Complete Physio - Injury prevention, Re-injury prevention and performance enhancement in distance running
- 1. Injury Prevention, Re-Injury Prevention, And Performance Enhancement in Distance Running: An Introduction To How You Can Quickly And Easily Get To The Front Of The Pack Wednesday, July 2nd, 2014 Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCS Consultant Musculoskeletal and Sports Physiotherapist Certified Strength and Conditioning Specialist [email protected] www.complete-physio.co.uk @
- 2. 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. @
- 3. 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 @
- 4. 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 @
- 5. 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 @
- 6. 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…? @
- 7. 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 @
- 8. 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 @
- 9. 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 @
- 10. How To Safely And Effectively Warm-Up Knee Hugs @ Photo courtesy Chris Myers
- 11. How To Safely And Effectively Warm-Up Rotating Squats @ Photo courtesy Chris Myers
- 12. How To Safely And Effectively Warm-Up Calf Press @ Photo courtesy Chris Myers
- 13. How To Safely And Effectively Warm-Up Running Posture Drills @ Photo courtesy Chris Myers
- 14. 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? @
- 15. 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 @
- 16. 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) @
- 17. 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 @
- 18. 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 @
- 19. Injury Prevention • Example screening test • Calf muscle strength endurance Caution: testing without supervision can cause injury @ Below Acceptable Level < 20 reps Benchmark Level 25-30 reps Advanced Level > 35 reps Meaningful Change in Score 3 reps Courtesy Chris Myers
- 20. Injury Prevention • Example screening test • Hip extensor strength endurance Caution: testing without supervision can cause injury @ Below Acceptable Level < 20 reps Benchmark Level 30 reps Advanced Level > 35 reps Meaningful Change in Score 3 reps Courtesy Chris Myers
- 21. 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…? @
- 22. 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) @
- 23. 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 @
- 24. 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 @
- 25. 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…? @
- 26. 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 @
- 27. 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 @
- 28. 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 @
- 29. Thank You @ Nicholas Clark, PhD, MSc, MCSP, MMACP, CSCS Consultant Musculoskeletal and Sports Physiotherapist Certified Strength and Conditioning Specialist [email protected] www.complete-physio.co.uk