Prevention of Running Injuries - Presented By: Mike Pameli, B.Sc.P.T. Registered Physiotherapist

Prevention of Running Injuries
    Presented By: Mike Pameli, B.Sc.P.T.
         Registered Physiotherapist
         mike@nobletonphysiotherapy.com

             Nobleton Physiotherapy
         13305 Highway 27 P.O. Box 1406
                  Nobleton, ON
                 (905) 859-6708

Outline for Evening

 Introduction
 Warm-up and Stretching
 Running Injuries
     Causes - foot mechanics, shoes, biomechanics of
      the lower body, muscle imbalances
     Common running injuries
     Prevention and treatment

Warm-up and Stretching
 Important for increasing body temp., stretching ligaments
  and muscles, and exciting the nervous system.
 Generally, a warm-up should be related to the activity
  being performed.
 It is advised that static prolonged stretching - although
  important, should be left to the end of your run in the
  cool-down phase.
 Static prolonged stretching in a warm-up will actually
  dampen the nervous system therefore affecting agility,
  speed, co-ordination and subsequent risk of injury

Warm-up and Stretching Cont’d
 Therefore, it is advised to perform a “dynamic warm-up”
  lasting 10 mins prior to running.
 Although, for those less flexible, starting with some
  prolonged stretching midway through the warm-up will
  have some benefits.
 List of recommended movements in the “dynamic warm-
  up “ for running:
         Shoulder circles
         Body twists
         Side bends
         Jumping jacks
         Walking knee tucks
         Kick backs on the spot
         Jogging on the spot

Running Injuries - Causes
 Mechanics of the Foot
      Proper footwear necessary to maintain correct posture of
       foot and minimize external stress - over pronation and
       supination
      Over-pronation is excessive flattening of the arch through
       the mid to late portion of the walking cycle
      Over-pronation leads to decreased running efficiency and
       increased strain on the foot, knee, hip, and back
      Supination relates to a higher arch and resultant
       increased load to the outside of the foot
      Improper foot mechanics can be corrected via exercise,
       proper shoes, or orthotics

Running Injuries - Causes

 Shoes
     Important to identify your foot type and use
      appropriate shoes in order to minimize injury risk
     Running room uses 3 categories:
            Motion control - excessive over-pronators
            Stability - some degree of over-pronation
            Cushioning - supinated foot
     Everyone has a different foot, make sure one of the
      staff addresses your needs!

Running Injuries - Biomechanics
 Foot, ankle, knee, hip, and pelvis all need to be working
  properly to minimize strain and prevent injury
 A fault in any of the biomechanics causes an altered
  running pattern and undue stress on the surrounding
  ligaments, muscles, and joints
 Most common biomechanical fault in the body is the
  internally rotated leg
 This results in over-pronation of the foot, internal twisting
  of the knee and hip, and associated rotations of the
  pelvis and low back
 Altered biomechanics causes muscle imbalances and
  resultant progression of injury

Running Injuries - Muscle Imbalances
 Muscle imbalance is when specific muscles
  differ in strength or flexibility based on their
  usage
 Due to altered mechanics where specific
  muscles are working harder than others
 Over time this imbalance creates wear and tear
  to joints and ligaments and causes injury,
  therefore limiting performance
 Identifying altered biomechanics important for
  prevention and treatment of injury

Common Running Injuries

 Iliotibial Band Friction Syndrome
 Patello-femoral Syndrome
 Shin Splints
 Plantar Fasciitis

Common Running Injuries

 Iliotibial Band(ITB) Friction Syndrome
      A.K.A. - “Runner’s Knee”
      Inflammation of the ITB at the outside of the knee
      Caused by altered biomechanics of the hip and knee
       or from altered foot mechanics
      Typically painful mid way through the run and
       persisting after exercise
      Sharp pain locally to the outside of the knee with
       some tightness feeling up the ITB

Common Running Injuries

 Patello-femoral Syndrome
     Inflammation of the kneecap undersurface due to
      altered muscle control
     Poor tracking of the kneecap results in abnormal
      contact with the femur
     Resultant pain around kneecap with repetitive
      weightbearing activities (I.e. running, walking, stairs,
      squatting)
     Better with rest from activity and ice

Common Running Injuries

 Shin Splints (Periostitis)
      Inflammation of the Tibialis Posterior muscle where it
       attaches to the bone
      Abnormal foot mechanics (over-pronation) main
       cause of muscle overuse and pain
      Pain along the inner part of the shin with possible
       swelling evident
      Early treatment with ice massage and rest to
       alleviate initial pain

Common Running Injuries

 Plantar Fasciitis
      Inflammation of the plantar fascia of the foot at the
       attachment into the heel
      Increased tension on the plantar fascia causes it to
       pull at the heel resulting in inflammation and possible
       tearing
      Altered foot mechanics, poor footwear, tight muscles,
       and training errors all possible causes of injury
      Worse in morning(first steps out of bed), slowly
       eases with more steps

Running Injuries - Prevention and
Treatment
 Early Warning Signs of Injury
      Minor aches and pains persistent after run
      Soft tissue or joint swelling
      Lasting tenderness on palpation days after run
      Loss of joint range of motion or stride
 RICE - rest, ice, compress, elevation
 Seek professional assistance
      Important to identify the cause therefore gait analysis
       or biomechanical evaluation may be necessary

Running Injuries - Keys to Prevention

 Here is a list of things to do for prevention:
      Keep a daily log
      Proper sleep for tissue repair, rest from running when
       injury arises!
      Balanced diet - consult your coach or dietician to
       ensure you are meeting the demands of your training
      Dynamic warm-up prior to run
      Static stretching in cool down phase
      Cross training and muscle strengthening to balance
       out body stress and muscle tone
      Proper footwear - consult with the experts at the
       Running Room

Running Injuries - GLUTES!!
 Strong glute muscles are important for
  biomechanical balance of the hip and knee
  thereby minimizing risk of injury
 During running cycle, glutes responsible for
  externally rotating leg and keeping the leg
  balanced
 Consists of three muscles: Gluteus Maximus,
  Gluteus Minimus, Gluteus Medius
 Problematic in people due to daily postures from
  sitting - muscle becomes de-activated and weak

Running Injuries - Buns of Steel!
 One Simple Exercise to Train the Glute Muscles:
      Standing - hold arms out in front of body at shoulder level
       with small weight in hands (soup can or water bottle).
       Feet shoulder width apart
      Slight forward tilt of pelvis, tighten core muscles. Slowly
       bend at hips and lower body as if sitting into chair. Lower
       down far enough where proper mechanics are kept.
      Ensure weight of body is through heels of feet on the way
       down and up.
      Make sure knees are behind toes and not drifting inwards.
      Repeat as many as possible with good form! Feel the
       burn in the buttocks!

Running Injuries - Conclusion

 Key Points:
  Proper footwear
  Adequate training program and coaching
  Cross training and strengthening for injury
   prevention (I.e. biking, swimming, wt training)
  Get a Physiotherapist to assess biomechanics
   and address any imbalances that may exist
  Common cause of running injuries is improper
   biomechanics.