1. H E A T H E R S M I T H , S P T A
F E B R U A R Y 2 0 1 6
“GEEP”:
Rehabilitation in Recreational
Runners

2. Overview
 Recreational running has increased over the last few decades
 Popular in Western society since the 1970’s
 Primarily due to increase in female runners since 2000
 Injury rates are between 18-92%
 When rehabilitating runners, remember GEEP!
 As in, “Geepers! those runners won’t ever listen to the advice I give them when they’re injured and
need to rest!!!!”
1. Gait analysis and retraining
2. Education
3. Exercise program
4. Psychosocial components

3. INJURIES
 Injury rates are between 18-92%
 Variation due to differences in definitions, populations, and follow-up
 Recreational runners estimated at 56%
 Males > Females
 Most injuries occur in the knee (~50%)
 Second common locations: upper and lower leg
 Least common locations: ankle, hip/pelvis/groin and low back
 Common Injuries:
 Patellafemoral Pain Syndrome
 ITB syndrome
 Patellar tendinopathy
 Medial tibial stress syndrome (shin splints)
 Gluteus medius injury
 Greater trochanteric bursitis
 TFL injury
 Achilles tendinopathy

4. INJURY RISK FACTORS
 PERSONAL
 Age, sex, height, BMI, alignment, genetics
 TRAINING
 Weekly running days, weekly distance, speed, warm-up,
running surface
 Overuse*
 LIFESTYLE
 Previous injuries*, use of orthotics*, comorbidity, smoking,
poor nutrition

5. GAIT ANALYSIS AND RETRAINING
 Foot Strike
 Heel strike (89%)
 Contacts ground in dorsiflexion
 More susceptible to tibial stress fractures and plantar fasciitis
 Potentially due to increased cushioning in running shoes
 Midfoot strike
 Forefoot strike
 Contacts ground in plantarflexion
 Requires higher eccentric control in calf muscles
 Transforms vertical forces into rotational kinetic energy and thus
reduces impact.
 Reduces anterior knee pain, anterior compartment syndrome
 More susceptible to achilles tendinopathy and calf strains.

6. GAIT ANALYSIS AND RETRAINING
 Step Length
 Shorter step length is associated with reduced loads to the hip and knee, reducing injury potential
 More common in natural forefoot strikers
 Even a 10% decrease in step length is associated with decreased load on hip and knee joints.
 Use metronome to get baseline and then increase rate at same running speed to shorten step
 Cadence/Turnover
 160-170 steps per minute for recreational runners
 180-200 for competitive or elite runners
 Metronome (phone application)
 Discourage use of random music, since tempo has a significant influence on cadence
 Apps such as “JogTunes” allows users to select playlist based on desired cadence
 Use drills (jogging in place) and shorter runs (<2 miles) to gradually introduce appropriate cadence
over 6-8 weeks.
 Vertical Loading Rate (VLR)
 Common to see a hard landing in heel strikers
 Increased VLR often leads to tibial stress fractures
 Agility training can help improve VLR and reduce ground reaction forces

7. EDUCATION
1. Warming up
 Differences between static vs. dynamic stretching and defining a proper
“warm-up”.
2. Distance
 Should not increase by >30% over two weeks, especially in novice
runners.
 Distance-related injuries: anterior knee pain/PFPS, ITBS, shin splints,
patellar tendinopathy, glut med injury, greater trochanteric bursitis,
TFL injury.
3. Speed
 Don’t introduce until regular completion of 5 continuous miles
 Use hills and speed drills
 1 mile warm-up, 3 fast miles, 1 miles cool down
 Use fastest mile to determine pace and build speed training from there
 Speed-related injuries: achilles tendinopathy,lplantar fasciitis, tibial
stress fracture, injury to the hamstrings, iliopsoas, and calf.

8. EXERCISE PROGRAM
 HIP or KNEE?
 Research shows faster improvements in hip and core
strengthening protocols than knee protocols
 Evens out by week six for similar results
 Males demonstrate greater weakness in knee extensors
 Females demonstrate greater weakness in hip and core
musculature
 *Specifically with anterior knee pain, knee protocols showed better
outcomes in males than hip protocols.

9. SAMPLE HIP PROTOCOL
 Week One:
 Standing SLR hip abduction, 3 x 10
 Lateral walks with yellow theraband 3 x 25’
 Clams with yellow theraband 3 x 10
 Week Two:
 Standing SLR abduction 3 x 10
 Lateral walks with red theraband 3 x 25’
 Prone internal rotation with yellow theraband 3 x 10
 Week Three:
 Standing hip abduction with cable resistance, 3 x 10
 Lateral walks with green theraband 3 x 25’
 Prone internal rotation with red theraband, 3 x 10
 Double-leg balance on Airex pad, 3 x 30s
 Week Four-Six:
 Standing hip extension, 3 x 12
 Lateral walks with green theraband, 3 x 12
 Standing internal rotation with cable resistance, 3 x 12
 Single-leg stance balance on Airex pad, 3 x 45s

10. SAMPLE KNEE PROTOCOL
 Week One:
 Quad sets, 3 x 10
 LAQ, 3 x 10
 ¼ squats, 3 x 10
 Week Two:
 Quad sets, 3 x 15
 ½ squats, 3 x 15
 ¼ squats, 3 x 30s
 TKEs with red theraband, 3 x 15
 Week Three:
 ½ squats, 3 x 10
 ¼ wall squats, 3 x 10
 Single-leg ¼ squats, 3 x 10
 TKEs with green theraband, 3 x 10
 Week Four-Six:
 Full wall squats, 3 x 45s
 Single-leg ½-full squats, 3 x 12
 Forward ¼-full lunges, 3 x 12
 Lateral step downs, 3 x 12
 Forward step downs, 3 x 12

11. PSYCHOSOCIAL COMPONENTS
 Running has psychological benefits, such as increases in perceived happiness,
relaxation, and energy.
 The “runner’s high” is also associated with dependency and addictive qualities.
 Considered a “healthy” and socially acceptable addiction.
 Can make it challenging for runners to train appropriately and stop when sore or injured.
 Likely why overuse injuries are so prevalent in this community.
 Injuries leading to a decrease or cessation of running can cause runners to feel
guilty, irritable, lethargic, even showing signs of depression and addiction.
 Important to address this aspect, demonstrating compassion, patience, and understanding towards
your patient.
 Encourage other coping mechanisms to reduce stress and improve energy.
 Obtain a referral to a mental health professional if patient demonstrates prolonged signs and
symptoms that interfere with their level of functioning.
 Any effective treatment program will address psychosocial and behavioral
components, including assessing the patient’s beliefs and opinions about injury
prevention and rehabilitation.
 Runner’s often have misconceptions about stretching, shoes, and injury
prevention/causation/treatment.

12. REFERENCES
 Bolgla, L. A., Earl-Boehm, J., Emery, C., Hamstra-Wright, K., & Ferber, R. (2015). Comparison of hip and knee strength in males with and without
patellofemoral pain. Physical Therapy in Sport, 16(3), 215-221. doi:10.1016/j.ptsp.2014.11.001
 Esculier, J., Bouyer, L. J., Dubois, B., Frémont, P., Moore, L., & Roy, J. (2016). Effects of rehabilitation approaches for runners with patellofemoral pain:
protocol of a randomised clinical trial addressing specific underlying mechanisms. BMC Musculoskeletal Disorders, 17(1). doi:10.1186/s12891-015-0859-9
 Ferber, R., Bolgla, L., Earl-Boehm, J. E., Emery, C., & Hamstra-Wright, K. (2015). Strengthening of the Hip and Core Versus Knee Muscles for the Treatment of
Patellofemoral Pain: A Multicenter Randomized Controlled Trial. Journal of Athletic Training, 50(4), 366-377. doi:10.4085/1062-6050-49.3.70
 Nielsen, R. Ø., Parner, E. T., Nohr, E. A., SØrensen, H., Lind, M., & Rasmussen, S. (2014). Excessive Progression in Weekly Running Distance and Risk of
Running-Related Injuries: An Association Which Varies According to Type of Injury. J Orthop Sports Phys Ther, 44(10), 739-747. doi:10.2519/jospt.2014.5164
 Saragiotto, B. T., Yamato, T. P., & Lopes, A. D. (2014). What Do Recreational Runners Think About Risk Factors for Running Injuries? A Descriptive Study of
Their Beliefs and Opinions. J Orthop Sports Phys Ther, 44(10), 733-738. doi:10.2519/jospt.2014.5710
 Saragiotto, B. T., Yamato, T. P., Hespanhol Junior, L. C., Rainbow, M. J., Davis, I. S., & Lopes, A. D. (2014). What are the Main Risk Factors for Running-
Related Injuries? Sports Med, 44(8), 1153-1163. doi:10.1007/s40279-014-0194-6
 Van der Worp, M. P., Ten Haaf, D. S., Van Cingel, R., De Wijer, A., Nijhuis-van der Sanden, M. W., & Staal, J. B. (2015). Injuries in Runners; A Systematic
Review on Risk Factors and Sex Differences. PLOS ONE, 10(2), e0114937. doi:10.1371/journal.pone.0114937
 Van Dyck, E., Moens, B., Buhmann, J., Demey, M., Coorevits, E., Dalla Bella, S., & Leman, M. (2015). Spontaneous Entrainment of Running Cadence to Music
Tempo. Sports Med - Open, 1(1). doi:10.1186/s40798-015-0025-9
 Willson, J. D., Ratcliff, O. M., Meardon, S. A., & Willy, R. W. (2015). Influence of step length and landing pattern on patellofemoral joint kinetics during
running. Scand J Med Sci Sports, 25(6), 736-743. doi:10.1111/sms.12383