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

How are your Hammies?

Every athlete who walks through my door might think that they are going to come in, lie down on a bench and press a bar for a few sets of eight and then maybe some bicep curls while staring at themselves in the mirror and so on; but this is not really the case.  Before we go through any types of strength movements we have to see what we are dealing with.  Are there any mobility issues, strength imbalances or flexibility concerns that need to be addressed for optimal health and future performance; for most people the answer is yes.

One of the most common problems I see is that lack of optimal hamstring flexibility, especially among younger male athletes.  Poor hamstring flexibility, over time, potentially leads to reduced athletic performance, future tears in the muscle and surrounding muscles and excessive low back pain and tightness.  One study by Henderson et al. concluded that the risk factors for injury increase with age.  In their study of English Premier League Football (soccer) players they concluded that, “Older, more powerful and less flexible soccer players are at greater risk of sustaining a hamstring injury.”

In this article I will show you how to assess hamstring flexibility and some tactics to increase and maintain proper hamstring length and function.

Assess Yourself before you Wreck Yourself

Hamstring assessment is very easy to establish.  There are several different tests that can be implemented but one test should be sufficient.  Kendall suggests using the Straight Leg Raising Test.  To perform this test lie on your back on a table or ground with your legs straight and sacrum flat.  Keeping one leg straight and the low back down, raise one leg up keeping the knee straight.  An angle of approximately 80-90 degrees between the table and the raised leg is considered normal, anything less is considered abnormal.

It is important to monitor the low back position during the raising of the leg because if the hamstring or surrounding musculature are tight they can cause the pelvis and low back to move to create a false positive test.

You Need Some Work, Now What?

Let’s assume that you or one of your athletes has a less than stellar straight leg test and need to get their hamstrings in check before they get into the discomfort zone.  Frequent foam rolling of the hamstrings and the surrounding muscles can improve tissue length and quality.  I also recommend that when you foam roll, you try three different positions; in leg internal rotation, neutral and in leg external rotation.  The hamstring group consists of four muscles (semitendinosus, semimembranosus, biceps femoris long & short head) each having their own origins and insertions and making it possible for one particular muscle to be shorter than another.

This may sound simple but adding the proper exercises into the strength and conditioning program is a huge asset when trying to gain optimal length of a particular muscle group.  For the hamstrings, almost any correctly performed leg movement can be a corrective exercise, however it is probably in your best interest to perform these movements with your bodyweight alone adding them in the beginning of your program or intermittently throughout.

Supine straight leg raises, high knee walks, cradle walks, single leg RDLs, and lunge variations in different directions are great ways to increase range of motion within the hamstrings and surrounding muscles.  Keep the movements within their full range, vary the direction and movements themselves, repeat frequently and keep the load at body weight or very light and your legs will be loose in no time.

One final component is the dreaded “s-word” STRETCHING.  According to Physical therapist Kelly Starrett of San Francisco Crossfit;

“Stretch often.  Muscles are like obedient dogs.  They need constant, repetitive training.”

Stretching is critical and needs to be done frequently for optimum results.  I like to stretch my hamstrings by lying on my back and using a strap for leverage.  Once I set my end range position without straining I then begin to contract my thigh muscles and hold the contraction for a few seconds and then release the muscles along with my breath and gain a few more degrees in the range of motion.

Like my foam rolling, I also like to position my leg in different angels to make sure I am stretching the various muscles that make up the hamstring group.  Stretching both with the knee straight and bent stretching the hamstring group over the two joints the muscles group crosses.  I have also found that pronating (turn in) and supinating (turn out) the foot to be very effective in targeting the medial and lateral muscles of the hamstring group.

If people do stretch at all during the day it is usually only done for a minimal amount of time, usually too short to be deemed effective.  Again, Starrett suggests that:

“One session of stretching lasting one minute isn’t going to change anything.  Stretching big muscles like hamstrings and quads takes time.  Ninety seconds per leg should be a baseline, five or six times a day.”

There you have it, some surefire ways to get your hamstring in shape.  With a little discipline and diligence you too can have hamstrings that are ready to perform whatever task you ask them too..

References:

Henderson G, Barnes CA, Portas MD. Factors associated with increased propensity for hamstring injury in English Premier League soccer players. J Sci Med Sport. Jul;13(4):397-402, 2010.

Kendall, FP, McCreary, EK, and Provance, PG. Muscle Testing and Function (4th ed.). Philadelphia: Lippincott Williams &Wilkins, 1993.

Starrett, Kelly. Hamstrung.  CrossFit Journal Issue 59 – July 2007.

Tags: Hamstring, low back pain, stretching

Around the Web: Eric Cressey’s “Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.”

Eric Cressey of Cressey Performance has written one of the best articles I have read all year. Many of you may have young little league players out there who are interested in pitching. I think this post is too important to pass up; please click the link below and read this informative article and gain the knowledge necessary to keep your kids safe from the common overuse injuries that occur in baseball.

Your Arm Hurts? Thank Your Little League, AAU, and Fall Ball Coaches.

Tags: baseball, little league, pitching