Running Workshop – Sports Therapy and Rehabilitation Clinic

Duration: 3 hours  Cumulative hours: 153.15

Preparation before the workshop

The objectives of the running workshop were:

• To gain an understanding of running injuries (presentation and prevalence)
• Be able to perform clinical assessment relevant to runners
• To be able to perform a basic analysis of running gait
• To be able to implement suitable management strategies for the prevention of running injuries

It was recommended that we listen to Episode 59 of the Physio Edge podcast on Running injuries as part of our preparation for the workshop (Pope, 2017).  It was a virtual group discussion between Tom Goom, Greg Lehman and Dr Christian Barton.   The discussion during the podcast identified the most important factors involved in patients’ running injuries such as gait, load, strength, foot strike, pelvic position, footwear, range of movement or other factors.

Notes from the podcast

What do physios do better as a profession? The consensus was that physios are currently doing good work in S&C for rehabilitation, but could also improve S&C for injury prevention.  Could improve the management of training load, ensuring it is at the right level.  Those involved in the discussion felt it was important to keep injured runners running if possible.  Most injured runners can keep running in some way despite their injury.  Education runners regarding increasing their running load sensibly is key – not increasing the load dramatically and having reasonable recovery. S&C training alongside running can reduce the load that some of the MSK tissues are exposed to.  Body needs to be strong enough to cope with the running load.  Runners get injured because they exceed the tissues capacity to tolerate load.  More research evidence is needed. S&C is more important for injury management than it is for prevention.

All of the podcast participants are keen to keep their patient’s running.  But what would be a reasonable scenario where they would stop a patient from running or reduce running load? It isn’t beneficial to keep runners running with bone stress injuries.  Running actually aggravates bone stress injuries and increases pain.  Calming things down a bit is needed in cases whether patient’s have tendinopathy when pain levels are high.  It is different for each individual.  Have to find the optimal load of running to keep runners running with certain injuries- this can be done by reducing the distances, and introducing cycling to replace longer distance runs.  Once size does not fit all, each case should be considered on an individual basis.

Stride pattern was also discussed. Wouldn’t necessarily advocate changing stride pattern, but small changes may help in some cases.  It is important to consider whether the patient has the muscle capacity to improve stride pattern.  It is a big change.  There are two clinical populations that it may be beneficial to work towards improving stride pattern: Anterior compartment syndrome – Tibialis anterior overload.  If you can keep the runner off of their heels this will reduce the runner’s pain & symptoms and get them pain free in the early stages.

The other group are those runners with chronic injuries that have been told that they shouldn’t run anymore.  If those individuals want to keep running and are in their early 30s it may be possible to transition their stride pattern away from their heels more to forefoot running.  This will reduce the impact upon the knee.  Improving the runner’s proximal strength may also be beneficial in reducing the impact upon the knee.

Increasing step rate, reducing load do not necessarily address issues such as over striding, or improve ground contact time.  There are other factors involved in improving running technique e.g. capacity of soft tissue, load management. We assume that less load is better, but it isn’t always. Some physios like to focus on the symptoms of running injuries first before making changes to running technique, then consider biomechanics and load management. It is individual specific because different individuals will respond to different things. In some individuals, increasing step rate can improve their symptoms and there is research out there regarding increasing step rate.

We don’t know much about the other options regarding decreasing over stride.  If you want to decrease the foot strike in relation to the person, thinking about the gait as a pendulum swinging back and forth, you want to shift that axis so that there is more hip extension and less hip flexion at foot strike.  That idea is that you don’t have to change gait and stride length, you can still change where the foot lands.  In some people hip and knee drive works well in reducing foot strike and in others it makes them land a lot heavier and increases foot strike.  Response is variable in different individuals, not everyone responds the same.

Increasing Hip/knee drive – a lot of propulsion is achieved by the release of elastic energy.

If you bring in an active cue in the propulsive phase are you creating more work?  As a runner trying to increase your hip/knee drive does actually feel like a lot of effort.  Is it just effort because it is new and it will get easier or is it acutely making the athlete less efficient because they are using a lot of effort to achieve the propulsion in the initial part of swing?

Assessment of running technique is important to establish if there is maladaptation to movement patterns.  What are the key features that we need to look forward in the running assessment? Looking for movement in the saggital plane, over stride, knee flexion on landing – to establish if the athlete has the ability to absorb shock when landing, ability to absorb load proximally.  3 key things to consider with biomechanics – kinematics (motion we can see), kinetics (actual load) and motor control. Try to link it to the subjective history.  E.g. Is the athlete experiencing pain towards the end of a run, on a specific surface such as tarmac or a treadmill.

Where do experts start with gait retraining after the assessment?  Looking to see if there is anything that was found during the assessment that can decrease pain or the load on the tissues.  Usually start with simple cues to begin with – getting the runner to try it out first e.g. beginning with getting the runner to run with a metronome (Buhmann, Moens, Lorenzoni, & Leman, 2017; Wang, Luo, Dai, & Fu, 2020), increasing step rate.  Usually start with 5% – see if it changes anything, and establish how it feels to the athlete.  Might give them another option, see how it feels and what the runner feels most comfortable with, whether it feels comfortable during their running.  If it feels uncomfortable and hard work it is going to affect their efficiency and they are less likely to do it.  Keeping the options simple and giving the athletes a chance to go away and practice the options in little bursts and establish whether it effects their symptoms.  If the runners are not symptomatic then focus on biomechanical issues.

Changing running gait will usually result in a runner becoming less efficient straight away as soon as you change it.  It becomes a different training stimulus – a stimulus for adaptation. Changes in different variables are training stimuli for adaptation, which leads to changes in technique.  Technique emerges as a result of changes in other things.  It is not the change in technique that leads to improvement, it is the change in a number of variables.

Advice to individuals just starting running it start slowly and build gradually.  It is important to find out about the individuals sporting history… if they are a footballer, then they will have been used to loads on the tissues and covering at least 10k in a match regularly, so they will progress in running training quicker than an individual who has never run before and isn’t as physically active.

During the Workshop 20.04.21

During the workshop we went through running injuries – how they present and their prevalence.  After discussing running injuries we participated in the practical part of the workshop, where we practised the clinical assessment of running injuries.  It was good to go through the assessment and seemed reasonably straight forward.  We also went through the protocol of a gait analysis and analysed one of our peers running on a treadmill.  We videod them from the side and from behind when running and analysed with Hudl.  We gave the runner cues to try and improve their cadence by encouraging them to run lightly with quicker steps (Wang et al., 2020).

It was a very interesting workshop and there was a lot of information to absorb and remember.  To feel more proficient in doing gait analysis I need the opportunity to analyse real patients.  I did read the literature accompanying the workshop materials, which I found interesting.  I am a runner myself so this would be useful to me in my own practice when I graduate.

I personally believe that S&C is really important for runners.  A lot of long distance runners have low cadence and an economic running gait – using the least amount of effort to make them more efficient.  S&C increases the tissues ability to tolerate load, especially for running long distances and would increase cadence.  My own experience is that when I do S&C regularly I am physically stronger and the risk of me getting an injury is reduced.

References

Buhmann, J., Moens, B., Lorenzoni, V., & Leman, M. (2017). Shifting the musical beat to influence running cadence. Proceedings of the 25th Anniversary Conference of the European Society for the Cognitive Sciences of Music, (August), 27–31. Retrieved from http://hdl.handle.net/1854/LU-8530848

Pope, D. (2017). Running Injuries – What are the most important factors? Retrieved from https://open.spotify.com/episode/5w7dxe0ykfEP6Ov2RF9K7e

Wang, J., Luo, Z., Dai, B., & Fu, W. (2020). Effects of 12-week cadence retraining on impact peak, load rates and lower extremity biomechanics in running. PeerJ, 8, 1–14. https://doi.org/10.7717/peerj.9813

 Areas for further improvement plus action plan

• Look for opportunities to perform running assessment and gait analysis of runners in clinic.

Returning to reflection at a later date

I have since gone through a running gait analysis with a male long distance runner (11.05.21).  I re-read all of the accompanying research literature and familiarised myself with the clinical assessment a couple of days before I saw the athlete in preparation.

On the day I felt reasonably comfortable going through the assessment and the analysis but also had a clinical supervisor present to guide me through it.  I found it very interesting.