Friday, May 24, 2013

Biomechanical Sources of Running Injuries


For a Sports Physiotherapist being good at assessing running technique will be as crucial as a Mechanic a chance to change engine oil. Good running technique is important for both compensation for injuries prevention, rehabilitation and performance. While there are common aspects, there are much more differences between endurance even push, sprinting and running included in field sports. For the point of this article I is extremely important primarily discussing running technique when it comes to field sports.

Many coaches continually result in the mistake of trying to train field sports athletes the same way as a track sprinter should your pursuit of increased fireplace. While there definitely are a lot of training techniques that truly borrowed, essentially the goals for speed with regards to a field sports athlete fluctuate to that of a passionate track sprinter.

Basically a location sports athlete will generally only sprint far away of about 5 shed 20m, occasionally up approximately 40m, and rarely even more, as well as needing to change direction numerous the seasons. So a field sports athlete needs to accelerate faster and reach top speed quicker, while changing direction, developing a ball or stick, fending and dodging other players plus much more tasks. Compare this to a track athlete, where they will still be accelerating well beyond the 40m mark and occasionally up to the 90m look in the 100m and there's a no changing direction.

I will even briefly talk about of your Barefoot Running phenomenon, particularly in relation to foot strike. The barefoot running craze has recently highlighted the differences amongst rearfoot, midfoot and forefoot running styles collectively with ground breaking research formerly Dr Daniel Lieberman on the evolution of running has provided a lot of insight to theory powering this. Research in terms of injury prevention and performance enhancement is lacking, however the biomechanical concept of premise that midfoot but will forefoot running styles in becoming a superior for injury prevention and performance is gaining momentum.

Swing Phase

Frontal View



  • Viewing the athlete from the front or back you can see where the foot is in relation to femur as soon as knee is flexed. If the foot is excessively on the outside of the femur, the hip and that is internally rotated. Conversely, if the foot is medial to the femur they can be externally rotated, and will also have to abduct the hip to make them don't trip over or even her feet!



  • Internally rotated hips usually are more common and also can indicative of weak highly regarded external rotators and abductors. Assessment of hip stability and strength is required. Secondly hip external rotation ROM will likely be tested, however this generally is not the cause.


Sagittal View



  • During toe off try to look for increased anterior pelvic point, as seen by an increase in lumbar extension and loss of hip extension. This compensatory movement is due to either shortened hip flexors, psoas, iliacus : rectus femoris, or less lumbopelvic instability or exhaustion, or more than likely with the multitude of the two. I assess this the time Thomas Test for stylish flexor length and there are plenty of hip extension exercises, these include, a Bird Dog raise a flexed knee, looking for compensatory lumbar extension to obtain the necessary hip extension. Athletes with this movement pattern may common to a complaint of lower back pain, with pain on lumbar extension and so they don't have back wreck they surely will do eventually in the future. Exercises to take care of this issue are intersting flexor mobility drills and glute activation and reinvigorating exercises for hip companion.



  • During the mid swing phase within the swing leg the quantity of knee flexion will change the moment arm for hip flexion of the hip joint. This skilled assistance Biomechanics; the longer several minnutes arm the more force required to move it. Picture trying to amass and Olympic bar with one hand part way through the bar, pretty recreational right? Then picture trying to pick it up with one hand within the end of the bar, unlikely I'd think. It's the equivalent weight, but now this time arm has dramatically a whole lot more. The same thing occurs on the internet hip joint and make a difference in the amount knee flexion occurring during the time. The more the knee is flexed worth spending mass of the leg nearer the hip joint, the less force would need to swing the leg produced by. Therefore if an runner is complaining of chronically tight or painful hip flexors assess the quantity of knee flexion during swing phase plus have decreased knee flexion they could be overloading their hip flexors to swing the tibia bone through.



  • Poor mechanics with arm swing generally doesn't contribute a lot to injury in field sports as much the arms widely-used to carry or manipulate a pleasing ball, stick or other apparatus or are utilized to fend off an opponent or assist a power mate. However, a set of energy can be "leaked" when kinetic chain with poor arm swing mechanics. The arm swing will likely be generated from the shoulder brace and utilise the stretch shortening reserved the shoulder flexors to operate a vehicle the arm forwards. If the arm swing is coming from the elbow this they could decrease performance, however in field outdoor activity I would think this is low on the main concern list.


Transverse View



  • To view the athletes biomechanics inside transverse plane is difficult as you ought to be looking down on the top of athlete. The easiest way to do this in the field is usually viewing them from a superior grandstand, where the athlete moves directly underneath. This is often somewhat impractical as well as a field sports athlete probably a bit of an overkill. However, if you feel you are required to determine poor biomechanics that's contributing to injury or at best poor performance, the primary component to research is the rotation of the pelvis in relation to the shoulders. Excessive rotation of the pelvis may be due to poor core juice or stability, where the core musculature is unable to control the rotation of the most pelvis. Alternatively it undoubtedly compensatory movement caused like this hip immobility, due to inadequate hip internal rotation within the extended hip, poor external rotation for the flexed hip, or a combination of both. Either way look at core stability and sensational rotation to prescribe punitive exercises.


Stance

Frontal View



  • Poor hip stability is the greatest assessed by viewing the athlete transformation front. The hip/pelvis to the stance leg, should have low lateral movement; if the hip appears to be shift laterally and a painless contralateral hip drops (trendelenburg), this is clinically a sign of poor hip control. Gluteus medius weakness tends to be the cause, however gluteus medius weakness is also and also this the entire lumbo-pelvic dependability system, so core stability and also this issue as well. This implies corrective exercises usually hide glute and core easy-guide.



  • Medial knee change, is where the leg falls to the from the foot, which can come from the foot or more you should always the hip. The knee is essentially sitting there the hip and the ankle/foot. Poor hip control then leads to internal rotation and adduction within the hip, which causes the knee to fall age line of the forefoot. In combination to the foregoing, excessive pronation of the will cause the tibia to internally rotate, which would drag the knee age foot. So, why is this medial knee collapse too little? Well, medial knee failure, is a major regarding "patellofemoral pain", which is really a general term for numerous reasons for knee pain, and probably similar concerning is a movement to finally potentially lead to a selected anterior cruciate (ACL) drag.



  • Pronation/supination has been the focus of most research in regards the running injuries and the main benefit of all shoe companies. Even though the pronation/supination research is pondered very poor and keep inconclusive; shoe companies have prompted the "over pronation causes injury" line so hard in direction of sell the anti-pronation/stability hallmarks of their shoes the past 40 years that most of us just accepted it sans questioning it.


That is until very recently when the explosion of Barefoot Running began collectively with whole idea of needing stability durring an shoe was thrown the actual window. As mentioned earlier Dr Lieberman has published research about development of running, showing that until the evolution of the modern running shoe, humans ran predominately within their forefoot and midfoot, vs . heel striking, which I will reveal during the sagittal pay a visit to stance leg section. To begin with, getting back to people supination/pronation topic, my view is unless their is easily the most obvious over-pronation or before supination, that can be observed by the naked watch, it is not the primary cause of the runner's pain. In reality the foot/ankle is a stack of joints that require on your mobility then stability, so the term designing shoes to procure external stability is counter-productive to this concept.



  • When screening the arm swing, ideally the arms will likely be moving in the sagittal jet; if the arms manage to moving excessively across our physical structures, and not straight vertical, this could result when considering inefficient force transfer employing a kinetic chain, and may increase the rotational torque through of your core, potentially over stressing the lumbar spine. Which means, in field sports if the arms are generally pre-occupied with other tasks, this would seldom be an issue.


Sagittal View



  • As mentioned earlier people explosion of Barefoot Bumping has really questioned most of the research conducted over the past +40 years into setting up and shoe design. When looking at the stance leg within ground strike, what part of the end strikes the ground first provides a lot of information.


The biomechanical theory to this in a nutshell is that when striking with the heel first quite a sharp spike in the soil reaction forces and the smaller muscles at the front end of the shin, like the tibialis anterior, eccentrically control the foot to the ground. This can cause a stress reaction from tibia, "shin splints", from the initial impact as well as the eccentric contraction can overstock these smaller muscles use cause injury. By landing more on the forefoot and mid-foot, forces are more gradually shared with the tibia and fibula and they all larger calf musculature (soleus and gastrocnemius) select a greater ability to lower the heel to the ground.



  • Stride length would be the other important factor to take when viewing an athlete produced by side on view. Over striding is commonly associated with heel striking and the combination of over striding and heel striking, places a world of stress on the technical chain. As mentioned above heel striking produces a larger ground reaction award causing bone stress pains and aches, but combine this with over striding so you massively increase the load on the hamstring. If as well as background athlete with recurrent hamstring muscle injuries, consider assessing his running means of over striding and heel bone striking.


Ideally the athlete's foot should choice the ground just in front of the body on the forefoot or midfoot. If the foot lands way out in front of the body on the heel this could cause injury and isn't an ideal running option.

Flight

The flight phase is when both feet are off the ground and is what separates running from walking. The discussion of knee flexion of the most swing leg above pertains to this area as cured.

Conclusion

Running is a most difficult and technical task to analyze and coach. My approach will be to break it down on top of segments, such as I've done above, and ensure it as simple as possible. Video is an excellent tool to assist with analysis and with better technology this is quite utilizing this. My opinion with video is that so as to slow it down or need technologically advanced software to determine the symptoms your probably looking for quite a while something that isn't liable for the problem. What Just imagine by this, is that when the problem doesn't project at normal speed it's probably not the cause. If an athlete is injured you need to consider what you find clinically and the athlete gets you familiar with the injury and combine this into the running assessment. Remember everyone has a worthwhile running technique and you will always be able to pick out something wrong, but if the accepted deficit is not similar to the injury or complaint it probably isn't the cause. From a performance enhancement watch, when dealing with pasture athletes, unless something is blatantly obvious which is often affecting performance, I wouldn't bother trying to correct it, unless I considered it a potential cause of injury, since they are not a track athlete and most likely they will go back to their old style when about the field anyway. Track athletes are obviously one more story and any a minimum of flaw in technique this is often the difference between 1st and lastly! If you have a new chronic running injury together with your Physiotherapist has not considered running technique, they are probably treating the difficulty and not what can cause your injury and until the cause is identified you are likely to remain injured.

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