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 trainingo 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

EFFICIENT GAIT:Storen (2011) Heise (2011) Halvorsen (2011) Fletcher (2010) Arellano (2011) Pontzer (2009) Tseh (2008) Fletcher (2007) Hasegawa (2007) Romonov (2007) Heise (2008) Conoboy (2006) Dallam (2005) Saunders (2004) Arendse (2004) Hardin (2004) )Divert (2004) DeWit (2000) Millani (1997) Anderson (1996) Morgon (1994) Kaneko (1990) Cavanagh (1989) Cavanagh (1982) Hennig (1996)

• Increased elastic energy propulsion

• Reduced vertical loading rate

• Reduced contact time with ground

• Reduced vertical displacement

• Initial weight bearing close to CoG

• Foot strike midfoot / forefoot

KINETICS / KINEMATICS

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…) D’aout 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 / ABCD’s / Fx testing / special tests / DDx by zone (osteo-articular, muscular –

tendon, neuro – meningeal, vascular etc)

Treadmill –1.2.3’s (“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 1.0.9 (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 - http://www.cadenceapp.com/ ($4.99) to run at your own rhythm from your

own music playlist

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

RUNNING INJURIES - MODEST TO NONSIGNIFICANT EFFECT:

Taunton JE, Ryan MB, Clement DB, McKenzie DC, Lloyd-Smith DR, Zumbo BD. A prospective study of running injuries: the Vancouver Sun Run ‘‘In Training’’ clinics. Br J Sports Med. 2003; 37:239–44. 38.

Blair SN, Kohl HW, Goodyear NN. Rates and risks for running and exercise injuries: studies in three populations. Res Q Exerc Sport. 1987;58:221–8

Buist I, Bredeweg SW, Lemmink KA, van Mechelen W, Diercks RL. Predictors of running-related injuries in novice runners en- rolled in a systematic training program: a prospective cohort study. Am J Sports Med. 2010;38:273–80.

Jones BH, Bovee MW, Harris JM, Cowan DN. Intrinsic risk fac- tors for exercise-related injuries among male and female army trainees. Am J Sports Med. 1993;21:705–10.

Koplan JP, Rothenberg RB, Jones EL. The natural history of ex- ercise: a 10-yr follow-up of a cohort of runners. Med Sci Sports Exerc. 1995;27(8):1180–4.

Marti B, Vader JP, Minder CE, Abelin T. On the epidemiology of running injuries. The 1984 Bern Grand-Prix study. Am J Sports Med. 1988;16:285–94.

Knapick JJ, Trone DW, Swedler DI, et al. Injury reduction ef- fectiveness of assigning running shoes based on plantar shape in Marine Corps Basic Training. Am J Sports Med. 2010;36:1469–75

Mattila VM, Sillanpa¨a¨ PJ, Salo T, Laine HJ, Ma¨enpa¨a¨ H, Pihlaja- ma¨ki H. Can orthotic insoles prevent lower limb overuse injuries? A randomized-controlled trial of 228 subjects. Scand J Med Sci Sports. 2010;21:804–8.

Ryan MB, Valliant GA, McDonald K, Taunton JE. The effect of three different levels of footwear stability on pain outcomes in women runners: a randomised control trial. Br J Sports Med. 2010; 45:715–21.

Schwellnus MP, Jordaan G, Noakes TD. Prevention of common overuse injuries by the use of shock absorbing insoles. A pro- spective study. Am J Sports Med. 1990;18:636–41.

EVOLUTIONARY BIOLOGY:

Lieberman et al (2010) Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463(7280):531-5

Daoud et al (2012) Foot strike and injury rate in endurance runners: A retrospective study. Med and Sci in Sp & Ex

Bramble DM and Lieberman, DE (2004) Endurance running and the Evolution of Homo. Nature. 432: 345-352.

Kerr G, Cairns L. The relationship of selected psychological fac- tors to athletic injury occurrence. Journal of Sport and Exercise Psychology 10 (2): 167–173, 1988

SHOESRichards 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):599-609

Rethnam U, Makwana N. 2012.Are old running shoes detrimental to your feet? A pedobarographic study. BMC Res Notes.

Hamill 2011 Evaluation of the minimum energy hypothesis and other potential optimality criteria for human running. Proc Biol Sci. 2012 Apr 22;279(1733):1498-505.

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 RT, Chung RC, Ng GY. 2011Efficacies of different external controls for excessive foot pronation: a meta-analysis.Br 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), 1-13.

GAIT EFFECIENCY / FOOT STRIKE PATTERN

Nigg, B., & Enders, H. (2013). Barefoot running – some critical considerations. Footwear Science, 5, 1-7. doi:10.1080/19424280.2013.766649

Kulmala, J-P. Avela, J. Pasanen, K. and Parkkari, J., 2013. Forefoot strikers exhibit lower running-induced knee loading than rearfoot strikers, Medicine and Science in Sports and Exercise, ahead of print

GAIT EFFECIENCY / FOOT STRIKE PATTERNPontzer H, Holloway JH 3rd, Raichlen DA, Lieberman DE (2009) Control and function of arm swing in human walking and running. Journal of Experimental Biology 212: 523-34.

Tseh W, Caputo JL, Morgan DW (2008) Influence of gait manipulation on running economy in female distance runners. J Sports Sci Med. 2008 Mar 1;7(1):91-5.

Hasegawa H, Yamauchi T, Kraemer WJ. (2007) Foot strike patterns of runners at the 15-km point during an elite-level half marathon. J Strength Cond Res. 21(3):888-93.

Romonov Fletcher (2007) Runners do not push off the ground but fall forwards via a gravitational torque. Sports biomechanics 6:(3)434-452

Conoboy & Dyson (2006) Effect of aging on the stride pattern of veteran marathon runners Br J Sports Med 40:601-604

Divert C., Mornieux G., Baur H., Mayer F., Belli A. (2004) Mechanical comparison of barefoot and shod running. International Journal of Sports Medicine 2005;Vol. 26 (7):593-598.

Chen YC, Lou SZ, Huang CY, Su FC. (2010) Effects of foot orthoses on gait patterns of flat feet patients. Clinical Biomechanics 25 (3):265-70.

Hennig E M, Valiant G A, Liu Q. (1996) Biomechanical Variables and the Perception of Cushioning for Running in Various Types of Footwear. Journal of Applied Biomechanics 12:143-150.

Hardin E.C., Van Den Bogert A.J.,(2004) Hamill J. Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Medicine and Science in Sports and Exercise 36 (5):838-844.

Dallam, Wilber, Jadelis, Fletcher & Romanov (2005) Effect of a global alteration of running technique on kinematics and economy. Journal of Sports Science 23: (7) 757-764

Saunders PU, Pyne DB, Telford RD, Hawley JA (2004) Factors affecting running economy in trained distance runners. Sports Med. 2004;34(7):465-85.

Arendse Noakes Azevedo Romonov Schwellnus Fletcher (2004) Reduced Eccentric Loading of the Knee with the Pose Running Method. Medicine & Science in Sports & Exercise: 36(2) 272-277

Hardin, Van der Bogart, Hamill (2004) Kinematic Adaptations during Running: Effects of Footwear, Surface, and Duration. Med & Sci in Sp & Ex 36 (5): 834-844

De Wit B, De Clercq D, Aerts P. (2000) Biomechanical analysis of the stance phase during barefoot and shod running. J Biomech. 33(3):269-78.

Lohman EB 3rd, Balan Sackiriyas KS, Swen RW. (2011) A comparison of the spatiotemporal parameters, kinematics, and biomechanics between shod, unshod, and minimally supported running as compared to walking. Phys Ther Sport. 12(4):151-63

Arellano, C.J., & Kram, R. (2011) The effects of step width and arm swing on energetic cost and lateral balance during running. Journal of Biomechanics 44 pg.1291–1295

Morgan, Mitchell, Craib (1996) Aerobic Demand of Running Shoes Designed to Exploit Energy Storage and Return Research Quarterly for Exercise and Sport 67 (1): 102-105

Kaneko, M. (1990). Mechanics and energetics in running with special reference to efficiency. Journal of Biomechanics, 23(Supp. 1), 57-63.

Cavanagh &Find all citations by this author (default).Or filter your current search Kram (1989) Stride length in distance running: velocity, body dimensions, and added mass effects. Medicine and Science in Sports and Exercise.Find all citations in this journal (default). 21(4):467-479]

Cavanagh PR, Williams KR. (1982) The effect of stride length variation on oxygen uptake during distance running.Or filter your current search Med Sci Sports Exerc. 14(1):30-5.

Vincent Gouttebarge, Julitta Boschman (2013) The Optimization of Running Technique: What Should Runners Change and How Should They Accomplish it?Journal of Sport and Human Performance 1(3)

Jungers (2010) Biomechanics: Barefoot running strikes back. Nature 463, 433-434

Kulmala Avela Pasanen Parkkari (2013) Effects of Striking Strategy on Lower Extremity Loading During Running Br J Sports Med 2013;47:e3 doi:10.1136/bjsports-2013-092558.46

Bonacci, J. Vicenzino, B. Spratford, W. and Collins, P., 2013. Take your shoes off to reduce patellofemoral joint stress during running, British Journal of Sports Medicine, ahead of print

Arellano, C.J., & Kram, R. (2011) The effects of step width and arm swing on energetic cost and lateral balance during running. Journal of Biomechanics 44 pg.1291–1295

Anderson T. (1996) Biomechanics and running economy. Sports Med. 22(2):76-89.

REVIEWS:

Jenkins DW, Cauthon DJ.(2011) Barefoot running claims and controversies: a review of the literature. J Am Podiatr Med Assoc. 101(3):231-46.

van Gent RM, Siem D, van Middlekoop M, van Os AG, Bierma- Zeinstra AMA, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007;41:469–4807. 39.

Hume P, Hopkins W, Rome K, Maulder P, Coyle G, Nigg B. Effectiveness of foot orthoses for treatment and prevention of lower limb injuries: a review. Sports Med. 2008;38:759–79.

Cheung RT, Wong MY, Ng GY.2011 Effects of motion control footwear on running: a systematic review.J Sports Sci.

van Mechelen W. Running injuries. A review of the epidemio- logical literature. Sports Med. 1992;14:320–35.

Reinoud W. Brouwer, Tom M van Raaij, Tijs T.S.C. Jakma, Arianne P Verhagen, Jan AN Verhaar, Sita MA Bierma-Zeinstra.(2005) Braces and orthoses for treating osteoarthritis of the knee. Cochrane Database of Systematic

Burns J, Landorf KB, Ryan MM, Crosbie J, Ouvrier RA. (2007) Interventions for the prevention and treatment of pes cavus. Cochrane Database of Systematic Reviews

Collins N, Bisset L, McPoil T, Vicenzino B. (2007) Foot orthoses in lower limb overuse conditions: a systematic review and meta-analysis. Foot & Ankle International 28 (3):396-412.

Gélis A, Coudeyre E, Aboukrat P, Cros P, Hérisson C, Pélissier J. (2005) Feet insoles and knee osteoarthritis: evaluation of biomechanical and clinical effects from a literature review [Orthèses plantaires et gonarthrose: évaluation des effets biomécaniques et cliniques à partir d'une revue de la littérature]. Annales De Réadaptation Et De Médecine Physique: Revue Scientifique De La Société Française De Rééducation Fonctionnelle De Réadaptation Et De Médecine Physique 48 (9):682-9.

Gillespie WJ, Grant I. (2000) Interventions for preventing and treating stress fractures and stress reactions of bone of the lower limbs in young adults. Cochrane Database Of Systematic Reviews

Hawke F, Burns J, Radford JA, du Toit V. (2008) Custom-made foot orthoses for the treatment of foot pain. Cochrane Database of Systematic Reviews