Injury Prevention, Re-Injury Prevention, AndPerformance Enhancement in Distance Running:

An Introduction To How You Can Quickly And EasilyGet To The Front Of The Pack

Wednesday, July 2nd, 2014

Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCSConsultant Musculoskeletal and Sports Physiotherapist

Certified Strength and Conditioning Specialistnicholas@complete-physio.co.uk

www.complete-physio.co.uk

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Preface & Acknowledgement

Some pictures have been omitted for copyright reasons.

Thank you to Chris Myers BSc, BSc, PG Cert, MSc, MCSP, for providing photographs and information for some slides.

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Outline

• Biomechanics of distance running– What you’re really doing to your body

• How to safely and effectively warm-up– The right stretches at the right time

• Injury and re-injury prevention– Prevent bone, joint, and tendon, injuries– When you stretch and when you strengthen

• Performance enhancement– Training programmes: increasing running economy– Running technique and shoe types

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Outline

• Biomechanics of distance running– What you’re really doing to your body

• How to safely and effectively warm-up– The right stretches at the right time

• Injury and re-injury prevention– Prevent bone, joint, and tendon, injuries– When you stretch and when you strengthen

• Performance enhancement– Training programmes: increasing running economy– Running technique and shoe types

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Biomechanics Of Distance Running

• Biomechanics– Application of mechanical principles

to the human body (forces)

• What you’re really doing to your body…

• Ground reaction forces (running 4m/sec)– Vertical: 2.7 × BW

• Compressive forces– Ankle joint: 14.1 × BW– Patellofemoral joint: 11.1 × BW

• Tensile forces– Achilles’ tendon: 8.2 × BW– Patellar tendon: 6.9 × BW

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Biomechanics Of Distance Running

• Male runner– 80kg– 4m/sec– 6:30 mile pace– 1072 strides

• Cumulative loads– Vertical GRF: 85,760kg (85.76t)– Ankle joint: 1,200,640kg (1,200.64t)– PFJ: 951,936kg (951.94t)– Achilles’ tendon: 703,232kg (703.23t)– Patellar tendon: 591,744kg (591.74t)

• How often can your body tolerate this…?

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Outline

• Biomechanics of distance running– What you’re really doing to your body

• How to safely and effectively warm-up– The right stretches at the right time

• Injury and re-injury prevention– Prevent bone, joint, and tendon, injuries– When you stretch and when you strengthen

• Performance enhancement– Training programmes: increasing running economy– Running technique and shoe types

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How To Safely And Effectively Warm-Up

• No static/passive stretching before running– can put the nervous system and muscles

to sleep

• Why “warm-up”?– ↑ HR + core temperature– ↑ active range-of-motion– ↑ connective tissue compliance– Wake-up nervous system– Improve movement patterns– Improve body awareness– Mental preparation

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How To Safely And Effectively Warm-Up

• Suggested warm-up routine– General locomotion (3 - 5 mins)

• Jogging, easy strides, side-stepping, backwards running

– Joint mobility (60 secs)• Leg swings, knee flexion/extension, ankle

circles

– Dynamic flexibility (3 - 5 mins)• Knee hugs, leg swings, side lunges, rotating

squats, calf press

– Running posture drills (3 × 10m each)• High knee-lifts, butt kicks, skipping

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How To Safely And Effectively Warm-UpKnee Hugs

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Photo courtesy Chris Myers

How To Safely And Effectively Warm-UpRotating Squats

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Photo courtesy Chris Myers

How To Safely And Effectively Warm-UpCalf Press

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Photo courtesy Chris Myers

How To Safely And Effectively Warm-UpRunning Posture Drills

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Photo courtesy Chris Myers

When To Stretch To Increase Flexibility

• Not before a training session

• After a training session

• Every other day

• Passive: mild / moderate discomfort

• No sharp pain

• 3 × 30 - 60 secs / muscle group

• Do you know how to stretch with correct technique?

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Outline

• Biomechanics of distance running– What you’re really doing to your body

• How to safely and effectively warm-up– The right stretches at the right time

• Injury and re-injury prevention– Prevent bone, joint, and tendon, injuries– When you stretch and when you strengthen

• Performance enhancement– Training programmes: increasing running economy– Running technique and shoe types

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Injury Prevention

• Types of injury

• Overuse– stress fracture (tibia)– arthropathy (patellofemoral)– tendinopathy (Achilles’)– other (ITB syndrome)

• Traumatic– joint sprain (ankle)– muscle strain (hamstring)– fall (bruise, laceration)

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Injury Prevention

• Scientifically-proven ‘predictors’ of injury

• Training habits– ↑ intensity = ↑ overuse injury– ‘train harder’ ≠ ‘ train better’

– ↑ weekly mileage = ↑ overuse injury– ‘more’ ≠ ‘better’

– ↑ road-running = ↑ overuse injury– ‘harder’ ≠ ‘tougher’

– sudden ↑ training volume

– sudden change in training surface

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Injury Prevention

• Scientifically-proven ‘predictors’ of injury

• Functional strength (500% ↑ risk)– ↓ leg press strength = ↑ stress fracture

• Core muscle performance (15% ↑ risk)– ↓ hip strength = ↑ knee / foot injury

• Calf muscle performance (10% ↑ risk)– ↓ calf endurance = ↑ stress reaction

• Calf muscle performance (50% ↑ risk)– ↓ calf strength = ↑ Achilles’ tendinopathy

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Injury Prevention

• Example screening test

• Calf muscle strength endurance

Caution: testing without supervision can cause injury

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Below Acceptable Level

< 20 reps

Benchmark Level 25-30 reps

Advanced Level > 35 reps

Meaningful Change in Score

3 reps

Courtesy Chris Myers

Injury Prevention

• Example screening test

• Hip extensor strength endurance

Caution: testing without supervision can cause injury

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Below Acceptable Level

< 20 reps

Benchmark Level 30 reps

Advanced Level > 35 reps

Meaningful Change in Score

3 reps

Courtesy Chris Myers

Injury Prevention

• Take-home points

• Use a ‘periodized’ training programme– different training sessions

• Strength training critical for preventing bone, joint, and tendon injuries– “can’t condition the engine if the chassis

gives out first…”

• When to stretch and strengthen– everyone’s different…– scientifically-valid personalized assessment– individualized targeted injury prevention programme– how strong are your hip and calf muscles…?

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Re-Injury Prevention

• Scientifically-proven ‘leftover’ effects of previous injury

• Post-injury osteopenia (thinning bone)

• Muscle wasting

• Severe muscle weakness

• Standard rehabilitation often inadequate

• Hidden problems can persist for decades

• ↑ risk permanent complications (e.g. arthritis)

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Re-Injury Prevention

• Scientifically-proven ‘predictors’ of re-injury

• Previous injury– Knee sprain: 480% ↑ risk arthritis– Ankle sprain: 260% ↑ risk 2nd sprain– Groin strain: 160% ↑ risk 2nd strain– Calf strain: 233% ↑ risk 2nd strain

• Poor balance– Knee sprain: 230% ↑ risk 2nd sprain

• Decreased quadriceps force (weakness)– Knee sprain: 330% ↑ risk 2nd sprain

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Re-Injury Prevention

• Example screening test

• Barefoot eyes-open single-leg balance– hands-on-hips: 45 seconds– hands-across-chest: 20 seconds

Caution: testing without supervision can cause injury

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Re-Injury Prevention

• Take-home points

• Previous injury = ↑ risk re-injury

• Previous injury = ↑ risk arthritis

• You might feel ‘normal’ and be able to run, but there will likely be subtle hidden problems that may persist for many years

• Only objective, targeted, injury-specific testing will find the hidden problems (e.g. weakness)

• How do you really know if you’ve recovered from a previous injury and it’s safe to run again…?

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Outline

• Biomechanics of distance running– What you’re really doing to your body

• How to safely and effectively warm-up– The right stretches at the right time

• Injury and re-injury prevention– Prevent bone, joint, and tendon, injuries– When you stretch and when you strengthen

• Performance enhancement– Training programmes: increasing running economy– Running technique and shoe types

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Performance Enhancement

• Running economy– O2 consumption for a given running

velocity

• Strength training and plyometric training can increase running economy

• Strength training can increase tendon thickness and stiffness

• ↑ tendon stiffness = ↑ elastic recoil potential

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Summary

• Massive forces in the body during running

• First-time injury can be predicted with scientifically-proven tests

• Full recovery from re-injury is rare and the risk of re-injury is high

• Re-injury can also be predicted with scientifically-proven tests

• Mixed training enhances running economy

• Scientifically-validated injury prevention tests can help you safely and quickly achieve your best running performances

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Thank You

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Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCSConsultant Musculoskeletal and Sports Physiotherapist

Certified Strength and Conditioning Specialistnicholas@complete-physio.co.uk

www.complete-physio.co.uk