2. Flying Pig Marathon Injury Prevention and Management Presented by: Sachin Patel and Brian Nash

3. PURPOSE The purpose of today’s lecture is to educate you about injuries that are related to running and how to prevent them. It is not intended to treat, diagnose or cure any injury you may have. Only a trained provider can make a definitive diagnosis and treatment plan.

4. Purpose This one hour lecture will focus on common running injuries with a special interest paid to injuries most commonly found amongst those who have run and trained for the Flying Pig. This one hour lecture will focus on common running injuries with a special interest paid to injuries most commonly found amongst those who have run and trained for the Flying Pig. Cincinnati's unique topography plays a huge role in certain running related injuries and we wish to touch upon that tonight. Cincinnati's unique topography plays a huge role in certain running related injuries and we wish to touch upon that tonight.

5. Sachin Patel DC Board Certified Chiropractic Physician Board Certified Chiropractic Physician Fully Certified ART provider Fully Certified ART provider Certified Functional Medicine Practitioner Certified Functional Medicine Practitioner Certified Kinesiologist Certified Kinesiologist Additional training in: Additional training in: Nutritional supplementation Nutritional supplementation Functional Diagnostic Medicine Functional Diagnostic Medicine Environmental and Household Toxins Environmental and Household Toxins Gait and Biomechanical analysis Gait and Biomechanical analysis Assessment and Management of shoulder injuries Assessment and Management of shoulder injuries

6. Brian Nash Avid runner and marathoner Avid runner and marathoner One of the assistant coaches for the Pig training group One of the assistant coaches for the Pig training group Flying Pig Streaker – Training for #10 Flying Pig Streaker – Training for #10

7. History and overview of the Flying Pig Marathon Course http://www.flyingpigmarathon.com/race_information/course/

8. Common Runner’s Complaints Shin Splints Shin Splints Plantar Fascitis/Heel Spurs Plantar Fascitis/Heel Spurs Achilles Tendonitis Achilles Tendonitis Pulled Hamstring(s) Pulled Hamstring(s) Low back pain Low back pain Calf Pain Calf Pain IT Band syndrome IT Band syndrome Hip pain Hip pain Stress fractures Stress fractures

9. Flying Pig Data Raw data collected from the 2007 Flying Pig Marathon (Cincinnati, Ohio) lists the top 7 complaints reported by marathon runners of variable age and skill level. This data only represents those that sought help post completion of the race. Data was collected based on subjective complaint(s). 1Calves24.4% 2Hamstring13.5% 3Knee11.5% 4Hips10.3% 5Feet7.1% 6 IT Band 5.8% 7Shins4.5%

10. Achilles Tendonitis Second most common reported running injury Second most common reported running injury Strongest tendon in the body (steel cable) Strongest tendon in the body (steel cable) Pain 1.5 inches above the heel Pain 1.5 inches above the heel May be torn or inflammed May be torn or inflammed Can be painful when running/walking Can be painful when running/walking Better with rest and ice Better with rest and ice Occur in runners with a floppy or rigid foot Occur in runners with a floppy or rigid foot

11. Causes of Achilles Tendonitis Rigid Foot (high arch) Rigid Foot (high arch) Use the foot as a strong lever, stressing the tendon throughout the movement Use the foot as a strong lever, stressing the tendon throughout the movement Sloppy Foot (Flat foot) Sloppy Foot (Flat foot) Runners who pronate will overstress the inside of the tendon Runners who pronate will overstress the inside of the tendon Hills, speedwork, and negative heel shoes all put more pressure on the achilles tensdon Hills, speedwork, and negative heel shoes all put more pressure on the achilles tensdon Tight calves, hamstrings, plantar fascia and poor footwear are common causes Tight calves, hamstrings, plantar fascia and poor footwear are common causes

12. Calf Pain Pain in the back of the lower leg Pain in the back of the lower leg Often linked to hamstring and achilles injuries or dysfunction Often linked to hamstring and achilles injuries or dysfunction Fascial adhesions between gastroc, soleus, flexor digitorum or flexor halicus can result in slow recovery Fascial adhesions between gastroc, soleus, flexor digitorum or flexor halicus can result in slow recovery Pain worse when running up hills Pain worse when running up hills Tightness and cramping, sometimes severe Tightness and cramping, sometimes severe Stretching may only helps temporarily if root cause is not addressed Stretching may only helps temporarily if root cause is not addressed

13. Causes of Calf Pain Uphill running Uphill running Lack of stretching Lack of stretching Increased mileage Increased mileage Over pronation Over pronation Poor hydration Poor hydration Poor footwear Poor footwear Short leg Short leg Inadequate flexibility Inadequate flexibility Fatigue Fatigue DVT DVT Varicose veins Varicose veins

14. Hamstring Injuries Pain usually near the proximal attachment (pain in the butt) or in the middle of the back of the thigh Pain usually near the proximal attachment (pain in the butt) or in the middle of the back of the thigh Pain may throb during and after running Pain may throb during and after running Often caused when muscle is “cold” Often caused when muscle is “cold” Continuous or intermittent pain when running Continuous or intermittent pain when running Symptoms tend to worsen with speed work and uphill runs Symptoms tend to worsen with speed work and uphill runs Will affect running mechanics and lead to further injuries Will affect running mechanics and lead to further injuries Can mimic nerve pain (sciatica) Can mimic nerve pain (sciatica)

15. Causes of Hamstring Injuries Insufficient stretching pre and post exercise Insufficient stretching pre and post exercise Overworking a weak muscle Overworking a weak muscle Excessive hill or speed work (up or down hill) Excessive hill or speed work (up or down hill) Running on sloped roads (over stretches) Running on sloped roads (over stretches) Tight hip flexors (muscle imbalance) Tight hip flexors (muscle imbalance) Over pronation Over pronation Muscle fatigue Muscle fatigue Re-current injury Re-current injury KGJ – Torn hamstring in 2001, 2002, 2004 KGJ – Torn hamstring in 2001, 2002, 2004 Pelvic dysfunction Pelvic dysfunction

16. Hip Pain Pain in femuro-acetabular joint Pain in femuro-acetabular joint Pain may refer to groin or down leg Pain may refer to groin or down leg Pain worse with loading or laying on the hip Pain worse with loading or laying on the hip Better with rest, worse with activity Better with rest, worse with activity Pain may be sharp, dull, stabbing or achy Pain may be sharp, dull, stabbing or achy Pain deep in hip joint Pain deep in hip joint

17. Causes of Hip Pain Arthritis Arthritis Muscular imbalances Muscular imbalances Overtraining Overtraining Capsulitis Capsulitis Muscular sprain/strain Muscular sprain/strain Stress fracture Stress fracture Pinched nerve Pinched nerve Short leg Short leg Bursitis Bursitis

18. Plantar Fascitis Pain in the front of the heel and arch Pain in the front of the heel and arch “12 steps of death” “12 steps of death” Can be very painful Can be very painful Can be uni or bi-lateral Can be uni or bi-lateral

19. Causes of Plantar Fascitis Poor Footwear Poor Footwear Flat foot/fallen arch Flat foot/fallen arch High arch High arch Overuse Overuse Bone spur Bone spur Tight calves Tight calves Tight hamstrings Tight hamstrings Poor mechanics Poor mechanics Weak intrinsic foot muscles Weak intrinsic foot muscles Running up-hill Running up-hill

20. Shin Splints Very common in new runners or seasonal runners Very common in new runners or seasonal runners Pain along the front of the shin, typically comes on a few minutes into the run Pain along the front of the shin, typically comes on a few minutes into the run Can go away shortly after running Can go away shortly after running Can cause numbness in the leg if severe enough Can cause numbness in the leg if severe enough Can be very, very painful and tender along front of shin Can be very, very painful and tender along front of shin Need to address root cause of the problem Need to address root cause of the problem

21. Causes of Shin Splints Pes planus (flat feet) Pes planus (flat feet) High Arch High Arch Over pronation Over pronation Weak Tibialis Anterior/posterior Weak Tibialis Anterior/posterior Tight hamstrings Tight hamstrings Tight calf muscles Tight calf muscles Poor/worn out footwear Poor/worn out footwear Running Pitch Running Pitch Downhill running Downhill running Running Downhill Running Downhill

22. ITB Syndrome Pain in outside of knee(s) or hip(s) Pain in outside of knee(s) or hip(s) Tightness in tendon will cause friction at knee or hip irritating the surrounding tissue Tightness in tendon will cause friction at knee or hip irritating the surrounding tissue Snapping at hip or knee is sometimes present Snapping at hip or knee is sometimes present Pain can come on during run and alleviated by rest in mild cases Pain can come on during run and alleviated by rest in mild cases

23. Causes of ITB Syndrome Poor footwear Poor footwear Pitch in road Pitch in road Weak abductors, weak glut max and med. Weak abductors, weak glut max and med. Overuse Overuse Overcorrection of pronation issues Overcorrection of pronation issues Flat feet Flat feet Tight lateral compartment of thigh Tight lateral compartment of thigh Poor pelvic function Poor pelvic function Short leg Short leg

24. Low Back Pain Low back pain may occur during or after a run Low back pain may occur during or after a run Multi-factorial in etiology Multi-factorial in etiology Pain may shoot into legs, buttock, foot, shoulder or groin Pain may shoot into legs, buttock, foot, shoulder or groin Pain may be sharp, dull, achy, burning Pain may be sharp, dull, achy, burning Low back may be a victim of dysfunction of hips, knees or ankles Low back may be a victim of dysfunction of hips, knees or ankles

25. Causes of Low Back Pain Multitude of causes Multitude of causes Short leg Short leg Lack of stability Lack of stability Lack of mobility Lack of mobility Lack of pelvic rotation Lack of pelvic rotation Pathological Pathological Scoliosis Scoliosis Mechanical Mechanical Muscular imbalance Muscular imbalance Structural predisposition Structural predisposition Arthritis Arthritis Lumbar disc Lumbar disc

26. Prevention Prevention is easier and more cost effective then intervention Prevention is easier and more cost effective then intervention Use appropriate training technique Use appropriate training technique Get a god pair of shoes that suit your foot mechanics Get a god pair of shoes that suit your foot mechanics Be sure to stretch and warm up prior to and during run Be sure to stretch and warm up prior to and during run Run on soft even surfaces when possible Run on soft even surfaces when possible Stretch and ice post running (regardless of pain) Stretch and ice post running (regardless of pain) NSAIDS will inhibit healing, avoid taking prior to running NSAIDS will inhibit healing, avoid taking prior to running Proteolytic enzymes to reduce inflammation while allowing healing to occur Proteolytic enzymes to reduce inflammation while allowing healing to occur Glucosamine HCl as a dietary supplement to proactively maintain joints Glucosamine HCl as a dietary supplement to proactively maintain joints Rest – allow your body to heal Rest – allow your body to heal Sleep – 6-8 hours to allow body to repair Sleep – 6-8 hours to allow body to repair Fish oil to reduce imflammation – 1-2 capsules with each meal Fish oil to reduce imflammation – 1-2 capsules with each meal Ensure your footwear is appropriate for your foot mechanics Ensure your footwear is appropriate for your foot mechanics Ensure proper spinal and extremity mobility Ensure proper spinal and extremity mobility Hydration and minerals….0.5 oz per pound of body weight Hydration and minerals….0.5 oz per pound of body weight

27. Treatment Chiropractic manipulation and ART to restore function of spine, hip, knee and ankle joints as well as their surrounding soft tissue Chiropractic manipulation and ART to restore function of spine, hip, knee and ankle joints as well as their surrounding soft tissue Address any issues with footwear Address any issues with footwear Orthotics or insoles to address foot mechanics Orthotics or insoles to address foot mechanics PT to strengthen the weak muscles PT to strengthen the weak muscles Stretch tight muscles and capsules Stretch tight muscles and capsules Rest, ice, compression, elevation Rest, ice, compression, elevation Proper dietary and supplementary nutrition Proper dietary and supplementary nutrition

28. Injury Summary Uphill Injuries Gluts Hamstrings Calves Achilles Tendon Plantar Fascia Downhill Injuries Shin Splints IT Band Knee and Quad

29. Course Analysis

40. Contacts Sachin Patel – Norwood Chiropractic 513 531 2277 patelchiropractic@yahoo.com www.norwoodchiropractic.comwww.ilovebeinghealthy.blogspot.com Brian Nash - “echoguy” on the Flying Pig forum, www.flyingpigmarathon.com. Brian Nash - “echoguy” on the Flying Pig forum, www.flyingpigmarathon.com. www.flyingpigmarathon.com Bob Roenker’s Running Spot Bob Roenker’s Running Spot 513 321 3006