Slide 1. Slide 2. Slide 3 TYPICAL INJURIES ASSOCIATED WITH RUNNING

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1 1 THE RELATIONSHIP BETWEEN FOOT STRIKE AND RUNNING INJURIES SUSAN THOMPSON PT, OCS ARLINGTON ORTHOPEDIC ASSOCIATES 2 RUNNING 30 million participants in the US alone. Running is an excellent form of exercise, but it is considered a high-impact sport. When a runner's foot hits the ground, forces equal to 3 times body weight are generated. Annual incidence of injury to the lower extremity has been reported to be as high as 79%. 3 TYPICAL INJURIES ASSOCIATED WITH RUNNING

2 4 TYPICAL INJURIES ASSOCIATED WITH RUNNING The more common running-related injuries include: Medial tibial stress syndrome Patellar tendinopathy/pf pain Achilles tendinopathy 5 TYPICAL INJURIES ASSOCIATED WITH RUNNING The more common running-related injuries include: Plantar fasciitis Stress fractures Ankle sprains 6 MEDIAL TIBIAL STRESS SYNDROME Calcaneal eversion and navicular drop are two components strongly associated as risk factors

3 7 PATELLOFEMORAL PAIN Runner s knee, patellar tendonitis, chondromalacia 8 PLANTAR FASCIITIS The ability to absorb impact depends on the resilience of the plantar fascia, the fat pad and the intrinsic muscles of the foot. 9 MECHANICS OF RUNNING

4 10 TYPICAL RUNNING CYCLE Initial Contact- Loading Response-Mid Stance-Toe off-double float-initial swing-mid swing-terminal swing 11 DOUBLE FLOAT PHASE 12 TYPE OF FOOT STRIKE PATTERS Rearfoot - initial contact with the ground occurs at the heel or posterior part of the foot Midfoot - striking pattern in which the posterior and anterior portions of the foot simultaneously contact the ground Forefoot - striking is a pattern in which the anterior region of the foot strikes the ground first.

5 13 BIOMECHANICAL MEASURES Ground reaction force Impact Peak rearfoot eversion Active peak rearfoot eversion 14 GROUND REACTION FORCE 15 BIOMECHANICAL MEASURES

6 16 BIOMECHANICS OF RUNNING Initial Contact- Loading Response-Mid Stance-Toe off-double float- Initial swing-mid swing-terminal swing 17 IDENTIFYING YOUR STRIKE PATTERN 18 INITIAL CONTACT Typically, the heel is the first contact point. (Impact Peak) In running, greater ankle dorsiflexion is required for heel strike. As speed increases, IC occurs more on forefoot.

7 19 STANCE PHASE Loading response- the ankle dorsiflexes as body weight is transferred to the stance leg. At midstance the calcaneus will evert while the tibia internally rotates. Going from midstance to pre-swing the calcaneus inverts and the tibia externally rotates. 20 TOE OFF Toe off occurs before 50% of the gait cycle is completed and is relative to the runner s speed. World class sprinters toe off as early as 22% of the gait cycle Windlass mechanism 21 CHAIN OF EVENTS SUMMARY Pronation: 1 st ray is mobile; midtarsal joint is unlocked ; calcaneal eversion; talar adduction and PF; ankle dorsiflexion; knee flexion (valgus) with internal tibial rotation; hip flexion, adduction and IR; pelvis is translated forward with anterior rotation Supination: 1 st ray is rigid; midtarsal joint is locked ; calcaneal inversion; talar abduction and DF; ankle plantarflexion; knee extension (varus) with external tibial rotation; hip extension, abduction and ER; pelvis is translated backward with posterior rotation

8 22 POTENTIAL CAUSES FOR INJURY 23 RISK FACTORS Prior running injury Higher weekly mileage Frequency of running Certain running mechanics Overstriding, excessive hip adduction, etc.. 24 BELOW THE KNEE More than 80% of running-related injuries occur at or below the knee Common mechanisms: Atypical foot pronation mechanics Inadequate hip muscle stabilization

9 25 TOO MUCH OR TOO LITTLE PRONATION? Right Foot Supinated Neutral Pronated (Inversion) (Eversion) 26 WHAT IS NORMAL? A standard for forefoot pronation has not been established. 27 WHAT IS NORMAL? AMA: rearfoot inversion and eversion normal of 5 degrees Standard goniometry: 8-12 degrees

10 28 PRONATION 29 OVERUSE RUNNING INJURIES Contributing factors to overuse running injures Excessive pronation Pronation velocity Time to maximum pronation 30 GENDER DIFFERENCES Running injuries including PF pain, MTSS, IT band pain and Achilles tendonitis occur up to 50% more often in female runners

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12 34 BAREFOOT Barefoot athletes landed in a more plantar flexed position at the ankle, resulting in a decrease peak vertical ground reaction force Leg stiffness significantly increased from barefoot to the cushioned shoe condition during hopping Stride length and contact time were significantly shorter with higher stride frequency 35 FOREFOOT AND MIDFOOT May protect the heel and lower limbs from some impactrelated injuries A forefoot running style may reduce ground reaction forces and reduce stress reactions/fractures, anterior knee pain, and low back pain 36 PT PREVENTION / INTERVENTION

13 37 PREVENTION Rest and recovery periods Stretches, stability work, strengthening Be consistent-stay with a schedule Crosstrain Running surface-track, side of road, gravel Mileage-avoid sudden increases or clusters Intensity- speed, timed runs, inclines 38 INTERVENTION Gait analysis: Weight shift Adequate DF Controlled PF Time in pronation Adequate 1 st ray mobility 39 FOOTWEAR Static measures of foot posture are regularly used as part of a clinical examination. Orthoses- limited to static alignment measures and has produced inconsistent findings.

14 40 TREATMENT FOR COMMON INJURIES 41 THERAPEUTIC EXERCISE 42 THERAPEUTIC EXERCISE Address musculoskeletal Issues for the foot, ankle, knee, hip and back! ROM, Strength Proprioception Assess malalignment

15 43 MANUAL THERAPY 44 CONCLUSIONS 45 RECOMMENDATIONS Prevention is best medicine! Rest and recovery, avoid cluster or overtraining Stay strong, but flexible. Gradually progress your training. Don t ignore an injury or pain. In case of injury, treat the whole system.

16 46 PEDIATRIC CONSIDERATIONS Teens may train 20 or more hours each week Children as young as six to eight to play organized sports 47 SEVER S DISEASE 48

17 49 THANK YOU 50 REFERENCES Gait and Posture 7 (1998) The biomechanics of running. Tom F. Novacheck Motion Analysis Laboratory, Gillette Children s Specialty Healthcare, University of Minnesota, 200 E. University Ave., St. Paul, MN 55101, USA Reliability of a Qualitative Video Analysis for Running Authors: Andrew Pipkin, DPT, Kristy Kotecki, DPT, Scott Hetzel, MS, Bryan Heiderscheit, PT, PhD J Foot Ankle Res. 2014; 7: 55. Published online 2014 Dec 19. doi: /s PMCID: PMC Foot posture as a risk factor for lower limb overuse injury: a systematic review and metaanalysis Bradley S Neal, Ian B Griffiths, Geoffrey J Dowling, George S Murley, Shannon E Munteanu, Melinda M Franettovich Smith, Natalie J Collins, and Christian J Barton corresponding author Sports Medicine October 2012, Volume 42, Issue 10, pp What are the Main Running-Related Musculoskeletal Injuries? A Systematic Review Alexandre Dias Lopes Luiz Carlos Hespanhol Jr. author Simon S. Yeung Leonardo Oliveira Pena Costa Foot Ankle Res. 2014; 7: 53. Published online 2014 Dec 19. doi: /s PMCID: PMC Dynamic foot function as a risk factor for lower limb overuse injury: a systematic review Geoffrey J Dowling, George S Murley, corresponding author Shannon E Munteanu, Melinda M Franettovich Smith, Bradley S Neal, Ian B Griffiths, Christian J Barton, and Natalie J Collins 51 REFERENCES How Well Do You Know Your Foot Strike Pattern? Study finds that participants who wear minimalist shoes often misidentify the way their foot hits the ground. By Alison Wade WEDNESDAY, FEBRUARY 25, 2015, 6:58 PM Sports Health May; 1(3): doi: / PMCID: PMC Suspected Mechanisms in the Cause of Overuse Running Injuries A Clinical Review Reed Ferber, PhD, * Alan Hreljac, PhD, and Karen D Kendall, MKin Gait and Posture 7 (1998) Review Paper The biomechanics of running Tom F. Novacheck Motion Analysis Laboratory, Gillette Children s Specialty Healthcare, University of Minnesota, 200 E. Uni6ersity Ave., St. Paul, MN 55101, USA Received 25 August 1997; accepted 22 September Calcaneal Eversion: The Switch That Turns On The Engine 2017 David Tiberio PhD, PT, OCS Sports Health May; 1(3): doi: / PMCID: PMC Suspected Mechanisms in the Cause of Overuse Running Injuries A Clinical Review Reed Ferber, PhD, Alan Hreljac, PhD, and Karen D Kendall, MKin

18 52 REFERENCES J Foot Ankle Res. 2014; 7: 55. Published online 2014 Dec 19. doi: /s PMCID: PMC Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis Bradley S Neal, Ian B Griffiths, Geoffrey J Dowling, George S Murley, Shannon E Munteanu, Melinda M Franettovich Smith, Natalie J Collins, and Christian J Bartoncorresponding author Clin Biomech (Bristol, Avon) May;18(4): Gender differences in lower extremity mechanics during running. Ferber R1, Davis IM, Williams DS 3rd. Athletic footwear, leg stiffness, and running kinematics. Bishop M, Fiolkowski P, Conrad B, Brunt D, Horodyski M J Athl Train Oct-Dec; 41(4): [PubMed] Biomechanical and physiological comparison of barefoot and two shod conditions in experienced barefoot runners. Squadrone R, Gallozzi C J Sports Med Phys Fitness Mar; 49(1):6-13. [PubMed] [Ref list] Foot strike patterns and collision forces in habitually barefoot versus shod runners. Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, Mang'eni RO, Pitsiladis Y Nature Jan 28; 463(7280): [PubMed] [Ref list] 53 REFERENCES Biomechanical Differences of Foot-Strike Patterns During Running: A Systematic Review With Metaanalysis Authors: Matheus O. Almeida, PT, PhD, Irene S. Davis, PT, PhD, Alexandre D. Lopes, PT, PhD Published: Journal of Orthopaedic & Sports Physical Therapy, 2015 Volume:45 Issue:10 Pages: DOI: /jospt Br J Sports Med Jul;45(9): doi: /bjsm Epub 2010 Nov 16. Greater peak rearfoot eversion predicts foot orthoses efficacy in individuals with patellofemoral pain syndrome. Barton CJ1, Menz HB, Levinger P, Webster KE, Crossley KM. J Foot Ankle Res Dec 19;7(1):55. doi: /s ecollection Foot posture as a risk factor for lower limb overuse injury: a systematic review and meta-analysis. Maffulli N, Caine D. In: Epidemiology of Pediatric Sports Injuries: Team Sports. Maffuli N, Caine D, editor. Basel: Karger; The epidemiology of children s team sports injuries; pp (Med Sport Sci, Volume 49). [PubMed] U.S. Department of Health and Human Services. Physical Activity Guidelines Advisory Committee Report. Washington, DC: U.S. Department of Health and Human Services; REFERENCES Emery CA. Injury prevention in paediatric sport-related injuries: A scientific approach. Br J Sports Med. 2010;44: doi: /bjsm Caine D, Caine C, Maffulli N. Incidence and distribution of pediatric sport-related injuries. Clin J Sport Med. 2006;16: [PubMed] Ingram JG, Fields SK, Yard EE. Epidemiology of knee injuries among boys and girls in US High School Athletes. Am J Sports Med. 2008;36: doi: / [PubMed] [Cross Ref] Darrow CJ, Collins CL, Yard EE, Comstock RD. Epidemiology of severe injures among United States high school athletes, Am J Sports Med. 2009;37: doi: / Caine D, DiFiori J, Maffulli N. Physeal injuries in children s and youth sports: Reasons for concern? Br J Sports Med. 2006;40: doi: /bjsm [PMC free article] [PubMed] [Cross Ref]

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