Welcome to the Resistance. Resistance Training for Runners

Transcription

1 Welcome to the Resistance Resistance Training for Runners

2 Running injuries It is estimated that over 60 million Americans currently participate in recreational or competitive running Despite an increased awareness of proper training, running biomechanics, and physiologic influences, up to 80% of runners continue to become injured in a given year. Van Gent et al 2007

3 Treatment of Running Injuries Stretching Gait retraining Eccentric exercise Early mobilization Bracing and orthoses Rest and gradual return to activity What exactly are these? How do I apply to my runners? Steroid Injections High load strength training NSAIDS Arnold et al 2018 Common Running Injuries Caratun 2018 Treatment of plantar fasciitis

4 ACSM Guidelines for Resistance Training The current recommendation is 2-3x/week for Strengthening Activity Only 18.6% of the cohort met the recommendations Those that did had a 23% reduction in all cause mortality Dankel 2016 Dose-dependent association

5 Slaughtering of the Sacred Cows...and other such myths for runners I am going to get bulky if I lift weights. Nope. I am going to gain weight if I lift weights. Nah-ah. Elite runners aren t lifting weights. Wrong! I don t know how to lift weights. I ll teach you.

6 Resistance Training for Improved Performance

7 RT for Improved Running Economy 40 weeks of Strength Training for Distance Runners Increased Running Economy, V VO 2 max, and strength without concomitant hypertrophy. Beattie et al 2017 Systematic Review with MA: Low to moderate intensity resistance exercises and plyometric exercises 2-3 times per week for 8-12 weeks improve RE in highly trained middle- and long-distance runners. Balsalobre-Fernandez et al 2016 Explosive strength training improves RE and 5k time in 9 weeks of training in well-trained endurance athletes. Paavolainen et al 1999

8 Strength training for performance Measures of Lean Body Mass and Muscular Cross Sectional Area associated with higher bone mineral density and bone mineral content and associated with decreased race times Roelofs et al 2015

9 Resistance Training for Decreased Injury Risk

10 Runners get injured Overuse injuries are common and prevalent in the running population, especially MSK injuries

11 Treatment of Common MSK injuries in Runners 1. Tendinopathy 2. PFPS 3. Hamstring Strains 4. Stress Fractures Is Resistance Training recommended?

12 Tendinopathy Rehab = Heavy Slow Resistance Treat the donut (the healthy tendon tissue), not the hole (irrelevant, damaged tissue) Eccentrics vs Heavy Slow Resistance Training Similar functional outcomes, differences in patient adherence and satisfaction Alfredson et al vs Beyer et al, Kongsgaard et al Load matters

13 Loading is not Loading Verhagen et al 2018

14 Tendinopathy Rehab = Heavy Slow Resistance Loading Goal: 4 sets of 6-8 reps, >80%, 12 weeks Beyer et al, Kongsgaard et al, Bohm et al. Load should be progressed in incremental fashion Rest is important Histological Goals: Decreased fibril mean area, Increased fibril density = normalization of tendon Long-term changes in tendon stiffness at high and low in response to high loading intensity Bohm et al.

15 PFPS Rehab = Resistance Training SR with MA: Hip and knee strengthening is effective and superior than knee strengthening knee alone for decreasing pain and improving activity in persons with PFPS Nascimiento et al 2018 Cochrane Review: Consistent evidence that exercise therapy for PFPS may result in clinically important reduction in pain and improvement in functional ability, as well as enhancing long-term recovery van der Heiden et al 2015

16 Hamstring Strain Rehab = Resistance Training 10 week progressive eccentric training program with weekly seasonal program decreased the rate of overall, new, AND recurrent acute hamstring injuries in men s professional and amateur soccer. Peterson et al 2011 SR with MA: Eccentric strengthening, with good compliance, appears to be successful in prevention of hamstring injury. Without compliance, eccentric hamstring training did not reduce the risk of hamstring injury. Goode et al 2015

17 Rehab for Stress Fractures = Resistance Training Though elevated compared to inactive controls, long-distance runners showed consistently lower BMD compared to sprinting and ball-sport athletes. CC runners y.o.: 28% w/ Z-score -1 or less 11.8% w/ Z-score -2 or less Wilks et al 2009 Barak et al Reduced relative BMD accrual over time; 8 month performance-season vs. gymnastics/inactive controls Taafe et al Low BMD (<-1 Z-score) High School Female Athletes 3.6 times as likely to incur injury than Normal BMD peers Rauh et al

18 Running injuries are (often) overtraining injuries Other systemic disorders can also stem from overtraining such as low bone density, gastrointestinal disorders, immunological differences, psychological disturbances (i.e. Female Athlete Triad and RED-S)

19 What will you see in your patients? Physical symptoms: Getting sick more often, significant decreases in weight in short periods of time due to decreased appetite, amenorrhea, decreased BMD, and increased risk of bone stress injuries Psychological disturbances: irritability, depression, fears of weight gain, decreased concentration, impaired judgement Performance deficits: decreased endurance performance, decreased muscle strength, decreased training response, decreased coordination Specifically affecting at women/girls participating in body composition sports and endurance sports such as dance, figure skating, gymnastics, diving, cross country, and swimming and men/boys participating in cycling, rowing, running, jockeying, and athletes in weight class combat sports

20 Tracking workload to decrease overtraining General guidelines to decrease risk of overtraining and burnout are to measure and track workload volume and avoid > 150% increases from week to week extrapolated from field sports studies looking at the effect of on acute on chronic workload stimulus on injury rate Gabbett, Blanch, and Hulin

21 RT to decrease overuse injuries SR, QA, and MA: Strength training as superior, dose-dependent and safe prevention of acute and overuse sports injuries Lauerson et al 2018

22 Current Recommendation for Iron Supplementation Current NIH Recommendation for Oral Iron Supplementation Current Evidential Recommendation for External Iron Supplementation 4 5 Exercises 3 5 sets 4 10 Repetitions > 70% 1 RM 2 3 Minutes Rest between sets Lesinski 2016 Borde 2015

23 Resistance Training Dosage for Runners

24 Ex Prescription Variables and Dosage F: Frequency I: Intensity T: Time T: Type V: Volume P: Progression

25 Frequency

26 Intensity

27 Rating of Perceived Exertion Reliable way to calculate effort Not as accurate for estimated failure or max effort when used in isolation The most important limitation is that less than max RPE scores are often reported even when max number of reps are performed Helms 2016

28 Repetitions in Reserve (RIR) based RPE Repetitions In Reserve: Estimated reps until volitional failure RIR more accurate for estimated failure vs. Borg RPE alone Zourdos 2016, Helms et al 2016 Consecutive sets improved accuracy More experienced (i.e. more sessions) improved accuracy Higher resistance improved accuracy (>RPE/<RIR) Previous resistance trained athletes improved accuracy

29 Time

30 Type

31 - Let s talk about implements

32 Why Barbell? 1. Load-able 2. Progress-able 3. Dur-able 4. Enjoy-able

33 Why not Dumbbell? 1. Load-able 2. Progress-able- limited by what you can hold and size of the dumbbell

34 Why not Dumbbell? 3. Progress-able- Depends on having access to MANY dumbbells

35 What about Resistance Bands? 1. Load-able- Limited resistance capacity 2. Progress-able- Requires multiple levels of bands with increasing intensity

36 Volume

37 Progression

38 Is goal to improve strength, power, hypertrophy, or muscular endurance?

39 Power High Force >80% 1RM Reps: 1-5 Sets: 3-5 Rest: 3-5 min between sets RIR-based RPE: 8-10 RIR: 2-3 High Velocity Reps: 2-5 Sets: 3-5 Rest: 3-5 min between sets RIR-based RPE: <4 RIR: Not calculated

40 Strength >80% 1 RM Reps: 2-6 Sets: 3-5 Rest: 2-3 min between sets RIR-based RPE: 7-10 RIR: 0-3

41 Strength/Hypertrophy Reps: 6-12 Sets: 3-5 Rest: min between sets RIR-based RPE: 6-8 RIR: 2-4

42 Muscular Endurance Train to failure Reps: Sets: 2-4 Rest: min between sets RIR-based RPE of 9 10 RIR 0 1

43 Simplicity is Key

44 Framed through a Running Lens

45 Selection of exercise Which exercises to do? Which implements to use? Dosage?

46 Squat -Muscles Loaded Quadriceps, Hamstrings, Gluteals, Spinal Erectors, Core muscles -Prime Movers Adductor Magnus, Quadriceps, Rectus Femoris, Gluteus Maximus

47 Deadlifts -Muscles Loaded Spinal Erectors,Quadriceps, Hamstrings, Gluteals, Core muscles -Prime Movers Spinal Erectors, Biceps Femoris, Quadriceps, Gluteus Maximus

48 Accessory Strength Movements

49 Plantar Flexion

50 Hamstrings

51 Single Limb Compound

52 Instability Training

53 Create a Return to Running Program for YOUR patient/athlete

54 How do we get where we are going? Transition Period Off Season Pre Season In Season Finish Line

55 Considerations to create a Return to Running Program

56 References van Gent RN, Siem D, van Middelkoop M, et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. British Journal of Sports Medicine 2007;41: Arnold M, Moody, A. Common Running Injuries: Evaluation and Management. American Family Physician Vol. 97 Issue 8, p Caratun R, Rutkowski NA, Finestone HM. Stubborn Heel Pain. Canadian Family Physician Jan 2018, 64 (1) Dankel et al. Dose-dependent association between muscle-strengthening activities and all-cause mortality: Prospective cohort study among a national sample of adults in the USA. Arch Cardiovascular Dis. Vol 109, 11 pgs Beattie, K., Carson, B. P., Lyons, M., Rossiter, A., & Kenny, I. C. (2017). The Effect of Strength Training on Performance Indicators in Distance Runners. Journal of Strength and Conditioning Research, 31(1), doi: /jsc Balsalobre-Fernández, C., Santos-Concejero, J., & Grivas, G. V. (2016). Effects of Strength Training on Running Economy in Highly Trained Runners. Journal of Strength and Conditioning Research,30(8), doi: /jsc Paavolainen L, et al. Explosive-strength training improves 5-km running time by improving running economy and muscle power. J Appl Phys, 86;5, p Roelofs EJ, Smith-Ryan AE, Melvin MN, Wingfield HL, Trexler ET, Walker N. Muscle size, quality, and body composition: characteristics of division I cross-country runners. J Strength Cond Res. 2015;29(2): Beyer, R., Kongsgaard, M., Kjær, B. H., Øhlenschlæger, T., Kjær, M., & Peter Magnusson, S. (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial. The American Journal of Sports Medicine, 43(7), Kongsgaard, M., Qvortrup, K., Larsen, J., Aagaard, P., Doessing, S., Hansen, P., Peter Magnusson, S. (2010). Fibril Morphology and Tendon Mechanical Properties in Patellar Tendinopathy: Effects of Heavy Slow Resistance Training. The American Journal of Sports Medicine, 38(4), Alfredson, H., Pietilä, T., Jonsson, P., & Lorentzon, R. (1998). Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis. The American Journal of Sports Medicine, 26(3), Nascimento L, et al Hip and Knee strengthening is more effective than knee strengthening alone for reducing pain and improving activity in individuals with patellofemoral pain: a Systematic Review with Meta-analysis. JOSPT :1, Lesinski M, et al. Effects and dose-response relationships of resistance training on physical performance in youth athletes: a systematic review and meta-analysis. Br J Sports Med Jul;50(13):781-95