Healthy Running Healthy Running The Body in BalanceThe Body in Balance

The Biomechanics of The Biomechanics of RunningRunning

Kinetic ChainKinetic Chain Running transfers force Running transfers force

of the foot hitting the of the foot hitting the ground up the kinetic ground up the kinetic chain to the knee, hip, chain to the knee, hip, pelvic region, lower back pelvic region, lower back and to the upper back and to the upper back and cervical regionand cervical region

Abnormal and Abnormal and inefficient movement inefficient movement can cause injury to can cause injury to joints and soft tissue joints and soft tissue facilitating adaptation facilitating adaptation to running and loss of to running and loss of performance performance

Gait AnalysisGait Analysis

Kinetic ChainKinetic Chain When the foot hit the When the foot hit the

ground force is ground force is transmitted up the leg transmitted up the leg to the trunkto the trunk

Distribution of forces is Distribution of forces is critical to safe and critical to safe and effective runningeffective running

Abnormal balance to Abnormal balance to the forces leads to the forces leads to injuriesinjuries

Walking Gait Analysis Walking Gait Analysis

The stance phase is the period where the foot is in contact with The stance phase is the period where the foot is in contact with the ground and equates to 60% of the cycle when the ground and equates to 60% of the cycle when walkingwalking. The . The swing phases makes up the remaining 40%. swing phases makes up the remaining 40%.

During walking there is a period called double stance, where both During walking there is a period called double stance, where both feet are in contact with the ground. The swing and stance phases feet are in contact with the ground. The swing and stance phases can be further divided into:can be further divided into:

StanceStance Heel strike - The point when the heel hits the floor Heel strike - The point when the heel hits the floor

Foot flat - The point where the whole of the foot comes into contact with the Foot flat - The point where the whole of the foot comes into contact with the floor floor

Mid stance - Where we are transferring weight from the back, to the front of Mid stance - Where we are transferring weight from the back, to the front of our feet our feet

Toe off - Pushing off with the toes to propel us forwards Toe off - Pushing off with the toes to propel us forwards

Gait AnalysisGait Analysis

SwingSwing Acceleration - The period from toe off to maximum knee flexion in Acceleration - The period from toe off to maximum knee flexion in

order for the foot to clear the ground order for the foot to clear the ground

Mid-swing - The period between maximum knee flexion and the Mid-swing - The period between maximum knee flexion and the forward movement of the tibia (shin bone) to a vertical position forward movement of the tibia (shin bone) to a vertical position

Deceleration - The end of the swing phase before heel strikeDeceleration - The end of the swing phase before heel strike

When running, a higher proportion of the cycle is swing phase as When running, a higher proportion of the cycle is swing phase as the foot is in contact with the ground for a shorter period. the foot is in contact with the ground for a shorter period.

Because of this there is now no double stance phase, and instead Because of this there is now no double stance phase, and instead there is a point where neither feet are in contact with the ground, there is a point where neither feet are in contact with the ground, this is called the airborne or flight phase. As running speed this is called the airborne or flight phase. As running speed increases, stance phase becomes shorter and shorter. increases, stance phase becomes shorter and shorter.

Running Cycle

The running cycle is composed of a Swing Phase

Initial Swing: Commences at toe-off and ends at mid-swing Terminal Swing: commences at mid-swing and ends at foot

strike Stance Phase

Absorption: commences at foot strike and ends mid-stance Propulsion: Commences at mid-stance and ends at toe off

These two phases take up 40-60% of the running cycle Airborne period that are when both feet are off the

ground occur at beginning and end of each swing phase

Running Cycle

Hip, Pelvis and Back 25% to 35% of all running injuries are

estimated to be in this region. That leaves the knee, ankle and foot to be responsible for 65-75% of the injuries.

Gait analysis have been shown to be able to pick up improper of inefficient movement patterns while running and to allow for the establishment of an exercise program to correct these abnormalities

Gait Analysis and hip, pelvis and back injuries Review

Slocum and Bowerman first to document that the position of the pelvis is the key to postural control. Gait Analysis was used in their studies

Gracovetsky and colleagues also moved the biomechanical study of hip, pelvis and low back injuries while running to the forefront

Improper alignment and or movement of the hip, pelvis and lower back can lead to debilitating injuries that can include:

Groin Injuries Hamstring Injuries Piriformis Injuries Back Spasms/hip flexor

spasms Runners Hip injuries

Gait Analysis and the hip, pelvis and low back

Pelvic Movement and running

The Anterior and Posterior tilting of the pelvis when running is noted to increase as the speed of running increases

To improve efficiency and endurance the amount of tilting is to be minimized

Gait Analysis and the hip, pelvis and low back

Hip movement and running As speed increases a reduction in

hip extension is seen and an increase in hip flexion is noted. This occurs at the toe off period of the cycle

Increase hip flex will increase stride length and increase overall speed

Hip extension is limited by the hip joint capsule

Noting an increase in hip flexion at time of foot strike at slower speeds allows for improved absorption at this point of the gait pattern

The maximum values of hip extension during running approaches the limits of passive hip extension.

Gait Analysis and the hip, pelvis and low back

Trunk Position It is thought that the lumbar

spine is the pivotal point of the lower extremity lever system during running

Movement of the lower limb backwards during stance phase is thought to commence with extension of the lumbar spine.

This anterior tilts the pelvis which effectively increase the working range of extension and contributes to the extension thrust mechanism of the lower extremity.

These finding support that the trunk should be in an erect position in early phases of stance

Pelvic Obliquity and trunk movement

At time of foot strike the pelvis obliquity is aligned being slightly higher on the stance side and lower on the swing side.

Pelvic Obliquity is thought to play a role in shock absorption and in smooth ascent and decent of the bodies center of gravity at this time

In stance phase the hip adducts (absorption) and into abduction during (propulsion)

Pathologies and Running

Muscle Imbalance, ineffective and inefficient running technique can lead to injuries to any aspect of the kinetic chain Spine Hips Knees Ankles Foot

Healing CycleHealing Cycle

Inflammation (4-6 Days)Inflammation (4-6 Days) Therapy most effective to decrease inflammatory cycle Therapy most effective to decrease inflammatory cycle

and to facilitate next stage of healingand to facilitate next stage of healing Remodeling (5-21 Days)Remodeling (5-21 Days)

Therapy applied here allows for the injured area to be Therapy applied here allows for the injured area to be stressed in a slow and graded fashion (slow progression stressed in a slow and graded fashion (slow progression of appropriate stress)of appropriate stress)

Maturation (20+ Days)Maturation (20+ Days) Critical area to develop injured tissues (apply appropriate Critical area to develop injured tissues (apply appropriate

stress) and proper balance to avoid further injuriesstress) and proper balance to avoid further injuries Key is to avoid the Chronic Inflammatory Key is to avoid the Chronic Inflammatory

Cycle Cycle

When to get help?When to get help?

Not always clearNot always clear If pain reappears If pain reappears

time and time time and time again rest is not again rest is not the solutionthe solution Balance of Balance of

musculaturemusculature FlexibilityFlexibility

Rehabilitation of the Rehabilitation of the Ankle-Foot ComplexAnkle-Foot Complex

Forces at the footForces at the foot Therapist must first Therapist must first

address the position address the position of the foot and of the foot and provide the proper:provide the proper:

FlexibilityFlexibility MobilityMobility Strength Strength Strength and control Strength and control

to the upper leg and to the upper leg and trunktrunk

Pronation of the FootPronation of the Foot

How mal-alignment affect How mal-alignment affect the entire bodythe entire body

Rehabilitation of the Rehabilitation of the KneeKnee

Knee JointKnee Joint Middle joint of the Middle joint of the

kinetic chain kinetic chain High level of three High level of three

dimensional forcesdimensional forces Requires high level of Requires high level of

ligaments and muscular ligaments and muscular supportsupport

Patella position and Patella position and smooth movement is smooth movement is critical to proper critical to proper functionfunction

Rehabilitation of Pelvic Rehabilitation of Pelvic InjuriesInjuries

Force transmitted to Force transmitted to the Sacral Joint and the Sacral Joint and lumbar regionlumbar region Three dimension forces Three dimension forces

on jointon joint Key Stone of lower Key Stone of lower

trunk core stabilitytrunk core stability Low back imbalance Low back imbalance

can present can present radiculopathy that can radiculopathy that can mask true problemmask true problem

Rehabilitation of Hip Rehabilitation of Hip InjuriesInjuries

Hip jointHip joint Ball and socket jointBall and socket joint High level of High level of

stabilitystability Limited mobilityLimited mobility Critical for straight Critical for straight

hip controlhip control Balance of Balance of

musculature musculature flexibility and flexibility and strength is essentialstrength is essential

Strengthening Requires Strengthening Requires BalanceBalance

Note the complexity Note the complexity of the musculature of the musculature alignmentalignment

Note muscles are Note muscles are not aligned in a not aligned in a linear fashion but linear fashion but more obliquemore oblique

Design promotes Design promotes rotational rotational component of component of movementmovement

Rehabilitation of the Thigh and Rehabilitation of the Thigh and hiphip

straight Hip Controlstraight Hip Control Injury to the lower Injury to the lower

extremityextremity Pain to an area is not Pain to an area is not

always the true always the true source of the source of the problemproblem

Rest not always the Rest not always the cure to the problemcure to the problem

Assessment essential Assessment essential to find source and to find source and avoid further injuryavoid further injury

Upper Body Upper Body involvement in Runninginvolvement in Running

BalanceBalance Coiling movement Coiling movement

of the bodyof the body Efficiency of Efficiency of

MovementMovement Propulsive forcePropulsive force Breaking forceBreaking force

Stretches Stretches

If you have a running If you have a running injury, The Do's and Don'tsinjury, The Do's and Don'ts

DODO Rest, ice, and elevate the leg (if that's what you injured!)Rest, ice, and elevate the leg (if that's what you injured!)

DODO Reduce your mileage to a pain free amount, even though it may be a blow to your ego. Reduce your mileage to a pain free amount, even though it may be a blow to your ego.

DODO Cross-train to maintain your overall fitness level with exercise such as biking, or swimming or Cross-train to maintain your overall fitness level with exercise such as biking, or swimming or perhaps stair climbing.perhaps stair climbing.

DODO Trust and listen to yourself. Irritability, fatigue, insomnia, severe muscle soreness, and getting Trust and listen to yourself. Irritability, fatigue, insomnia, severe muscle soreness, and getting colds and flu easily may me signs that you are overtraining. colds and flu easily may me signs that you are overtraining.

DODO Progress at a naturally comfortable rate. Progress at a naturally comfortable rate.

DODO See a doctor, physical therapist, or other health professional who you trust. If they can't help you, See a doctor, physical therapist, or other health professional who you trust. If they can't help you, they probably know someone who can.they probably know someone who can.

DODO Warm up by walking or jogging slowly for at least five minutes. Warm up by walking or jogging slowly for at least five minutes.

DODO Cool down slowly at the end of your run by walking at least five minutes.Cool down slowly at the end of your run by walking at least five minutes.

DODO Stretch before and after every run, especially the Achilles tendon, hamstrings, and quadriceps. Stretch before and after every run, especially the Achilles tendon, hamstrings, and quadriceps. Remember the best time to stretch is after you run when the muscles are pliable.Remember the best time to stretch is after you run when the muscles are pliable.

DODO Get on a weight training program to strengthen muscles around the hip, knee, ankle, and Get on a weight training program to strengthen muscles around the hip, knee, ankle, and abdominal area. This may take some of the shock away from the knee and hips.abdominal area. This may take some of the shock away from the knee and hips.

If you have a running If you have a running injury, The Do's and injury, The Do's and

Don'tsDon'tsDON'TDON'T

Run though the pain. Your body is trying to tell you Run though the pain. Your body is trying to tell you something–listen to it.something–listen to it.

DON'TDON'T

Think you have to give up running. There's help out there!Think you have to give up running. There's help out there!

DON'TDON'T

Ignore the problem. If you do, it is more likely to come back. Ignore the problem. If you do, it is more likely to come back. Or get worse.Or get worse.

DON'TDON'T

Think that someone else can fix your problem. Physical Think that someone else can fix your problem. Physical therapists and others can help a great deal, but therapists and others can help a great deal, but the ultimate the ultimate responsibility for being injury free is yours!responsibility for being injury free is yours!

Contact InformationContact Information

Dr. Charles CurtisDr. Charles Curtis Dr Charles Curtis MS, PT, DPT, Cert MDT, Dr Charles Curtis MS, PT, DPT, Cert MDT,

Vestibular Rehab SpecialistVestibular Rehab Specialist

ccurtis33@verizon.net 732 320 0768732 320 0768