Posts tagged running injury
Which Running Gait Mechanics Predict Knee Injury?

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.

Click Here to schedule your next running gait analysis with the experts at MEND

Is Lack Of Mobility Or Flexibility A Factor In My Running Injury?

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.

What Is A Safe Weekly Running Progression?

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.

What is the best way to reduce loading forces in runners?

In our previous blog posts we have discussed the variety of interventions available to reduce the high injury rates seen among both novice and experienced runners.  Many of these interventions are designed to reduce the loading forces across the lower body at foot strike and push off.  In our Boulder Physical Therapy practice we commonly utilize strength training, patient education, and running gait retraining.  No consensus has been reached on the an ideal running form for all individuals, but each runner can improve their gait efficiency and injury risk through analysis and form correction.  We often find simple cues such as "land softer" are most effective at improving a runner's gait.  With runners, like most athletes, complex and multiple cues only lead to "paralysis by analysis".  Most often these cues are designed to improve step frequency (cadence) or vertical oscillation.  A new study provides insight into which cue may be most effective.

Adams and colleagues analyzed healthy runners under 3 running conditions: self selected running gait, cuing to increase step frequency, and cuing to reduce vertical oscillation (International J Sports PT. 2018).  Data on vertical loading, ground reaction forces, and braking impulse during each condition were analyzed in a biomechanics lab.  Although both the vertical oscillation and step frequency groups demonstrated improved loading measurements compared to the baseline group greater improvements were seen among the runners aiming to reduce their vertical oscillations. 

These findings are consistent with prior research indicating runners with high vertical oscillation rates (picture greater up and down movements with each stride) not only are more inefficient but also have greater rates of lower body loading and injury risk. 

Click Here to schedule your running gait analysis with the experts at MEND


Should I add a lift in my running shoe to improve my symptoms?

One of the greatest misconceptions in the treatment of musculoskeletal injuries is using interventions to create symmetry in the body between right and left sides.  Asymmetry is often the norm vs. the exception but we function very well in life and sport with these asymmetries.  Small asymmetries should be accepted while larger asymmetries should be examined and treated on an individual basis.   A previous article in the NY Times highlighted the amazing performances of Usain Bolt despite having a significant leg length difference and resulting asymmetrical running gait. 

Patient's often come into our Boulder Physical Therapy practice with heel lifts based on a previous clinician's assessment and resulting intervention for a "short leg".  Side Note: We will leave the ridiculousness of SI and pelvic asymmetries or functional leg length discrepancies for another post.  There are two main errors with this reasoning first and foremost all clinical tests have significant false positives and negatives limiting their ability to find a truly short leg.  Second, static measurements, including leg alignment, have not been shown to significantly impact running injuries.  The majority of us have small differences in leg length but how much do these differences impact running injuries?

A recent study in the International Journal of Sports Physical Therapy both described the incidence of leg leg differences and examined the impact of these differences on running injuries (Rauh et al. 2018).  Authors screened 322 high school cross country athletes for leg leg differences and then followed them to determine if these differences increased the risk of lower body injury during the upcoming season.  The authors found 1 in 5 runners had a significant difference in leg length, but these differences were not associated with future injury risk.  One exception was found in athletes with a leg leg discrepancy of > 1.5 cm who were 7 times more likely to experience an injury than an athlete without a significant leg length difference. 

This study highlights and supports our clinical practice of removing more lifts than we put into a runner's shoes.  Small differences should be accepted and left alone while large differences, > 2 cm, should be lifted on an individual basis. 


Is running volume or intensity more to blame for injury?

Running injuries remain a common problem for the vast majority of runners.  Many of these athletes report a loss of training days or competition due to a current or previous injury.  Contributing factors include muscle weakness, decreased mobility, and training errors.  Progressing training volumes (frequency, intensity, duration, terrain) too quickly prevent the tissues from properly adapting to the stresses of exercise.  A recent study examined if training intensity or training volume is more to blame for running related injuries.

A randomized controlled trial in the Journal of Orthopedic and Sports Physical Therapy was conducted to determine the impact of running intensity and running volume progression on future injury rates (Ramskov et al. 2018).  447 runners were randomized to one of two 16 week training programs after a combined 8 week preconditioning program.  The first group focused on intensity with runners training at > 88% of their VO2max.  The second group focused on running volume with progressive increases in training volume each week.   The authors reported 80 runners sustained an injury which kept them from completing the prescribed training sessions, but the authors found no difference in injury risk between the two groups.