Running and Injury Prevention Alicia Burillo Clinical Education III April 17, 2012

1. Running and Injury PreventionAlicia BurilloClinical Education IIIApril 17, 2012

2. Running Facts • About 36 million Americans ran at least once in 2003 • 12 million have been in the sport for ≥ 10 yrs • 10 million people competed in road races in 2009 • The average age of frequent runners (>100 days/yr) is 30.6 years and > 40% are female • The incidence of hip injuries/yr. is between 37% and 70% for the average recreational runner • 25% of runners experience musculoskeletal injuries that necessitate evaluation at some point in their running careers • Routine high mileage, rapid increase in mileage, increased intensity, running hills & running on irregular surfaces account for ~ 65% of chronic injuries in distance runners

3. Gait Cycle

4. Biomechanics of Normal Gait • Gait cycle: initial contact of R foot to next initial contact of R foot. • Stance phase (60%) • Initial contact (heel strike • Loading response (foot flat • Midstance (single limb support) • Terminal stance (heel off) • Preswing (toe off) • Swing phase (40%) • Acceleration (initial swing) • Midswing • Deceleration (terminal swing) • 2 periods of double support • 1 period of single limb support • Walking • Stance (60%) • Swing (40%) • Running • Stance (40%) • Float (15%) • Swing (30%) • Float (15%) • As the velocity of gait cycle increases, the stance phase decreases & a float phase appears. The required ROM increases with the speed of activity. Each heel strike produces a force = to 3-4 X BW.

5. Proper Running Form • http://www.youtube.com/watch?v=Tx6x2cD6Y8Q

6. Common Running Injuries • Hip injuries • Muscle strains & tendonitis (33% of sports injuries & most common etiology of hip pain in runners) • ITBS • Bursitis • Snapping hip syndrome • Acetabularlabral tears • Osteoarthritis • Knee and leg injuries • Iliotibial Band Syndrome • Patellofemoral pain syndrome • Shin splints • Anterior compartment syndrome • Stress fractures • Ankle and foot • Achilles tendinitis • Plantar fasciitis • Ankle sprains • Posterior tibialis tendinitis

7. Injury Prevention • Injuries result from: • Intrinsic factors • Weak muscles • Reduced muscle flexibility • LE malalignments • Extrinsic factors • Errors in training (rapid  in intensity, excessive mileage – 40miles/wk, insufficient warm up) • Inappropriate shoes • Training surfaces

8. Injury Prevention • Appropriate training • Shoes • Warm up • Pre-performance stretching • Running surfaces • Orthoses • Muscle strength • Core strengthening • Walk to run programs

9. Walk to Run program

10. Rehab of common running injuries • ITBS • Acutely: alternate activity (deep water running, swimming, avoiding repetitive knee flex & hills) • Progress to running –start slow, progress mileage, only run until sx appear • Ice • Stretching • Foam roller • Massage • Strengthening of core, hip abductors, quads, hams

11. ITB stretches

12. Rehab of Common Running Injuries • PFPS • There may be several different causes (tight ITB, weak quads-VMO& tight hams, weak hip rotators) • Exercises to address these issues • Stretch ITB & hams, strengthen VMO & hip ER & abd • Ice massage • Initial rest period, followed by progressive return to running

13. Plantar fasciitis • Ice water baths • Massage • Plantar fascia & FHL stretch • PF eccentrics • Initial rest period & walking boot if sig. pain with walking • Well fitting shoes with good medial longitudinal arch support • Achilles tendinitis • Initial rest period from running and avoid hills • Stretching gastrocsoleus complex • Eccentrics

14. What to eat before & after a run • Before • Complex carbs • Oatmeal • Whole wheat breads with honey & PB • Brown rice • Pasta • Bagel • Beans, lentils • bananas • Almonds & Walnuts • Fluids • After • Complex carbs • Chocolate milk • Coconut water • Protein bars • Lab made products

15. References • Messier S, Legault C, Schoenlank C, Newman J, Martin D, DeVita P. Risk factors and mechanisms of knee injury in runners. Medicine And Science In Sports And Exercise. November 2008;40(11):1873-1879. • Lohman E, BalanSackiriyas K, Swen R. A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking. Physical Therapy In Sport: Official Journal Of The Association Of Chartered Physiotherapists In Sports Medicine. November 2011;12(4):151-163. • Magee DJ. Orthopedic Physical Assessment. St. Louis, Missouri: Saunders Elsevier; 2008. • Nicola T, El Shami A. Rehabilitation of running injuries. Clinics In Sports Medicine. April 2012;31(2):351-372. • Johnston C, Taunton J, Lloyd-Smith D, McKenzie D. Preventing running injuries. Practical approach for family doctors. Canadian Family Physician Médecin De FamilleCanadien. September 2003;49:1101-1109. • Shrier I. Warm-up and stretching in the prevention of muscular injury. Sports Medicine (Auckland, N.Z.). 2008;38(10):879; author reply 879-80.

16. References • Fletcher I, Jones B. The effect of different warm-up stretch protocols on 20 meter sprint performance in trained rugby union players. Journal Of Strength And Conditioning Research / National Strength & Conditioning Association. November 2004;18(4):885-888. • Paluska S. An overview of hip injuries in running. Sports Medicine (Auckland, N.Z.). 2005;35(11):991-1014. • Ryan M, Valiant G, McDonald K, Taunton J. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. British Journal Of Sports Medicine. July 2011;45(9):715-721. • http://www.madetorun.com/running-diet-and-nutrition/what-to-eat-before-running/. • http://www.madetorun.com/running-resources/questions-about-running/what-to-eat-after-a-run/. • http://sportsmedicine.about.com/od/tipsandtricks/a/replaceshoes.htm---running shoes • http://www.youtube.com/watch?v=Tx6x2cD6Y8Q • http://www.hindawi.com/journals/ijped/2010/835984.fig.002.jpg