removing the rust: seasonal runner's workshop...van gent et al. br j sports med 2007...
TRANSCRIPT
Removing Removing the Rust: the Rust: Seasonal Seasonal Runner's Runner's
WorkshopWorkshop4/12/114/12/11
Jenny Kempf, MPT, CSCSJenny Kempf, MPT, CSCSAmy G. Schubert, DPTAmy G. Schubert, DPT
ObjectivesObjectives
Discuss common running related injuriesDiscuss common running related injuries
Identify causes of running related injuriesIdentify causes of running related injuries
Analyze the biomechanics of runningAnalyze the biomechanics of running
Discuss proper footwear selection Discuss proper footwear selection
Present successful strengthening and training Present successful strengthening and training methods for preventing injuries methods for preventing injuries
van Gent et al. Br J Sports Med 2007
Epidemiology
Injury Incidence 19.4‐79.3%Predominant injury location knee
Incidence 7.2‐50%
Other common sitesLower leg = 9‐32.2%Foot = 5.7‐39.3%Upper leg = 3.4‐38.1%
Epidemiology
Knee 42.1%
Foot/Ankle 16.9%
Lower leg 12.8%
Hip/Pelvis 10.9%
Achilles/Calf6.4%
Other 10.8%
Taunton et al. Br J Sports Med 2002
Common Running Injuries
Patellofemoral pain syndromeIliotibial band syndromePlantar fasciitis Tibial stress fractureKnee meniscal injuries
Causes of Running InjuriesCauses of Running Injuries
Causes of Running InjuriesCauses of Running Injuries
Running Biomechanics
2 main forces that act on the body
Ground Reaction Forces (GRV)
NewtonNewton’’s 3s 3rdrd Law:Law:
Mutual forces of action Mutual forces of action and reaction between and reaction between
two bodies are equal in two bodies are equal in magnitude and magnitude and
opposite in directionopposite in direction
Vertical GRFVertical GRF
Vertical GRFVertical GRF
Anterior‐Posterior GRF
Braking Impulse
How can you reduce GRF?
correct commonly seen running faults
Low Stride Ratenovice runners – 150‐160 foot contacts per minuteintermediate runners – 180 foot contacts per minuteelite runners – 200 foot contacts per minute
Low stride rate ‐ Video
Increase Stride RateIncrease Stride Rate
Use a metronomeUse a metronome5 minute cycles 5 minute cycles
2 min stride rate work2 min stride rate work3 min recovery3 min recovery
NO CHANGE IN SPEED NO CHANGE IN SPEED
44--6 weeks to notice change6 weeks to notice change
How can you reduce GRF?
correct commonly seen running faults
Improve your hip strengthRunner’s with IT band syndrome and patellofemoral pain syndrome have been found to have:
hip weakness Poor hip control when running
Fredericson et al. Clin J Sport Med 2000 Dierks et al. JOSPT 2008 Ferber et al. JOSPT 2010
Hip control ‐ Video
Musculoskeletal
Musculoskeletal Fault
Many sources of painDecreased flexibility **Muscular weakness **Leg length discrepancyLeg alignment **Flat feet (pronation)High arches (supination)
FlexibilityFlexibility
Has not been proven in literature to be a source of Has not been proven in literature to be a source of pain in recreational runnerpain in recreational runner’’ss
General guidelinesGeneral guidelinesDynamic warm up prior to runningDynamic warm up prior to runningStretching after running for cool downStretching after running for cool down
HamstringsHamstringsHip flexorsHip flexorsCalfCalf
Dynamic Warm up Dynamic Warm up -- VideoVideo
Leg Alignment Leg Alignment
““Knocked KneeKnocked Knee””Literature has shown this can Literature has shown this can be a predictor of running be a predictor of running related injuriesrelated injuries
““Bow LeggedBow Legged””
Hip WeaknessHip Weakness
Buttock muscles need to be Buttock muscles need to be highlightedhighlighted
Knees behind toesKnees behind toesShould feel work in buttock Should feel work in buttock not knees or quadsnot knees or quads
Foot KinematicsFoot Kinematics
~80% of distance runners are rear~80% of distance runners are rear‐‐foot strikersfoot strikers3,143,14
Most of remaining 20% are midMost of remaining 20% are mid‐‐foot strikersfoot strikers
Initial ContactInitial Contact
More About the FootMore About the Foot……
Pronation occurs during loading to Pronation occurs during loading to ““unlockunlock”” the midthe mid‐‐foot foot joints for effective shock absorptionjoints for effective shock absorption4,54,5
Foot supinates during midFoot supinates during mid‐‐stance; midstance; mid‐‐foot foot ““lockslocks””allowing rigid lever for pushallowing rigid lever for push‐‐offoff55
Pronation is Pronation is normalnormal; it allows the foot to distribute energy ; it allows the foot to distribute energy to entire footto entire foot3,43,4
Extrinsic Faults
SHOESSHOES……
Shoe Support HierarchyShoe Support Hierarchy
ResearchResearch‐‐ footwearfootwear
Shoe selection based on foot shape has little influence on Shoe selection based on foot shape has little influence on injury riskinjury risk7,117,11
Shoe selection based on Foot Posture Index is overly Shoe selection based on Foot Posture Index is overly simplistic and potentially injurioussimplistic and potentially injurious66
‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐‐
Visual foot shape assessment has 35% error rate when Visual foot shape assessment has 35% error rate when compared to measurement of actual arch heightcompared to measurement of actual arch height1010
Motion ControlMotion Control‐‐‐‐‐‐‐‐‐‐‐‐‐‐Barefoot/MinimalistBarefoot/Minimalist
Barefoot Running
Habitual shod runners mostly rear‐foot strike (even when barefoot)Habitual barefoot runners often forefoot strikeEven on hard surfaces, barefoot runners who forefoot strike generate smaller collision force than shod rear‐foot strikers
Running SurfaceRunning Surface
Sand, GrassSand, Grass
Hard Paved SurfacesHard Paved Surfaces
TreadmillTreadmill
*Most runners will self*Most runners will self‐‐adjust biomechanicsadjust biomechanics
in response to surface variationin response to surface variation1616
Banked/inclined SurfaceBanked/inclined Surface
Single direction track Single direction track
Training Error
Training Training RecommendationsRecommendations
Walk‐run progressions
Every other day running
Cross‐training
Avoid speed training
WalkWalk‐‐Jog IntervalsJog Intervals
Sample Novice ProgramSample Novice Program
Week 1 4 walk, 1 jog repeats x 5 (20 mins total)
Week 2 3 walk, 2 jog repeats x 4 (20 mins total)
Week 3 2 walk, 3 jog repeats x 4 (20 mins total)
Week 4 2 walk, 3 jog repeats x 5 (25 mins total)
Week 5 1 walk, 4 jog repeats x 5 (25 mins total)
Week 6 1 walk, 4 jog repeats x 6 (30 mins total)
Week 7 0 walk, 5 jog repeats x 6 (30 mins total)
Cross TrainingCross Training
EllipticalElliptical
BikingBiking
SwimmingSwimming
Weight liftingWeight lifting
Barefoot Barefoot RunningRunning
Consider a grassy surface or soft Consider a grassy surface or soft track to starttrack to start
Begin with agility drills 2Begin with agility drills 2‐‐3x/week: 3x/week: skipping, sideshuffle, skipping, sideshuffle,
carioca/grapevine (15carioca/grapevine (15‐‐20 yards x 420 yards x 4‐‐6 6 sets)sets)
Progress to jogging: halfProgress to jogging: half‐‐speed speed followed by followed by ¾¾ speed, etc (50 yards x speed, etc (50 yards x
44‐‐6 sets)6 sets)
Consider as a warmConsider as a warm‐‐up or coolup or cool‐‐downdown
Consider alternating barefoot runs Consider alternating barefoot runs with shod runswith shod runs
Ten Percent RuleTen Percent Rule
VolumeVolume
IntensityIntensity
SummarySummaryPronation is normal part of foot kinematics during running
Selecting shoes based on foot shape does not reduce injury risk
Until evidence proves otherwise, pronation control shoes should be considered unproven to reduce injury associated with running
Barefoot runners have smaller collision force on initial contact
Increases in cadence reduces load to hip and knee during running
Consider walk‐run progressions, every‐other day running, and cross training when initiating a program
10% rule of thumb for running volume and intensity progression
UW Runners Clinic Services
Providers: Bryan Heiderscheit, PT, PhD Jenny Kempf, MPT, CSCSAmy Schubert, PT, DPT
Services: Injury EvaluationPerformance Evaluation
Days: Tuesdays and Wednesdays
Website: http://www.uwhealth.org/sports‐medicine/runners‐clinic
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3. Cavanagh, PR. The Biomechanics of Lower Extremity Action in 3. Cavanagh, PR. The Biomechanics of Lower Extremity Action in Distance Running. Distance Running. Foot & AnkleFoot & Ankle; 1987 (7): 197; 1987 (7): 197‐‐217217..
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