Runner's Injury Prevention

JEN DAVIS DPT Runner's Injury Prevention Jen Davis DPT Orthopedic Physical Therapy Foot Traffic 7718 SE 13th Ave Portland, OR 97202 (503) 482-7232 Jen@runfastpt.com www.runfastpt.com!1

THE AMAZING RUNNER Objectives Deliver an overview of the most common running injuries encountered and signs and symptoms of unbalanced running training Provide insight and solutions for running injury free Education on a general flexibility and strength program to address runner specific needs for Balanced training The Act of Running Body must absorb lots of shock with ground reaction forces (GRF) 11-14 times body weight The body must Reverse these forces to propel self forward Cadence= steps per minute typically 145-180, in elite runners well over 180-220 steps per minute Must control forces in three dimensions: front and back, sideways, rotational through out the whole body head to toe in all tissues, bones and joints Must maintain this ability and control on all types of running terrain for extended periods of time These GRFs are not evenly distributed in a balanced way The typical runner Focuses on time and distance Tend to ignore mild symptoms and " signal alarms" our body gives us Train and compete with one another and train through fatigue and discomfort Takes little equipment or specific knowledge or training to do, easy to take advantage of our body running!2

Why running injuries occur Poor training or inadequate preparation ( nutrition, recovery, fatigue) Cumulative tightness and weakness over time ( inadequate muscle strength and flexibility) Imbalances of absorption of GRF up and down the kinetic chain, loads certain tissues, joints more than others. Develop compensatory patterns The activity exceeds the tissues threshold/ tolerance for force attenuation so it begins to breakdown. Overuse injuries primarily from micro trauma not macro trauma Most Common Running Injuries Medial Tibial Stress Syndrome (shin splints) Achilles Tendonitis Plantar Fasciitis Anterior Knee Pain Iliotibial Band Syndrome Medial tibial stress syndrome ( Shin Splints) 10-20% of injuries in runners Increased rate and magnitude of shock absorption through the foot and lower leg Knee drop toward midline excessive and poorly controlled Tight and strong calf muscles cause bow string effect Muscular control of forces decreases with fatigue Bone mineral density Increased activation and work of the tibial is anterior Pain along the inside of the lower leg Symptoms occur at the beginning of the run then dissipate and return after the run Pain resolves within several minutes if allowed to rest If it becomes chronic will hurt consistently More diffuse pain, all over, stress fractures more localized!3

Achilles Tendonitis (Tendonosis) Pain or soreness above the insertion of the tendon onto the heel (especially in the AM) can be sharp as condition worsens Tightness at rest, then loosens up during the warm up Diffuse soreness at the end of a run, and a few hours after Possible localized swelling around the tendon Eventually painful all the time Plantar Fasciitis Sharp pain along the front and inside part of the bottom of the heel and arch of the foot Worse with the first few steps in the morning "stepping on glass" Better as the day goes on, then gets bad again later on from prolonged weight bearing Increased tenderness with increased GRF, running down hill, increased speed Soreness and tightness after a run Calf tightness Speed and extent of arch drop ( uncontrolled loading of the arch quickly or too much) Increased tension if the knee drops towards Midline or if the foot rotates outward Iliotibial Band Syndrome Pain along the outside of the knee and outer thigh Pain usually begins after running for a while Increased pain with running hills, stairs, striding out Sometimes snapping hip syndrome present along side Tightness and soreness after a run Foam roll stretching? More common in females!4

Weakness or fatigue of the hip muscles that control the drop of the knee toward midline during Single leg stance in running Quick and or excessive pronation Pain and possible swelling of bursa ( fluid filled cushion) on the outside of the knee from friction Anterior Knee Pain Pain along the front of the knee at the base of the patella Stiffness and difficulty bending the knee after periods of sitting in a bent knee posture Increased pain when running down hill, and activities requiring increased shock absorption Loosens up after warmed up, but gets sore at the end of a run Inflammation from increased force through the patellar tendon Pain due to irritation of the patella femoral joint Increase in hills, distance or speed Increased knee bend at impact/loading response Poor hip and knee alignment Tightness of the ITB What do all these Running injuries have in common Weakness, or inhibition of the gluteus medius muscle The gluteus medius muscles primary function in standing, walking and running is to maintain pelvic stability This muscle controls deceleration when landing on one foot during running and controls the collapse of the knee and arch of the foot towards midline What does that look like? Either collapse or compensate!5

Is there any hope for us runners then? YES!!! Focus on your posture and form when running consistently, and in everyday activities Train you muscles to be good at controlling against gravity Maintain or obtain functional flexibility... Dynamic and static stretching Perform a maintenance program 2-3x week to counteract common postural deficits that running and activities of daily living can predispose you to Follow the runners golden rule: don't increase your frequency duration or intensity more than 10% a week from week to week to allow tissues to slowly and safely adapt to the new loads. Especially as we age. Our tissues take longer to recover Repeat after me: " I WILL NOT BECOME A WEEKEND WARRIOR " Listen to your body Don't drastically change running form, style and shoe wear ( 10% rule) ie stability shoe to neutral shoe without cutting back on duration (time or mileage), frequency and intensity to allow body to adapt. Give muscles and joints proper warm up before and cool down after training Better to increase running based on time not mileage Train all three planes of motion: saggital, frontal and transverse for optimal performance and injury prevention Use cross training to allow muscles and tissues to adapt and heal from fatigue of running Don't wait until last minute to seek help for nagging injuries, or until you can no longer run to get checked out. This usually leads to increased time off of running, and longer recovery time Stay In tune with your body while training, avoid the urge to train through nagging symptoms Use caution when adding uneven terrain, inclines and speed work into training If all else fails learn to ride a bike!!! ( Just kidding)!6

Jen's Practical Prevention Program: Passion, Persistence & Patience Foam roll progression for spinal posture Swiss ball scapular retractions Gluteus medius strengthening progression Abdominal core stabilization exercises 3D hamstring stretch 3D calf stretch 3D hip flexor stretch Piriformis/ Hip External rotator stretch The ultimate key to success: Passion, Persistence and Patience!!!!7