marathon training injuries and treatment-part1
TRANSCRIPT
Common injuries and how to prevent them
Sebastian CormierMsc Physio, Bsc Sports Med, CSCSChartered PhysiotherapistStrength & Conditioning Specialist
Overview
1. Very quick recap on understanding your training programme.
2. The big three:1. “Runner’s knee” or Iliotibial friction syndrome (ITB)
2. “Shin Splints” or medial tibial stress sydnrome (MTSS)
3. “Achilles pain” or achilles tendinopathy
3. The running gods exercise tips
4. Summary
Less than 2 months to go!!
HOW FAR TO GO?
TaperBase 1 Base 2 Speed
Base 2 – The volume phase (milage/duration) 4-8 weeks.
Prepare the body for the intense speed phase to come!
EASY – HILLS – UP-TEMPO (60-75% effort)
Goals:
1. High mileage/ duration
2. Low-intensity training
3. Improve recovery rate
4. Improve tolerance to running
Common mistakes in Base 2 Too much mileage too soon
Too much speedwork too soon
Hills too often too fast
Too little recovery
Copying programmes of more experienced runners may lead to injuries
• Some up-tempo work can be included, but remember base 2 phase is slow!
• Hills – slow strides with emphasis on legs NOT lungs!
Speed training phase (4-8 weeks)
Working at 75-95% of effort in:
Intervals training on track i.e. 400m sprints with 90 sec rest X 5. Reduce rest/ increase intervals
Hill intervals I.e. Sprint up Primrose hill, down slow X 20. Increase gradient, decrease rest, increase distance
Long run 50 % run at race pace (20km) +- intervals
Prepares you psychologically and physiologically for the race! THE CRITICAL ZONE!
Stimulate race conditions and intensities
Common mistakes in Speed Phase
Assess the intensity based on your running experience and your preparation during base 2.
Remember, training volume decreases while intensity increases!
Not enough RECOVERY time built in!
Make sure to contrast speed and slow sessions to avoid repetition
Ouch – I am hurt, what now?
How common are injuries with running
65%-90% of runners get injured each year
Previous injuries, age and muscle weakness are the most consistent INTRISIC risk factors for injuries
Sudden increase in running load and intensity are the most EXTRINSIC risk factors
Overuse injuries are more common than acute injuries
Br J Sports Med. 2002 Apr;36(2):95-101.
Clin Sports Med. 2004 Jan;23(1):55-81, vi.
How common are injuries with running
Beginners more prone to injury than veterans
Low BMI in females prone to stress fractures
Higher risk of injury zone when running more than 40miles/weeks
Sports Med. 2007;37(4-5):437-9.
Myths about injury prevention in running
Stretching pre running does not reduce injuries
There is no evidence to suggest that running shoes prevent injuries
No evidence for insoles/ orthotics
No evidence to suggest specific biomechanical contributors predispose for running injuries, including individual running technique and foot strike patterns
Br J Sports Med. 2007 Aug;41(8):469-80;
Key messages from the evidence
EXPERIENCE offers real injury prevention value:
The stronger and more coordinated the better
Recurrent injuries are warning signs for lack of stability and control of joints
Too many consecutive days running does not give the body adequate time to heal
Post running stretching seem to be beneficial
Archives of Internal Medicine, vol. 149(11), pp. 2561-2564, 1989
Acute vs. overuse injuryACUTE INJURY
Onset is acute, sharp, shooting pain
Localized
Immediate inability to run further without aggravation
Maybe associated with muscle power loss according to severity of damage
Common sites with running are calf belly, hamstring strains and ankle sprains.
Example of an acute grade 2 Hamstring tear
Treatment for acute injuriesBEST PRACTICE in the first 48 Hours:
1. PRICE
2. Avoid use of NSAID’s
3. Ice & compression critical
4. Early movement useful, but avoid stretching
5. Avoid direct soft tissue work
6. Avoid excessive travel
Orchard et al. (2008)
PRICEP – Protection Don’t stretch/ crutches/ brace/ tape
R – Rest Give adequate healing time depending on severity
I – Ice Crushed ice for 15 min every 2h
C – Compression Tape, double tubigrip,
E – Elevation
ACPSM (2011) Executive summary on PRICE guidelines
Overuse injuriesOVERUSE INJURY CATEGORIES:
1. Training volume/intensity
2. Anatomical variation
3. Biomechanical factors
However, etiology of overuse injuries remains multifactorialand can include all of the above.
Early DIAGNOSIS is KEY!!!!
Three most common overuse running injuries
1. “Runner’s Knee” or Iliotibial friction syndrome
2. “Shin Splints” or medial tibial stress syndrome
3. “Achilles pain” or achilles tendinopathy
Runner’s knee – ITB friction syndrome
• Most common injury to the lateral knee (21%)
• Inflammation of the fat pad/ perosteum/distal ITB tendon
• Grad increase in pain during running, which may disappear afterwards. Can be stiff later especially with walking down stairs.
Runner’s knee – ITB friction syndrome
Internal risk factors:
• Weak or tight hip/ pelvic muscles
• Weak or tight hamstrings
• Poor control/ balance with single leg stance/landing
• Excessive overpronation
• Bony abnormalities
External risk factors:
• New to running/ sudden increase in mileage
• Excessive hill running esp. downhill
• Running on a camber
Runner’s knee – ITB friction syndrome
TREATMENT:
ACUTE onset (less than 2 weeks):
Active rest from running
Anti-inflammatories as prescribed
Regular icing for 15 min every 3 hours
Stretching gluts, hamstrings, front of thigh, calves.
Foamrolling along ITB and front of thigh to release tight tissue
Sports massage
CT guided corticosteroid injection if it doesn’t settle or race is imminent.
Ellis R, Hing W, Reid D. Man Ther. 2007 Aug;12(3):200-8.
Runner’s knee – ITB friction syndrome
ACUTE AND CHRONIC ITB syndrome (2 weeks+)
Correct biomechanical issues affecting compression forces of distal ITB:
Strengthen hip, pelvic and core muscles
Increase power in the lower limb muscles to improve shock absorption
Stretch or foamroll tight muscles of the thigh
Correct shoe wear or orthotics
Ellis R, Hing W, Reid D. Man Ther. 2007 Aug;12(3):200-8.
“Shin Splints” Misleading terminology: Most commonly associated
with medial tibial stress syndrome
Associate with diffuse irritation to the bone lining of the tibia
Different to compartment syndrome and stress fractures
“Shin Splints”
Internal risk factors:
Excessive pronation
Calf muscle tightness
Weakness hip and pelvic musculature
Decrease calf endurance
External factors:
New to running/ sudden increase in volume/intensity
Worn out shoes
Luke T Madeley, Shannon E Munteanu, Daniel R BonannoJournal of Science and Medicine in Sport, Volume 10, Issue 6, December 2007, Pages 356-362
“Shin Splints”TREATMENT
ACUTE onset:
Active rest from running
Anti-inflammatories as prescribed
Regular icing for 15 min every 3 hours
Stretching Calves and anterior shin +++
Sports taping to offload anterior and/or posterior shin
Sports massage
“Shin Splints”ACUTE AND CHRONIC symptoms (2 weeks+)
Correct biomechanical issues affecting load to the shinbone:
Strengthen hip, pelvic and core muscles
Increase power in the lower limb muscles to improve shock absorption
Improve especially calf muscle endurance
Correct shoe wear or orthotics
Riley, R. Journal of Science and Medicine in Sport, Volume 6, Issue 4, Supplement 1, December 2003, Page 13
Achilles tendinopathy• Overuse tendon
injury that is characterized by a changes in tendon structure and a reduction in function
• Usually occurs in the mid-tendon of the Achilles
• Some respond to simple treatment, some fail ALL treatments
Achilles tendinopathy
Diagnosis is most important here as it guides further interventions !!! Seek help from physiotherapist or sports physician EARLY!
Tendon changes are reversible if early warning signs are recognized and training volume and intensity are modified IMMEDIATELY!
If an intense bout of exercise flared-up the Achilles, it will respond to a reduction in load, adequate recovery, ice and anti-inflammatories.
Achilles tendinopathy Chronic overload of the Achilles tendon will result in a
focal “thickened tendon” (not inflammed), that is painful with forceful push-off and stiff in the morning.
Often present in the elite athlete with chronically overloaded tendons or the middle-aged recreational runner.
Stories.. Dame Kelly Holmes, GB 800
and 1500m runner, won Double Gold with bilateral chronic Achilles tendinopathy
Liu Xiang, Chinese 110 meter Hurdler, Triple Crown winner unable to continue training 6
months prior to Olympics Beijing
Biggest Medical Budget in the World unable to get him starting at the Games 2008.
Achilles tendinopathyTREATMENT:
Anti-inflammatories are not helpful in the chronic stage
Exercise with an eccentric(lengthening) / heavy slow resistance component to it i.e calf raises off step with straight and bend knee
Extracorporeal shockwave therapy
Ultrasound guided injections (not cortisone)
Surgery if all fails
Cook JL, Purdam CR. Br J Sports Med. 2009 Jun;43(6):409-16.
Question and Answers
"If you want to win something, run 100 meters.If you want to experience something, run a marathon." –
Emil Zatopek