Learn to run. What we know and what we made up.


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Learn to run presentation by Max Martin at Filex2013. Evidence behind shoe selection, footstrike patterns and injury.

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  • We have the capacity to rehabilitate. Behaviours that affect our function.
  • PA injury range from 20-80%
  • Ticks can be easily coachable with cues? Need MSK interventionAll well accepted,But still disagreement about foot posture/landing
  • Whole limb strengthROM under loadCNS coordination,etc
  • Learn to run. What we know and what we made up.

    1. 1. http://www.slideshare.net/informmax
    2. 2. What we know and whatwe made up!
    3. 3. We are runners!!We have glutes!!Achilles tendon/ITB/peroneus longusLongitudinal archNuchal ligamentBramble & Lieberman 2004
    5. 5. Variance?ENVIRONMENT!•Forward head and shoulders•++Thoracic kyphosis•Ineffective core•Deconditioned glutes andlower leg muscles•INJURY?
    6. 6. Running RequirementsSkillPhysical capacity
    7. 7. InjuryCapacityVsDemand50% injuredannually!!Fields et al 201040%+ injuries are tothe knee!!Taunton et al 2002
    8. 8. Skill: The non-negotiables•A stable head•Open shoulders/chest•Slight forward lean (50)•Elbows (to 900)- not crossing midline•Smooth symmetrical trunk rotation•Tri-planar alignment at pelvis- neutral lumbar spine•Stable hips (no catwalk models!!) that extend 100•Frontal plane knee alignment•Feet and knees aligned•Feet not crossing the midline•SYMMETRY!!???????www.theperfectrunner.com
    9. 9. Building a body to run- Physical CapacityWhat we know.....Weak hips = More injuriesStrong hips = Less injuries(Fredericson et al 2000, Cowan 2006 , Niemuth et al 2005,Noehren et al 2007, Noehren 2012, Snyder et al 2009)
    10. 10. Can you do a single-legged squat?Commonly used in literature asa determinant of hip musclestrength (gl mx/md)Describes much more than justthis!
    11. 11. Skill- Good Running?Learn to walk!
    12. 12. Skill- Good Running?A Paradigm.....Pose Tech Corp
    13. 13. The Forefoot StrikeShow me the evidence!!Analysis of shod elite runners who participated in a1/2 marathon (Hasegawa et al. 2007):75% of the runners were heel strikers,24% were midfoot strikers,and 1% were forefoot strikersRetrospective study comparing 52 cross-countryrunners (Daoud et al 2012):Heel-strike runners twice as likely to experience repetitivestress injuries compared to the forefoot strikers.
    14. 14. The Forefoot StrikeShow me the evidence!!Retrospective descriptive epidemiology survey (Goss & Gross2012)2,509 runners (1,254 male, 1,255 female, aged 18 to 50)Online survey assessed running tendencies, footstrikepatterns, shoe preferences, and injury history.Significant association between shoe selection and foot-strike.Traditionally shod runners 3.41x more likely to report injuriesthan experienced minimalist shoe wearers.
    15. 15. Thank you!
    16. 16. What we know and whatwe made up!
    17. 17. The Forefoot StrikeShow me the evidence!!10 participants with anterior compartmentsyndrome (surgery rec.). Deibal et al (2012)6 week heel-strike to forefoot strike adaptationprogram.All participants improved pain and disability scores.All participants avoided surgeryAll maintained improvement and running style at1yr follow-up
    18. 18. The Forefoot StrikeWhy varying foot patterns?Ground hardness and shoe build seem to affectFoot strike patterns (Goss & Gross 2012)40 RFS asked to run BF on a hard surface and a softsurface. (Grubera et al 2012)20% used MF/FF on softer surface65% used a MF/FF on harder surface
    19. 19. The Forefoot StrikeWhy would this be?Heel strikers produce an ‘impacttransient force’ (Lieberman et al 2010,Cavanagh 1980).Forefoot strikers produce peakcollision forces equal if not greaterthan Heel strikers (Lieberman et al 2010)Lieberman etal 2010
    20. 20. The Forefoot StrikeLieberman etal 2010How is the force accepted by the body?Rearfoot strike displays greater deceleration at the kneeForefoot strike displays greater deceleration at the anklePaquettea et al 2013; Hamilla et al 2010; Williams et al 2012
    21. 21. The Forefoot Strike – training required!Forefoot strikers:Land on a more compliant section of the footCan utilise greater range of dorsi-flexion todissipate force/create elastic recoilPaquetta 2013: greater rate of loading in FFS(gastrocs) – train this!Hamilla 2012: runners can change foot-strikepatternBut associated re-organisation ofcontrol – train this too!Lieberman etal 2010
    22. 22. The Forefoot StrikeThere is more to it than just foot-strike!Goss and Gross (2012) show that FFS have shorterstride length with greater frequency, and lessvertical displacement.Running speed is stride length x stride frequencyExample: 2 runners running 200m in 1min (12km/h)•Runner 1: Stride length 1.43m= Frequency 140spm•Runner 2: Stride length 1.11m= Frequency 180spmWhich is better?
    23. 23. The Forefoot StrikeThere is more to it than just foot-strike!Which is better?Heiderscheit et al 20115% increase to preferred (172.6± 8.8) cadence =• Decreased knee power absorption (20% reduction)• Decreased knee flexion angle• Decreased COM vertical excursion• Decreased braking impulse
    24. 24. The Forefoot StrikeThere is more to it than just foot-strike!Which is better?10% increase to preferred (172.6± 8.8) cadence =• Decreased knee power absorption (34% reduction)• Decreased knee flexion angle (related to ITBs)• Decreased COM vertical excursion• Decreased braking impulse• Decreased hip power absorption• Decreased hip adduction angle• Decreased hip internal rotation momentsHeiderscheit et al 2011
    25. 25. The Forefoot StrikeAthletic Performance benefits?Hayes & Caplan 2012181 runners across twenty two 800m and 1500m seeded races in UK.FF and MF strikers had significantly shorter ground contact times (GCT)than HSThey also had significantly quicker average race speeds than HS!Strong correlations between GCT and race speedsGCT in first laps were significantly shorter than in last laps – fatigue!
    26. 26. The Forefoot StrikeShould I barefoot run?Differences in running gait between experiencedbarefoot and shod runners include:decreased stride lengthincrease stride frequencyIncreased ROM at the ankle (with increased PFlx loading),Decreased ROM knee and hip (with decreased loading)a more plantar-flexed foot at foot-strikeNo credible-scientific studies have proven barefootrunning reduces injury riskJenkins and Cauthon 2011.
    27. 27. The Forefoot StrikeShould I barefoot run?Mechanics of FFS and BFs similar to eachother, and different to RFSHabitual heel-strikers still heel-strike barefootTransient forces greatest in barefoot heelstrikersGreater loading of metatarsalsWilliams 2012; Goss and Gross 2012Are you equipped?!
    28. 28. Building a body to forefoot strikeCan you do single-legged calf raises?Can you comfortably hop on oneleg- with good joint alignment?
    29. 29. Physical CapacityDon’t run to get fit- get fit to run!source unknownCan you/r client:Stabilise pelvis?Extend and rotate Tx spine?Activate glutes?Do SL squats?Do SL calf raises?Hop on one foot?Are there chronic tightnesses?
    30. 30. Physical CapacityDon’t run to get fit- get fit to run!source unknownEven GREAT running is inherently damaging-ACCEPT IT!Management Strategies:SupplementationProteinOmega 3sMagnesiumFoam Rolling/StretchingSpecific functional/corrective trainingRest weeks
    31. 31. Physical CapacityDon’t run to get fit- get fit to run!source unknownIncrease km’s gradually (5% p/wk)Set conservative goals and updatewhen appropriateThere is a skill to itBe patient- you’ll have it for life!
    32. 32. In summary!Heel StrikeFFS & BF(similar biomechs)Forefoot Strike(but not necessarily BF)Knee forcesstride lengthstride frequencyinjuries (knees,hips, shins)Plantar flexionrate of forcestride lengthstride rateathl. Performanceinjury rates (?)(plantar flexors andconnective tissues,metatarsals).Different controlrequirements
    33. 33. In summary!Tailor to the individual!Consider Capacity vs Technique(skill) approach.THANK YOU!!http://www.slideshare.net/informmax
    34. 34. Bramble DM, Lieberman DE. Endurance running and the evolution of Homo. Nature. 2004;432:345–52.Cavanagh PR, Lafortune MA. Ground reaction forces in distance running. J Biomech. 1980;13:397–406.Cowan, S. (2006). The role of gluteus medius in patellofemoral pain. Journal of Science and Medicine in Sport , 6.Daoud AI, Geissler GJ, Wang F, Saretsky J, Daoud YA, Lieberman DE. (2012) Foot Strike and Injury Rates in EnduranceRunners: A Retrospective Study. MEDICINE & SCIENCE IN SPORTS & EXERCISE. Vol. 44, No. 7, pp. 1325–1334Diebal AR, Gregory R, Alitz C, Gerber JP. (2012). Forefoot running improves pain and disability associated with chronicexertional compartment syndrome. Am J Sports Med. 2012 May;40(5):1060-7Federicson, M., Cookingham, C. L., Chaudhari, A. M., Dowdell, B. C., Oestriecher, N., & Sahrmann, S. A. (2000). Hipabductor weakness in distance runners with iliotibial band syndrome. Clinical Journal of Sports Medicine , 10, 169-175.Fields KB, Sykes JC, Walker KM, Jackson JC. (2010). Prevention of running injuries. Curr Sports Med Rep. 2010 May-Jun;9(3):176-82Goss DL & Gross MT (2012). Relationships among self-reported shoe type, footstrike pattern, and injury incidence. USArmy Med Dep J. 2012 Oct-Dec:25-30Grubera AH, Silvernaila JF, Brueggemannb P, Rohrc E & Hamilla J. (2012). Footfall patterns during barefoot running onharder and softer surfaces. Footwear Science, Volume 5, Issue 1, 39-44Hamilla J, GruberaAH, Derrick TR, (2010). Lower extremity joint stiffness characteristics during running with differentfootfall pattern. European Journal of Sport Science. 113(3), 599-609.Hasegawa H, Yamauchi T, Kraemer WJ. (2007). Foot strike patterns of runners at the 15-km point during an elite-level halfmarathon. J Strength Cond Res. 2007 Aug;21(3):888-93.Hayes P & Caplan N, (2012). Foot strike patterns and ground contact times during high-calibre middle-distance races. MedSci Sports Exerc. 2012 Jul;44(7):1335-43.Heiderscheit BC.(2011). Gait retraining for runners: in search of the ideal. J Orthop Sports Phys Ther. 2011Dec;41(12):909-10Jenkins DW, Cauthon DJ (2011). Barefoot running claims and controversies: a review of the literature. J Am Podiatr MedAssoc. 2011 May-Jun;101(3):231-46.Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, DAndrea S, Davis IS. Mangeni RO, Pitsiladis Y. Foot strike patternsand collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531‐5.Niemuth, P. E., Johnson, R. J., Myers, M. J., & Thieman, T. J. (2005). hip muscle weakness and overuse injuries inrecreational runners. Clinical Journal of Sports Medicine , 15, 14-21.Noehren, B., Davis, I., & Hamill, J. (2007). ASB Clinical biomechanics award winner 2006: Prospective study of thebiomechanical facotrs associated with iliotibial band syndrome. Clinical Biomechanics , 22, 951-956.Paquette MR, Songning Z, Baumgartnera LD. (2013). Acute effects of barefoot, minimal shoes and running shoes on lowerlimb mechanics in rear and forefootstrike runners. Footwear Science. 5(1). 9-18Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A prospective study of running injuries: theVancouver Sun Run ‘‘In Training’’ clinics. Br J Sports Med. 2003; 37:239–44.Williams, DSB, Green DH, Wurzinger B. (2012). Changes in lower extremity movement and power absorption duringforefoot striking and barefoot running. Int J Sports Ther. 7(5): 525-532References