1. RUNNING MEDICINE Common injuries and causes, core strength evaluation and treatment options Daniel Day, DO Sports Medicine Physician Western New York Sports and Ortho

2. History  Mileage  Training regimen  Training for anything  Shoes  Foot strike  Type of runner Beginner, recreational, avid, competitive

3. Common Running Injuries  Patellofemoral syndrome  IT band syndrome  Plantar Fasciitis  Medial Tibial Stress Syndrome (Shin Splints)  Achilles Tendinitis  Patellar tendinopathy

4.  20 percent of running injuries  Worse during and after exercise, stiffness  Causes – Glut Medius, hip flexors, extensors, external rotators, Quad inhibition Causes – foot overpronation Running on uneven surface, downhill running Patellofemoral Syndrome

5.  IT band gliding over lateral femoral condyle. +/- snapping  Worse at after exercise, stiff with sitting.  Causes: excessive supination of the foot (overposting), tight quad, tight hip flexor, decreased hip abductor tone Running same direction (track/road), excessive downhill running (overstride) IT Band Syndrome

6.  Functions as shock absorber  Degenerative process  Worse at the start of motion  Risk factors – age, DM, hard running surface, excessive increase in mileage/intensity  Causes – over pronation, tight gastroc/soleus Plantar Fasciitis

7.  Periostitis – periosteal stress where the muscle inserts on the bone (FDL, Soleus, Post tibialis)  Worse with activity  Cause: decreased dorsiflexion (tight achilles/gastroc), foot supination/bow legged, late stage pronation Sudden increase in mileage/intensity Weak core Medial Tibial Stress Syndrome (Shin Splints)

8.  Middle aged runners  Poor blood supply  Worsens with activity  Causes – Weak/tight gastroc, soleus, tight hamstring, midfoot/forefoot strikers Achilles Tendinitis

9.  Jumpers knee  Anterior knee pain worsened by activity and prolonged knee flexion  Reproduced with squat/lunge  Causes – over striding, poor shock absorption, weak quads, poor flexibility, increased Q angle Patellar tendinopathy

10.  More common in women – Patellofemoral, IT band, MTSS, Stress fracture  Common cause throughout Intrinsic »Hip/knee weakness »Leg length discrepancy Extrinsic – »Sudden increase in mileage/frequency »Change in running surface »Excessive downhill running »Footwear Patterns???

11. What is your core???

12.  Rectus abdominus  External oblique's  Internal oblique's  Transverse abdominus  Iliopsoas  Quadriceps  Paraspinals  Glut maximus  Glut med/min  Hip External rotators – piriformis  IT band  Hamstring Core

13. - Measures overall posture and balance – ankle, knee and hip working in coordinated pattern Miller, Scott. Smart Running Solution: Funtional strength tests for runners for injury-free, smart strides. Replyforal, Inc. 2011

14. - Measures core strength, Gluteus Maximus and hip/heel flexibility Miller, Scott. Smart Running Solution: Funtional strength tests for runners for injury-free, smart strides. Replyforal, Inc. 2011

15. - Measures Gluteus Medius/Minimus Miller, Scott. Smart Running Solution: Funtional strength tests for runners for injury-free, smart strides. Replyforal, Inc. 2011

16. - Proper recruitment – Hamstring, Glut, contralateral low back, ipsilateral low back Miller, Scott. Smart Running Solution: Funtional strength tests for runners for injury-free, smart strides. Replyforal, Inc. 2011

17.  Hip Flexor  Hamstring  IT band Flexibility Miller, Scott. Smart Running Solution: Funtional strength tests for runners for injury-free, smart strides. Replyforal, Inc. 2011

18. Treatment team  Physician  PT Therapy Gait Analysis  Personal trainers  Orthotist  Local running stores/clubs  Running coach

19. Training regimen  Decrease mileage = decreased wear and tear  Increase variety of workouts Hill workouts Speed workouts – 400m to mile segments Tempo runs  Increase cross training  Increase resistance trainings

20. Shoes

21. Foot Strike

23. Thank you!