Factors & Injuries Most Commonly Associated With Distance Running

Transcription

1 Factors & Injuries Most Commonly Associated With Distance Running Paul McKenzie Sports Therapist 1

2 Introduction Despite being an efficient way of improving fitness and health, running has a high injury rate. Studies show that; 50% of runners are injured annually (acute though more commonly overuse) 25% of runners injured at any given time Injury prevention and treatment important. 2

3 The Common Factors 3

4 1 Running In Excess of 40 miles per week A study in the International Journal of Sports Medicine in 1989 followed 115 runners over months. 85% picked up an injury and missed at least 1 day of training. When assessed the strongest factor for the prevalence of their injuries was the weekly mileage being greater than 40. Other factor included; Running daily Previous injury in the last 12 months Length of the long run Week 1 Day M T W T F S S Miles Week 2 Day M T W T F S S Miles

5 2 Erratic Training Schedules Erratic unplanned training increases injury rates. Sudden increases in weekly distance is a risk factor. Some experts suggest the 10% rule i.e. Increasing your weekly distance by no more than 10%. Change in training type e.g. hills, Fartlek, intervals.. They have their place but need to be introduced at the right time and be performed for a suitable duration. 5

6 3 Muscle Imbalances Weak muscles in the lumbopelvic hip complex (LPHC) increases overall risk of injuries in the lower limbs. Hip abductors (mainly gluteus medius) and hip flexor (mainly iliopsoas) weakness are associated with specific injuries. ITB syndrome Patellofemoral pain syndrome 6

7 4 Over Pronation (Sub Talar) Over pronation has often been seen as the scourge of ankle biomechanics but there is little clinical evidence to support this however it may be associated with; Plantar fasciitis MTSS Stress fractures Patellofemoral disorders ITB syndrome Posterior tibial tendinopathy Achilles tendinopathy Hallux valgus Interdigital neuromas Metatarsalgia 7

8 5 Excessive Rehydration During the race it is not necessary to rehydrate at every drinks station. Hyponatremia is a condition that occurs when the level of sodium in your blood is abnormally low. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells. Hyponatremia can occur when hypotonic fluids which contain little or no sodium are used to replace sweat which is hypertonic and does contain sodium. Risk factors Slow runners Females Endurance racers Those rehydrating with water rather than a sports drink or home made hypertonic drink containing sodium 8

9 6 Doing Things Differently On Race Day It is important that on race day you do what you have done during your training and make no changes to; Pre race fuelling The food you eat During race refuelling Sports drinks Sports gels Running shoes Do not wear new ones without breaking them in Don t use inserts /orthotics if you didn t while training Warm up 9

10 7 Not Running Barefoot! Over the last few years barefoot running and the use of minimalist type shoes has gained increased popularity. Its benefits may include; Shorter stride length Decreased heel strike More mid / forefoot strike Decreased impact More springy steps Reduced ground reaction forces Use muscles slightly differently Decreased injury rates 10

11 8 Pre Race Static Stretching Static stretching before running has been shown to be of no value. Studies have shown a small increase in the number of injuries among runners who do static stretches before running. A proper warm up may reduce the risk of injuries. Post race stretching may reduce the risk of injury but there is no evidence it reduces delayed onset muscle soreness. 11

12 9 Overuse of Running Footwear Studies show that running shoes lose their shock absorption by up to 60% after miles of running dependent on the quality of the shoe. Replace your running shoes between 250 and 500 miles. 12

13 10 Ignoring The Warning Signs Aches, pains, tiredness, lethargy, the female athlete triad (eating disorder, amenorrhea & osteoporosis) etc are all signs that there is something wrong.do NOT IGNORE THEM. Ouch! I m OK... At the first sign that something is wrong seek advice from your GP, Sports Therapist, Physiotherapist, Sports Masseur, Osteopath etc. Rest from your schedule but maintain your CV fitness by other means. 13

14 The Big Running Injuries 14

15 Injury 1 Anterior Knee Pain (1) Patellofemoral Pain Syndrome Runner s Knee Often the result of downhill running Increased load on PFJ Probable weak VMO (vastus medialis oblique) Increased femoral rotation Increased knee valgus Subtalar pronation Muscle tightness (esp. quadriceps) Medial, lateral or infra patellar pain Not chondromalacia patellae Treatment Retrain VMO Taping (McConell) Stretch tight muscles Strengthen weak muscles Orthotics NSAIDs 15

16 Injury 1 Anterior Knee Pain (2) Patellar Tendinopathy Jumper s Knee Degenerative therefore tendinosis Not inflammatory therefore not tendonitis Inferior pole of patellar though occasionally distal (tibial tuberosity). Very rarely mid tendon General quadriceps wasting Weak gluteals and calf Hamstring tightness Faulty biomechanics Treatment Reduction of relative load on patellar tendon Isolated eccentric loading (leg extension) Compound eccentric loading (single leg squat on a 25º decline board) Stretch hamstrings Strengthen glutes, quads and calf Soft tissue therapy Correct faulty biomechanics 16

17 Injury 2 ITB Friction Syndrome Friction between distal ITB and lateral femoral condyle MRI shows no change in distal ITB therefore pain related to adventitious bursa not an anatomical one Friction occurs at about 30º knee flexion on foot contact Aggravated by downhill running Pain usually comes on at the same time / distance Weak hip abductors Reduced ability to control hip adduction Treatment Soft tissue therapy Corticosteroid injection Activity modification Stretch ITB / abductors SMFR (foam roller) Strengthen abductors 17

18 Injury 3 Achilles Tendinosis Degenerative No inflammatory cells therefore not tendonitis Causes include; Years running Change of surface Increase in activity (time, distance, gradient) Decreased recovery time Calf weakness Over pronation Limited dorsiflexion (ankle equinus < 10-20º) Tight calves Change of footwear Faulty biomechanics Treatment Heel drop (eccentric loading) Alfredson et al. Corticosteroid injection (though only once) Sclerosing injections Nitric Oxide donor therapy Soft tissue therapy Gel heel cup Tendinosis Tendinosis 18

19 Injury 4 Stress Fracture Common in the metatarsals of runners (typically 3 rd & 4 th ) but can occur elsewhere e.g. tibia and fibula Risk factors include; High mileage Running on hard surfaces Sudden increase in mileage Over pronation / pes planus Pes cavus (high arch) FAT... Female Athlete Triad (eating disorder, amenorrhea & osteoporosis) Treatment Modify training regime Orthotics Cross train with non impact cardio Women: improve nutrition and reduce training intensity if experiencing FAT 19

20 Injury 5 Plantar Fasciitis (Fasciosis) The plantar fascia runs from the heel and fans out towards the toes. It supports the arches of the feet Pain is usually felt on the medial aspect of the plantar surface of the heel Pain first thing in the morning and following periods of long rest Risk factors include; Over pronation / pes planus Ankle equinus (limited dorsi flexion < 10-20º) Pes cavus Heavier individuals Tight calves, hamstrings and gluteals Treatment Taping Corticosteroid injection Strengthening of toe flexors Soft tissue therapy NSAIDs - Night splint (keeps the fascia on stretch) - Ice massage - Gel heel cup - Orthotics - Activity modification 20

21 Injury 6 MTTP (MTSS) Medial Tibial Traction Periostitis, commonly know as Medial Tibial Stress Syndrome and in layman s term as Shin Splints. Pain along the medial tibial border (typically distal two thirds) that increases after training and may be worse the following morning. Risk factors include; Over pronation / pes planus Training errors Surface type Type of training shoe Pain localised to the distal two thirds of the posterior medial tibial border in MTTP (MTSS) Treatment Soft tissue therapy Orthotics Switch to cross training while recovering (e.g. swim) Vacuum cupping Taping 21

22 Injury 7 Hamstring Strain Posterior thigh muscles (part of the posterior chain) most commonly injured in sprinters than distance runners however in distance runners the injuries are commonly nearer the hamstring origin on the ischium. During gait the hamstring contracts concentrically during the propulsion phase and eccentrically during the terminal swing phase. Risk factors include; Previous injury Weak glutes (mainly gluteus maximus) Lumbopelvic instability Poor warm up Fatigue Treatment Stretch hamstrings Strengthen hamstrings Soft tissue therapy 22

23 Other Considerations Shorten your stride length Maintain strong posterior chain muscles Maintain a strong core Don t always run the same way around a track Have a regular sports massage Consider cryotherapy on your lower limbs after a long run Appreciate that running plans on the internet don t suit everybody Complete an Injury Screening (risk assessment) questionnaire 23

24 Bibliography Brown AMP, et al. International Journal of Sports Medicine 1989 Walter SD, et al. Archive of International Medicine 1989 Van Mechelen, et al. American Journal of Sports Medicine 1993 Alfredson H, et al American Journal of Sports Medicine 1998 Fredricson M, et al. Clinical Journal of Sports Medicine 2000 Herbert RD, Gabriel M. British Medical Journal 2002 Ireland ML, et al. Journal of Orthopaedic Sports Physical Therapy 2003 Niemuth PE, et al. Clinical Journal of Sports Medicine 2005 Verrall GM, et al. British Medical Journal 2005 Ryan MB, et al. International Journal of Sports Medicine 2006 Bruckner & Khan. Clinical Sports Medicine