Part 1 - Texas Children's
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6/10/17 1 Jeffrey Shilt, M.D. Chief Surgical Officer, The Woodlands, Texas Children's Hospital Associate Professor, Orthopedic and Scoliosis Surgery, Baylor College of Medicine Running Injuries in Adolescents Page 1 xxx00.#####.ppt 6/10/17 8:51 AM Part 1
Transcript of Part 1 - Texas Children's
6/10/17
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Jeffrey Shilt, M.D. Chief Surgical Officer, The Woodlands, Texas Children's Hospital Associate Professor, Orthopedic and Scoliosis Surgery, Baylor College of Medicine
Running Injuries in Adolescents
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Part 1
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Running • Why? – Effective
• Longer lifespan • Reduce cancer risk • Lower blood pressure • Boost immunity • Raise HDL • Reduces vision loss • Improves mental health
– Simple…shoes, shorts, anywhere
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Running
• Despite often cited as most popular physical activity in North America… – Only 16% of North
Americans participate in an organized running program
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Why low participation rate?
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Running Injuries
• 27-70% of recreational & competitive distance runners sustain overuse injury in any given year
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Why such a high rate of Overuse?
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Biomechanical vs Cardiac Fitness
• Tendons, bones and joints are slow to adapt to forces in relation to cardiac fitness…days vs. months
• Merrel 40 days to 1.5 miles barefoot
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Injury Mechanism
• Injuries due to chronic overuse; rarely traumatic events
• All biological structures adapt both positively and negatively to stress placed on them.
Injury Mechanism
• Positive adaptation = stresses are repeated below the mechanical limits of a structure and adequate rest between stress applications
• Negative adaptation/ (injury) = repeated stresses with an insufficient rest between stress applications
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Evaluating Injury
• Interrelationships between: – gait biomechanics – anatomical alignment – muscular strength – muscular flexibility
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Running Injuries
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Running Injuries
• Most common site of injury: – Leg = 70% – Knee = 40%
Endurance Medicine Expertise
>10,000 hours/ 20 yrs of “experience” • 6,000,000 yds swimming • 14,000 miles running • 120,000 miles biking • 12 Ironmans, Kona • 3 Ultramarathons • 5 marathons, Boston • Xterra, Maui • Adventure Racing • Consulted/Coached Olympians &
world champions
• Plantar Fasciitis
• ITB Syndrome
• Rotator Cuff Tendinitis
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Case Example
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K.B.
• Aussie Female Professional Triathlete
• 2nd year pro, beat 6 x 1/2 IM Tauranga champion
• 2nd in sprint finish IM NZ
• Rapidly ramped up her run volume & intensity to go faster
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• Took time off
• Decreasing pain in front of pelvis
• Increased training
• New pain in SI joint
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Treatment
1. Revised Training
2. Altered Biomechanics
3. Adjusted diet and OBCP use
4. Adjusted Shoewear
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2010 IM Western Australia
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Treatment Options
1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions – Shoewear Adaptions
5. Nutrition
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Training
Training stresses:
• Necessary for improvement in performance & function
• When inappropriately applied, can be detrimental
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Treatment Options
1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions – Shoewear Adaptions
5. Nutrition
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Treatment Options
1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions – Shoewear Adaptions
5. Nutrition
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• Customized for focal weaknesses to address injury
• Performance
– Combination of resistance with endurance training provides a 3.62% in 5km TT performance in moderate trained recreational runners
– Posterior chain emphasis
• Strength discrepancies btw. Post & ant chains result in:
• Poor posture/Muscular compensations/injury
Karsten,etalTheeffectsofasportspecificmaximalstrengthandconi9oning…
IntJSports2016
• Strength Training
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Treatment Options
1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions – Shoewear Adaptions
5. Nutrition
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Running Biomechanics
Gait Cycle
• Walking – Running – Double support
vs. Double Float
– Stance phase of walking is > 50%
– Elite sprinters > 20%
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Shoes
• Despite advances in shoe technology, running injuries have not decreased
• Incidence of ITBS and stress fractures have doubled over the past 35 years
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Why Minimalist Shoes…
• Increased intrinisic foot muscle strength
• Improved run biomechanics
• Decreased injuries
• Improved posture
• Sense of freedom while running
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Kinematics
• Pelvis and trunk more anterior tilt
• Hip extension later in cycle (at toe-off)
• Hip extends in 2nd half of swing
• Knee similar – different magnitudes
walk
walk
walk
GRF
• Rearfoot striker – Midfoot striker doesn’t
typically have initial peak
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Moments & Powers
• During stance – What type of moment? – Abductor (Glute med) – Adduction due to GRF
medial to hip • During propulsion
– Glute med adducts hip to generate power
Kinetic Summary
• The main sources of power generation are – Hip extensors during
second half of swing and first half of stance
– Hip flexors after toe-off – Knee extensors, hip
abductors, and ankle plantar flexors during stance phase generation
Hip Flex, 30
Hip Abd, 6 Knee
Ext, 4
Ankle Ext, 53
Hip Ext, 7
Walk
Hip Flex, 20 Hip
Abd, 3
Knee Ext, 22 Ankle
Ext, 41
Hip Ext, 14
Run
Hip Flex, 25
Hip Abd, 3 Knee
Ext, 14 Ankle Ext, 34
Hip Ext, 24
Sprint
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Kinetic Summary
• Hamstring and glute max – pull body forward after
swing phase reversal when foot is ahead of body
• Second half of stance – Quads\gastroc push
forward
Hip Flex, 30
Hip Abd,
6 Knee Ext, 4
Ankle Ext, 53
Hip Ext, 7
Walk
Hip Flex, 20 Hip Abd,
3
Knee Ext, 22 Ankle
Ext, 41
Hip Ext, 14
Run
Hip Flex, 25
Hip Abd, 3
Knee Ext, 14 Ankle Ext,
34
Hip Ext, 24
Sprint
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4G: The impact peak disappears with a MFS
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Prerequisites for Minimalist Running Approach
1. Good Alignment
2. Good Biomechanics
3. Trunk & Hip Core Strength
4. “Biomechanical Fitness”
5. Appropriate Recovery
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5 Necessities: Alignment
• Good alignment directs biomechanical forces where we are best suited anatomically to handle them
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5 Necessities: Biomechanics
• Good biomechanics reduce stresses associated with increased forces associated with running
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5 Necessities: Core Strength
• Strength in trunk and hip core maintain stresses in skeleton best equipped to handle them
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5 Necessities: Recovery
• Without appropriate recovery, musculoskeletal system cannot respond to training stresses
• Unique to each individual
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Treatment Options
1. Training Alterations 2. Temporal-Spatial Gait Changes 3. Strengthening 4. Biomechanical Adaptions – Shoewear Adaptions
5. Nutrition
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