Running Strong
Monday October 26, 2009
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“I don’t like to write anyone off,” says Kirsten Gleeson, PT, who works at Dartmouth-Hitchcock Medical Center in New Hampshire. “That said, running can be a double-edged sword. Most of us have the capacity to run, but we don’t always get the immediate feedback when we’re doing it wrong that comes with other sports. Many people who take up running may not be ready for it biomechanically, or may be unaware of the stress their body will undergo every step of the way.”
Recognizing Risk
Kevin Rausch, PT, owner of Rausch Physical Therapy & Sports Performance in Laguna Niguel, Calif., has identified two categories of runners who tend to have trouble. “One group is females who’ve given birth in the past two or three years,” he notes. “They often go back to running without doing much core or flexibility training, and end up having quite a bit of IT band or SI joint pain. It all has to do with how weak and unstable they are in their core and hips.”
“The other group is comprised of young people of junior or high school age who are, again, weak and unstable at hips and core so that they just can’t run correctly; they have very poor mechanics. They may end up with anterior knee pain, patellofemoral syndrome — the so-called ‘runner’s knee’ — and other problems,” Rausch says.
For those with running injuries, treating the damage is the first course of action. But once healing is complete, patients must often be retrained in how to run, Rausch says: “If they go back to running and the therapy hasn’t addressed their mechanics, they’ll end up back in the office within six weeks with the same exact problem.”
Undiagnosed biomechanical issues aren’t limited to just novices, Gleeson observes. “I work with a few patients who are excellent athletes but have injuries that keep hampering them,” she says. “When I test their muscle strength and flexibility, I find some very profound muscle imbalances that are probably being compensated for when they run, but which are certainly not helping them.”
A host of biomechanical factors can contribute to running injuries, including genu varum and the more common problem, genu valgus. Associated with an excessive Q-angle, the valgus condition creates stress and shearing across the patellar tendon and a shortening effect at the iliotibial band, causing chronic irritation and inflammation.
Although a severe valgus angle may contraindicate safe recreational running, specific stretches to elongate soft tissue structures may be helpful to reduce symptoms. Too much foot supination or pronation can be problematic as well, but can be successfully treated with supportive orthoses.
To show patients how their running mechanics may be working against them, Rausch uses the V1 biomechanical analysis system. “We put them on a treadmill with a video camera so they can watch a real-time image of themselves running,” he explains. “We can draw lines on the display that represent targeted positions and have them try to keep their knees inside those lines as they run. Patients respond well to that kind of real-time biomechanical feedback — it’s really neuromuscular re-education at its most basic.”
Varying Routines
Even older age shouldn’t prevent people from running, as long as they vary their routines and there are no exacerbating factors such as osteoarthritis, Rausch says. Mixing running with other forms of exercise is a must for anyone, Gleeson agrees, because it makes the body move in many different ways, helping avoid repetitive stress injuries.
“Our ancestors walked on varied terrain, but today we spend most of our time on hard, flat surfaces such as asphalt and concrete,” she observes. “My bias is toward trails, whether it’s hiking, walking, or running.”
Running may be the most effective form of cardiovascular exercise, but Rausch admits that patients with chondromalacia or osteoarthritis might be better served by working out in other ways as well. “If you have that kind of diagnosis, it would probably be best to spend more time walking or doing the elliptical rather than putting in heavy mileage on your knees,” he says.
“Those exercises, as well as things like biking and swimming, put much less strain on joint surfaces.” Patients with severe structural deformities may also be advised to switch to lower impact activities.
Rausch has established an injury prevention program at his clinic, using run/gait analysis and a mini musculoskeletal exam to pinpoint potential problem areas for runners. He then recommends either a preventive or corrective exercise program that allows clients to run with less danger of injuring themselves.
“It’s much more enjoyable to prevent injuries than to treat them after they’ve already happened,” he says.
Mark Cantrell is a medical writer for the Gannett Healthcare Group.
To comment, e-mail pteditor@gannetthg.com.
