higher running economy
Both programs focus on leaning to use gravity as a gas pedal. Pose uses legs more – pick up feet and increase cadence and has specific landing suggestions Chi runners relax their lower legs as much as possible – focus on lengthening stride Slogan: “A revolutionary approach to effortless, injury-free running” Partnership with New Balance
3 different foot strike patterns: natural heel-toe running with learned Mid foot and Pose running (ball of foot). Interesting study since there is such a high incidence of knee injuries among runners. However, the work showed up at the ankle and therefore may lead to increased demands of achilles platform. Pose running was characterized by shorter stride lengths and smaller vertical oscillations of the sacrum and left heel marker. Compared with midfoot and Pose running heel-toe running was characterized by greater magnitudes and loading rates of the vertical impact force. In preparation for initial contact, the knee flexed more in Pose than in heel-toe and midfoot running. The ankle at initial contact was neutral in Pose compared with a dorsiflexed and plantarflexed position in heel-toe and midfoot running, respectively. The knee power absorption and eccentric work were significant lower ( P < 0.05) in Pose than in either heel-toe or midfoot running. In contrast, there was a higher power absorption and eccentric work at the ankle in Pose compared with heel-toe and midfoot running. The possibility that such gait differences could be associated with different types and frequencies of running injuries should be evaluated in controlled clinical trails. One of the consequences of this running style is that the peak ground reaction force is only 25-33% of that measured during forward running, suggesting that the calf musculature absorbs more of the impact forces during backward running ( 15 ). The peak patellofemoral compressive force is also reduced with backward running (3.0 � 0.6 body weight (BW) compared with 5.6 � 1.3 BW for forward running
It’s called POSE Based on the theory that there is an ideal POSE/position for the movement of running. The perfect pose is with the runner balanced on his/her support: a direct line goes from head to toe. The whole body has an S like shape. Romanov: Russian coach Sure enough, the gait analysis showed the following changes had taken place after training (compared to before, and natural running in each case): Stride lengths were shorter, and stride rates were higher - this is consistent with what Pose theory predicts, as we discussed yesterday. The vertical oscillations of the sacrum and left heel marker were reduced (this means there was less up and down movement of both the hips and the feet) Pose running had a lower loading rate of the vertical impact force than the BEFORE training running styles. This was explained because during Pose running, the knee flexed more in Pose than in heel-toe and midfoot running. Basically, during Pose, you land on a slightly more bent knee and it lowers the rate of loading. The knee power absorption and eccentric work were significant lower in Pose than in either heel-toe or midfoot running There was a higher power absorption and eccentric work at the ankle in Pose compared with heel-toe and midfoot running the conclusion made is that Pose will reduce the risk of knee injury.
West Coast ultra marathoner Danny Dreyer. Chi Running is built on the principles of tai chi, the martial art that emphasizes integrating mind and body to achieve health. Fundamentally, Chi Running is about making running easier by relaxing your legs and relying instead on your core abdominals and trunk muscles to do the work of propelling you forward
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