Nicholas Clark from Complete Physio talks about Complete Physio - Injury prevention, Re-injury prevention and performance enhancement in distance running How to warm up and recover When should I stretch and when should I strengthen How to prevent muscle, bone and tendon injuries What is the perfect running technique and what shoes should I buy

1. Injury Prevention, Re-Injury Prevention, And
Performance Enhancement in Distance Running:
An Introduction To How You Can Quickly And Easily
Get To The Front Of The Pack
Wednesday, July 2nd, 2014
Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCS
Consultant Musculoskeletal and Sports Physiotherapist
Certified Strength and Conditioning Specialist
nicholas@complete-physio.co.uk
www.complete-physio.co.uk
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2. Preface & Acknowledgement
Some pictures have been omitted for copyright reasons.
Thank you to Chris Myers BSc, BSc, PG Cert, MSc, MCSP, for
providing photographs and information for some slides.
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3. Outline
• Biomechanics of distance running
– What you’re really doing to your body
• How to safely and effectively warm-up
– The right stretches at the right time
• Injury and re-injury prevention
– Prevent bone, joint, and tendon, injuries
– When you stretch and when you strengthen
• Performance enhancement
– Training programmes: increasing running economy
– Running technique and shoe types
@

4. Outline
• Biomechanics of distance running
– What you’re really doing to your body
• How to safely and effectively warm-up
– The right stretches at the right time
• Injury and re-injury prevention
– Prevent bone, joint, and tendon, injuries
– When you stretch and when you strengthen
• Performance enhancement
– Training programmes: increasing running economy
– Running technique and shoe types
@

5. Biomechanics Of Distance Running
• Biomechanics
– Application of mechanical principles
to the human body (forces)
• What you’re really doing to your body…
• Ground reaction forces (running 4m/sec)
– Vertical: 2.7 × BW
• Compressive forces
– Ankle joint: 14.1 × BW
– Patellofemoral joint: 11.1 × BW
• Tensile forces
– Achilles’ tendon: 8.2 × BW
– Patellar tendon: 6.9 × BW
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6. Biomechanics Of Distance Running
• Male runner
– 80kg
– 4m/sec
– 6:30 mile pace
– 1072 strides
• Cumulative loads
– Vertical GRF: 85,760kg (85.76t)
– Ankle joint: 1,200,640kg (1,200.64t)
– PFJ: 951,936kg (951.94t)
– Achilles’ tendon: 703,232kg (703.23t)
– Patellar tendon: 591,744kg (591.74t)
• How often can your body tolerate this…?
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7. Outline
• Biomechanics of distance running
– What you’re really doing to your body
• How to safely and effectively warm-up
– The right stretches at the right time
• Injury and re-injury prevention
– Prevent bone, joint, and tendon, injuries
– When you stretch and when you strengthen
• Performance enhancement
– Training programmes: increasing running economy
– Running technique and shoe types
@

8. How To Safely And Effectively Warm-Up
• No static/passive stretching before
running
– can put the nervous system and
muscles to sleep
• Why “warm-up”?
– ↑ HR + core temperature
– ↑ active range-of-motion
– ↑ connective tissue compliance
– Wake-up nervous system
– Improve movement patterns
– Improve body awareness
– Mental preparation
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9. How To Safely And Effectively Warm-Up
• Suggested warm-up routine
– General locomotion (3 - 5 mins)
• Jogging, easy strides, side-stepping,
backwards running
– Joint mobility (60 secs)
• Leg swings, knee flexion/extension,
ankle circles
– Dynamic flexibility (3 - 5 mins)
• Knee hugs, leg swings, side lunges,
rotating squats, calf press
– Running posture drills (3 × 10m each)
• High knee-lifts, butt kicks, skipping
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10. How To Safely And Effectively Warm-Up
Knee Hugs
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Photo courtesy Chris Myers

11. How To Safely And Effectively Warm-Up
Rotating Squats
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Photo courtesy Chris Myers

12. How To Safely And Effectively Warm-Up
Calf Press
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Photo courtesy Chris Myers

13. How To Safely And Effectively Warm-Up
Running Posture Drills
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Photo courtesy Chris Myers

14. When To Stretch To Increase Flexibility
• Not before a training session
• After a training session
• Every other day
• Passive: mild / moderate discomfort
• No sharp pain
• 3 × 30 - 60 secs / muscle group
• Do you know how to stretch with
correct technique?
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15. Outline
• Biomechanics of distance running
– What you’re really doing to your body
• How to safely and effectively warm-up
– The right stretches at the right time
• Injury and re-injury prevention
– Prevent bone, joint, and tendon, injuries
– When you stretch and when you strengthen
• Performance enhancement
– Training programmes: increasing running economy
– Running technique and shoe types
@

16. Injury Prevention
• Types of injury
• Overuse
– stress fracture (tibia)
– arthropathy (patellofemoral)
– tendinopathy (Achilles’)
– other (ITB syndrome)
• Traumatic
– joint sprain (ankle)
– muscle strain (hamstring)
– fall (bruise, laceration)
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17. Injury Prevention
• Scientifically-proven ‘predictors’ of injury
• Training habits
– ↑ intensity = ↑ overuse injury
– ‘train harder’ ≠ ‘ train better’
– ↑ weekly mileage = ↑ overuse injury
– ‘more’ ≠ ‘better’
– ↑ road-running = ↑ overuse injury
– ‘harder’ ≠ ‘tougher’
– sudden ↑ training volume
– sudden change in training surface
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18. Injury Prevention
• Scientifically-proven ‘predictors’ of injury
• Functional strength (500% ↑ risk)
– ↓ leg press strength = ↑ stress fracture
• Core muscle performance (15% ↑ risk)
– ↓ hip strength = ↑ knee / foot injury
• Calf muscle performance (10% ↑ risk)
– ↓ calf endurance = ↑ stress reaction
• Calf muscle performance (50% ↑ risk)
– ↓ calf strength = ↑ Achilles’ tendinopathy
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19. Injury Prevention
• Example screening test
• Calf muscle strength endurance
Caution: testing without supervision
can cause injury
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Below Acceptable
Level
< 20 reps
Benchmark Level 25-30 reps
Advanced Level > 35 reps
Meaningful Change
in Score
3 reps
Courtesy Chris Myers

20. Injury Prevention
• Example screening test
• Hip extensor strength endurance
Caution: testing without supervision
can cause injury
@
Below Acceptable
Level
< 20 reps
Benchmark Level 30 reps
Advanced Level > 35 reps
Meaningful Change
in Score
3 reps
Courtesy Chris Myers

21. Injury Prevention
• Take-home points
• Use a ‘periodized’ training programme
– different training sessions
• Strength training critical for preventing
bone, joint, and tendon injuries
– “can’t condition the engine if the
chassis gives out first…”
• When to stretch and strengthen
– everyone’s different…
– scientifically-valid personalized assessment
– individualized targeted injury prevention programme
– how strong are your hip and calf muscles…?
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22. Re-Injury Prevention
• Scientifically-proven ‘leftover’ effects of
previous injury
• Post-injury osteopenia (thinning bone)
• Muscle wasting
• Severe muscle weakness
• Standard rehabilitation often inadequate
• Hidden problems can persist for decades
• ↑ risk permanent complications (e.g. arthritis)
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23. Re-Injury Prevention
• Scientifically-proven ‘predictors’ of re-injury
• Previous injury
– Knee sprain: 480% ↑ risk arthritis
– Ankle sprain: 260% ↑ risk 2nd sprain
– Groin strain: 160% ↑ risk 2nd strain
– Calf strain: 233% ↑ risk 2nd strain
• Poor balance
– Knee sprain: 230% ↑ risk 2nd sprain
• Decreased quadriceps force (weakness)
– Knee sprain: 330% ↑ risk 2nd sprain
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24. Re-Injury Prevention
• Example screening test
• Barefoot eyes-open single-leg balance
– hands-on-hips: 45 seconds
– hands-across-chest: 20 seconds
Caution: testing without supervision
can cause injury
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25. Re-Injury Prevention
• Take-home points
• Previous injury = ↑ risk re-injury
• Previous injury = ↑ risk arthritis
• You might feel ‘normal’ and be able to run,
but there will likely be subtle hidden problems
that may persist for many years
• Only objective, targeted, injury-specific testing
will find the hidden problems (e.g. weakness)
• How do you really know if you’ve recovered
from a previous injury and it’s safe to run again…?
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26. Outline
• Biomechanics of distance running
– What you’re really doing to your body
• How to safely and effectively warm-up
– The right stretches at the right time
• Injury and re-injury prevention
– Prevent bone, joint, and tendon, injuries
– When you stretch and when you strengthen
• Performance enhancement
– Training programmes: increasing running economy
– Running technique and shoe types
@

27. Performance Enhancement
• Running economy
– O2 consumption for a given
running velocity
• Strength training and plyometric
training can increase running
economy
• Strength training can increase
tendon thickness and stiffness
• ↑ tendon stiffness = ↑ elastic recoil
potential
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28. Summary
• Massive forces in the body during running
• First-time injury can be predicted with
scientifically-proven tests
• Full recovery from re-injury is rare
and the risk of re-injury is high
• Re-injury can also be predicted with
scientifically-proven tests
• Mixed training enhances running economy
• Scientifically-validated injury prevention
tests can help you safely and quickly
achieve your best running performances
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29. Thank You
@
Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCS
Consultant Musculoskeletal and Sports Physiotherapist
Certified Strength and Conditioning Specialist
nicholas@complete-physio.co.uk
www.complete-physio.co.uk