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Friday, 28-Apr-2017 02:08:57 EDT
factors that can lead to running injuries
FROM THE VAULT by DR JOHN DEFINNEY
HEALTH & FITNESS

Spring is upon us and with the warmer temperatures the runner in you will no doubt be tempted to get out and join the many who have braved the elements all winter. And for the winter runner, the temptation is always to double up on the mileage as the nice weather beckons... These are some factors that can lead to running injuries.

The most common flaws in the running form are over-striding and a slow stride rate.

There are many factors that can contribute to running injuries. Not necessarily in any order of importance, here are some of the most common ones:

  • Volume and Speed
  • Running Form
  • Body Alignment
  • Shoes and Running Surface
  • Flexibility and Strength

VOLUME AND SPEED
Of the two between volume and speed, the number of miles covered in one instance will definitely influence the risk of developing injuries. Research has shown that running too far too soon is the main cause of running injuries. The body has to be prepared to withstand the stresses of pounding the pavement. The big question is: How much is too much?

There is no simple formula to help a beginning or returning runner in determining how far to run. It depends on fitness, age, weight and whether or not some running activities have taken place in their recent past:

  • Generally a new runner can begin running at a slow pace and half the distance that can be walked at a brisk pace. Increasing the distance should only take place if the run can be intersperced with brief periods of walking;
  • If a new runner is really out of shape and inefficient at the sport, then they should begin by including brief periods of running into the walk over a period of weeks, slowly introducing more running until the ability to run non-stop for longer periods of time is achieved.
  • If a new runner is able to run more comfortably and can cover more than two or three kilometres, then they should only increase their mileage by 10% per week.

It is wise to take rest days during the week. For the beginner, it may mean not running at all for a day or two in between run days. For experienced runners, it may mean cutting back on mileage the day after a longer or harder workout.

Another strategy, particularly when preparing for a race, is to run hard for three weeks and then cut back the mileage by 50% on the fourth week. This is especially effective if a race is at the end of that fourth week.

Cross-training is important. This involves participating in a separate aerobic activity that does not involve running. It can be a very effective tool to keep a runner's body fit without beating up their legs. In some cases, the cross-training can strengthen the body to prevent injuries.

RUNNING FORM
In most sports, beginners are given advice and have coaches that help them with the mechanics of their activity – but in running, they are handed a pair of running shoes and are told to go out and run. A proper running form will not only dictate performance but also help to avoid running injuries.

Like in any other sport, an athlete can make dramatic changes in their technique. First, a runner must know what and how they are doing, then have a coach point out any flaw, and then be taught how to correct them. These corrections need to be practiced and, soon enough, voilà: a runner is transformed from a hippopotamus to a gazelle!

In my experience analyzing running form, over-striding or a slow stride rate are the most common flaws. Runners simply spend too long with their feet on the ground because their stride rate is too slow. Runners with a slower stride rate tend to land more on their heels creating a breaking force when their foot hits the ground. Running uphill will encourage running more on the toes and shortens stride.

They also tend to hop from one foot to the other, wasting energy by creating excessive vertical displacement.

Stride rate should be 90 beats per minute for each foot. It doesn't matter if the runner is 7 feet or 4 feet tall, if they're running a 100 metre dash or a marathon – each foot should still hit the ground 90 times per minute. The faster the run, the longer the stride will be.

To check your stride rate, use your stop watch and count how many steps you take in 30 seconds with the same foot and multiply that number by two to get your stride rate per minute.

Assessing the running form. A good way to assess running form is for the runner to watch him / herself run in front of a mirror. Another is to run with someone that is a fairly efficient runner to compare the shadows on the road. The inefficient runner's shadow will reveal side-to-side and / or up-and-down bobbing movements. There are many drills and exercises that can help to improve this.

Focus on posture, even when tired. At the end of a run, a few short faster runs are recommended. These 'strides' are approximately 100 metres at 50- 75% of a runner's sprinting speed.

BODY ALIGNMENT
Like any machine, the human body will function best when its parts are properly aligned in order to perform the desired task. Doing so in an economical fashion requires proper functioning of the whole body's musculoskeletal system:

  • The lower body has to deal with the ground's reaction forces when feet hit the pavement and when a runner pushes off to propel forward;
  • The upper body helps to keep the body properly positioned and balanced; and,
  • The major joints in the feet, the ankles, the knees, the hips and the lower back must all work in unison and must have an optimal range of motion to function in order to prevent injuries.

Please remember that nobody is created perfectly:

  • No person has identical foot alignment;
  • In most people, one foot is bigger than the other; and,
  • 60% of people have a leg-length inequality.

Foot alignment is important. The major issue with foot alignment is whether they have over-pronated feet (when feet turn in too much causing them to flatten out) or whether they have over-supinated feet (high-arched feet). Both of these alignment problems will put extra stress on a runner's feet, legs, and back that eventually leads to injuries.These problems usually require a change in shoes or special shoe inserts (orthotics) to help realign the feet.

Lower leg and knee alignment is also important. Individuals who are valgus (knocked-kneed) or varus (bow-legged), can have altered mechanics of the foot, knees, and hips and should make an attempt at correcting these problems. Unfortunately it is not that easy. It's near-impossible to straighten out a crooked bone without surgery, so the best solution is to minimize the effect that it has on the body with shoes and orthotics.

Leg and hip alignment.

  • Minimize the effect of abnormal lower leg alignment with exercises to strengthen the quadriceps muscles and, in some cases, with braces;
  • Minimize the effect of altered hip alignment with specific shoes and orthotics. In some cases, hip alignment is the result of muscle imbalances and can be corrected through exercise;
  • Use of heel lifts or orthotics may correct issues stemming from leg-length inequalities; and,
  • Spinal or pelvic manipulation, mobilization techniques, and / or exercises can correct pelvic and lower back alignment issues.

SHOES AND RUNNING SURFACE
Most people run on hard surfaces and land on their heels first when contacting the ground. For them, a modern technical shoe will make their running more enjoyable and safer.

The first thing to know is foot type and foot shape. Foot types include: neutral foot, over-pronated foot and over-supinated foot. Shoe companies have made shoes to suit these foot types:

  • Neutral shoes for the neutral foot and the over-supinated foot;
  • Stability shoes for the moderate over-pronator foot; and,
  • Motion control shoes for the more severe over-pronator foot.

The shoe shape should match the foot shape. Foot shape will help to determine which style of shoe to get:

  • Shoes can have a straight last (shape), a semi-curved last, or a curved last;
  • The width of the heel and the toe box should also match the foot. Women for instance tend to have a narrow heel and a wide forefoot. Only a few companies make shoes with these features; and,
  • There are many other features in a shoe that can help to make the runner much more comfortable. A runner should seek assistance from a qualified and knowledgable shoe sales person to learn what shoe offers the best fit for their needs.

Companies use different materials and designs in their shoes which help to cushion a runner's foot plant with more flexibility and responsiveness on push-off. There is not one shoe that is better than another because every foot is different.

Find out from your health practitioner, who is knowledgeable in this area, what your needs are and then go to a running shoe store where trained staff are on hand with this in mind:

  • Buy shoes later in the day when feet have had a chance to spread out a bit;
  • Always try on a few pairs of shoes before deciding to purchase;
  • Don't look at the colour, don't look at the price, and forget what everybody else has said or recommended; and,
  • Choose the pair of shoes that 'feel' the best (with orthotics inserted, if applicable).

Shoe companies will change their models. What was suitable for a runner's foot may change in subsequent purchases. A runner's needs may also change making it a good practice to try on the previous model but to also try different ones. Always keep more than one pair of running shoes and rotate them after each run, especially if they have gotten wet.

Shoes are like cars – their value deteriorates soon after their first wear. Shoes may still 'look good' but the shock absorption qualities can diminish drastically. Shoes will wear out at different speeds depending on the runner but on average should be replaced between 500-1000 kilometres.

FLEXIBILITY AND STRENGTH. TO STRETCH OR TO STRENGTHEN?
Strength prepares the runner for the job of resisting the effects of gravity when their foot hits the ground. Flexibility allows the runner to position their body in the most appropriate position so that their muscles can propel them forward.

In the past there, more emphasis was placed on stretching to prevent running injuries than on strengthening exercises. Research has shown that stretching before a run doesn't necessarily prevent injury from occurring. However, runners have been taught that warming up improves performance and prevents injury, so why doesn't it?

Stretching and warming up are not synonymous. Warming up involves increasing the temperature of the tissues which are going to be exercised (mostly muscle) and this is done with movement to bring more blood into the tissues.

Stretching helps to lengthen the tissues. In some cases when lengthening an injured or stiff tissue, it will be irritated and further pain and restriction is caused. The muscle tissue proper (contractile tissue) can be lengthened more easily than tendons and ligaments or even the fascia which holds the muscle fibres and muscle bundles together.

There are many different types of stretching exercises and they all work for different reasons. It's important to know which tissue needs to be lengthened and that will dictate the type of exercise for the best results. Recent research has shown that muscle tissue responds better to a gradual static stretch, whereas fascia, tendons and ligaments respond better to active stretching which involvesa gentle stretching and repeated movements.

Studies have shown that strengthening specific running muscles reduces fatigue and injury. In truth, it is too often the last thing on a runner's mind. Strengthening muscles prevents them from stiffening up and then requiring continual massage therapy. During long runs, runners stiffen up and muscles fatigue from the repetitive muscle action. If the muscles were stronger they wouldn't fatigue.

For the average runner, the muscles that tend to weaken most regularly are the gluteal and hamstring muscles. Of course in the case of a speed runner, the propulsive muscles would need to be primarily strengthened.

It is also important to work on core strength. The strength required for running is muscle endurance. In order to achieve this, a runner needs to do frequent repetitions with lower weights.

When to stretch and when to strengthen. A seriously-committed runner must always engage in proper stretching and strengthening exercises. Depending on the situation, they may need to do more of one than the other. Analyzing the onset of pain during a running session can indicate where a runner should focus:

  • Stiffness and soreness at the start of a run that loosens up after a bit of running, stretching before and after the run is recommended; and,
  • Pain towards the end of a long run is the result of fatigue. Strengthening exercises are recommended.

How Much Stretching and Strengthening. If a runner is injured, they should stretch as often as possible – the more the better, providing they aren't overstretching. Overstretching leads to more pain during or after stretching. If a runner isn't injured, they may focus on stretching areas that aren't as flexible, as well as their regular stretching routine once daily.

In order to maintain adequate strength, a runner should work out four to five times per week. The workouts should be organized to gradually increase the resistance in a variety of exercises to keep the runner motivated and interested. Once optimal strength is achieved, a runner should maintain their workout routine to retain all of its gains.

  • Stretching exercises should be done daily;
  • Strengthening exercises should be done at a minimum of three times per week for maintenance;
  • De-training will take effect after a two-week layoff.

GREAT EXERCISES
The more that the exercise mimics the running action, the better. When it comes to stretching, the runner should primarily focus on the muscles that are either tight or that tend to stiffen. The most common areas include the plantar muscles (muscles on the foot's bottom), calves, hamstrings, and gluteal muscles. 'Active stretches' are very good for runners. Some of the more specific exercises in this class include:

  • The standing leg cycle action. This exercise works the hamstrings, gluteals, thigh muscles and hip flexors. It involves standing on one leg while the other leg completes a 'cycling action' by bringing the knee up to waist height, stretching the leg forward as far as possible, then pulling the foot back as far as possible. The cylcle finishes by pulling the heel up to the buttocks. Repeat one cycle per second and do thirty per leg, eventually building up to two or three sets.

  • The Duck Walk. This exercise helps to stretch and strengthen calves, thigh muscles, and the plantar muscles (muscles on the foot's bottom). It involves walking while keeping heels to the ground as long as possible while flexing the knees. It is very reminiscent of Groucho Marx's famous walking style.

  • Yoga is highly effective with relatively safe exercises to perform. The same principle of specificity applies for strengthening exercises. It is therefore best to do strengthening exercises while standing.

  • Squats, either two-legged or one-legged are excellent. This helps to increase strength, improve balance, and develop core strength. Keep feet flat on the floor to reduce stress on the knees.

  • Lunges are also very effective. Graduating to 'lunge walking' is especially effective and ideal.

  • Bench step-ups. This exercise is excellent for strengthening the running muscles and core strength.

Increasing reps improves muscle endurance and strength. A runner should build up to thirty reps to a maximum of two to three sets.

__________

Dr. John DeFinney is a bilingual chiropractor with a Bachelor of Physical and Health Education and a Specialty in Sports Chiropractic. He graduated from the Canadian Memorial Chiropractic College (CMCC) in 1976. He is also one of the founding members of the College of Chiropractic Sports Sciences and one of its first three Fellows.

Dr. DeFinney is currently involved in a variety of recreational sports and has won national titles as an age class runner setting a new Canadian record during the 2006 US Indoor Championships in Boston. He has lectured at the undergraduate and post graduate level in sports injuries and published articles on the topic of running. 'The Running Chiropractor has joined the Trigenics Institute, serving as its research consultant with specific interests in running, sport injuries, and rehabilitation.

Dr. John DeFinney
©2007, 2013 SayItCornell.com / SayItCanada.ca. All rights reserved.

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