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  • 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

Capital sports symposiumfinal2 Capital sports symposiumfinal2 Presentation 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.
  • Running
    • 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:
      • step length
      • contact time
      • vertical displacement
    Treadmill: Cadence (steps/min) Forward lean
      • Other:
        • 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.
    • (Geraci, Michael C., Brown, Walter. 2005)
    • Improved Economy IF DECREASED :
    • vertical oscillation (Cavanagh, Pollock & Landa, 1997)
        • support time (Paavolainen et al., 1999)
        • peak GRF (Anderson, 1996)
        • Improved Economy if INCREASED:
        • Cadence (180 +/- 10)
        • Knee flexion during support
        • forward lean of trunk
        • (Williams & Cavanagh, 1987)
  • PSI’s Runner’s Clinic
    • The Goal
        • Educate runners on “good” running form.
        • Educate runners on training progression and injury prevention.
        • Specifically for runners with chronic injuries, or those who are looking to make changes to their biomechanics.
    • The Process:
        • 60 minutes
        • Review of training, past injuries and rehabilitation
        • Shoe assessment
        • Functional, strength, flexibility assessment
        • Video assessment
        • 4 min. warm-up
        • 1% incline, speed (varies from jog to speed)
        • Digital video camera from R/L/B/ on TM and Outside
    • Video Analysis: : ~ 60 min. for analysis and exercise program using Dartfish software
    • Follow Up visits: ~ 60 min. for education and exercise program
  • Running Form- check list
    • Observation:
    • Cadence (180 +/- 10)
    • Sound (GRF), Smooth & Symmetric
    • Posture (head, shoulders, trunk, core)
    • Arms: compact; elbow or hand does not cross midline
    • Foot contact/placement:
      • as close to vertical line (plumb line) going through your hips
    • Video Analysis:
    • Short contact time : 0.200-0.300 sec. (Buckalew et al., 1986)
    • Angles at pelvis (4-5 deg.) , hip/knee (20/25 deg.) , ankle (8-10 deg. pron.)
    • Lean forward with entire body (chi running, pose tech)
    • Vertical Displacement (minimal < 8cm)
  • Running gait cycle Swing phase
    • M. Swing:
    • Knee flex speed dependant
    • T. Swing:
    • 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
      • (SP) (FP)
        
  • 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.
    • HOWEVER…..
    • Running decreases death by 63%!
  • Top 5 Running Injuries (overuse)
    • PFPS
    • ITBS
    • Plantar Fasciapathy
    • Achilles Tendonopathy
    • MTSS (shin splints)
  • Running Injuries
    • 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!
  • www.therunningclinic.ca
  • 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
    • Ice
    • Rest
    • Therapy – ART, MT, US, IFC, AP
    • Other: injections (cortisone, PRP), shock wave….
    • ADAPTATION –CHRONIC ( THE MISSING LINK)
    • Eccentric exercises
    • Re-load tissues gradually in sport specific mode
        • return to run program
        • plyometrics
  • www.therunningclinic.ca Return to Run Level 1
  • The Shoe Dilemma
    • MYTH: Cushioning prevents injury by reducing shock to the runner’s body.
    • FACTS:
    • 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
    • FACTS:
    • 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
    (2010-Lieberman, 2009-Squadrone, 2009-Vormittag, 2008-Donoghue, 2007-Clinghan, 2006-Shakoor)
  • Barefoot vs. Shod
  • The Running Shoe what to wear?
    • All changes should be done gradually (4 + weeks)
    • Pick a shoe that is simple, flat, flexible (light trainer / racer)
    • Pick a shoe that is comfortable and has proper fit
    CAUTION: MFS and running with minimalist shoes will increase work of gastroc- soleus complexe, AT, plantar fascia, IFM and metatarsal heads.
    • In Summary:
    • Natural is not = Efficient running form
    • Biomechanical Assessment (observation +/- video analysis) is an important part of assessing/treating a runner
    • Efficient running form always has a high cadence (180)
    • 80% of all running injuries are caused by overload
    • Running decreases death by 63%!
  • Top 10 Ways To Injure Yourself While Running
    • Wear shoes that are trendy and that are uncomfortable.
    • Never do any core strengthening.
    • Start every run without a warm up, and go hard right away.
    • Skip the easy or off days and run more than you are ready for.
    • Run really far and hard, often.
    • Take weeks off, then start back up where you left off.
    • Don’t listen to your body. Pain and stiffness are not good warning signs.
    • Change your running form dramatically without giving yourself time for any sort of muscle adaptation.
    • Do not listen to your coach or therapist and wait until your injury is chronic before seeking help.
    • If you are new to running (< 3 yrs), start with a marathon. Don’t bother giving yourself time to work up to what the best athletes in the world take years to do.
    As seen in Irun magazine, R. Hellard/F. Eastwood, 2011
  • Recommended Reading
    • BOOKS:
    • Lore of Running, Tim Noakes, MD. Fourth Edition, 2003
    • Programmed to run, Thomas S. Miller, PhD, 2002
    • Websites: www.posetech.com and www.chirunning.com and
    • www.therunningclinic.ca
    • ARTICLES:
    • See website: www.therunningclinic.ca - go to experts around the world
    • SPECIAL THANKS TO:
    • Blaise Dubois – Physiotherapist and founder of the running clinic website
    • Eric Nielson – Chiropractor at PSI Sports Medicine West
    • Eric Collard – Chi Running Instructor: www.ecinc.ca/chirunning.html
  • Study: Factors related to top running speed and economy
    • (Int J Sports Med. 2007 Aug, Nummela A, Keranen T, Mikkelsson LO)
    • 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)
    • Results:
      • 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
    • Method:
    • 283 runners filmed at the 15km mark obtaining sagittal foot landing/take off
    • Results:
    • Rear foot strike (RFS) = 74.9% of runners (top 50 runners = 62%)
    • Mid foot Strike (MFS) = 23.7% of runners (top 50 runners = 36%)
    • Forefoot Strike (FFS) = 1.4% of runners (top 50 runners = 2%)
    • Conclusion:
    • Contact time increased with slower runners especially with RFS.
    • Percentage of MFS as running speed
    • Therefore…. A shorter contact time might contribute to higher Running Economy
    Study: Foot strike patterns of runners at the 15-Km point during an elite-level half marathon Hasegawa H, Yamauchi T, Kraemer WJ. 2007
  • Several developed programs for ‘ideal running form’
    • Pose Technique ( www.posetech.com )
        • Founder: Dr. Nicholas S. Romanov, PhD, 2 time Olympic coach
        • Established in 1977
        • 2 peer reviewed scientific studies
    • Chi Running ( www.chirunning.com )
        • Founders: Danny Dryer
        • Developed in 2003 – from Chi Living
        • No peer-reviewed scientific literature found
  • Reduced Eccentric Loading of the Knee with the Pose Running Method
    • Arendse, Regan E; Noakes, Timothy D.; Azevedo, Liane B.; Romanov, Nicholas; et al. (2003)
    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.
    • Running mechanics:
        • 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.
    • www.chirunning.com
    • Goal: make running easier
    • Built on the principles of tai chi
    • Focus on good posture
  • Running Injuries
    • Predisposing Factors:
    • 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