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Learning to Run: Simple Prevention Strategies for the Novice Runner Michael Fredericson, MD, FACSM Professor and Director PM&R Sports Medicine Director, Stanford RunSafe Program Slide 2 Objectives To provide practical tips for the novice runner to help prevent running injury and improve performance. Slide 3 THE 10 TOP FORM RECOMMENDATIONS FOR THE NOVICE RUNNER Slide 4 #1 Soft Landing with Relaxed Knee Knee stiffness or reduced knee flexion may be associated with tibial stress fractures and certain sub- groups of patients with patellofemoral pain. Dierks et al. Med Sci Sports Exer 2011. Milner et al. Med Sci Sports Exer 2006 Slide 5 #2 Use your Butt Muscles to Push Off Reduced hip extension and pushoff may be observed with compensations that include: Increased lumbar spine extension Bounding Souza R. PM&R Clinics 2015 Slide 6 #3 Slight Lean Forward A small increase in trunk lean (~7 degrees) results in a significant lowering of patellofemoral joint stress. Teng & Powers. J of Orthoped Sports Phys Ther 2014; Teng & Powers. Med Sci Sports Exer 2015 Slide 7 #4 Land With Foot Under Center of Mass Overstriding is associated with : Reaching (hip flexion with knee extension prior to initial contact) Reduced shock attenuation Increased running energetics Edwards et al. Med Sci Sports Exer 2009; Wille et al. J of Orthoped Sports Phys Ther 2014 Slide 8 #5 Push Forward not Upward Bounding leads to increase float time, often in response to other deficits (e.g. reduced hip extension). Increasing cadence by 10% during running can significantly reduce vertical displacement and overstriding. Wille et al. J of Orthoped Sports Phys Ther 2014; Heiderscheit et al. Med Sci Sports Exerc 2011 Slide 9 #6 Beware of a Crossover Gait A narrow base of support has been linked to tibial stress fractures, iliotibial band syndrome, and several kinematic patterns that have been associated with running injuries, such as excessive hip adduction and over pronation. 9 Meardon et al. Internl Soc of Biomechics in Sports 2012 Brindle et al. Gait & Posture 2014; Meardon et al. J of Biomechanics 2014 Slide 10 #7 Avoid Excessive Pronation Several studies have linked excessive pronation to various running injuries, such as tibial stress fractures, patellofemoral pain, and Achilles tendonopathy... Barton et al. J of Orthoped Sports Phys Ther 2010; Milner et al. J of Orthoped Sports Phys Ther 2010; Silbernagel et al. J of Orthoped Sports Phys Ther 2012 Slide 11 Velocity of Pronation Slide 12 #8 Maintain a Knee Window Excessive hip adduction, excessive hip internal rotation, and excessive knee valgus have been implicated in running injuries and can impact the knee window. Noehren et al. J. Clinical Biomechanics 2007; Wilson et al. J. Clinical Biomechanics 2008; Herrington et al. The Knee 2014 Slide 13 #9 Stable Hips Pelvic drop contributes to excessive hip adduction, a variable that has been linked to numerous running injuries. This is related to both decreased hip abductor and hip extension strength. Noehren et al. J. Clinical Biomechanics 2007; Wilson et al. J. Clinical Biomechanics 2008 Slide 14 #10 Consider a Forefoot Strike Pattern or Change in Cadence Slide 15 Foot Strike Patterns One study on competitive collegiate runners suggested that runners with a RFS pattern developed more repetitive overuse injuries when compared to runners with a FFS pattern. However, more work is necessary before broad conclusions on foot strike recommendations can be made to modify injury risk or improved performance. 15 Daoud et al. Med Sci Sports Exerc 2012 Slide 16 Foot Strike Patterns High speed videos showing the footstrike for every entrant in the Womens 2012 U.S. Olympic Trials 10,000-meter race. 16 Slide 17 #10 Increase Cadence Increasing cadence by 10% can reduce center of mass vertical excursion, braking impulse, and mechanical energy absorbed at the knee, as well as to decrease peak hip adduction angle and peak hip adduction and internal rotation moments during running. The optimal cadence has been an area of debate, with some suggesting that ~180 steps per minute being ideal. Slide 18 Increasing Cadence vs Forefoot Strike Pattern 18 Slide 19 Average Loading Rate Running Pattern Average Loading Rate (BW/s) Forefoot Striking 30.8823 Increased Cadence 53.0041 Rearfoot Striking 49.8786 Slide 20 Maximum Loading Rate Running Pattern Average Loading Rate (BW/s) Forefoot Striking 46.6835 Increased Cadence 79.4522 Rearfoot Striking 78.4272 Slide 21 Peak Absolute Free Moment Running Pattern Peak Free Moment (N-m/BW) Forefoot Striking 10.5458 x10 -3 Increased Cadence 9.9167x10 -3 Rearfoot Striking 9.3292x10 -3 Slide 22 22 Donald et al. Army Medical Journal 2013 Slide 23 Typical RunSafe Profiles Slide 24 Cassie 12-16 Y/O Male or Female Motivation: Starting cross country/track and field. Symptoms: Osgood-Schlatter, shin splints Classic Issues: increased internal hip rotation, decreased hip extension, increased stride length, low arch, valgus heel, mild overpronation Key Recommendations: increase core and hip stabilization;include functional single leg balance exercisesstrengthen glutes ts), stretch hip flexors, work on quick turnover/short stride Shoes: foot strengthening exercises Slide 25 Brad 25-35 Y/O Male Motivation: training for a triathlon wants to improve speed Symptoms: mild patellofemoral pain or iliotibial band pain Classic Issues: decreased knee flexion, decreased hip extension, increased stride length, mild overpronation Key Recommendations: stretch quads and hip flexors regularly; increase running cadence by 5-8%; and or moving to a forefoot strike pattern Shoes: no change Slide 26 Andrea 35-50 Y/O Female Classic Issues: valgus collapse at knee, increased pelvic drop, decreased knee flexion at initial contact, decreased hip extension, low arch, valgus heel, excessive heel eversion and overpronation Key Recommendations: core and hip stabilization + ilipsoas flexibility Shoes: try stability shoe and/or OTC orthotics Motivation: weight loss + half marathons Symptoms: knee pain Slide 27 Ben 45-60 Y/O Male Classic Issues: decreased knee flexion, decreased hip extension, decreased stride length, poor ROM throughout body, varus hindfoot Key Recommendations: general flexibility (hip flexors, quads, calves, hamstrings, spine) Shoes: cushioned shoe Motivation: lifetime runner, training for marathons Symptoms: hip pain, knee pain, arthritis Slide 28 Thank You!