Monday, December 30, 2013
Running With Pain - Part IV - So What Now?
In our previous three articles we have talked about some common orthopedic injuries with running, the role that fatigue plays on mechanics and injury rates and finally how running assessments may aid in guiding some individualized interventions. However, when looking at some of the draw backs of running assessments, to get a complete comprehensive picture, we must look at movement in a closed kinetic chain. Why?
In 2008, Dierks et al showed that runners who suffered patellofemoral pain (PFP) displayed weaker hip abductor muscles and experienced greater hip adduction moments during running than those who did not. Ironically, also in 2008, Willson et al showed these same mechanics and associated weaknesses were also present in female athletes who presented with PFP in a single leg jump. Souza et al took it one step further in 2009 to show those with PFP had decreased EMG activity of the gluteus medius which may have led to the increased internal rotation and hip adduction that was observed. In a literature review published in 2004 by Bolgla et al, proximal hip weakness could also result in increased pronation and decreased force attenuation at the foot leading to plantar fasciitis. In a comprehensive literature review in 2012, Chutter et al found strong supporting evidence of proximal hip weakness leading to knee and foot injuries. All this said, all the studies would indicate that lower limb problems (knee or foot) could be the combination of proximal (hip) or distal (foot/ankle) weakness or one or the other in isolation.
So, how do we assess this outside of a running assessment? If we know these mechanics are in fact contributing to injury and decreased performance, is there a way to assess outside of running? The biggest and most obvious question is, if assessed with a series of isolated movements in a closed kinetic chain, do these have carry over to what you would see in running? Is there a correlation? The easiest and most obvious answer is derived from the research. All of the aforementioned studies in each of these articles have started to look at the mechanics in running and then found that they correlate with what they see in the lab with isolated movements. This would lead us to believe then that if these same movements used in these studies are done in the clinic then what you see there should also correlate to what you see with running.
That is the premise of the Dynamic Movement Assessment™ or DMA™. The DMA™ is simply a battery of tests that have individually been taken from the research to aid in quantifying the movements associated with these injuries and aid in identifying the “root cause”. The following video is a perfect example of what an assessment in a closed kinetic chain can tell you. This is a Olympic track athlete (1500 m) who’s coaches tell us they have had difficulty breaking through a given time barrier. They see when she is running that her mechanics are bad and have been attempting to improve with training. She also complains of knee pain that progressively gets worse during the season and which has progressed to include low back (SI joint pain). After performing this test in conjunction with the battery of DMA™ tests, we were able to identify the root cause. For her and her coaches, this has meant decreased knee and SI pain and improved sprint speed and decrease 1500 m times.
After assessing 1000s of athletes’ movements, there are some common themes that can be identified. As such, there are some exercises that most athletes will benefit from and which work on a core of mobility and neuromuscular retraining. The easiest to implement into any training program is the dynamic stretches. These are typically used as a neuromuscular setting and mobility exercise that is performed prior to training. The term stretches often leads people to the misconception that these will be easy. However, if performed with proper technique, these will work on mobility, strength, endurance and proprioception. The key is proper form. To help with proper form, we are including instructional videos of each of the exercises where we will walk through the exercise as well as what to look for and what to avoid.
This first of these videos is the Dynamic Lunge Stretch. This is a great stretch for overall mobility of the hips and key for proprioception of the entire lower kinetic chain. Improvement here will aid with mobility but also aid in improving proprioception and control of the entire lower kinetic chain. The key with this movement is ensuring you are doing it correctly. If this is performed incorrectly with improper technique, this will simply strengthen your poor movements and not aid in decreasing injury rates or improve performance. This video is 2 minutes in length and with a lot of instruction on technique.
The second video is theDynamic Sumo Stretch.This is a great stretch for overall mobility of the hips and hamstring flexibility. This is also a key movement to work on mobility and stability of the lower lumbar spine. The key with this movement is ensuring you are doing it correctly.If this is performed incorrectly with improper technique, this will simply strengthen your poor movements and not aid in decreasing injury rates or improve performance.This video is also 2 minutes in length and with a lot of instruction on technique.
The final video is Side Stepping with a Theraband which is a very basic gluteus medius strengthening exercise. Although this is a very basic exercise and one that is used frequently, it is also one that is performed incorrectly most of the time. If performed correctly, this is a great exercise for the G.med, core and quads. If using with clients, when this is combined with perturbations to the hips, core and knees, this can become a very intensive exercise for the entire lower kinetic chain.
Hopefully you have found this series of articles helpful and useful. Check back to our blog often as each week we will be providing more literature reviews, exercise videos, etc.