UCSF Sports and Injury Rehabilitation Conference Recap: Running Injuries

One of the most popular forms of exercise in the United States is running and every year the number of runners increases.  According to Running USA’s 2009 State of the Sport, there was an 18% increase in the total running population in 2008 (35,904,000 runners) compared to 2007, and a 15% increase in the estimated number of trail runners in 2008 (4,857,000).  These numbers do not even account for the running involved during sport participation and training for sports.

A simple assumption can be made that with the growing number of people participating in running there will be an increase in the number of running related injuries along with it.  In a recent online article in the New York Times, Dr. Ron L. Diercks and their colleagues at the University of Groningen in the Netherlands who study running and the potential injuries caused by the sport stated:

“The injury problem is huge, as many as 40 percent of runners are injured, usually to their feet, ankles, knees or legs. At [our] university’s running clinics, 30 to 40 percent of beginning runners gave up because of injuries.”

It is difficult to pinpoint the reasons or the exact candidates for running injuries, however Dr. Diercks hints at a correlation between injuries and the new runner:

“Most people, who take up running, think it will be easy, all they need is a pair of shoes. But in fact, running is a difficult sport, and most people quit before it becomes fun, often because they are injured. Experienced runners know how to adjust and return to the sport. Novices usually do not.”

With the large number of people participating in running and with many athletes using running during their sports and training I took the opportunity to attend the 2011 University of California San Francisco (UCSF) Sports Injury and Rehabilitation Conference and the focus this year was on running injuries.  I boiled down the information from this conference and will share with you some of the more compelling and useful information that I learned in hopes that it helps the runners and athletes you are working with remain injury free.

The presenters for this conference were all experts in the fields in sports medicine and running injuries.  Many were medical doctors and professors from UCSF and other distinguished universities and have extensive experience in dealing with patients with injuries associated with running.

More Force than You Think

According to Dr. Anthony Luke, a common running heel strike can produce force anywhere from 400-500 times a person’s body-weight load.  Multiply that over the number of steps taken and it is easy to potentially understand that if an athlete is not properly conditioned or structurally sound, they can get hurt while running.  Luke quoted a study by Wentz et al. that indicated that 10% of female athletes are likely to get a stress fracture in one of their joints and this was most common in women who were in less than optimal physical shape (lower aerobic capacity, smaller muscle, and poor diet).

These loading forces along with low strength, conditioning and health levels may be main indicators as to why runners, especially the new ones, get hurt.  Richard Souza, PhD, indicated that there is a strong correlation between hip mal-alignment and muscle weakness and patellofemoral pain especially with female runners.  During Dr. Christina Allen and Dr. Chris Daprato’s presentation they stated that: patellofemoral pain accounts for about 25% of all sports related injuries and 16-20% of all running related injuries.  Patellofemoral pain may not be noticeable during low impact activities like walking, however when the joint reaction forces (going up stairs, squatting, running) significantly increase the pain can be more noticeable and potentially debilitating.

What Can we Do?

With such a high number of people participating in running the injuries associated with it also will remain high.  Preventative measures to minimize risk are a must and it is in the best interest of the athlete to understand the risks and how to minimize them.  In my slightly biased opinion, I would recommend that a person who is committed to running seek the help of professionals to help them with their strength program and even to learn proper running mechanics optimal for their body type.

One of the first things to consider is the appropriate amount of body-weight for your activity.  A distance runner would benefit from shedding excessive body weight which increases the stress on the joints.  During Dr. Brian Feeley’s presentation on the Cartilage Lesions of the Knee, he stated that: “For every pound of body-weight lost there is 10 lbs. less weight off of the knee joint.”  Imagine the potential damage to the body of a runner who is not in the best physical shape; if you multiply the amount of weight placed on your knee joints with the force from the heel impact during running over time there can be some serious potential injury problems.

To prevent the likelihood of future injuries it is a good idea to assess the athlete to determine if they have any flexibility, mobility and strength discrepancies.  Can the athlete squat, lunge and hold a plank without pain?  Does the athlete have major differences in movement patterns between each side and with equal and appropriate muscle strength and endurance?

If you are a trainer I am willing to bet you have heard a client say something along the lines, “My legs are strong because I do a lot of running, so I should focus more on my upper body.”  Strength is a relative terms and being strong for one sport might not be strong enough for another, also being strong for your body type and activity is also variable.  Like Dr. Luke mentioned, the force of a heel strike is much greater when running and it is paramount that the person’s body be able to absorb and use the high level of force appropriately.  Without the right amount of strength development the body will not be able to handle the forces and then must distribute the force unevenly throughout the body which eventually wears certain joints down and causes injuries.

A suitable program for runners consist of a balanced routine between upper and lower body movements with plenty of emphasis on the lower body movements consisting of: mobility work, double leg exercises (squat and deadlift variations) as well as plenty of single leg exercises (lunge and step up variations).

Running might be the desired form of exercise a person might prefer, however, it may be best to treat running as a sport and realize that there is necessity for all of the supplemental training to be a successful runner throughout the years.

 

References:

Kolata, Gina. When Running Up Mileage, 10 Percent Isn’t the Cap, New York Times online, June 20, 2011.

Wentz L, Females have a greater incidence of stress fractures than males in both military and athletic populations: a systemic review. Mil Med. 2011 Apr;176(4):420-30

Tags: jogging, running, X Country

Sports Performance Series – Hip Adductors

The second video in this sports performance series we look at common muscle imbalances found in the adductor muscle group of youth, high school, college and professional athletes. We will go over how to test and assess these imbalances, how to mobilize and stabilize these areas and finally what exercises can be used to strengthen these areas.

Tags: Conditioning, flexability, Mobility

Five Mistakes when Training Young Athletes

It seems more and more that younger athletes are not only starting to specialize in specific sports earlier but that they are also beginning to complement their sports with outside strength and conditioning.  While this is potentially positive for the athletes and the coaches that train them, with younger athletes there runs a great risk of not exposing them to a proper program and actually making them perform worse or even set them up for injury down the road.

In this article I want to expose some of the potential pitfalls that may occur when dealing with athletes who are pre or early teens and being exposed to strength and conditioning for the first time.  My goal is to not only give coaches some insight but to help parents understand what they should look for in a coach and what they should expect when they are looking for the right strength and conditioning coach.

Assuming Everything is A-Ok

You have an 8th Grader coming into the gym today and you know that he is brand new to training, never had an injury and is all excited to go.  Like a blank canvas; a coach might assume that everything is pristine and just waiting for any type of movement to create an athletic masterpiece; however not doing some form of initial assessment will be setting up your young athlete for failure down the road.

A basic medical history from the parents and a candid interview of the athlete is a good place to start.  After I get familiar with the young athlete’s background, I like to run through some mobility and body-weight drills. These drills are not only a good warm up; they also give me a chance to evaluate how the athlete moves.  In my experience, a young athlete and their parents will not have a reference point of how well they move relative to how they think they should move.

Can they do a body-weight squat without the knees shooting forward or the legs caving in?  Can they raise their leg straight up to 90 degrees while lying on their back? Can they extend their shoulders directly overhead?  Are there differences in movement patterns between the right and left sides of their bodies?  These are just a few of the things I look for before I design a program to help correct poor movements patterns, flexibility issues and increase strength and conditioning.

Ignoring Stretching and Rehabilitation Work

I always get a chuckle when I ask the young athletes whether or not they get sore after all of the physical activity they do.  Many say “no” and some say “a little.”  As I brood in jealously pining for my lost youth, I remind myself not to assume that because the new athletes don’t really get sore, have injuries or poor movement patterns that they do not need to do some preventative rehabilitation work.

Foam rolling, corrective exercises, and stretching are essential in every athlete’s program.  Not only do they make up a complete program they also prevent any unforeseen problems that may occur if these modalities are neglected.

These modalities also create proper training habits.  As athletes get older they tend to get tighter in the muscles, especially in male athletes.  By consistently incorporating these rehabilitative modalities, athletes are more likely to turn them into good habits as they progress through their athletic career.

Ignoring the Proper Movements

Young athletes look up to older athletes as their guideline for how they want to act, play and train.  Grinding bench press sessions, eye popping squat reps and walking around with chains strapped to your body look impressive and potentially serve a quality purpose; but they are most likely not right for the young athlete.

Stress the basics and by basics; we are talking mastering complete body control (mobility, stability and strength) through a full range of motion of primarily large, full-body movements.   Basic bodyweight movements like pushups, squats, lunges, planks and pull ups are great movements to focus on and mastering them can lay the foundation for success in other movements down the road.

Ever see the young boy that is 5ft.1 and has a size 12 shoe? Many young athletes are not only growing into their bodies they are still learning how to move themselves efficiently.  Mastering full body movements allows for great neuromuscular coordination which not only makes the athlete stronger they gain more balance while going through the movements.

Progressing too Quickly

To piggyback on the previous point, when an athlete is new to training the learning curve is much larger than a more seasoned athlete. Generally speaking when the newer athlete is exposed to a specific stimulus, after a brief period of learning and small failures, there is a steep increase in task performance success.  This rapid growth of success can be validated through exercise progression success, weight lifted and work volume done in a certain amount of time.

This quick success should lead to some caution as to not get over aggressive with the progression of the program.  If an athlete is doing well with the kettlebell goblet squat it still might not be a good idea to move right into barbell back or front squats.  Essentially they are the same movements, however barbell back squats puts the load in a different position causing more spinal compression and barbell front squats cause much less spinal compression but demand much more flexibility in the wrists (depending how the bar is held) and also a much larger demand in core strength and stability to keep the weight in its proper place.  Another component to consider is that neurological muscle adaptations occur much faster than ligament and tendon strengthening.  The young athlete may have enough strength to move a particular amount of weight, however the supporting structures might not be able to properly handle the external loads and therefore fatigue, a compromise in technique and potential injury could occur.

Smaller progressions are usually more beneficial for younger athletes.  Keeping the same movement with a safe increase in weight and a decrease in repetitions is an easy way to get your athlete to progress.  I also prefer slight changes in the exercise movement, for example, going from using one kettlebell in the goblet squat and holding it with two hands to using one kettlebell and holding it in the racked position on one side of the body.  The racked position requires more balance and core stability than the goblet squat, yet it is not such a dramatic shift between the two movements.

Expecting too Much

This one goes out primarily to the parents.  Parents put their kids into strength and conditioning programs to help them in some way.  Whether it is to gain strength, size, speed, or to increase athletic performance; the reason is there.  All of those qualities take time to build and take time to transfer towards athletic success.  It is important to see improvements due to the training that you are paying for; however, it is more important to focus on the smaller gains rather than the optimal end results.  Is your child getting stronger overall, are they moving better, gaining more flexibility, are they more confident when playing and during life in general?

Also, another point to consider is that training should be considered a long term accumulation of the positive qualities of movement and mentality working together to create a more complete athlete over time.  Much like investing in the stock market, slow steady gains assure greater success over the long term rather than peaking quickly only to reach the inevitable descent just as rapidly.  Is your child’s goal to enjoy their sports and work their way to a college scholarship, or is it to be the best soccer player in the 8^th grade?

To have fully well-rounded athletes that perform well in their sport, strength training alone may not be enough.  A well balanced program should incorporate some appropriate conditioning protocol to get the most out of training and athletic potential.

Tags: athletes, gyms, youth training