1. Running injuries: update

2. Not for everyone!

3. INCIDENCE /PREVELANCE OF RUNNING INJURIES
Most common injuries are: MTSS, TA, PF, PFS Lopes 2012
Previous research areas: Biomechanical abnormalities, sex, BMI, previous injury, flexibility, core strength, intensity duration and frequency of training.
Knapik 2010 Ryan 2010 Mattila 2010 Buist 2010 Hume 2008 Taunton 2003 VanGent 2007 Jones 1993 Van Mechelen 1992 Blair 1987 Schwellnus 1990 Koplan 1995 Marti 1988
Mechanical stress = emerging area of research (aka gait efficiency/minimalism etc)
Lieberman (2010) [[Heel strikers v. forefoot strikers - X2 incidence of injuries in RFS compared to FFS]] different kinetics/kinematics shod v unshod – media went mad with findings -
Running very rarely involves technical training
When running we will favour performance over protection e.g. modern day marathon
Nigg & Enders 2013 Kulmala 2013 Delgado 2012 Goss 2012 Giandolini 2012 Diebal 2012 Daoud 2012 Walther 2005

4. Basic sciences: Evolutionary biology “nothing in biology makes sense except through the light of evolution” (Dobzhansky 1972)
Homo erectus set itself apart from others 2 million years ago by its capacity for long distance running – persistence hunting e.g. Kudu
A humans maximum endurance speed is exceptionally high
Characteristic anatomical adaptations Bramble & Lieberman 2004 Kerr et al 1987
Stabilisation (e.g. nucheal ligament, glute max) – Australopithecus / Neanderthal
Skeletal adaptations – (e.g. boader lower limb joint surfaces, SIJ, plantar arch)
Thermoregulation
Energetics – walking is pendular, running is like a spring. Compared to chimps we are endowed with a set of springy tendons and ligaments in legs and feet. E.g. Achillies tendon 35% and plantar arch 17% – app to plyo

5. Increased elastic energy propulsion Reduced vertical loading rate
EFFICIENT GAIT:
Storen (2011) Heise (2011) Halvorsen (2011) Fletcher (2010) Arellano (2011) Pontzer (2009) Tseh (2008) Fletcher (2007) Hasegawa (2007) Romonov (2007) Heise (2008) Conoboy (2006) Dallam (2005) Saunders (2004) Arendse (2004) Hardin (2004) )Divert (2004) DeWit (2000) Millani (1997) Anderson (1996) Morgon (1994) Kaneko (1990) Cavanagh (1989) Cavanagh (1982) Hennig (1996)
Increased elastic energy propulsion
Reduced vertical loading rate
Reduced contact time with ground
Reduced vertical displacement
Initial weight bearing close to CoG
Foot strike midfoot / forefoot

7. KINETICS / KINEMATICS
– link to Dan Lieberman 1) shod RFS 2) unshod RFS 3) shod MFS 4) unshod MFS

8. Clinical sciences & evidence based
Principal databases
Medline (PubMed) – 45% of the pertinent literature +/- 200 articles per month
EMBASE – 20% of the pertinent literature +/- 200 articles per month
Sportdiscus - 20% of the pertinent literature +/- 200 articles per month
Web of Science - 5% of the pertinent literature +/- 200 articles per month
Review databases
The Cochrane Library
PEDro
TRIP Database

9. ARGUMENT in favour of MINIMALISM
Running shoes change natural biomechanics:
Promotion of heel strike Lohman 2011 Vincent 2011 Wegener 2011 Jenkins (R) 2011 Hamill 2011 Chen 2010 Jungers 2010 Lieberman Squadrone 2009 Kurz 2004 Bihop 2006 Divert 2004 Aguinaldo 2003 Dewit 2000
Increase pronation Stackoff 2001 Hamill 1992 Heil 1992
Loss of knee alignment Radzimski (SR) 2011 Chen 2010 Kerrigan 2009 Burkett 1985
Decrease in cadence Vincent 2011 Squadrone 2009 Divert 2008
“Anti-pronator” shoe technologies do not control foot pronation in lower limb biomechanics Cheung (SR) 2011 Rose 2011 Maclean 2009 Stacoff 2000 Gheluwe 1999

10. Running shoe cushioning increases the mechanical stress on the skeleton (except on the foot) Rethnam 2011, Hamill 2011, Lieberman 2010 Bergman 2010 Brqunstein Kerrigan 2009 Shakoor 2006 Divert 2004 Shorten 2002Hennig 1996 Bergman 1995 – Hardin 2002 Cole 1995 McNaire 1994 Nigg 1987
Shoes fragilise foot tissue, weaken foot muscles and flatten foot arches Bruggemann 2005 & 2004 Pothast 2005 Sachithandam 1995 Rao 1992 Robbins 1987
Shoes are responsible for certain foot deformities (hallus valgus, hammer toes, callus…) D’aout 2009, Zipfel 2007 Mafart 2007 Mays 2005 Sachithanadam 1995
No evidence for prescription running shoes or “arch types” Richards 2008
MF/FF striking could decrease the incidence of some pathologies (Less VLR/IT) Kulmala 2013 Delgado Nigg & Enders 2013 Goss 2012 Giandolini 2012 Diebal 2012 Daoud Walther 2005
Most efficient cue for LT change on running gait is neurophysiological proprioceptive through BF running Giandolini (2013)

11. PRACTICAL IMPLEMENTATION
Normal Subj / Obj / quick tests / ABCD’s / Fx testing / special tests / DDx by zone (osteo-articular, muscular – tendon, neuro – meningeal, vascular etc)
Treadmill –1.2.3’s (“have you used a treadmill before?”; “are those the shoes you normally run in?”; “chose a pace that you feel comfortable with” )
10 min shod – evaluate noise, cadence, vertical displacement, ankle/knee/pelvis/hip biomechs.
4 mins max fully barefoot as patient usually unused to it
Looking for…
Noise, Cadence, Biomechanics – use visual, auditory &kinaesthetic cues – see which works best to ↑cad/freq ↓ stride length
Advice includes…
Progressive overload as Rx (Interval Programme) Supervised increases in mechanical stress
Max 1 extra min p/d
Soreness during drills (esp eccentric) normal, pain +30 mins after exercise/increase in morning stiffness ↓ freq/intensity
Shoe recommendation..
%TRC rating dependant on location / timeframe of injury and current activity levels – usually over 75% to begin with

12. RESOURCES
Shoe selection guide – handout / poster (
Quantifying Mechanical Stress – handout (
Interval Programme – handout 9http://
TRC ratings on all running shoes (
Cadence Apps: Apple
Tap tempo (free) 8 steps needed
Tap tempo BPM (free) average for the last minute, longer duration
Sensor Monitor (free) press on motion and place the ipod on the treadmill to know the impact force
Metronome - Marketwall.com (free) to give your patients the right suggested cadence
Cadence. your music. your motion - ($4.99) to run at your own rhythm from your own music playlist
Android
Tempo Tap (free)
Accelerometer Monitor (free) press on motion and place the ipod on the treadmill to know the impact force
Metronome Beats (free) give your patients the right suggested cadence)
DjRun (free) run at your own rhythm from your own music playlist

13. RUNNING INJURIES - MODEST TO NONSIGNIFICANT EFFECT:
Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A prospective study of running injuries: the Vancouver Sun Run ‘‘In Training’’ clinics. Br J Sports Med. 2003; 37:239–
Blair SN, Kohl HW, Goodyear NN. Rates and risks for running and exercise injuries: studies in three populations. Res Q Exerc Sport. 1987;58:221–8
Buist I, Bredeweg SW, Lemmink KA, van Mechelen W, Diercks RL. Predictors of running-related injuries in novice runners en- rolled in a systematic training program: a prospective cohort study. Am J Sports Med. 2010;38:273–80.
Jones BH, Bovee MW, Harris JM, Cowan DN. Intrinsic risk fac- tors for exercise-related injuries among male and female army trainees. Am J Sports Med. 1993;21:705–10.
Koplan JP, Rothenberg RB, Jones EL. The natural history of ex- ercise: a 10-yr follow-up of a cohort of runners. Med Sci Sports Exerc. 1995;27(8):1180–4.
Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of running injuries. The 1984 Bern Grand-Prix study. Am J Sports Med. 1988;16:285–94.
Knapick JJ, Trone DW, Swedler DI, et al. Injury reduction ef- fectiveness of assigning running shoes based on plantar shape in Marine Corps Basic Training. Am J Sports Med. 2010;36:1469–75
Mattila VM, Sillanpa¨a¨ PJ, Salo T, Laine HJ, Ma¨enpa¨a¨ H, Pihlaja- ma¨ki H. Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects. Scand J Med Sci Sports ;21:804–8.
Ryan MB, Valliant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med. 2010; 45:715–21.
Schwellnus MP, Jordaan G, Noakes TD. Prevention of common overuse injuries by the use of shock absorbing insoles. A pro- spective study. Am J Sports Med. 1990;18:636–41.
EVOLUTIONARY BIOLOGY:
Lieberman et al (2010) Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463(7280):531-5
Daoud et al (2012) Foot strike and injury rate in endurance runners: A retrospective study. Med and Sci in Sp & Ex
Bramble DM and Lieberman, DE (2004) Endurance running and the Evolution of Homo. Nature. 432:
Kerr G, Cairns L. The relationship of selected psychological fac- tors to athletic injury occurrence. Journal of Sport and Exercise Psychology 10 (2): 167–173, 1988

14. SHOES GAIT EFFECIENCY / FOOT STRIKE PATTERN
Richards Magin & Callister (2008) is your prescription of distance running shoes evidence based? Br J of Sp Med 43: 159 – 162
Giandolini M, Arnal PJ, Millet GY, Peyrot N, Samozino P, Dubois B, Morin JB. (2013) Impact reduction during running: efficiency of simple acute interventions in recreational runners. Eur J Appl Physiol.113(3):
Rethnam U, Makwana N Are old running shoes detrimental to your feet? A pedobarographic study. BMC Res Notes.
Hamill 2011 Evaluation of the minimum energy hypothesis and other potential optimality criteria for human running. Proc Biol Sci Apr 22;279(1733):
Kerrigan DC, Johansson JL, Bryant MG, Boxer JA, Della Croce U, Riley PO. Moderate-heeled shoes and knee joint torques relevant to the development and progression of knee osteoarthritis. Arch Phys Med Rehabil ;86:871–875
Kerrigan DC, Todd MK, Riley PO. Knee osteoarthritis and high-heeled shoes. Lancet. 1998;351:1399–1401
Kerrigan DC, Lelas JL, Karvosky ME. Women's shoes and knee osteoarthritis. Lancet. 2001;357:1097–1098
De Wit B, De Clercq D, Aerts P. Biomechanical analysis of the stance phase during barefoot and shod running. J Biomech. 2000;33:269–278
Squadrone R, Gallozzi C. Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. J Sports Med Phys Fitness. 2009;49:6–13
Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidence based?. Br J Sports Med. 2008;43:159–162
Butler RJ, Hamill J, Davis I. Effect of footwear on high and low arched runners' mechanics during a prolonged run. Gait Posture. 2007;26:219–225
Nigg BM. Biomechanics of Running Shoes. Champaign, IL: Human Kinetics Publishers; 1986;
Kerrigan DC, Karvosky ME, Lelas JL, Riley PO. Men's shoes and knee joint torques relevant to the development and progression of knee osteoarthritis. J Rheumatol. 2003;30:529–533
Chakravarty EF, Hubert HB, Lingala VB, Zatarain E, Fries JF. Long distance running and knee osteoarthritis (A prospective study). Am J Prev Med. 2008;35:133–138
Cheung RT, Chung RC, Ng GY. 2011Efficacies of different external controls for excessive foot pronation: a meta-analysis.Br J Sports Med.
Wegener, C., Hunt, A., Vanwanseele, B., Burns, J., Smith, R. (2011). Effect of children's shoes on gait: a systematic review and meta-analysis. Journal of Foot and Ankle Research, 4(3), 1-13.
GAIT EFFECIENCY / FOOT STRIKE PATTERN
Nigg, B., & Enders, H. (2013). Barefoot running – some critical considerations. Footwear Science, 5, 1-7. doi: /
Kulmala, J-P. Avela, J. Pasanen, K. and Parkkari, J., Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers, Medicine and Science in Sports and Exercise, ahead of print

15. GAIT EFFECIENCY / FOOT STRIKE PATTERN
Pontzer H, Holloway JH 3rd, Raichlen DA, Lieberman DE (2009) Control and function of arm swing in human walking and running. Journal of Experimental Biology 212:
Tseh W, Caputo JL, Morgan DW (2008) Influence of gait manipulation on running economy in female distance runners. J Sports Sci Med Mar 1;7(1):91-5.
Hasegawa H, Yamauchi T, Kraemer WJ. (2007) Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res. 21(3):
Romonov Fletcher (2007) Runners do not push off the ground but fall forwards via a gravitational torque. Sports biomechanics 6:(3)
Conoboy & Dyson (2006) Effect of aging on the stride pattern of veteran marathon runners Br J Sports Med 40:
Divert C., Mornieux G., Baur H., Mayer F., Belli A. (2004) Mechanical comparison of barefoot and shod running. International Journal of Sports Medicine 2005;Vol. 26 (7):
Chen YC, Lou SZ, Huang CY, Su FC. (2010) Effects of foot orthoses on gait patterns of flat feet patients. Clinical Biomechanics 25 (3):
Hennig E M, Valiant G A, Liu Q. (1996) Biomechanical Variables and the Perception of Cushioning for Running in Various Types of Footwear. Journal of Applied Biomechanics 12:
Hardin E.C., Van Den Bogert A.J.,(2004) Hamill J. Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Medicine and Science in Sports and Exercise 36 (5):
Dallam, Wilber, Jadelis, Fletcher & Romanov (2005) Effect of a global alteration of running technique on kinematics and economy. Journal of Sports Science 23: (7)
Saunders PU, Pyne DB, Telford RD, Hawley JA (2004) Factors affecting running economy in trained distance runners. Sports Med. 2004;34(7):
Arendse Noakes Azevedo Romonov Schwellnus Fletcher (2004) Reduced Eccentric Loading of the Knee with the Pose Running Method. Medicine & Science in Sports & Exercise: 36(2)
Hardin, Van der Bogart, Hamill (2004) Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Med & Sci in Sp & Ex 36 (5):
De Wit B, De Clercq D, Aerts P. (2000) Biomechanical analysis of the stance phase during barefoot and shod running. J Biomech. 33(3):
Lohman EB 3rd, Balan Sackiriyas KS, Swen RW. (2011) A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking. Phys Ther Sport. 12(4):151-63
Arellano, C.J., & Kram, R. (2011) The effects of step width and arm swing on energetic cost and lateral balance during running. Journal of Biomechanics 44 pg.1291–1295
Morgan, Mitchell, Craib (1996) Aerobic Demand of Running Shoes Designed to Exploit Energy Storage and Return Research Quarterly for Exercise and Sport 67 (1):
Kaneko, M. (1990). Mechanics and energetics in running with special reference to efficiency. Journal of Biomechanics, 23(Supp. 1),
Cavanagh &Find all citations by this author (default).Or filter your current search Kram (1989) Stride length in distance running: velocity, body dimensions, and added mass effects. Medicine and Science in Sports and Exercise.Find all citations in this journal (default). 21(4): ]
Cavanagh PR, Williams KR. (1982) The effect of stride length variation on oxygen uptake during distance running.Or filter your current search Med Sci Sports Exerc. 14(1):30-5.

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