Running injuries are very specific due to the repetitive nature of the sport. Injuries are caused either by the bodies own intrinsic factors or by external extrinsic factors.
Intrinsic Factors
Extrinsic Factors
Flexibility Issues
Strength Issues
Joint Instability
Excessive Pronation
Excessive Supination
Running Shoes
Environmental Influences
-Running Surface
-Weather
Clothing
Rarely are injuries due to just one of these factors; more commonly it is a combination. Likewise, injuries are rarely resolved by changing only one thing; usually a comprehensive approach is required. By taking this open approach to injury rehabilitation/prevention let us look at some of the factors involved and how you can help your clients.
By understanding some of the more common running injuries, a sensible approach to prevention can be initiated early and injury can possibly be avoided altogether. Here is a list of the most frequently presented injuries:
Runner’s Knee – generic term for pain in or around the patella
Illiotibial Band Syndrome – inflammation of illiotibial band below the knee
Tibial Stress Syndrome – generic term for shin pain
Posterior shin pain
Anterior shin splints
Compartment syndrome
Stress Fractures – generally occur in the lower third medial surface of the tibia
Metatarsal Stress Syndrome – pain in ball or dorsal surface of foot
Achillies Tendonitis – Inflammation of the Achilles tendon
Plantar Faciitis – inflammation of the Plantar Fascia (bottom of the foot)
1. Extrinsic
Footwear
With so many makes and models of running shoe available from either the ‘Specialist Running’ shops or ‘Internet sales’ sites, making the choice of what shoe to buy is made very difficult. No longer is pulling a shoe off the shelf sufficient to ensure injury free activity.
Fact 1: every make and model of running shoe has a different prescription. This applies even across the range of neutral cushion i.e. Asics Nimbus is different in function to the Saucony Triumph, even though the marketing suggests that they are similar in function.
Fact 2: On the whole a shoe has a lifecycle of 12 months, so more often than not when you are ready to buy a new shoe, the technical function may have changed.
So as a consumer, how are we to know what shoes are good or bad for us? No longer is reading an article or listening to someone review a shoe sufficient in the selection process of selecting our shoes. The process needs to be more informed.
When running the body works on a closed chain system i.e. when the foot is in contact with the ground, the forces and mechanics transmit through the leg to the spine. This is repeated every step and means if anywhere throughout the chain is out of line then potential injuries can happen. Add the complexity of the wrong footwear into the equation and all sorts of issues may happen.
By understanding what an individuals needs are, we are able to take out the element of guess when choosing a shoe. There are several sources from which we can gain the relevant information:
• Exercise & Injury History
• Video Analysis – observing:
Initial contact
Loading response
Mid stance
Terminal Stance
Pre swing
Once we have gained this information we can start to make a selection on the prescription of the shoe. Having made our selection, we must confirm that the shoe is doing what it says on the box (neutral cushion, anti-pronating, motion control). However, be careful, as explained earlier not all of the same technical shoes produce the same result, it is all dependent on how the body makes the shoe work.
2. Intrinsic
Flexibility
Stretching is probably one of the most neglected and understated components of fitness. Historically we are taught that if we stretch the right we do the same to the left - with no thought about taking issue with the tighter side. If an individual is assessed correctly, it is more likely the case that we would be presented with a list of muscle groups identifying their tighter sides – this information is very useable and more specific than a notional stretch programme.
However, some say that due to the imbalances that are created as a result of being left or right handed, that it is questionable as to whether we need to change this. i.e. that we should always have a dominance/imbalance.
In this case the benefits of achieving symmetry are enormous; it allows the bodies natural myofascial tensions to be more balanced enabling our natural movement patterns to be carried out with joints in their optimal position and alignment. Think about the myofascial sling systems, add an irregular tension pattern to this and the consequences are significant, maybe resulting in accumulative tissue overload, in either the muscular or fascial systems.
Given that stretching is so important, by changing the body’s setup and achieving more of a symmetrical framework – we must be aware of not leaving the body in a vulnerable state e.g. not creating too much flexibility without functional stability:
For example, if flexibility about a joint was increased there may be a period where the proprioceptive qualities of the joint are compromised; here the need to provide ‘Prehabilitation’(specific personalised programme based on injury prevention) exercises would be indicated to limit any injury occurring.
Footbeds / Orthotics – Is it a necessary intervention?
With the custom insert being quite a topical issue where more clinics/websites are purporting to have the solution for back pain and leg pain, we need to have a better understanding of what to expect when going to seek resolution.
Orthotics are custom made inserts that are placed in the shoe to support the structures of the foot. In some cases, the foot can over-pronate, leading to excessive rolling in of the heel and collapse of the arch. The result of this could lead to abnormal and repetitive stresses to the ligaments, tendons and other connective tissue in the foot. Excessive torsional forces can be produced through the leg, resulting in an overloading response to the ligaments and tendons supporting the knee (esp. medial knee and the soft tissue in the hip, sacro-iliac and spine. If there is an asymmetric loading pattern present, i.e. one foot pronating excessively, this will further influence biomechanical issues into the knees, hips, pelvis and spine
Making the decision to support the foot should not be taken lightly and should be an outcome of an informed physical assessment. This should include as a minimum -
• Exercise & Injury History
• Video & Pressure Plate Analysis – observing:
Initial contact
Loading response
Mid stance
Terminal Stance
Pre-Swing
• Postural & Flexibility Testing
The information gained from this process allows for a comprehensive understanding on how functional the feet are, but more importantly how the feet impact on lower limb mechanics (from the low back and pelvis downwards) and vice versa. Unless this relationship is quantified, making an orthotic is only addressing part of the problem rather than the whole.
i.e. Once the orthotic has been made this must fit into the process for change. When looking at running shoes, it must be noted that a large percentage of people in need of an orthotic are already in an anti-pronating shoe (Asics 2120/Kayano, Saucony Guide/Stabil, New Balance 766/1221). If an orthotic is added to this shoe prescription, further evaluation of this unit must be made otherwise we are in danger of overstabilising the foot and loading the lateral structures of the leg and thigh, which may lead to injury and further imbalance.