What is it and why is it important? Running Analysis What is it and why is it important? A survey from runnerworld.com showed that 66% of runners had at least one injury in 2009 alone. As you know, to run well you need to have a number of key body systems working as one. What we intend to do today is highlight some common issues relating to the onset of injury in runners and how we/you can help to correct them It is also important to consider the differences between men and women and when considering what injuries could affect each gender. Some key differences in incidence rates are. Women are twice as likely to develop pfps and ITB friction syndrome Women are also twice as likely to develop metatarsal stress # Mens gastroc injuries make up 70% of all calf tears (poor hip e/more lover leg proplosion in men) digital video analysis to record a patient running Play back in slow motion and analyze motion more effectively and focus on what is happening at specific joints and points in the kinetic chain Identify functional impairments such as muscle imbalances and/or poor pelvic positioning and technique/form faults Good visual feedback for patient Provides a comparative tool to track progress

STANCE AND SWING PHASES OF RUNNING. Six phases in the running cycle Can be divided into support and swing phases Support describes weight bearing. Pelvic and core stability is important on the contact side IC- adequate DF needed, glute and core stability MSt- pelvic stab,, quad/hammy strength TS/TO- calf strength, tib ant flexibility IS- hip extension, hip flexor length MSw- knee flexion, extensor flexibiltiy TSw- DF, knee extension Form faults- excessive trunk incline, fixed shoulders STANCE SWING

GOOD RUNNING FORM: what to look for? Minimal vertical displacement Cadence Lean forwards from the ankles Foot strike beneath body Compact arm positioning Relaxed shoulder girdle Minimal vertical displacement- For optimal performance and energy conservation Focus on driving forwards, not losing momentum up and down Optimal cadance is 180 steps per minute, this will ensure there is no over striding or shuffling Foot should strike beneath the body for good COG, reduce breaking mechanism and GRF Compact arm positioning to minimise trunk rotation and promote good posture Relaxed shoulder girdle- posterior oblique sling

COMMON TECHNIQUE FAULTS Component Fault Correction Trunk incline/general posture Excessive trunk lean forwards or backwards General posture e.g. overextended Slight forward inclination “Imagine running into a stiff breeze” “Ribs down” “Chest out” Arm swing “Opening up” arm swing: arms > 90 degrees, or away from body Hand grip tight Arms close to body around 90° “Hands to pockets” “Potato chip hold” Hip flexion/extension Inadequate or poorly timed hip flexion/extension Paw-back Stride length Over-striding: initial foot contact in front of body’s centre of gravity Land with feet under body Correct cadence Foot strike Heel-strike Mid-foot strike Excessive thoracic kyphosis or flexion at the hips can make it harder to breathe and decrease oxygen intake Arm positioning above or below 90 degrees can cause altered trunk inclination and poor scapular positioning . Excessive abduction can lead to excessive trunk rotation which can affect the posterior oblique sling. This causes braking and increasing ground reaction forces

FUNCTIONAL IMPAIRMENTS: POSTERIOR VIEW Pelvis/hip/knee: Pelvic heights Femoral rotation Hip/knee angle Trendelenberg – a weakness of hip abductors (gluteus medius/minimus) on one side causing contra-lateral lateral drop of pelvis Foot/ankle: Normal pronation is 6-8 degrees with re- supination Over pronation of ankle/foot – a rolling out of the heel relative to the leg +/- a collapse of the arch, leading to late re-supination for push-off

FUNCTIONAL IMPAIRMENTS: LATERAL VIEW Pelvis/hip: Normal anterior/posterior tilt – 11° anterior rotation, 15° with leg extension Excessive anterior tilt of pelvis –muscle imbalances of the hip flexor/extensor muscles, reduced core control Knee: Excessive knee flexion in land Poor strength/co-control of quads/hamstrings Foot/ankle: Dorsiflexion control Listen for “foot slap” Reduced control often from calf tightness +/- tibialis anterior weakness/poor control Dorsiflexion control – increased impact up the shin/knee

COMMON RUNNNG INJURIES Component Common diagnoses Possible impairments Spine Non Specific Low Back Pain (NSLBP) SIJ pain Pelvic dysfunction Rib pain/subluxation Poor TVA/Oblique ratios Imbalance through oblique slings Hypomobile spinal segments Poor spinal awareness Tight and short H/S/QL/ES Hip Gluteal tendinopathy High hamstring tear/ensethop’ Femoroacetabular imp’ Labral tears Weak glutes (Neuro/Strength) Tight ITB/Overactive TFL/ADD Overactive and short H/S Poor ant oblique sling co-ord Knee PFPS/ITBFS Degenerative meniscal tears Patella tendinopathy/bursitis a/a Weak or poorly timed VMO Poor patella position/movements Foot/Ankle Plantar fasciitis Achilles/Peroneal/Tib Post tendinopathies Poor arch control/support Poor footwear for level of intrinsic foot strength Tight calves LL biomechanic (check a/a) Excessive thoracic kyphosis or flexion at the hips can make it harder to breathe and decrease oxygen intake Arm positioning above or below 90 degrees can cause altered trunk inclination and poor scapular positioning . Excessive abduction can lead to excessive trunk rotation which can affect the posterior oblique sling. This causes braking and increasing ground reaction forces

REAL TIME ULTRASOUND IMAGING

VIDEO ANALYSIS

STRATEGIES FOR CORRECTING IMPAIRMENTS AND TECHNIQUE Strength and/or endurance Functional re-education Part practice Whole practice Whole side step Overpronation: muscles involved- abductor hallucis, adductor hallucis, flexor digitorum brevis, tib posterior, gluteus medius, soleus These intrinsic foot muscles help to support the medial longitudinal arch. Working these muscles appropriately without compensatory use of other muscles is important with the exercises. Retraining the foot can be tedious but the stability is key as it is the first point of shock absorption whilst running. Slow the task down with a focus on control and higher exercise frequency of these muscles during the day. Basic Training: - staggered stance, partial weight bearing, statci single leg balance and ankle stability Functional training:- Dynamic single leg balance and ankle stability Side: Clam shells Alternate arm/leg extensions TVA isometric contractions Supine leg lifts Stand: Pleas One legged squats with pelvic control and TVA activation Paw back Dynamic arm swing with theraband and scap neutral Lean forwards from ankles- stiff breeze Step Step ups Step down decline High knees Kick backs with theraband Whole- treadmill practice stand

QUESTIONS?