running considerations for athletic therapists2015

8/9/2019 Running Considerations for Athletic Therapists2015

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What ATs should know about

running injuries

CATA 447 January 2015

Marc-Antoine Dor B.Sc. CAT(C)


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Plan

Presentation

Understand: Running biomechanic

Available Tools: Exercise prescription forrunners

Apply: Common injuries and treatment

considerations for runners References

Questions


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Presentation

Former sprinter

Track and field coach since 2006

Personnal trainer

Concordia University 2010-2013

CAT(C) 2013

Athltisme Qubec Head AT 2013

Athletics Canada Therapist (XC NACAC andWorlds) 2015


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Who works with runners?

Soccer?

Basketball?

Football? .


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RUNNING BIOMECHANIC ANDMOVEMENT ANALYSIS


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How important is running

biomechanic?


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The five phases

Back swing

(Toe off)

Forward swing (Preparation)

(Ground contact)


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Back Swing

Starts at the preparation phase

Ends at the forward swing (max ext)

Includes toe-off and ground contact

Pelvis anteriorly rotated; load hip flex

Back arm loads core

Releases energy from hamstrings


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Toe-off

Release energy of grastoc

No contraction of hamstrings (lever)

So reactive hip flexion, knee flexion anddorsiflexion (3F reflex) and trunk erect

Windlass mechanism


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Adductor longus (Eccentric

Hip ER & Flex)

Iliacus (loading)


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Forward swing

Release the energy from hip flexors

Ends with preparation phase

Hamstrings are passive Ankle dorsiflexed

Heel to buttock in one movement


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Preparation

Starts when thigh is max height

Back swing starts

Loading hamstrings and calves


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Ground contact

So short, impossible to build up

sufficient power for concentric contraction

Vertical Tibia position

Knee slightly flex

Foot position? (rear-mid-forefoot)

Foot under CoG (hips)

Foot-ground angle AVOID OVERSTRIDING


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Pronation


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Posture

Kenyan vs Ethiopian

Forward leaing vs trunk leaning

Stable AND mobile trunk


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Arms movement


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Force Transmission Pattern

Plantar Fascia 15%

Achilles tendon 35-50%

Meniscus Biceps femoris/Sacrotuberous ligament

ITB/Thoracolumbar fascia (switches side)

Intervertrebal discs Ligament Nuchae


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Trail running differences

Slope (are shoes adapted? Runner?)

Fatigue

Surface? Changing shoes?


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Practice


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EXERCISES FOR RUNNERS


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What do they all have in common?


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Feedbacks

Auditive feedbacks(The less you talk the

better)

Running is a reflex controlled activity (Stumble

Reflex, Triple Flexions/Extensions, Extension

Reflex)


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Mobility

If the hips are not mobile expect something

else to be!

Make sure mobile joints are mobile and stable

joints are stable

Mobility is not just flexibility

Think movement rather than isolation


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Stability

Whatsthe real definition of core?

Are planks, bridgestransferable?


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Muscle actions

Eccentric vs concentric

Reactivity ++ (strech-shortening cycle)


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Neuromuscular skills

Agility

Balance

Coordination Speed


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Speed definition

Same for distance runners and sprinter, less

than 8 seconds


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Barefoot activities


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Ribs and Thoracic mobility

Breathing

Torso rotation


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R.A.I.L. Principle

Release

Activate

Integrate Locomotion


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Stride frequency

Athletes average 170-190 (Jack Daniels,

Olympics 1984)

Casual runners 145-165

Influence on vertical loading rate and ground

contact duration

Noise indicator


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COMMON INJURIES ANDTREATMENT


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Causes of running injuries

Lower body malalignment

Muscular dysfunction

Impact forces/stress

Others (shoes, ortheses, surface)


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Shin splints

Causes:

1. Impacts?

2. Toe flexors?

3. Proximal control?

4. Biomechanic?

5. Hyperpronation?6. Intermuscular coordination Tib Post/Ant


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Shin Splints

Assessment

1. Palpation

2. Find the cause!

Treatment considerations

1. Increase volume (change activity in acute)

2. Treat the cause3. Forefoot running RTP


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Patello-Femoral Syndrome

Causes

1. Q-angle? Pronation? Valgus? VMO? Quad

Strength?

2. Proximal control (Hip ER, Core stab)

3. Impacts

4. Hip position/restriction


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Patello-Femoral Syndrome

Assessment1. Descending stairs

2. Anterior knee pain

3. Changes in volume/surface


1. Reduce volume (split to intervals) and avoid downhill/stair running

2. Glutes control

3. Pelvis pathologies

4. Femur and tibial rotations5. Patient education (QC studies)

6. Pain control during RTP


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Ilio-Tibial Band Syndrome

Causes

1. Friction

Assessment

1. Pain location (lat/sup PAT)

2. Pelvis dysfunctions

3. New activity, volume, surface


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Ilio-Tibial Band Syndrome


1. Agressive, consider cortisone

2. Decrease volume, inscrease intensity

(intervals)

3. Avoid downhill running

4. Manual therapy ITB? Desensitization vsrelease


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Back Pain

Causes

1. Overstriding

2. Weak/dysfunctional core

3. Bad posture

4. Breathing dysfunctions

5. Ground contact time and position


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Back Pain

Assessment

1. Find the right structure


1. Change activity until causes are treated

2. Start progressively (integration of new

informations)


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Hamstring strains

Causes

1. Flexibility?

2. Strength?

3. Pelvis alignment

4. Weak core

5. Changes in intensity


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Hamstring strains

Assessment

1. Dontfocus on the hamstring if chronic


1. Eccentric and frx massage (chronic)

2. Treat the cause at the same time

3. Acute change activity (vascularization)4. Avoid power activity (acute)


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Achilles Tendinopathy

Causes

1. Runnersankle foot loose

2. Rigid (supinated) foot

3. Transition to minimalism

4. Increased volume of hills or sprint trainings


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Achilles tendinopathy

Assessment


1. Avoid NSAIDs

2. Protect the tendon + ice (for ACUTE)

3. Minimalist footwear (eccentric load forchronic ONLY)

4. Patient education (pain, impacts, shoes)5. No flexibility for gastroc


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Stress fracture

Causes

1. Bone density

2. Stress

3. Calcium deficit?


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Stress fracture

Assessment1. Imaging


1. Rest (1-2 wks)2. Progression to weight bearing then running

3. Avoid uphill

4. Control pain (tape, ice, manual therapy)

5. Minimalist/barefoot6. Low intensity ultrasound (LIPUS)


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Minimalism vs maximalism


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Injury Prevention

Posture and core

FMS?

Gradual progression

Clear past injuries and medical conditions

Warm-up

Technique Neuromuscular training (ABCS)


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Conclusion

Just like other sports, find a GOOD coach and

learn how to run

Many factors influence running, you have to

consider all of them. The higher level of

performance, the better your staff has to be!

Start with easy feedbacks: less noise, light

strides, increase stride frequency, arms pull

Teaching opportunity


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References

BK Running (book and DVD)

Pose running (book and DVD)

Evolution running (DVD)

Courir mieuxJean-Franois Harvey Lore of running (Bible of runners) & WaterloggedTim

Noakes

RunnersanatomyJay Dicchary

Guy Thibault (Lentranement cardio & en pleine forme) Jack Daniels (the booknot the alcohol)

Running technique Brian Martin


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References

http://www.runresearchjunkie.com (Craig Payne,Podiatrist)

http://www.runningtechniquetips.com/ (Brian Martin)

http://www.therunningclinic.com/en/home/ (BlaiseDubois PT)

http://runblogger.com/ (Peter Larson PhD anatomy)

http://naturalrunningcenter.com/ (Mark Cucuzzella,MD)

http://www.volodalen.com/ (French scientists)


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Thank you!

How to contact me?

Marc-Antoine Dor (LinkedIn)

@TrackTherapist (Twitter)

[email protected]

www.TrackTherapist.blogspot.ca

www.Osteo-MedSport.com (like us on Facebook)

More courses and presentation on running visit

www.formationsMAD.com

S h f A T t d


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Speech from Assess, Treat and

Condition "Good evening. I m Steve Middleton. Im the Director of Rehabilitation & Sports Medicine at Assess, Treat & Condition in Carbondale [Illinois]. When I was asked to

come here this evening, I tried to think of what I could talk about that runners dont hear much about. So, I decided to focus on why we shouldnt run since Im sure

none of you have ever heard that from a healthcare provider before."

On joint strength and stability

"You also shouldnt run because of your knees. Running has been shown to improve the strength of the muscles, tendons and ligaments surrounding the joints. If you

are able to maintain or strengthen your knees, you will most likely never be able to get a knee replacement. We, as Americans, always like new and shiny things, but

youll just be stuck with your same old knees forever."

On immune function

"You shouldnt run because it has been shown to improve your immune function long-term. If you are never ill, that means you have to work every day. Not only will

people start expecting more from you because you are more productive but all of your sick days will also go to waste."

On heart disease

"You shouldnt run because it has been shown not only to strengthen your heart but also to decrease the risk of heart disease. If your heart remains fine, you will

never need a heart transplant. Based on current medical bills, this is the only surgery you need to qualify as the 6-Million Dollar Man [or Woman]."

On cholesterol and blood pressure

"Running can naturally offset many of todays preventable diseases such as lowering blood pressure and cholesterol so you probably wont have to take medicine to

do that. This means that you wont get to experience the breakthroughs of modern medicine. Also, you will have to continue topay for health insurance that you

wont even use."

On osteoporosis

"Weight-bearing activities, including running, improves bone health. If your bones arent porous, they will weigh more. Therefore running will make you gain weight."

On stress

"Running decreases stress. If you arent pulling your hair out, that means you will have to find time in your busy running schedule to actually go and have it cut."

On goal setting

"Running requires planning and training especially if you are working towards longer distances like a half or full marathon. Once you complete your target distance,

you will start thinking you can do anything. Well thats just crazy talk.

But in all seriousness, lets be careful as we start the 2014 running season. Pace yourself, especially if you have taken thewinter off, which I wouldnt blame you if you

did. But, by pace yourself, you dont have to follow the increase by blank % a week but just listen to your body; it tends to know best.

running considerations for athletic therapists2015

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