Capital sports symposiumfinal2Presentation Transcript
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
What we will cover:
The Running paradox
Treadmill vs. Over ground running
Efficient Running Form – the basics
PSI’s Runner’s Clinic
How to assess a runner
The good, the bad and the just plain ugly
What causes Injuries?
Treatment of Common Running Injuries
The Running Paradox
Natural = efficient or biomechanically sound (Miller, 2002)
Ones natural running style is a motor habit influenced by: innate athleticism, training, compensations for injuries, responses to aging process (Miller, 2002)
Do runners practice running?
Most runners work on increasing speed and mileage, very few work on form.
Speed determined by:
Cadence - number of steps/ minute
constant from 5-10mph
Stride length – distance between IC of same foot
Varies: increases with speed
Running or “jogging”:
Novice or Intermediate: 5 -10mph
Cadence: 168-180 steps/min (Kaneko et al., 1987)
Elite distance runners: 10 - 13 mph
Cadence: 180-184 steps/min (Miller, 2002)
Treadmill vs. Over ground running
Treadmill: Cadence (steps/min) Forward lean
EMG generally similar with minor differences (increased work of HS,
decreased work of RF)
A number of researchers have concluded that the TM is an acceptable tool for studying running (Schache A.G. et al. 2002)
Wank V. et al., 1998
Running Economy and Efficient Running Form
Running Economy: energy demand for a given velocity of sub maximal running
The best athletes are usually the most economical. (Noakes, 1988)
Efficient running based on elite model
Biomechanical factors influencing Running Economy
Efficient running requires: momentum in sagittal plane with minimal VD, FP, TP motion.
Lean forward with entire body (chi running, pose tech)
Vertical Displacement (minimal < 8cm)
Running gait cycle Swing phase
Knee flex speed dependant
Ecc. HS and Popliteus.
See “paw back ” just prior to IC
12 mph 6.5mph
Running gait cycle Support Phase
Max hip adductor activity just prior to IC
Pronation occurs in first 50% of stance phase
Running Gait Cycle - Upper body Mechanics
Arms can help max. running efficiency
Compact, front to back arm swing
Drive back, recover forward (40-60 hum. ext)
Do not cross coordinate systems
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
Running Injuries Statistics
16.4 million people run in US (>100 d/year).
Marathons are growing in popularity.
There are to date over 530 marathons/year.
Up to 80% of runners are injured every year.
More than 40% of injuries occur at the knee.
Running decreases death by 63%!
Top 5 Running Injuries (overuse)
MTSS (shin splints)
How Do Injuries Happen?
Extrinsic Factors (shoes, orthotics, surface)
Intrinsic Factors (biomechanics, msk dysfunction)
Stress on Tissue (duration, type, intensity)
Running Injuries 80%
Why do they do too much, too soon?
And some just don’t do enough!
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”
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
Treatment of Running Injuries
PROTECTION – ACUTE AND SUBACUTE STAGES
Taping, brace, orthotics
Therapy – ART, MT, US, IFC, AP
Other: injections (cortisone, PRP), shock wave….
ADAPTATION –CHRONIC ( THE MISSING LINK)
Re-load tissues gradually in sport specific mode
return to run program
www.therunningclinic.ca Return to Run Level 1
The Shoe Dilemma
MYTH: Cushioning prevents injury by reducing shock to the runner’s body.
1990’s: Technological advances in running shoes without scientific evidence.
2000’s: Clinical and scientific results do not support the fact that shoe cushioning reduces the incidence of running injuries.
Cushioning does not change the stress on the skeleton, nor decrease the GRF.
The running shoe is one of the primary causes of altered running biomechanics.
The shoe reduces the body’s natural absorption reflexes.
The Shoe Dilemma
Fewer injuries are reported with running shoes that have thinner soles or that are less expensive.
Barefoot runners report fewer injuries than those with running shoes, even in countries where both populations coexist.
Barefoot running produces less pronation and supination and the same or LESS ground reaction forces (GRF) than shod running
Goal: investigate the relationships between running mechanics, top running speed and economy in young endurance athletes
Method: 25 endurance athletes (19.8 +/- yrs)
TEST 1: 8 x 30m with increasing speeds (measured ground reaction forces and stride characteristics)
TEST 2: incremental 5-6 x 1000m (measured running economy at the speed of 3.89m/s and Max O2 uptake)
*(~4.29min/km) or (6.86min/mile) or (8.4miles/hour)
Ground Contact time was the only factor which correlated significantly with both running economy and max running speed
Conclusion: Therefore, short contact times required in economical and high speed running suggests that fast force production is important for both economical running and high top running speed in distance runners.
Purpose/goal: To document actual foot strike patterns during an elite half marathon
283 runners filmed at the 15km mark obtaining sagittal foot landing/take off
Purpose: compare the biomechanical changes during 3 different foot strike patterns Methods : 20 runners instructed in mid foot and Pose running. Clinical gait analysis and biomechanical variables compared. Results: Pose stride lengths vertical displacement vertical impact force eccentric work in knee eccentric work at the ankle
POSE METHOD® OF RUNNING
There is an ideal position “pose” for running.
Line goes from head-shoulder-hip-ball of foot.
Mid-foot striking pattern (ball of foot), below COM
Vertical foot removal immediately after foot strike
Minimal use of arms
Small forward trunk lean
Romanov & Robson, 2003 www.posetech.com
Chi Running® and Chi Walking®
It encourages runners to lean forward from the ankles.
The legs start in a run powered by gravity instead of muscles.
One of the best developed learn to run programs offered.
Goal: make running easier
Built on the principles of tai chi
Focus on good posture
Anatomy: No relationship between an “installed” anatomical peculiarity and a pathology of the LE
Except: Significant asymmetry (>2cm) or after acute change
Biomechanics: No relationship between an “installed” biomechanical peculiarity and pathologies of the LE
Except: above + significant weakness which changes entire LE biomechanics.
New to running and fitness
Previous history of injuries
(2010- Buist, 2008- Buist)
Barefoot vs. Shod
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