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Tri Athlete - Don\'t Let Bad Mechanics Sideline Your Training


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This presentation provides the most current research related to running mechanics and how to train to prevent some of the most common running injuries.

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Tri Athlete - Don\'t Let Bad Mechanics Sideline Your Training

  1. 1. Running Mechanics in the Tri-athletes Don’t let bad mechanics sideline your training
  2. 2. Triathlons are so physically demanding that it comes down to who is the smartest.” —Peter Reid Three-time Ironman World Champion Two-time Ironman Canada Champion
  3. 3. The Research • ~75% of all competitors have sustained at least one overuse injury during their training (1,3) • Most injuries occur during training for the running component of triathlon (1,2,3); • Risk of injury is heightened with higher training mileage.(3) • Running generates the greatest impact and stress to the muscles, tendons, bones and ligaments of the triathlete’s lower limbs.(1,3,4). 1. Egermann M, Brocai D, Lill CA, and Schmitt H. Analysis of injuries in long-distance triathletes. International Journal of Sports Medicine 2003; 24(4):271-6. 2. Shaw T, Howat P, Trainor M, Maycock B. Training patterns and sports injuries in triathletes. Journal of Science Medicine and Sport 2004; 7(4):446-50. 3. Burns J, Keenan AM, Redmond AC. Factors associated with triathlon-related overuse injuries. Journal of Orthopaedic & Sports Physical Therapy 2003; 33(4):177-184. 4. Cipriani DJ, Swartz JD, and Hodgson CM. Triathlon and the multisport athlete. Journal of Orthopaedic & Sports Physical Therapy 1998; 27(1):42-50.
  4. 4. Most Common Orthopedic Injuries • Low back – SI Joint & L5/S1 • Hip – Hamstrings, stress fractures, bursitis • Knee – IT band, meniscus, PF syndrome • Lower Leg/Foot/Ankle – Shin splints, anterior compartment syndrome, plantar fascitis
  5. 5. What are the causes? • Improper conditioning/poor mechanics – Preseason • Improper training – Mileage progressions – Strengthening progressions ( endurance) • Inappropriate warm-up – Warm up – Stretching • Nutrition/hydration – Water recommendations • .5 oz to 1.0 oz./lb BW – Caffeine • 420 mg/day – avg. 1600 mg/day Micheals, K; Wolk, A. A prospective study of variety of healthy foods and mortality in women. Journal of Epidemiology. 2002; 31 847-854.
  6. 6. What are the causes? • Crossed Pelvis Syndrome – Muscular Imbalance – Tight: Hip Flexors and Erector Spinae – Weak: Gluts and transverse abdominus – Adds to abnormal force attenuation at knee, hip and spine – Must address entire system • Solution: – Stretch: • Hip Flexors • Standing IT band – Strengthen • Transverse abdominus • Glut Medius/Maximus Described by Janda, 1996 Evaluation of Muscular Imbalances: Rehabilitation of the Spine.
  7. 7. What are the causes? • Core Weakness • Lumbar Spine is very complex – ~30 muscles indirectly/directly associated with stability of lumbar spine • Hx of pain results in ~25% decrease in cross sectional area of multifidus, must be trained to return – Previous pain results in continued weakness (must provide stimulus to get growth and return of baseline function). 1. Thoracolumbar Fascia 2. Gluteus Maximus 3. Latissimus Dorsi 4. Glut medius 5. Internal Obliques 6. Multifidus 4 5 6 Hides, Julie A. PhD; Richardson, Carolyn A. PhD; Jull, Gwendolen A. MPhty. Multifidus Muscle Recovery Is Not Automatic After Resolution of Acute, First-Episode Low Back Pain. Spine. 21(23):2763-2769,1996
  8. 8. What are the causes? • Poor Balance – Static vs. Dynamic – Core balance vs. lower limb balance • Impaired core proprioception, predictor of knee and hip injury risk in females Zazulak, B, et al. The Effects of Core Proprioception on Knee Injury. A Prospective Biomechanical-Epidemiological Study. American Journal of Sports Med, Vol 35, No. 3, 2007 • Factors related to core stability predicted risk of hip, knee, and ligament, with high sensitivity Zazulak, B, et al. Deficits in Neuromuscular Control of the Trunk Predict Knee Injury Risk: A Prospective Biomechanical- Epidemiological Study. American Journal of Sports Med, Vol 35, No.7, 2007 SEBT – measures dynamic balance and indicates asymmetries – here a 19 degree difference
  9. 9. What are the causes? Abnormal movement patterns at foot, ankle, knee, hip, pelvis and lumbar spine adding to increased stress in Knee – 38 degree difference • Abnormal movement patterns • Components of pathokinematics (abnormal movement) – These add to abnormal force distribution along the entire kinetic chain • Why sometimes your knee pain may be related to hip weakness – Combination of weakness/tightness + – Poor motor programming • Retraining must be a component of the overall training program Zazulack, B; Hewett, T; Reeves, P; Goldberg, B; Cholewicki, J. The Effects of Core Proprioception on Knee Injury : A Prospective Biomechanical- Epidemiologic Study. Am J Sports Med; 35:368-373.
  10. 10. A Dart Fish Assessment: Pathokinematics in Motion • What is dartfish? • Steps: – Video (demo): • Running • Functional testing – Import to dart fish – Analysis of movements • Frame by frame • Degrees of variation College football player returned to sport by another provider, comparison of B results
  11. 11. Running Mechanics in Motion • Subject: – 40 y/o Marathon Runner, 5 year history of running, complains of R PF issues and low back pain Decreased terminal hip ext @ TO Trendelenburg @ MS RCalcaneal pronation at MS
  12. 12. Running Mechanics in Motion • What does it mean? – Decrease in THE, decrease knee ext & increased trunk rotation with TO (assymetries) • + thomas for IS tightness • + hamstring tightness (100L/80R) • Poor grade on TA • Poor grade on MMT • Poor grade on g.max MMT Decreased terminal hip ext @ TO Trendelenburg @ MS RCalcaneal pronation at MS
  13. 13. Functional Testing in Motion Squat: adduction/IR w/ ascent, L lateral shift at end ROM Step-up: add/IR with ascent SL Squat: sig adduction/IR, pes plantus Squat: Sig lateral shift with ascent > 3 inches
  14. 14. Functional Testing in Motion Squat: adduction/IR w/ ascent, L lateral shift at end ROM Squat: Sig lateral shift with ascent •What does it tell us? •Add/IR – indicates weakness of the g.medius •Phase of motion indicates strengthening focus – eccentric vs. concentric •Lateral shift – multifactorial •Pain, limited ROM, quad weakness or poor motor patterns •Phase of motion indicates strengthening focus
  15. 15. Functional Testing in Motion SL Squat: sig adduction/IR, pes plantus SL Squat: sig lateral sidebending, trendelenburg, add/IR •What does it tell us? •Add/IR – indicates weakness of the g.medius •Number of joints involved can indicate degree •Should assess foot mechanics and if orthotic indicated •Trunk sidebending and trendelenburg •Should assess core weakness – TA, multifidus, etc.
  16. 16. Program Design • Core Basics – Designed to address the common deficits – Individualized based on assessment Dynamic Stretches •Benefits •Dynamic Lunge •Sumo
  17. 17. Program Design • Exercise selection based on: – Proven in the research – #1 exercise for • Multifidus • • Lower abs
  18. 18. Program Design • Exercise selection based on: – Focus on all components adding to poor mechanics – Component of supersets – Dynamic balance
  19. 19. Contact Information Trent Nessler, PT, DPT, MPT Area Vice President Champion Sports Medicine/Physiotherapy Associates Owner – A.C.L. – Accelerated Conditioning and Learning For more information contract us at
  20. 20. References 1. Deyo, RA. Practice variations, treatment fads, rising disability: Do we need a new clinical research paradign? Spine 1993; 18: 2153-2162. 2. DeRosa, CP; Porterfield, JA. Mechanical Low Back Pain: Functional Anatomy and Treatment Perspectives. Saunders. 1993. 3. Frymoyer, JW. An overview of the incidence and cost of low back pain. Orthopedic Clinics of NA 1991; 22:262-271. 4. Frymoyer, JW. Epidemiological studies of low back pain. Spine 1980; 14: 419.
  21. 21. References 5. Agel, J., Arendt, E. A., and Bershadsky, B.: Anterior Cruciate Ligament Injury in National Collegiate Athletic Association Basketball and Soccer: A 13-Year Review. Am J Sports Med. 33:524-531, 2005. 6. Arendt, E. and Dick, R.: Knee injury patterns among men and women in collegiate basketball and soccer. NCAA data and review of literature. Am J Sports Med. 23:694-701, 1995. 7. Boden, B. P., Dean, G. S., Feagin, J. A., and Garrett, W. E.: Mechanisms of anterior cruciate ligament injury. Orthopedics. 23:573-578, 2000. 8. Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., and Rizzo, A.: Prevention of anterior cruciate ligament injuries in soccer. A prospective controlled study of proprioceptive training. Knee Surg Sports Traumatol Arthrosc. 4:19-21, 1996.
  22. 22. References 9. Chappell, J. D., Yu, B., Kirkendall, D. T., and Garrett, W. E.: A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Am. J. Sports Med. 30:261-267, 2002. 10. Chappell, J. D., Herman, D. C., Knight, B. S., Kirkendall, D. T., Garrett, W. E., and Yu, B.: Effect of Fatigue on Knee Kinetics and Kinematics in Stop-Jump Tasks. American Journal of Sports Medicine. 33:1022-1029, 2005. 11. Chaudhari, A. M., Hearn, B. K., and Andriacchi, T. P.: Sport-Dependent Variations in Arm Position During Single-Limb Landing Influence Knee Loading: Implications for Anterior Cruciate Ligament Injury. American Journal of Sports Medicine. 33:824-830, 2005. 12. Ford, K. R., Myer, G. D., and Hewett, T. E.: Valgus knee motion during landing in high school female and male basketball players. Med. Sci. Sports Exerc. 35:1745-1750, 2003. 13. Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., Garrick, J. G., Hewett, T. E., Huston, L., Ireland, M. L., Johnson, R. J., Kibler, W. B., Lephart, S., Lewis, J. L., Lindenfeld, T. N., Mandelbaum, B. R., Marchak, P., Teitz, C. C., and Wojtys, E. M.: Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J. Am. Acad. Orthop. Surg. 8:141-150, 2000.
  23. 23. References 14. Hewett, T. E., Lindenfeld, T. N., Riccobene, J. V., and Noyes, F. R.: The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am. J. Sports Med. 27:699- 706, 1999. 15. Leetun, D. T., Ireland, M. L., Willson, J. D., Ballantyne, B. T., and Davis, I. M.: Core stability measures as risk factors for lower extremity injury in athletes. Med. Sci. Sports Exerc. 36:926-934, 2004. 16. Lephart, S. M., Ferris, C. M., Riemann, B. L., Myers, J. B., and Fu, F. H.: Gender differences in strength and lower extremity kinematics during landing. Clin. Sports Med.162-169, 2002. 17. Mandelbaum, B. R., Silvers, H. J., Watanabe, D. S., Knarr, J. F., Thomas, S. D., Griffin, L. Y., Kirkendall, D. T., and Garrett, W., Jr.: Effectiveness of a Neuromuscular and Proprioceptive Training Program in Preventing Anterior Cruciate Ligament Injuries in Female Athletes: 2-Year Follow-up. Am J Sports Med. 33:1003- 1010, 2005.
  24. 24. References 18. McLean, S. G., Lipfert, S. W., and van den Bogert, A. J.: Effect of gender and defensive opponent on the biomechanics of sidestep cutting. Med. Sci. Sports Exerc. 36:1008-1016, 2004. 19. McLean, SG., Huang, X., and van den Bogert, A. J.: Association between lower extremity posture at contact and peak knee valgus moment during sidestepping: Implications for ACL injury. Clinical Biomechanics. 20:863-870, 2005. 20. McNair, P. J., Marshall, R. N., and Matheson, J. A.: Important features associated with acute anterior cruciate ligament injury. N Z Med J. 103:537-539, 1990. 21. Pantano, K. J., White, S. C., Gilchrist, L. A., and Leddy, J.: Differences in peak knee valgus angles between individuals with high and low Q-angles during a single limb squat. Clinical Biomechanics. In Press, Corrected Proof. 22. Sigward SM and Powers CM: The Influence of gender on knee kinematics, kinetics, and muscle activation patterns during side- step cutting. Clin Biomech. 2005. In press.
  25. 25. References 23. Traina, S. M. and Bromberg, D. F.: ACL injury patterns in women. Orthopedics. 20:545- 549, 1997.