What ATs should know about

running injuries
CATA 447 January 2015
Marc-Antoine Dor B.Sc. CAT(C)

Plan
Presentation
Understand: Running biomechanic
Available Tools: Exercise prescription for
runners
Apply: Common injuries and treatment
considerations for runners
References
Questions

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 and
Worlds) 2015

Who works with runners?

Soccer?
Basketball?
Football?
.

RUNNING BIOMECHANIC AND

MOVEMENT ANALYSIS

How important is running

biomechanic?

The five phases

Back swing
(Toe off)
Forward swing
(Preparation)
(Ground contact)

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

Toe-off
Release energy of grastoc
No contraction of hamstrings (lever)
So reactive hip flexion, knee flexion and
dorsiflexion (3F reflex) and trunk erect
Windlass mechanism

Iliacus (loading)

Adductor longus (Eccentric

Hip ER & Flex)

Forward swing

Release the energy from hip flexors

Ends with preparation phase
Hamstrings are passive
Ankle dorsiflexed
Heel to buttock in one movement

Preparation
Starts when thigh is max height
Back swing starts
Loading hamstrings and calves

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

Pronation

Posture
Kenyan vs Ethiopian
Forward leaing vs trunk leaning
Stable AND mobile trunk

Arms movement

Force Transmission Pattern

Plantar Fascia 15%

Achilles tendon 35-50%
Meniscus
Biceps femoris/Sacrotuberous ligament
ITB/Thoracolumbar fascia (switches side)
Intervertrebal discs
Ligament Nuchae

Trail running differences

Slope (are shoes adapted? Runner?)

Fatigue
Surface?
Changing shoes?

Practice

EXERCISES FOR RUNNERS

What do they all have in common?

Feedbacks
Auditive feedbacks(The less you talk the
better)
Running is a reflex controlled activity (Stumble
Reflex, Triple Flexions/Extensions, Extension
Reflex)

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

Stability
Whats the real definition of core?
Are planks, bridgestransferable?

Muscle actions
Eccentric vs concentric
Reactivity ++ (strech-shortening cycle)

Neuromuscular skills

Agility
Balance
Coordination
Speed

Speed definition
Same for distance runners and sprinter, less
than 8 seconds

Barefoot activities

Ribs and Thoracic mobility

Breathing
Torso rotation

R.A.I.L. Principle

Release
Activate
Integrate
Locomotion

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

COMMON INJURIES AND

TREATMENT

Causes of running injuries

Lower body malalignment

Muscular dysfunction
Impact forces/stress
Others (shoes, ortheses, surface)

Shin splints
Causes:
1. Impacts?
2. Toe flexors?
3. Proximal control?
4. Biomechanic?
5. Hyperpronation?
6. Intermuscular coordination Tib Post/Ant

Shin Splints
Assessment
1. Palpation
2. Find the cause!
Treatment considerations
1. Increase volume (change activity in acute)
2. Treat the cause
3. Forefoot running RTP

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

Patello-Femoral Syndrome
Assessment
1. Descending stairs
2. Anterior knee pain
3. Changes in volume/surface
Treatment considerations
1. Reduce volume (split to intervals) and avoid downhill/stair running
2. Glutes control
3. Pelvis pathologies
4. Femur and tibial rotations
5. Patient education (QC studies)
6. Pain control during RTP

Ilio-Tibial Band Syndrome

Causes
1. Friction
Assessment
1. Pain location (lat/sup PAT)
2. Pelvis dysfunctions
3. New activity, volume, surface

Ilio-Tibial Band Syndrome

Treatment considerations
1. Agressive, consider cortisone
2. Decrease volume, inscrease intensity
(intervals)
3. Avoid downhill running
4. Manual therapy ITB? Desensitization vs
release

Back Pain
Causes
1. Overstriding
2. Weak/dysfunctional core
3. Bad posture
4. Breathing dysfunctions
5. Ground contact time and position

Back Pain
Assessment
1. Find the right structure
Treatment considerations
1. Change activity until causes are treated
2. Start progressively (integration of new
informations)

Hamstring strains
Causes
1. Flexibility?
2. Strength?
3. Pelvis alignment
4. Weak core
5. Changes in intensity

Hamstring strains
Assessment
1. Dont focus on the hamstring if chronic
Treatment considerations
1. Eccentric and frx massage (chronic)
2. Treat the cause at the same time
3. Acute change activity (vascularization)
4. Avoid power activity (acute)

Achilles Tendinopathy
Causes
1. Runners ankle foot loose
2. Rigid (supinated) foot
3. Transition to minimalism
4. Increased volume of hills or sprint trainings

Achilles tendinopathy
Assessment
Treatment considerations
1. Avoid NSAIDs
2. Protect the tendon + ice (for ACUTE)
3. Minimalist footwear (eccentric load for
chronic ONLY)
4. Patient education (pain, impacts, shoes)
5. No flexibility for gastroc

Stress fracture
Causes
1. Bone density
2. Stress
3. Calcium deficit?

Stress fracture
Assessment
1. Imaging
Treatment considerations
1. Rest (1-2 wks)
2. Progression to weight bearing then running
3. Avoid uphill
4. Control pain (tape, ice, manual therapy)
5. Minimalist/barefoot
6. Low intensity ultrasound (LIPUS)

Minimalism vs maximalism

Injury Prevention

Posture and core

FMS?
Gradual progression
Clear past injuries and medical conditions
Warm-up
Technique
Neuromuscular training (ABCS)

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

References

BK Running (book and DVD)

Pose running (book and DVD)
Evolution running (DVD)
Courir mieux Jean-Franois Harvey
Lore of running (Bible of runners) & Waterlogged Tim
Noakes
Runners anatomy Jay Dicchary
Guy Thibault (Lentranement cardio & en pleine forme)
Jack Daniels (the booknot the alcohol)
Running technique Brian Martin

References
http://www.runresearchjunkie.com (Craig Payne,
Podiatrist)
http://www.runningtechniquetips.com/ (Brian Martin)
http://www.therunningclinic.com/en/home/ (Blaise
Dubois PT)
http://runblogger.com/ (Peter Larson PhD anatomy)
http://naturalrunningcenter.com/ (Mark Cucuzzella,
MD)
http://www.volodalen.com/ (French scientists)

Thank you!

How to contact me?

Marc-Antoine Dor (LinkedIn)
@TrackTherapist (Twitter)
marc-antoine@osteo-medsport.com
www.TrackTherapist.blogspot.ca
www.Osteo-MedSport.com (like us on Facebook)
More courses and presentation on running visit
www.formationsMAD.com

Speech from Assess, Treat and

Condition

"Good evening. Im 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 to pay 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 the winter 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.
I want to thank you for your time this evening. I hope to see you out on the roads."