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PREVENTION OF RUNNING INJURIES

It is two months away from the 25th Steamtown Marathon. This column is dedicated to those dedicated runners preparing for the big day, Sunday, October 9, 2022.

Congratulations and thank you to Bill King, founder and race director, and his band of brothers, for their tireless efforts organizing and sustaining a great race that instills pride for all people of NEPA. It has inspired many people, including me, to transfer the discipline and determination required to complete a marathon by overcoming challenges one mile at a time.

Now, a little marathon history: In 490 B.C. Phedippides, ran 25 miles from Marathon to Athens to deliver an important military message and died immediately. Ironically, the first marathon of the modern Olympic Games in 1896 in Athens was won by Spiridon Louis, a humble Greek peasant, who stopped along the way for a glass of wine and told the owner of the tavern that he would win the race. He was determined to pace himself properly, as he knew the dusty, hilly path better than anyone in the field. He was greeted with jubilation and become a hero and legend.

HOW TO PREVENT RUNNING INJURIES

Avoid the “terrible too’s”

Only run miles needed to meet your goals

Avoid inconsistent training

Avoid repeating hard workouts without any easy workouts in between

Consider cross training to avoid overtraining without compromising fitness level

Treat your feet right

Visit your doctor regularly and listen to your body. 

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

For all of Dr. Mackarey's articles visit: www.mackareyphysicaltherapy.com/forum

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

Spring is just around the corner so it is time for running enthusiasts to lace up their sneakers, get outside and run! Runners are addicted to running for good reason. There is nothing like it! No exercise offers so much in such little time. For example, the caloric expenditure while running is higher than for most other exercises, including biking. Also, it allows for fresh air and beautiful scenery with a minimal investment in clothing or equipment.  It requires little skill and time to learn. Runners suffer from less depression, colds and flu symptoms, and experience less pain due to an endorphine release (natural chemical in the brain associated with euphoria and pain control) that is greater than found in other sports and activities. These are some of the motives that cause people to run every day, in spite of the constant loading and wear and tear on the joints.

To be a competitive runner and have longevity in the sport, optimal form is necessary. Moreover, a recent study shows that a runner can decrease the stresses on the lower body and reduce the incidence of stress fractures when trained to run with proper form using visual feedback while on a treadmill. The application of this information has significant implications for training programs for runners for the prevention and recovery from injury. One such low impact method is called the “Pose Running Technique,” by Dr. Nicholas Romanov. It is a “soft landing” method which promotes; an S-like body position with slightly bent knees, a slightly forward lean at the ankles to employ gravity and momentum, lifting the feet up under the hips, and landing on the ball of the foot under the body to absorb the center of mass.

It is my opinion, that the best runners, with the least injuries, such as Jordan Hoyt, speedster from Abington Heights, employ these techniques naturally. Additionally, many of the world’s best runners use coaches and trainers to assist them in their quest for success and injury prevention by using perfect form. However, for the rest of us, we must learn to maximize the efficient use of the body as it works with, not against gravity. We must learn to run “soft” to prevent injuries.

PROPER FORM

Head Position

A slight upward tilt of the head to allow a view of the horizon ahead should be most comfortable. Avoid looking down or up to extremes. Do not rock or rotate the head while running.

Shoulder Position

Loose and relaxed shoulders set the tone for a good run. Keep them level without tilting side to side or rotating left to right.  Avoid holding the shoulders in a tight and high position.  

Arms

Loose and relaxed arms also set the tone for a good run. A good arm swing is always in forward motion in a linear direction and stays between the waist and lower chest. Never clench the fist. Do not rotate or twist the arms across the body.

Torso

If the head, shoulders and arms are in correct position, then the torso will be upright. An erect running posture is necessary to promote efficient movement and breathing. The posture that you assume when taking a deep breath is the correct torso position for good breathing while running. 

Hips

The hips will follow the position of the parts above in a linear forward direction. However, if the torso leans forward because the head hangs down then the hips will tilt downward. If the arms swing and torso rotates side to side, then the hips will also rotate.

Legs/Stride

Sprinters need to lift the knees high to thrust the lower legs forward. Long distance runners cannot maintain a high knee lift for a long period of time, however, a slight knee lift with a shorter but quicker stride is more efficient. Proper running requires the foot to softly strike the ground with the knee slightly bent. If the knee is fully extended in front of the body upon impact, the stride is too long and the force too great.

Ankles/Feet

To excel as a runner, when the foot hits the ground it should land lightly, between the heel and the midfoot. The ankle is flexed and rolls quickly forward to the toes to push off the ground with maximum force. The calf muscle propels the runner forward. Efficient running has a quiet and springy landing. A loud foot slap on impact is a sign of poor form and results in excessive force transferred to the lower leg. The foot should spend as little time as possible in contact with the ground…thus a soft runner “floats” when they run.

SOURCES: Runner’s World, Pose Running Technique (www.posetech.com), Journal of Orthopaedic and Sports Physical Therapy.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.

OVERTRAINING CAN LEAD TO STRESS FRACTURES

After enduring the challenges of a cold and snowy winter, late spring and early summer is the time of year when long distance runners ramp up their training in preparation for the some of the best half and full marathons in the fall: Steamtown, Philadelphia, New York, Marine Corps in DC to name a few. But, runners beware; overtraining can lead to stress fractures.

I would like to introduce this topic with some marathon history. In 490 B.C. Athens was under attack by the Persians and was outnumbered more than two to one. The Athenians fought bravely and defeated the enemy in the town of Marathon to keep the intruders 26 miles away from their families in Athens. To keep the anxious citizens of Athens calm, leaders immediately ordered a foot soldier, Phedippides, to the capital to share the news. Phedippides ran, in full armor, for 26 miles from Marathon to Athens, delivered the message and died immediately. Now, people do the same thing of their own free will!

In the modern age, marathon and recreational runners enjoy testing their mental and physical stamina in pursuit of fitness and wellness. If not careful, many runners (and other competitive athletes) will develop pain in their shins (shin splints). Unfortunately, in many of these well-intended athletes, this problem can lead to a much more severe and advanced problem with shin splints called a stress fracture. Some very good athletes have been hindered by this problem.

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk?

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.           

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Causes of Stress Fractures

  1. Overuse, Overload, Overtraining – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
  2. Inadequate Fitness Level – or inadequate activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program too quickly for cross-country in August/September.
  3. Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
  4. Recent Change in Training Schedule – sudden increased intensity or speed
  5. Recent Change in Running Surface – sudden change to a hard or soft surface
  6. Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
  7. Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
  8. Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
  9. History of Stress Fractures – makes the athlete two times as likely to have another

Treatment & Management

  1. Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
  2. Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
  3. Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
  4. Gradual Change in Training Schedule
  5. Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
  6. Gradual Change in Footwear – walk in new shoes first, then run 1-2 miles
  7. If Overweight – gradual exercise with diet, not too much too quickly. Mix run & walk every 10 minutes
  8. If Underweight – improve diet maintain healthly body fat%
  9. Consult Family Physician – Early management often involves immobilization, rest, pain medicine 4-6 weeks for healing. non weight bearing cross training such as the recumbent bike, swimming, elliptical.
  10. Physical Therapy- Physical therapy modalities such as ultrasound, cold with electrical stimulation, biomechanical taping or orthotic supports, and exercises for foot, ankle muscles.

Visit your doctor regularly and listen to your body.

NEXT MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!”  

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

To read all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.