Running
Benefits of Running
Regular Running Can Slow the Aging Process
It is undeniable that youthfulness is quickly becoming a modern obsession. For those struggling to stay young, there is good news: a longitudinal study conducted over two decades by Stanford University School of Medicine in California may have revealed the key to postponing the onset of the aging process.
Lead researcher James Fries, M.D. and colleagues surveyed 538 members of a nationwide running club and 423 healthy controls from Northern California. Participants were 50 years and older when the study started in 1984. Over a period of 21 years, participants completed self-administered questionnaires annually by mail about exercise frequency, body mass index, and ability to perform everyday activities such as walking, dressing, and grooming. Accessing national death records, researchers discovered that after 19 years, 34% of controls (non-runners) had died, compared to only 15% of runners, proving that running provides a noteworthy survival advantage.
“The study has a very pro-exercise message,” says Dr. Fries. Functional ability levels were higher in runners at all time points of the study. Although both groups ultimately became more disabled with age, the onset of disability started much later for runners—an average of 16 years later. As well, running regularly at middle and older ages is associated with a decrease in illnesses such as heart disease, cancer, and neurological disorders. There was no evidence that runners were more likely to suffer osteoarthritis or require knee replacements than non-runners – something scientists have feared.
Source: Archives of Internal Medicine, JAMA
10 Laws of Running Injuries
1. Injuries are not an Act of God. There are certain injuries that are intrinsic to an individual. Three main factors can be identified. The only constant factor is genetic: our lower limb structure. The two variable factors are the environment in which you train, and training methods.
2. Each running injury progresses through four grades. Running-related injuries generally become progressively more debilitating, passing through four stages or grades:
* Grade I injuries are those which cause pain only after running
* Grade II injuries cause pain during running but does not affect performance
* Grade III injuries cause pain and limits running performance
* Grade IV injuries are so severe that running is impossible
This allows a rational approach to treatment. Except in the case of stress fractures, or the iliotibial band friction syndrome, which can deteriorate very rapidly, you are not going to move from Grade I to Grade IV all of a sudden. A Grade I injury requires less attention than a Grade IV injury, although it is important not to let it progress.
3. Each injury indicates a breakdown. This simply restates the fact that there is a reason for running injuries, which must be analyzed before effective treatment can begin. The breakdown point is usually because of some change in training routine. You may be training harder or running further. You may be running on different terrain, or in different or worn-out running shoes. Injury resistance comes with an understanding of your own genetic limitations.
4. Most injuries are curable. Exceptions to this are injuries that occur in runners with severe biomechanical abnormalities which cannot be compensated for by conventional methods. Injuries which result in degeneration of internal structures such as the Achilles tendon, and those which happen to people who start running on already damaged or abnormal joints are also exceptions.
5. Sophisticated methods are seldom necessary. Most running injuries affect soft tissues – tendons, ligaments and muscles. These do not show up on X-ray. Rely on someone who takes a good history, and examines you thoroughly with their hands!
6. Treat the cause, not the effect. Surgery, physiotherapy, cortisone injections, drug therapy, chiropractic manipulations and homeopathic remedies will probably fail if they do not address the genetic, environmental and training factors which have caused your injury in the first place.
7. Complete rest is seldom the best treatment. Rest will cure only acute symptoms, and is anyway, generally an unacceptable remedy to most runners who are obsessed with their sport! The only injuries that require complete rest are those that make running impossible, such as stress fractures and grade 3 or 4 ITB problems. Tim Noakes’ approach is to advise injured runners to continue running, but only to a point at which they experience discomfort. Pain is not recommended!
8. Never accept as final the advice of a non-runner (MD or other). Make sure that your adviser is a runner. He or she should be able to discuss in detail the genetic, environmental and training factors that have caused your injury.
9. Avoid surgery! Surgery is the first line of treatment only in muscle compartment syndromes and interdigital neuromas. There may also be a role for surgery in chronic Achilles tendinitis which has lasted for more than six months, back pain due to a prolapsed disc, and the iliotibial friction band syndrome, but, only after a more conservative approach has been thoroughly tried, and failed.
10. Recreational running does not appear to cause osteoarthritis. Indeed there is evidence that with age, runners show fewer musculoskeletal problems, and develop them at a slower rate, than do non-runners! Generally sportspeople who develop osteoarthritis have usually had previous joint surgery. This is often as a result of injuries sustained during contact sports, such as rugby. However, there may be evidence that long-term, long-distance and high-intensity competitive running, may predispose to premature osteoarthritis of the hip. This finding comes from a single study, so clearly more research is needed.
adapted from Lore of Running by Tim Noakes, MD
Biomechanics
Optimum running biomechanics incorporates efficient posture, optimal stride rate and stride length to minimize use of energy, and this coincidentally results in a decreased risk of injury.
Since we run forward, we minimize energy waste by avoiding too much vertical bounce. We should lean forward, whether running uphill or downhill. This lean should happen from the ankles, not from the hips. Our posture should be tall, with relaxed shoulders, and arms swinging mildly. When running this way, we use momentum and gravity, thus preserving energy to last throughout our run. Practice standing and leaning forward from the ankles.
For distances of 5K or greater, the ideal stride rate is 180 steps per minute. This capitalizes on the natural attribute of elastic recoil in our Achilles tendon (on the back of our ankle). Because of this elastic recoil, using a stride rate of 180 saves our muscle energy even more. Count the number of times your right foot strikes the ground for one minute, and double, to determine your “steps/minute”.
The length of each stride (too long, or too short) can overuse or preserve (just right) our muscle energy. We should avoid over striding – landing with the foot in front of our center of gravity – as this causes a braking action to our forward momentum. Our foot should make contact with the ground directly below us, and should be pulling back as it makes contact, to propel us forward. This propulsion requires flexibility from the front of our hips and power from the back of our hips (buttocks). Sitting at a desk or while driving shortens the muscles on the front of the hip. This may result in a different efficiency running in the morning vs. after a day of work. Our hips need to be flexible and if they are not, can result in pain in the SI joints or low back as we compensate for the lack of hip flexibility. Practice leg pendulums and focus on pulling back.
To pre-tune your hips for best running biomechanics, create (1) flexibility, (2) strength/endurance, and (3) balance. Simple exercises are One Leg Hip Hikes, and One Leg Pendulums (in varied directions).
Injury Prevention
It is believed that 25% of running injuries are preventable. Steps that can be taken include
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Proper rehabilitation of a previous injury. (50% of running injuries are a re-occurrence of an old injury)
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Wear appropriate shoes and change them regularly. (Different shoes are designed to accommodate your individual foot mechanics and last approximately 500 kilometers)
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Avoid overuse problems. (50-65% of injuries are attributed to training errors)
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Too much (what is your present fitness level capable of)
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Too soon (only increase your weekly miles and long run distance by 10%)
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Too often (the number of consecutive days correspond to the likelihood of injury; rest days allow your body to repair itself)
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Too fast (run your recovery runs and long slow distance runs slow)
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Causes of Injuries
65% of runners will be injured in a given year. Runners will miss about 10% of their scheduled workouts due to injury. The best predictors of running injuries are:
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High mileage
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Beginners
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Competitive runners
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Previous injury
Previous injury is the best predictor of future injuries because 50% of running injuries are a re-occurrence of an old injury.
Running injuries are a result of:
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Genetics (lower limbs)
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Environment (shoes, training surface)
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Training methods (overuse)
Training methods account for 50-65% of running injuries. This includes doing:
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Too much (more than what your body is presently capable of)
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Too soon (greater than 10% increase in weekly and long run mileage)
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Too often (consecutive running days)
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Too fast (recovery and long slow distance runs)
Treatment
Most running injuries are curable and about 25% of running injuries will require consultation of a professional health care provider. Although our body is capable of adapting to stresses we put on it, an injury usually indicates a breakdown of our reparative process. Each injury progresses through 4 grades and gives us ample warning of impending problems. Most importantly, treat the cause, not the symptoms of each injury. Rest, ice, and medications may eliminate the symptoms, but the injury will return if you do not address the primary reason behind the injury (genetics, environment, training methods). Therefore, one must look for biomechanical deficiencies/imbalances, footwear, and possible training errors that may have contributed to the injury.
Flexibility Training
Proper flexibility training addresses any muscular imbalances (tightness), allowing for the runner to decrease the probability of injury. Pre and post activity needs are different and therefore need different types of stretching.
Before Running
Before running, the goal is to warm up the body and recruit the necessary muscles involved in running. Dynamic stretching involves using sport specific movements to stimulate the neuromuscular system and increase the body temperature.
After Running
After running, the muscles used for running become tight. Static stretching restores the muscle to its original length and prevents any adhesion (scar tissue) from being formed. Stretches can be held for 30 seconds and repeated up to 5 times.
Using Orthotics
Over pronation accounts for 10% of running injuries but 70% of runners with lower limb running injuries will improve with orthotics or shoe inserts. It is suggested that orthotics do not alter the joint movement patterns but alter the function of the lower limb muscles during the stance phase of running. Orthotics help reduce the risk of injury by:
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Reducing lower limb muscle activation
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Improving running comfort
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Improving running economy (efficiency)
Common Injuries
Plantar Fasciitis
The plantar fascia is a band that runs from the heel to the base of the toes. It provides support for the arch of the foot and assists in the biomechanics of walking and running.
Contributing factors
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Over pronation (stretching of plantar fascia)
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Under pronation
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Leg length inequality
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Faulty biomechanics (reduced ankle motion)
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Muscle imbalances (reduced muscle strength)
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Overuse
Symptoms
Localized tenderness can be felt at attachment at the heel or along the arch of the foot noticed during and after running. Symptoms are worse with weight bearing after a period of rest or immobility (first step in the morning).
Treatment
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Ice
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Rest
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Stretching (plantar fascia and calf muscles)
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Night splints (91% success after 12 weeks)
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Orthotics (correct foot mechanics)
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Avoid uphill and speed work
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Evaluate footwear
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Identify and address training errors
Achilles Tendinosis
The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone. It transmits the forces of the calf muscle to the foot to allow heel lift. Injury to the tendon can be inflammatory (tendinitis) or degenerative (tendinosis).
Contributing factors
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Greater rear foot pronation
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Reduced ankle muscle strength
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Running more miles per week
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Been running for more years
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Running at faster than average pace
Symptoms
Pain or tenderness can be localized along the tendon. Stiffness may be present in the morning. Stretching or contracting the calf muscle can be painful. Running hills, speedwork, or jumping can aggravate this problem. A complete rupture of the tendon can occur if there is a sudden unexpected movement and requires immediate medical attention (surgery). There is a complete gap in the tendon and you will be unable to push off with the ankle because the calf will no longer be attached to the ankle.
Treatment
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Ice
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Rest (pool running, cycling, swimming)
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Heel lifts (reduce stress on tendon)
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Stretch calf muscles
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Eccentric (contacting muscle during stretch) heel drops
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Correct muscle imbalance (anterior and posterior lower leg muscles)
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Orthotics (correct rear foot pronation)
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Evaluate footwear
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Avoid hills
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Identify and address training errors
Tibial Stress Syndrome (Shin Splints)
During running, repetitive stresses can cause small tears in the attachment of the muscle to the shin bone (tibia). Tibialis anterior (anterior shin splints) and tibialis posterior (posterior shin splints) muscles are involved in limiting pronation during foot strike.
Contributing factors
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Faulty foot, knee, or hip mechanics
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Muscle imbalances (tight or weak)
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Training errors (overuse)
Symptoms
Tenderness along the front or inside the shin bone is typical. Symptoms are similar to tibial stress fracture and caution is needed to diagnose the injury and make the appropriate treatment.
Treatment
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Ice
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Rest
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Reduce mileage
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Correct muscle imbalances (weak or tight lower leg muscles)
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Evaluate footwear
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Orthotics (correct foot mechanics)
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Identify and address training errors
Patellofemoral Pain Syndrome (Runner’s Knee)
Patellofemoral Pain Syndrome causes localized pain around the knee cap (patella) in runners. It is due to abnormal tracking of the knee cap over the thigh bone (femur).
Contributing factors
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Knee alignment (knock knees, bowed legs)
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Reduced ankle flexibilty
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Over pronation
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Under pronation
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Excessive supination
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Quadriceps weakness (vastus medialis endurance)
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Iliotibial band tightness
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Training errors
Symptoms
Pain is normally felt in the front of the knee along the outer borders of the knee cap. Prolonged sitting (knees bent), walking up or down stairs, and running down hill will aggravate this condition by putting more pressure behind the knee cap.
Treatment
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Ice
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Rest
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Stretch (ITB, quadriceps, hamstrings)
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Correct muscle imbalance (vastus lateralis)
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Evaluate footwear
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Orthotics (correct foot mechanics)
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Identify and address training errors (cambered roads)
Iliotibial Band Friction Syndrome
The iliotibial (IT) band is a superficial thickening of tissue that runs from the outside of the pelvis (ilium) above the hip bone and extends along the outside of the thigh and inserts below the knee joint to the upper shin (tibia) bone. Iliotibial band friction syndrome (ITFS) occurs when there is constant rubbing and friction of the IT band at the outside of the knee during 30 degrees of flexion.
Contributing factors
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Leg length discrepancies
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Hard surfaces
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Uneven surfaces (downhill side on cambered road)
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Downhill running
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Over pronation
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Under pronation (bowed legs)
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Pelvic weakness (gluteus medius in 70%)
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Training error (peak training season, high mileage, slower pace)
Symptoms
Severe localized pain and tenderness is felt outside the knee joint only during exercise and is absent at rest. Running downhill aggravates the pain. The pain subsides when running is stopped but will return rapidly when running is continued. Pain is worse going down stairs.
Treatment
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Ice
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Rest
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Reduce training
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Strengthen gluteus medius (92% success)
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Stretch ITB
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Orthotics (foot mechanics)
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Evaluate footwear
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Identify and address training errors (overuse, uneven roads)
Stress Fractures
Stress fractures occur most frequently in the shin bone (tibia), foot (metatarsal), and hip (femur or pelvis). For new runners, cardiovascular fitness comes after 10 weeks whereas bone fitness requires 10 months. Stress fractures are a result of the bone not adapting fast enough for the increased stresses put on it.
Contributing factors
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Female (12 times more likely)
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Amenorrhea (6 times more likely)
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Low dietary calcium (8 times more likely, best predictor)
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Low bone density
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Race (Caucasian)
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Leg length inequality (73% in long leg: femur, tibia, metatarsal; 60% in short leg: fibula)
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Beginners
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Competitive (female)
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Over pronation
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Muscle imbalance (weakness)
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Training errors
Symptoms
The pain comes on suddenly and there is no history of trauma. Persistent pain and local tenderness, even after rest, ice and decreased training is suggestive of stress fracture. Hopping on the injured leg is painful and running is unbearable. Tibial stress fractures can mimic shin splints and is often incorrectly diagnosed. With continued running, this problem can lead to a complete fracture.
X-rays will usually not show any signs of a fracture (57% are negative in the first 3 weeks). A bone scan will show increased activity (hot spot) where there is an active repair process of the bone presently underway. CT scan is best to visualize the small bones of the foot.
Treatment
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Rest
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Restricted weight bearing (pneumatic leg brace)
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Alternate activity (pool running)
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Orthotics (foot mechanics)
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Evaluate footwear
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Identify and address training errors
Most stress fractures will heal after 6-8 weeks depending on the site (longer for the bones higher up the leg). Continuation of activity to a complete fracture will require 6-8 months of rest. This is a longer healing time than a regular fracture (6-8 weeks) because the blood supply and hence the healing ability of the bone is compromised.
Testimonials
“I value the knowledge that both Dr. Lees bring to share with our running/walking clinics. They act as a resource in biomechanics, gait analysis, injury prevention, and injury treatment. It is with utmost confidence that I refer a customer in need of sports chiropractic services to Lee Chiropractic.”
Jackie S
Burnaby Running Room Manager
“Thank you, Anne and Eugene, for the things that you do for the marathon clinic. In many respects, the advice and guidance that you give to each and every participant is something that is very special. I believe that the participants in the clinics have a huge advantage as a result of both of you working and running with them and I can see that it contributes directly to their success.”
Alan A
Running Room Marathon and Half Marathon Clinic Leader
“I have asked Anne and Eugene to speak to the Full and Half Marathoners on Injury Prevention and Biomechanics of Running. These talks have been useful and informative to clinic members. Both Anne and Eugene are avid runners and the Running Room has been blessed with their presence and professional expertise.”
Albert T
Running Room Marathon and Half Marathon Clinic Leader
"I completed the marathon in Minneapolis, slow but happy to finish! The good news is I had no problem with any injuries, my shin splint or right knee. Thank you both so much for all the adjustments, strengthening and stretching exercises (which I'm still doing) and the great taping job Eugene 😊. You guys are fabulous, thank you so much."
Carole I (2017)