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R4L Management of Runners Outline
• Background
• Injury factors
– Tissue overload
– Intrinsic
– Extrinsic
• Assessment
– Subjective
– Objective Screening
– Treadmill
• General R4L Management Tips for Runners
James Wilson and Rohan Singleton
BIM Northcote
Are we Built for Running? Background – The Problem
• Up to 82% of runners
injured each year
• Most common injuries
PFPS, ITBFS, P.Fascia,
Achilles and patellar
tendinopathies, MTSS
5 Common Misconceptions Causes of Running Injuries
1. Causes of running Misconception
injuries • Most running injuries are caused by intrinsic factors
(flexibility, strength, biomechanics) or extrinsic factors
2. Frequency of Training (shoes, running surfaces)
sessions per week Reality
3. Flexibility • The main cause of running injuries is the amount of
4. Arthritis stress applied to the tissues
5. Orthotics
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Flexibility Frequency of Training Session
Misconception Misconception
• Pre-workout stretching will
decreased your risk of injury • To avoid injury it is better to run 2-3 times a
Reality week and cross train with cycling or
• Pre-workout stretching doesn’t swimming than to run 6 times per week
reduce incidence of injury.
Stretching has no influence on post Reality
run pain or recovery. Negatively • To prevent running injuries, no study has
effects speed and endurance.
Regular stretching done separately successfully quantified optimal or ideal
appears to improve speed frequency of training. We recommend 4 -6
times a week
Arthritis Orthotics
Misconception Misconception
• Running increase • Orthotics prevent and treat
arthritis of the knee overuse injuries to the lower
because over time due to limbs by correction
repeated impact “abnormal” biomechanics
damaging the cartilage Reality
Reality • An absence of clear studies
• Several studies have showing the effect of
shown that arthritis is no orthotics in the treatment
more common in runner and prevention of lower limb
than non runners injuries in runners
Running Injuries Running Injuries
• Why do runners get injured?
1. Tissue overloading (training errors) Stress on
2. Extrinsic factors (running shoes, surfaces) Tissue
3. Intrinsic factors (biomechanical, muscle
dysfunction, tissue frailty)
Intrinsic Extrinsic
Factors Factors
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Tissue Overloading Mechanical Stress
MECHANICAL STRESS =
QUANTITY (of load on tissue) x FREQUENCY (of load application)
Types of mechanical stress:
• Load: (Intensity) eg. speed, plio, up hills
• Repetition: (Volume) eg. same surface
• Range: eg. sprinting/speed, down hills
Types of Injuries
Load
MTSS
Stress # (Distal)
Plantar Fasciopathy
The Body Will Adapt!
Tendinopathy (Ach, Pat)
Muscle Strain PFPS As long as the applied stress is not greater than its
Stress # (Proximal) capacity to adapt
Hip and LBP
Tendinopathy (IllioPsoas) ITBFS
Range Repetition
Mechanical Stress Management Running Injuries
Capacity to adapt to mechanical stress is unique to each
individual • Why do runners get injured?
General Guidelines 1. Tissue overloading (training errors)
• Rehab programs 2. Extrinsic factors (running shoes, surfaces)
• Volume – no more than 10% 3. Intrinsic factors (biomechanical, muscle
• Intensity – no more than 3% dysfunction, tissue frailty)
• Long run should be no more than half the weekly
volume
• Continue to apply stress in the offseason
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Extrinsic Factors Shoes
• Shoes
“The goal is to figure out how to tune a shoe
• Orthotics to match a runners needs”
Jay Dicharry
• Surfaces
Definitions Heel Height Differential
• Heel Height Differential (Ramp)
• Flare
• Cushioning
• Last
• Toe Spring
Flare Cushioning
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Last Toe Spring
Definitions Footwear Prescription
• Traditional • Very topical – Get Reading!!
>10mm HHD, >20mm cushioning • Be wary of market hype and extreme
• Transitional opinions either side
6-10mm HHD, 14-20mm cushioning • Market will likely settle in the middle.
• Minimalist • Our opinion?
< 6mm HHD, <14mm Cushioning
• You need to have an answer to “what
shoes should I run in?”
Transitioning to Less Shoe Useful Links
Running Clinic
• Slowly!! • http://www.therunningclinic.com/en/home/
• Need to have certain RunBlogger
biomechanical qualities • http://www.runblogger.com/
ie. Small KTW and low
HHD don’t mix! Running Warehouse
• http://www.runningwarehouse.com/
• Improve Running
Technique Natural Running Centre
• http://naturalrunningcenter.com/
• Run/Walk program
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Orthotics Surfaces
• Running on a hard surface does not
• Research is divided about whether or not
increase the prevalence of injuries
orthotics can be used to treat lower limb
pathologies • A natural irregular surface contributes to
stimulation natural absorption reflexes to
• Reason for people having orthotics?
providing a variety of movements
• Prescription of orthotics
– Short term offloading (6-8weeks)
Biomechanical Implications Surface Summary
• Hard surface – impact moderating behaviour • Be cautious with
surface changes
• Soft surface – stability behaviour • Choose cross country
• Level surface – increases the risk of overuse running and avoid very,
injuries level, repetitive surfaces
• Choose the surface
• Irregular surface – increased risk of traumatic according to the
injuries, increased proprioception and variety pathology
of gait
Running Injuries Intrinsic Factors
• Why do runners get injured?
1. Tissue overloading (training errors)
2. Extrinsic factors (running shoes, surfaces)
3. Intrinsic factors (biomechanical, muscle
dysfunction, tissue frailty)
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Subjective Assessment Objective Assessment
• What’s the cause:
– Soft tissue overload • Posture
– Extrinsic factors
– Intrinsic factors • Strength
• Recent changes in:
– Volume • Mobility
– intensity
– Surface • Neuromuscular control
– Gradient
– running shoe • Running technique
– orthotics
– fatigue-stress
– history of pathology
Screening Assessment Balance
• Posture
• Balance – eyes closed >30seconds – foot contact OR head turns • Want proactive balance not reactive.
• Squat
•
•
Single leg squat 6/6
Hop • Want even weight between forefoot and
• Toe Yoga
• KTW - >12cm heel
• Big toe mobility > 30 degrees in DF
•
•
SLHR – 20 – 25 (rec athlete), 25-30 (marathon runner), >30 (professional).
Modified Thomas > 15 hip ext, 0 ab/add
• Want even contact between 5th met head,
•
•
Internal Rotation > 30 degrees
Hamstring Length > 70
1st met head and great toe.
• Single leg bridge - glutes, pelvic control.
• Thoracic Rotation = 90 degrees
• Any pathology related tests
Single Leg Squat Toe Yoga
• Everyone starts with 6/6. • Big Toe function is crucial!
• 6 reps each leg • During pronation – big toe actively stabilises
Deductions Scored Criteria Implications the twisting of the rearfoot on forefoot.
-1 Loss of foot
contact
Foot stability • During supination – toe locks the foot out to
-1 Trunk Shift Hip or Foot
create a rigid lever for push off
-1 Pelvic control Hip • Important if thinking about going to less shoe
-1 Knee control Hip due to rocker in traditional shoes and less
-1 Hands off hips Gross instability rocker in transitional shoes
-1 Loss of balance Gross Instability
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Big Toe Mobility Running Assessment
Why?
• If big toe mobility is restricted, push off is
• 16% of population
restricted
run
• Test: Seated, knees in line with toes. Big • Only 3% run
Toe DF – 30 degrees. enough
• We are told how
much to run but
not how to do it
http://www.youtube.com/watch?v=zSIDRHUWlVo
What is good running technique?
• No perfect running form
• A few general rules
https://www.youtube.com/watch?v=EAW87NsiGuI
Running Biomechanics
Efficient Technique (Comparable to barefoot)
Use of elastic recoil
Initial contact close to COG in front of body
Foot strike towards forefoot
Mid-stance foot under body
Short time of contact with ground (but not too short)
Low vertical displacement
Upright posture
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Common Biomechanical Errors Lieberman et al 2010
Inefficient Technique (High energy cost)
Initial WB way ahead of COG (Overstriding)
>80% >80%
of barefoot runners of shod runners heel strike
Increased vertical displacement midfoot/forefoot strike
Decreased cadence (long contact time)
Heavy heel strike – Noisy (will hear them coming a mile away)
Decreased elastic energy, increased muscle use
Decreased hip extension
Posture – bent at hip, tense upper body and/or shoulders
Loss of multi planar stability
Running Assessment Running Assessment
• 40 min ext session ideal Process:
• Hard treadmill
1. Ensure comfortable on treadmill
• Difficult to do proper Biomechanical Ax if painful (Have you run on a tready before?)
• No incline
2. Usual shoes
• Noise – soft/medium/loud
• Determine cadence (tap tempo) 3. Comfortable/Functional speed
(jog 30mins)
• Visual analysis/Recording (ubersense): posterior
and lateral 4. 4 mins of progressive jogging
(settle into normal biomechanics and stabilise softness of shoes)
Big Rocks, Pebbles, Sand Running Cues and Interventions
1. Noise (VLR) 1. Cadence
2. Cadence (Efficient 170-190 per min) 2. Noise 90% of the problem
(maybe combo)
3. Take off shoes
3. Knee position at landing/foot strike (Flexed
knee and vertical tibia – better able to shock 4. Global interventions eg. Run under a roof,
absorb) run tall, as if you were going to kiss
someone
Correlate running Ax with objective assessment 5. Specific interventions eg. foot or knee
position, arms.
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Cadence Noise
• Efficiency – maximise elastic recoil • Impact sound
• Clinically tend to see a lot around 150 • Correlates with ground reaction force (VLR)
• Goal 170-190 to prevent over striding • Can measure – accelerometer
• Cues: • Cues:
1. Run with shorter steps
1. Run softly
2. Metronome
2. Creeping up on someone
3. Foot pod
Barefoot Posture
• Max 1-2 mins 1. Head Chaser
initially (bilsters) 2. Pelvis Chaser
• May need to start
with barefoot 3. Sternum Chaser
running to get
proper
biomechanics
going
Running Assessment: Intervention A Movement Mantra
• Test intervention to fix the problem
1. Posture
– Always aim for major problems first, medium
problems if needed. Usually unnecessary to 2. Rhythm
go for small issues. 3. Relax
• Run normally between interventions to
wash out old intervention -Lee Saxby
• “One minute per training” rule
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Beginning to Run Post Injury
• Interval programs to maximise physiological stress
while minimising mechanical stress
• According to symptoms and comfort speed up or slow
down programs
• Frequent stimuli to create tissue adaptations by
running minimum 4 x a week
• Ensure biomechanical preparation by walking 5mins
(especially from sitting)
• Early days – complete workout with cross-training
activity that produces less mechanical stress but
ensures cardio workout
General R4L Management Advice Questions/Comments??
1. Surround yourself with the right people: to treat runners well, experience
running
2. Your body will adapt:Integrate new stimulus slowly • Feel free to email us with any concerns,
3. Cadence170 to 190
4. The Kenyan Surface: Best surface is firm irregular clarification, references etc.
5. Warm Up’s: Increase body temp with 15-20min jog +/- funcitonal ballistic
stretches
6. Stretching: Only if running biomechanics are altered by a shortened muscle
7. Specific stabilisation, prop and strengthening programs: Next month
8. Regular Massage and Self Myofascial Release: Spikey balls, foam rollers,
• r.singleton@backinmotion.com.au
weekly massages ideal
9. Cross-training: People who’s only sport is running are more often injured than • james.wilson@backinmotion.com.au
those who practice another sport.
10. Complete rest is rarely the best treatment: Safe cardiothoracic exercise will
decrease recovery time
11. Eat well, Sleep well
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