Running Injuries in Adolescents Jeffrey Shilt, M.D. Part 1 Page 1

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1 Running Injuries in Adolescents Jeffrey Shilt, M.D. Chief Surgical Officer, The Woodlands, Texas Children's Hospital Associate Professor, Orthopedic and Scoliosis Surgery, Baylor College of Medicine Part 1 Page 1 1

2 Why? Effective Longer lifespan Reduce cancer risk Lower blood pressure Boost immunity Raise HDL Reduces vision loss Improves mental health Simple shoes, shorts, anywhere Running Page 2 Running Despite often cited as most popular physical activity in North America Only 16% of North Americans participate in an organized running program Page 3 2

3 Why low participation rate? Page 4 Running Injuries 27-70% of recreational & competitive distance runners sustain overuse injury in any given year Page 5 3

4 Why such a high rate of Overuse? Page 6 Biomechanical vs Cardiac Fitness Tendons, bones and joints are slow to adapt to forces in relation to cardiac fitness days vs. months Merrel 40 days to 1.5 miles barefoot Page 7 4

5 Injury Mechanism Injuries due to chronic overuse; rarely traumatic events All biological structures adapt both positively and negatively to stress placed on them. Injury Mechanism Positive adaptation = stresses are repeated below the mechanical limits of a structure and adequate rest between stress applications Negative adaptation/ (injury) = repeated stresses with an insufficient rest between stress applications 5

6 Evaluating Injury Interrelationships between: gait biomechanics anatomical alignment muscular strength muscular flexibility Page 10 Running Injuries Page 11 6

7 Running Injuries Most common site of injury: Leg = 70% Knee = 40% Page 12 Endurance Medicine Expertise >10,000 hours/ 20 yrs of experience 6,000,000 yds swimming 14,000 miles running 120,000 miles biking 12 Ironmans, Plantar Kona Fasciitis 3 Ultramarathons ITB Syndrome 5 marathons, Boston Xterra, Rotator Maui Cuff Tendinitis Adventure Racing Consulted/Coached Olympians & world champions 7

8 Case Example K.B. Aussie Female Professional Triathlete 2nd year pro, beat 6 x 1/2 IM Tauranga champion 2nd in sprint finish IM NZ Rapidly ramped up her run volume & intensity to go faster Page 15 8

9 Page 16 Took time off Decreasing pain in front of pelvis Increased training New pain in SI joint Page 17 9

10 Treatment 1. Revised Training 2. Altered Biomechanics 3. Adjusted diet and OBCP use 4. Adjusted Shoewear Page IM Western Australia Page 19 10

11 Treatment Options 1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions Shoewear Adaptions 5. Nutrition Page 20 Training Training stresses: Necessary for improvement in performance & function When inappropriately applied, can be detrimental Page 21 11

12 Treatment Options 1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions Shoewear Adaptions 5. Nutrition Page 22 Treatment Options 1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions Shoewear Adaptions 5. Nutrition Page 23 12

13 Strength Training Customized for focal weaknesses to address injury Performance Combination of resistance with endurance training provides a 3.62% in 5km TT performance in moderate trained recreational runners Posterior chain emphasis Strength discrepancies btw. Post & ant chains result in: Poor posture/muscular compensations/injury Karsten, et al The effects of a sport specific maximal strength and coni9oning Page 24 Int J Sports 2016 Treatment Options 1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions Shoewear Adaptions 5. Nutrition Page 25 13

14 Running Biomechanics Gait Cycle Walking Running Double support vs. Double Float Stance phase of walking is > 50% Elite sprinters > 20% 14

15 Shoes Despite advances in shoe technology, running injuries have not decreased Incidence of ITBS and stress fractures have doubled over the past 35 years Page 28 Why Minimalist Shoes Increased intrinisic foot muscle strength Improved run biomechanics Decreased injuries Improved posture Sense of freedom while running Page 29 15

16 Kinematics Pelvis and trunk more anterior tilt Hip extension later in cycle (at toe-off) Hip extends in 2 nd half of swing Knee similar different magnitudes walk walk walk GRF Rearfoot striker Midfoot striker doesn t typically have initial peak 16

17 Moments & Powers During stance What type of moment? Abductor (Glute med) Adduction due to GRF medial to hip During propulsion Glute med adducts hip to generate power Kinetic Summary The main sources of power generation are Hip extensors during second half of swing and first half of stance Hip flexors after toe-off Knee extensors, hip abductors, and ankle plantar flexors during stance phase generation Hip Ext, 14 Ankle Ext, 41 Run Hip Ext, 7 Ankle Ext, 53 Hip Flex, 20 Hip Abd, 3 Knee Ext, 22 Walk Hip Flex, 30 Hip Ext, 24 Ankle Ext, 34 Hip Abd, 6 Knee Ext, 4 Sprint Hip Flex, 25 Knee Ext, 14 Hip Abd, 3 17

18 Kinetic Summary Hamstring and glute max pull body forward after swing phase reversal when foot is ahead of body Second half of stance Quads\gastroc push forward Hip Ext, 14 Ankle Ext, 41 Run Hip Flex, 20 Knee Ext, 22 Hip Walk Ext, 7 Hip Abd, 3 Ankle Ext, 53 Hip Ext, 24 Hip Flex, 30 Sprint Hip Abd, 6 Knee Ext, 4 Hip Flex, 25 Ankle Ext, 34 Knee Ext, 14 Hip Abd, 3 4G: The impact peak disappears with a MFS Page 35 18

19 Prerequisites for Minimalist Running Approach 1. Good Alignment 2. Good Biomechanics 3. Trunk & Hip Core Strength 4. Biomechanical Fitness 5. Appropriate Recovery Page 36 5 Necessities: Alignment Good alignment directs biomechanical forces where we are best suited anatomically to handle them Page 37 19

20 5 Necessities: Biomechanics Good biomechanics reduce stresses associated with increased forces associated with running Page 38 5 Necessities: Core Strength Strength in trunk and hip core maintain stresses in skeleton best equipped to handle them Page 39 20

21 5 Necessities: Recovery Without appropriate recovery, musculoskeletal system cannot respond to training stresses Unique to each individual Page 40 Treatment Options 1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions Shoewear Adaptions 5. Nutrition Page 41 21

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