Common injuries and how to prevent them Sebastian Cormier Msc Physio, Bsc Sports Med, CSCS Chartered Physiotherapist Strength & Conditioning Specialist
Overview 1. Very quick recap on understanding your training programme. 2. The big three: 1. Runner s knee or Iliotibial friction syndrome (ITB) 2. Shin Splints or medial tibial stress sydnrome (MTSS) 3. Achilles pain or achilles tendinopathy 3. The running gods exercise tips 4. Summary
Less than 2 months to go!!
HOW FAR TO GO? Base 1 Base 2 Speed Taper
Base 2 The volume phase (milage/duration) 4-8 weeks. Prepare the body for the intense speed phase to come! Goals: EASY HILLS UP-TEMPO (60-75% effort) 1. High mileage/ duration 2. Low-intensity training 3. Improve recovery rate 4. Improve tolerance to running
Common mistakes in Base 2 Too much mileage too soon Too much speedwork too soon Hills too often too fast Too little recovery Copying programmes of more experienced runners may lead to injuries Some up-tempo work can be included, but remember base 2 phase is slow! Hills slow strides with emphasis on legs NOT lungs!
Speed training phase (4-8 weeks) Working at 75-95% of effort in: Intervals training on track i.e. 400m sprints with 90 sec rest X 5. Reduce rest/ increase intervals Hill intervals I.e. Sprint up Primrose hill, down slow X 20. Increase gradient, decrease rest, increase distance Long run 50 % run at race pace (20km) +- intervals Prepares you psychologically and physiologically for the race! THE CRITICAL ZONE! Stimulate race conditions and intensities
Common mistakes in Speed Phase Assess the intensity based on your running experience and your preparation during base 2. Remember, training volume decreases while intensity increases! Not enough RECOVERY time built in! Make sure to contrast speed and slow sessions to avoid repetition
Ouch I am hurt, what now?
How common are injuries with running 65%-90% of runners get injured each year Previous injuries, age and muscle weakness are the most consistent INTRISIC risk factors for injuries Sudden increase in running load and intensity are the most EXTRINSIC risk factors Overuse injuries are more common than acute injuries Clin Sports Med. 2004 Jan;23(1):55-81, vi. Br J Sports Med. 2002 Apr;36(2):95-101.
How common are injuries with running Beginners more prone to injury than veterans Low BMI in females prone to stress fractures Higher risk of injury zone when running more than 40miles/weeks Sports Med. 2007;37(4-5):437-9.
Myths about injury prevention in running Stretching pre running does not reduce injuries There is no evidence to suggest that running shoes prevent injuries No evidence for insoles/ orthotics No evidence to suggest specific biomechanical contributors predispose for running injuries, including individual running technique and foot strike patterns Br J Sports Med. 2007 Aug;41(8):469-80;
Key messages from the evidence EXPERIENCE offers real injury prevention value: The stronger and more coordinated the better Recurrent injuries are warning signs for lack of stability and control of joints Too many consecutive days running does not give the body adequate time to heal Post running stretching seem to be beneficial Archives of Internal Medicine, vol. 149(11), pp. 2561-2564, 1989
Acute vs. overuse injury ACUTE INJURY Onset is acute, sharp, shooting pain Localized Immediate inability to run further without aggravation Maybe associated with muscle power loss according to severity of damage Common sites with running are calf belly, hamstring strains and ankle sprains.
Example of an acute grade 2 Hamstring tear
Treatment for acute injuries BEST PRACTICE in the first 48 Hours: 1. PRICE 2. Avoid use of NSAID s 3. Ice & compression critical 4. Early movement useful, but avoid stretching 5. Avoid direct soft tissue work 6. Avoid excessive travel Orchard et al. (2008)
PRICE P Protection Don t stretch/ crutches/ brace/ tape R Rest Give adequate healing time depending on severity I Ice Crushed ice for 15 min every 2h C Compression Tape, double tubigrip, E Elevation ACPSM (2011) Executive summary on PRICE guidelines
Overuse injuries OVERUSE INJURY CATEGORIES: 1. Training volume/intensity 2. Anatomical variation 3. Biomechanical factors However, etiology of overuse injuries remains multifactorial and can include all of the above. Early DIAGNOSIS is KEY!!!!
Three most common overuse running injuries 1. Runner s Knee or Iliotibial friction syndrome 2. Shin Splints or medial tibial stress syndrome 3. Achilles pain or achilles tendinopathy
Runner s knee ITB friction syndrome Most common injury to the lateral knee (21%) Inflammation of the fat pad/ perosteum/distal ITB tendon Grad increase in pain during running, which may disappear afterwards. Can be stiff later especially with walking down stairs.
Internal risk factors: Weak or tight hip/ pelvic muscles Weak or tight hamstrings Poor control/ balance with single leg stance/landing Excessive overpronation Bony abnormalities Runner s knee ITB friction syndrome External risk factors: New to running/ sudden increase in mileage Excessive hill running esp. downhill Running on a camber
Runner s knee ITB friction syndrome TREATMENT: ACUTE onset (less than 2 weeks): Active rest from running Anti-inflammatories as prescribed Regular icing for 15 min every 3 hours Stretching gluts, hamstrings, front of thigh, calves. Foamrolling along ITB and front of thigh to release tight tissue Sports massage CT guided corticosteroid injection if it doesn t settle or race is imminent. Ellis R, Hing W, Reid D. Man Ther. 2007 Aug;12(3):200-8.
Runner s knee ITB friction syndrome ACUTE AND CHRONIC ITB syndrome (2 weeks+) Correct biomechanical issues affecting compression forces of distal ITB: Strengthen hip, pelvic and core muscles Increase power in the lower limb muscles to improve shock absorption Stretch or foamroll tight muscles of the thigh Correct shoe wear or orthotics Ellis R, Hing W, Reid D. Man Ther. 2007 Aug;12(3):200-8.
Shin Splints Misleading terminology: Most commonly associated with medial tibial stress syndrome Associate with diffuse irritation to the bone lining of the tibia Different to compartment syndrome and stress fractures
Shin Splints Internal risk factors: Excessive pronation Calf muscle tightness Weakness hip and pelvic musculature Decrease calf endurance External factors: New to running/ sudden increase in volume/intensity Worn out shoes Luke T Madeley, Shannon E Munteanu, Daniel R BonannoJournal of Science and Medicine in Sport, Volume 10, Issue 6, December 2007, Pages 356-362
Shin Splints TREATMENT ACUTE onset: Active rest from running Anti-inflammatories as prescribed Regular icing for 15 min every 3 hours Stretching Calves and anterior shin +++ Sports taping to offload anterior and/or posterior shin Sports massage
Shin Splints ACUTE AND CHRONIC symptoms (2 weeks+) Correct biomechanical issues affecting load to the shinbone: Strengthen hip, pelvic and core muscles Increase power in the lower limb muscles to improve shock absorption Improve especially calf muscle endurance Correct shoe wear or orthotics Riley, R. Journal of Science and Medicine in Sport, Volume 6, Issue 4, Supplement 1, December 2003, Page 13
Achilles tendinopathy Overuse tendon injury that is characterized by a changes in tendon structure and a reduction in function Usually occurs in the mid-tendon of the Achilles Some respond to simple treatment, some fail ALL treatments
Achilles tendinopathy Diagnosis is most important here as it guides further interventions!!! Seek help from physiotherapist or sports physician EARLY! Tendon changes are reversible if early warning signs are recognized and training volume and intensity are modified IMMEDIATELY! If an intense bout of exercise flared-up the Achilles, it will respond to a reduction in load, adequate recovery, ice and anti-inflammatories.
Achilles tendinopathy Chronic overload of the Achilles tendon will result in a focal thickened tendon (not inflammed), that is painful with forceful push-off and stiff in the morning. Often present in the elite athlete with chronically overloaded tendons or the middle-aged recreational runner.
Stories.. Dame Kelly Holmes, GB 800 and 1500m runner, won Double Gold with bilateral chronic Achilles tendinopathy Liu Xiang, Chinese 110 meter Hurdler, Triple Crown winner unable to continue training 6 months prior to Olympics Beijing Biggest Medical Budget in the World unable to get him starting at the Games 2008.
Achilles tendinopathy TREATMENT: Anti-inflammatories are not helpful in the chronic stage Exercise with an eccentric(lengthening) / heavy slow resistance component to it i.e calf raises off step with straight and bend knee Extracorporeal shockwave therapy Ultrasound guided injections (not cortisone) Surgery if all fails Cook JL, Purdam CR. Br J Sports Med. 2009 Jun;43(6):409-16.
Question and Answers "If you want to win something, run 100 meters. If you want to experience something, run a marathon." Emil Zatopek