Posts in Running Injuries
Which Running Gait Mechanics Predict Knee Injury?
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With access to miles of paths and acres of open space running remains one of the most popular outdoor activities in Boulder. Despite its’ accessibility, low cost of participation, and health benefits running related injuries keep many from training or competing at their preferred levels. One recent area of research has focused on gait retraining by Physical Therapists to reduce forces among runners. Although an “ideal” running gait does not exist some factors including foot strike, impact forces, vertical translation can help us differentiate injured from non injured runners or determine who is at a greater risk of injury. A recent study determined additional factors which can help identify injured runners.

Dingenen and colleagues in the journal Physical Therapy in Sport analyzed the running gait of 42 recreational runners (2019). About half of the participants currently experienced pain on the front or side of their knee. Researchers assessed their lower quarter mechanics to determine how those with knee injuries differed from their non injured peers. Researchers found the injured runners demonstrated greater degrees of opposite sided pelvic drop and knee adduction (inward movement) during their running analysis. We often find these running gait impairments in runners with hip abductor (glut) weakness. Increased inward motion or “wag” of the knee in stance increases forces across the knee joint. Conversely, a level pelvis and stable knee helps dissipate the forces of running over a greater surface area in the joints.

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Real Time Feedback Reduces Forces In Runners

Up to 80% of recreational runners will experience an injury limiting training time or competition in a given year. Running injuries are multifactorial in nature with contributions from muscle imbalances, training errors, and running biomechanics. High magnitude and rates of lower limb loading have previously been associated with running injuries. In our Physical Therapy practice, we utilize gait retraining in runners with real time feedback to correct these biomechanical errors in turn reduce the abnormal forces across the lower body. Often runner’s will feel an immediate change in their symptoms will simple gait corrections. A recent study supports the utilization of gait retraining for runners with high rates of peak braking forces.

Napier and colleagues studied the impact of real time running gait biofeedback in 12 female recreational runners with high peak braking forces (JOSPT. 2019). All runners were given 8 lab based sessions of gait retraining at weeks 1, 2, 4, 6, 8, 10, 12, and 14 of their 1/2 marathon training. Real time feedback was provided to help reduce the peak braking forces occurring at foot strike. Authors found the runners reduced their peak forces by 15% during the training by reducing their step length and increasing their step frequency. The researchers also found the changes in each runner’s gait became part of their natural running gait cycle at the end of the trial.

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Is Lack Of Mobility Or Flexibility A Factor In My Running Injury?
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Lower extremity stiffness (“leg stiffness”) describes the resistance the joints and muscles in your lower body will have to movement when your foot contacts the ground during running. Think of your leg as a spring; the more tightly coiled spring will be stiffer, the more loosely coiled will be more deformable. A stiffer leg is associated with less joint movement (less mobility) and increased loads to bones and cartilage whereas a less stiff leg is associated with increased joint motion/mobility and relies more heavily on active muscle contraction to dissipate forces when your foot hits the ground.

 Leg stiffness may be one of many variables that contribute to running related injuries. A recent study of 92 runners {Goodwin:2019bk} identified 4 variables that may allow us to more easily predict leg stiffness with clinical measures versus technical laboratory analysis. Less mobility in the ankle joint, hip and big toe joint along with increased BMI are associated with greater leg stiffness. What is the clinical significance of this for our Boulder runners? For runners suffering from knee pain or stress fractures, reducing leg stiffness by improving the mobility of hip, ankle and foot may reduce joint loading. Conversely, in runners with soft tissue injuries such as Achilles or tibialis posterior tendinopathy, increasing leg stiffness with targeted strengthening exercises to improved stability and control of the joints of the lower extremity may be an important component of rehabilitation.

Contact your physical therapy experts at Mend to learn more about how your mobility may contribute to running injury.

Does Running Gait Retraining Translate To Running Outside The Lab?
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Researchers and clinicians continue to explore interventions to reduce the significant numbers of running related injuries. These injuries, mainly overuse in nature, often cause a loss in training time and are found among both novice and experienced runners. In addition to strength training, gait retraining has shown promise in reducing the forces placed across the lower body during running. Simple strategies such as reducing step length (heel to mid foot strike) and landing softer (reducing vertical forces) can quickly reduce forces during gait. In addition, providing runners with real time feed back through simple video analysis and verbal cuing accelerates utilization of these new running strategies. Few research articles have examined the retention rate and transfer of learning between laboratory running gait retraining and a runner’s outdoor training, but a new study shows old running habits may die harder than originally thought.

Zhang and colleagues examined runners’ gait mechanics under various conditions including overground running, treadmill running, as well as, running inclines and declines (Gait Posture. 2019). Each runner’s lower body forces were measured in a biomechanics laboratory during their preferred running gait. Based off this analysis, runners were then provided with 8 sessions of gait retraining with real time feedback (soften your foot strike) to reduce forces across the lower body. Runners were then reassessed to determine if the gait retraining transferred to an outside environment. Consistent with prior research, the majority of runners were able to reduce lower body forces during gait retraining in the laboratory. Outside of the gait retraining, they were able to reduce their overall forces during overground and treadmill running, but peak forces were not reduced during overground running. Not surprisingly, this study highlights the difficulty of changing a movement pattern like running. Consistent, deliberate practice with the principles learned during gait retraining is required to create an automatic process with athletes.

Reducing Impact Forces In Runners
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In our previous blogs, we have described interventions designed to reduce the high rates of running related injuries. To date, our best Physical Therapy interventions include controlling training volume, concurrent strength training, and gait retraining. In our Boulder Physical Therapy practice we aim to reduce peak loading forces and poor biomechanics at foot strike in our runners. This can be achieved by increasing a runner’s forward lean (from the ankles) and stride length to reduce braking forces at the foot and ankle, as well as, reducing vertical oscillation in the flight phase of running. A recent article reviewed the use of real time biofeedback to reduce these braking forces in runners.

Napier and colleagues in the Journal of Orthopedic and Sports Physical Therapy utilized biofeedback in healthy, female runners with high rates of peak braking forces (2018). Each participant was provided with an 8 session gait retraining program aimed to increase step frequency and reduce step length. Basic cuing, such as “land softer”, can be used in this population to reduce the braking forces and in turn conserve energy for forward propulsion. Authors reported significantly reduced peak braking forces after the gait retraining sessions. In addition, these gait changes have been previously associated with increased running economy and performance.

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What Is A Safe Weekly Running Progression?
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Running remains one of the most popular forms of aerobic exercise due to its’ effectiveness and minimal equipment costs and entry fees. The majority of runners will sustain a running related injury at some point in their careers limiting their ability to train or compete. Training errors, increases in a runner’s volume (frequency, duration, terrain, intensity) too quickly over time, often contribute to the development of an overuse injury. Increasing running volume without adequate recovery prevents body tissues from positively adapting to the stress of exercise. A recent study documents what percentage increases in running volume are most associated with injury.

Damsted and colleagues in the Journal of Sports Physical Therapy studied 261 healthy runners over a 14 week period as they trained for an upcoming 1/2 marathon race (2018). 22% of the runners sustained a running related injury over the 14 week study period. Authors examined participants’ running volume increases and found those who increased their running volume > 20% per week sustained significantly more injures than those increasing their volume < 20% per week.