Presentation on theme: "RUNNING INJURIES: UPDATE. Not for everyone! INCIDENCE /PREVELANCE OF RUNNING INJURIES Most common injuries are : MTSS, TA, PF, PFS Lopes 2012 Previous."— Presentation transcript:
RUNNING INJURIES: UPDATE
Not for everyone!
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) o 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 - o Running very rarely involves technical training o 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
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
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
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 2010 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 ARGUMENT IN FAVOUR OF MINIMALISM
Running shoe cushioning increases the mechanical stress on the skeleton (except on the foot) Rethnam 2011, Hamill 2011, Lieberman 2010 Bergman 2010 Brqunstein 2010 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…) Daout 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 2012 Nigg & Enders 2013 Goss 2012 Giandolini 2012 Diebal 2012 Daoud 2012 Walther 2005 Most efficient cue for LT change on running gait is neurophysiological proprioceptive through BF running Giandolini (2013 )
PRACTICAL IMPLEMENTATION Normal Subj / Obj / quick tests / ABCDs / Fx testing / special tests / DDx by zone (osteo-articular, muscular – tendon, neuro – meningeal, vascular etc) Treadmill –1.2.3s (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
RESOURCES Shoe selection guide – handout / poster (http://www.therunningclinic.com/en/runners-information/tools-for-runners.php) Quantifying Mechanical Stress – handout (http://www.therunningclinic.com/en/runners-information/tools-for-runners.php) Interval Programme – handout 9http://www.therunningclinic.com/en/runners-information/tools-for-runners.php) TRC ratings on all running shoes (http://www.therunningclinic.com/en/runners-information/recommended-shoes.php) 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 playlisthttp://www.cadenceapp.com/ 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
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SHOES 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.Are old running shoes detrimental to your feet? A pedobarographic study. Hamill 2011 Evaluation of the minimum energy hypothesis and other potential optimality criteria for human running. Proc Biol Sci Apr 22;279(1733): Evaluation of the minimum energy hypothesis and other potential optimality criteria for human running. 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. 2005;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 RTCheung RT, Chung RC, Ng GY. 2011Efficacies of different external controls for excessive foot pronation: a meta-analysis.Br J Sports Med.Chung RCNg GYBr 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), 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
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