Posts in running
Orthotics Impact on Leg Mechanics

The use of foot orthotics are commonly prescribed for many lower quarter conditions including running injuries, foot and ankle pain, and even low back pain.  As we have described in previous posts off the shelf orthotics perform as well as more expensive custom orthotics, but overall their impact on many conditions is limited.  When compared to more active approaches including Physical Therapy and exercise, orthotics fall short of manufacturer's and clinician's promises of pain relief and improved function.  

A recent study out of the University of Wisconsin examined the impact of off the shelf orthotics on running mechanics (O'Conner et al. JOSPT. 2016).  Authors studied 31 recreational runners in a biomechanics laboratory while running with or without a foot orthotic.  In particular, the authors were interested in the amount of dynamic foot motion at the heel and mid foot during the stance phase of running.  Runners were then grouped based on the amount of motion in their feet during running.  They hypothesized that runners with the greatest amount of motion may benefit most from the orthotic.  The results of this study show that orthotics did not significantly impact motion at the hip or knee and thus the use of orthotics based on a patients degree of foot and ankle motion is not supported.

Athletes are advised to understand the limitations of orthotics to change lower quarter running mechanics and instead work with a local Physical Therapist to correct these running mechanics.

Influence of Shoe Type and Foot Strike Pattern on Loading Rates in Runners

The selection of running shoes continues to be a controversial topic in the sport.  Arguments are heard from both sides of the running shoe continuum from barefoot/minimalist to heavily cushioned shoes.  Both groups advocate their product based on its' perceived influence on reducing the large numbers of running injuries seen every year among both recreational and professional runners.  In addition to shoe wear many athletes are pushed toward either a fore or rear foot strike gait pattern to reduce adverse loading during each foot contact with the ground.  As we have noted in a previous post their are benefits to both contact approaches.

A recent study by Harvard University's Spaulding National Running Center examined the impact of foot strike pattern and shoe wear on loading rates during running (Rice et al. Med Sci Sp Ex. 2016).  The authors studies 29 healthy runners as they ran in their preferred gait pattern and shoe type.  Not surprisingly, athletes who used minimalist shoes with a fore foot running pattern had the lowest force rates compared to runners who ran in either foot strike pattern in traditional running shoes.  Authors noted runners who habituated to the minimalist shoe and used a fore foot strike pattern had the lowest impacts at landing.  Among the runners using standard shoes, similar load rates were noted between forefoot and rearfoot patterns.   

Does Running Cause Knee Osteoarthritis?

Knee arthritis is a common condition among older adults leading to increased knee pain and decreased participation in recreational and sporting activities.  A incorrect, but commonly held belief is exercise may lead to further arthritis or knee damage due to a "wear and tear" effect.  This outdated line of thought has been disproven by many research studies documenting a beneficial not harmful effect of exercise on both young and old knee joints.  Unfortunately, the myth of exercise causing knee arthritis remains especially in regards to sports including running.

A recent study by Lo and colleagues should finally put this myth to rest (Arthritis Care and Research 2016).  Authors studied over 2500 participants to retrospectively identify risk factors which were associated with the eventual development of knee arthritis.  Among these individuals, 30% had run at some time in their lives.  The authors reported no increased risk of knee arthritis among the running participants compared to their age matched peers.  They concluded that running does not appear to be detrimental to the knees.  

Risk Factors for Shin Splints and IT Band Pain

As we move towards the middle of summer many runners have experienced an increase in overuse injuries in their legs.  Unfortunately, these running injuries are common among athletes with the vast majority of runners reporting one injury over the last year of training.  Two of the most common injuries include shin splints (medial tibial stress syndrome) and IT band pain.  Both of these injuries can be successfully treated with Physical Therapy, but also may be prevented by modifying known risk factors for the conditions.  

A review article identified the known risk factors for the development of medial tibial stress syndrome in runners (Newman et al. J Sports Med. 2013).  Authors reported prior history of medial tibial stress syndrome, increased body mass index, increased pronation, orthotic use, and fewer years of running experience are all associated with increased risk of these symptoms.

A second review article documented the known risk factors for iliotibial band pain (IT band pain) in runners.  Aderem and colleagues reviewed the available literature on the development of IT band pain from 13 research studies (BMC Musculoskelet Disord. 2015).  They noted increased risk of IT band pain among runners with poor knee control at foot strike.  Increased movement of the knee is due to weakness and coordination in the hip musculature.  Overtime these abnormal movements create friction between the IT band and thigh bone at the knee.  Athletes are encouraged to work with a local Physical Therapist on gait retraining to improve knee control during running.  

Accuracy of Self Reported Foot Strike Patterns

The analysis and implementation of different foot strike patterns among runners has grown over the last 10 years.  Changes in foot strike patterns have been shown to reduce loading through the leg and may help reduce the risk or symptoms associated with different running related injuries.  Many runners entering our Physical Therapy clinic state confidence in their ability to utilize a certain gait pattern (fore, mid, or rear foot striking), but often their subjective report is inconsistent with our objective video taped gait analysis.   In prior research less than 70% of runners were shown to accurately determine their foot strike pattern without confirmed video tape analysis.  

A recent research article in the International Journal of Sports Physical Therapy compared the subjective report of foot strike patterns to the objective biomechanical measurement among collegiate and recreational runners (Bade et al. 2016).  Runners were asked for their preferred foot strike pattern (fore, mid, or heel) and then tested as they ran at their preferred speed on a treadmill.  Although collegiate runners were able to more accurately identify their strike pattern (56.5 vs. 43.5%), both groups were not able to accurately identify their gait pattern.

This study highlights the importance of using a skilled Physical Therapist to analyze a runner's gait to determine its' impact on their biomechanics and injury risk.  Importantly, this may question a runner's ability to independently change their gait pattern without an objective measurement by a Physical Therapist. 

Ankle Mobility and Achilles Tendon Injury

The achilles tendon is a strong, durable structure capable of absorbing and producing large loads as we walk, hike, and run.  When the tendon is overloaded without adequate recovery periods this structure is prone to painful and limiting conditions such as achilles tendonitis and tendinopathy.  One of the important risk factors for achilles injury among athletes and patients is a lack of ankle mobility.  If the ankle is unable to bend adequately during functional movements the achilles is placed under increased load leading to tendon injury.  In our Boulder Physical Therapy practice, we commonly see a loss of ankle mobility among patients with achilles tendon injury.

During our Physical Therapy examination we often see a loss of rear foot or ankle mobility and a compensatory increase in motion at the mid foot or arch (pronation).  A recent study in the journal Clinical Biomechanics confirmed our observations (Chimenti, R. et al. 2016).  The authors assessed individuals with and without achilles tendinopathy to determine their ability to bend their ankle as well as which areas of the ankle and foot where contributing to this movement.  The group with achilles tendinopathy had significantly less ankle mobility than the control group.  Importantly, this group compensated during testing with increased mobility of their arch instead due to an inability to move through the rearfoot.

This study highlights the importance of treating the ankle in patients with achilles tendon injury.  To learn more about how to safely and effectively treat this condition contact your local PT.