SRLA 26.2 Injury Prevention

1. SRLA 26.2Injury Prevention Keys for Coaches Strengthening & Stretching Normal & Abnormal Motion Catching Problems Early Dr. Mary Schuh, D.P.M., Board Certified in Podiatric Orthopedics & Primary Podiatric Medicine Associate, American Academy of Podiatric Sports Medicine

2. Developing the 4 types of fitness 1. muscle strength (how powerful is one step?) 2. muscle endurance (how many powerful steps?) 3. Cardio-respiratory endurance (a.k.a. aerobic fitness) (how many steps before you’re “winded”?) 4. Flexibility (how many degrees of joint motion?)

3. Youth Vs. Adult Tissues Adult: a braided rope Protein Cross linking Tendons- decrease length but increases pulling strength Ligaments- decreases joint range of motion Sprain (tear) injuries Over age 22: No growth plate injuries possible Youth: a stretchy band • Growth Spurts- • Temporary imbalances possible • Strain (elongation) injuries • Active Bone Growth plates & age of closure: • Foot 14-21 • Heel 12-22 • Ankle 16-18 • Knee 16-19 • Hip 16-18

4. But we all train together…. • Remember… • Pain in the same place may not be the same problem • Calcaneal apophysitisvs calcaneal stress fracture vsinsertionalachilles tendonitis… all are “heel pain” • A limit in 1 or more of the 4 types of exercise fitness will impact the runner’s training, and point to what the problem is. (Overweight youth do more aerobic work to oxygenate their tissues: 1 lb fat has > 1 mile capillaries) • Training for a marathon requires all 4 types of fitness- the goal is to complete 4-8 hours of vigorous exercise in March 2014

5. Running is a Vigorous ExerciseIt increases Strength, Endurance & Aerobic CapacityIt does not increase Flexibility • Strengthens bones • Cyclical loading • Strengthen muscles • Especially front and back of the hips and legs • Increased aerobic function • Oxygen delivery to cells • Improved organ efficiency • Liver, pancreas, brain • The body may put some organ works “ on hold” such as digestion in the stomach and GI Tract during distance running • Aerobic exercise requires WATER, Glucose and OXYGEN to run efficiently. • (50% food energy goes to making ATP, 20% to muscle action, 30% lost as heat) • Hydrate!“ drink till you pee”

6. Flexibility The 4th FitnessWhy Stretch? Adult Maintain full range of motion Prevent ligament and tendon tears and sprains Prevent focal joint damage “wear and tear arthritis” Increase energy efficiency Youth • Maintain full range of motion • Overcome growth spurt imbalances • Prevent tendon & ligament strain injuries • Increase energy efficiency

7. Hamstrings need to stretch more? • Hamstrings Tight • Run with pelvis straight or tipped back (normal is anterior tilt of 15 deg) • Knees don’t extend fully • Back, hip, knee pain • Quads over work / cramp

8. Where is the piriformis?And why do I care? • The piriformis runs at an angle across the buttock. • A tight piriformis can cause debilitating sciatica. Recurrent piriformis spasms can stop a runner completely. • Stretch the piriformis by pulling the knee up and towards the opposite shoulder with both hands, while lying on your back. • The knee should be bent and foot relaxed. • The arms are doing the work.

9. Groin need to stretch more? • Groin muscles tight • Short stride • Decreased hip flexion • Inability to clear hurdles • Decreases running efficiency • Increases aerobic exercise demands

10. Quadriceps need to stretch more? • Quadriceps tightness • Crouching tiger….unable to stand in place without pelvic tilt anteriorly. • Unable to bend knee back while standing erect. • Patella, hip, back pain

11. Calf (gastrocnemius & soleus) tight? • Calf tightness/ cramping • Knee hyperextended • Toe walker • Bouncing heel • Can’t stand and lift ball of foot off floor 20 degrees • Achilles tendonitis, plantar fasciitis, tendon rupture, collapsing flat foot, posterior tibial tendonitis

12. I can’t tell degrees…. You probably can and don’t realize it! clock face = 360 deg A pie slice of time: 1 minute= 6 degrees 5 minutes= 30 degrees (on the clock, the pie slice from 3 to 2 is 30 degrees)

13. Posterior muscles Towel Stretch • Plantar fascia, long toe flexor tendons, gastrocnemius, soleus, hamstrings • Prevent: posterior tibial tendonitis, metatarsalgia, shin splints, tight calf, torn achilles, torn hamstrings, and strain • Start seated on floor, back upright, towel around ball + arch, arms in a sawing position, ( no “ stage coach driving, no chicken dance), with knee locked, gradually pull foot towards body with arms. The foot goes for a free ride, pull till tension ,hold till tension relaxes, pull again to tension and hold till relaxed. Gradually lie back and bring the foot and leg up as one till the hip is flexed ( your toes are over your body ) to tension, hold till relaxes. • Sit up & Do other side

14. Cross Training • Any forward LINEAR exercise other than running IS NOT cross training. • Examples of not cross training for running: bicycle, elliptical, stair stepper. • There are muscles NEEDED TO RUN EFFICIENTLY that are minimally strengthened or stretched by running. • (Hip abductors and adductors) • Cross training requires Non linear motion ( SIDE TO SIDE, CIRCULAR, UP & DOWN)

15. Cross training Muscles Up & Down Hopscotch, jump rope, basketball, volleyball, musical chairs, rock climbing / climbing walls SIDE TO SIDE • Soccer, tennis, dancing, racquetball, martial arts, swimming (especially frog kick), chasing (dog, or kids, such as playing tag, capture the flag,) hockey, skating (ice, roller or in-line), calisthenics, wrestling, wii, ddr,

16. Functional Genu Valgum • Standing the knees are straight, aligned, kneecaps facing forward • Walking, the knee appears to move toward or past the midline & this increases with pace, on the leg with the body weight.

17. Problems of functional genu valgum IT band syndrome Patella tracking pain/ problems Knee pain Over-pronation with foot/ ankle pain Abnormal knee joint (excessive focal) wear

18. Testing for functional genu valgum One leg deep knee bend. Does the leg stay aligned or does it become a > or < sign?

19. Training tips to decrease/ resolve functional genu valgum • Strengthen abductor of hip ( gluteus medius) • Doorway exercise: gently & slowly lift leg to side, keeping body aligned to doorway, toes pointed directly forward ( no external rotation) and slowly lower leg. • Side lying on floor and raising leg, toes pointed forward. • Stretch hip adductors • Sitting cross legged and gently lowering the knees toward the floor • Sitting legs extended and gradually widening the V of legs. Keep toes pointed straight up.

20. Ankle Problems • Sprains: somewhere there is a pothole with your name on it…. • If they can’t put weight on it, it needs to get an X ray.. Don’t run through the pain.. Rest & ice and call for help.. It may be broken not sprained • Mild sprains: • Taping or soft compression bracing till recovered. • Rest, ice, elevate initially and after 1st week contrasts of heat and cold, “ the 25 minute treatment” • 5 cold +5 warm + 5 cold+ 5 warm + 5 cold= 25 min. treatment. • Avoid uneven ground initially until the sprain is healed.

21. Foot Sprains Same rules as ankle sprains apply- if they can’t bear weight, they need an X ray. Taping helps, often, just a good arch supportive insole can do a lot and allow you to keep running. Over the counter, soft support from gel to spencopolysorbs, firmer support such as Powerstep and foot soldiers, and hard support such as Superfeet. Stretching toes may be necessary.

22. Foot problems Athlete’s foot Wicking socks, gore tex vents and allowing shoes to air out after runs Antifungals for at least 2 weeks. Skin shear • Friction in shoes is the enemy • Blisters are from too much SHEAR force between the skin and the tissues deep inside. • Calluses are the skin response to low level friction, that is recurrent. The skin makes more, tougher, skin.

23. Foot skin Problems Skin problems: do not poke and drain the blisters with your dirty finger nails!! Running with Blisters and calluses? Grease them up! ( plant based products like cocoa butter, olive oil, shea butter, sesame oil do not clog pores) Avoid petroleum based products like mineral oil, vaseline, baby oil which can clog pores, leading to more problems. Surf wax on the shoe spot, or teflon patch on the shoe spot, often decreases friction.

24. Temporary support : taping Basket weave Immobilizes motion at the midfoot, fat pad of heel, insertion of achilles, and inside and outside tendons from the foot to the calf, increase it above the ankle and immobilize the ankle joint High dye, J strap • Elastoplast ( less expensive) • Kinesiotape ( pre cut) • How to is online at K-tape website • Athletic tape • Pre- tape ( spray) • Under tape ( wrap)

25. Temporary support: taping • IT Band / Patellar tracking • Any runner who thinks they need a brace needs to see a doctor to prescribe the correct one. • Often a brace is the last thing they need, and isolated balancing exercises maty be prescribed. • Taping is a temporary alignment guide that provides neuromuscular re-education just by being there. • Athletic taping maintains its strength for about 20 minutes in vigorous exercise. • K tape and elastoplast last longer due to their ability to stretch.

26. Coaching out bad form… Muscle endurance Your training program is excellent, follow it. If you have a runner who just can’t keep up in the early weeks, intermittent running and power walking will help them build muscle endurance. For more detail….. “ Couch to 5K” Cardio/ aerobic • Keep the upper body relaxed to prevent chest muscle wall tightness. Shoulder shrugs, neck rolls, “limp doll” • Keep the arms from crossing or “closing off” the chest.

27. Coaching out bad form New research: Athletes advised to change form based on external cues do better than those advised on internal cues… For example- that functional genu valgum runner will improve more being told to point each knee forward and have them see themselves run on a treadmill in front of a mirror, than to tell them to hold the knees straight as the foot lands, or feel the knees coming out from where they were, with no visual cue, real or imagined, to guide them.

28. Muscle aches Ice, Heat & massage Ice pack massage, Foam rollers, frozen tennis balls, Cold soak before the hot shower all help decrease tissue congestion, clear the tissues of excess fluid. Then adding warmth after these cold treatments helps bring in new nutrients from the circulation to heal and repair micro damage. Hydrate! electrolytes! • Post run care : refill, refuel, refresh, replace • Refill: the water tank • Refuel & refresh: healthy balanced meals with food based vitamins, minerals, proteins and complex carbohydrates (veggies, fruits and a protein source) • Replace: lost electrolytes –Especially if you are a heavy sweat-er, that white stuff on your black t shirt is your lost electrolytes!

29. SLEEP: You’ll Need a LOT Average teen needs 8- 9 hours for optimal cellular function

30. Sleep • Prime cellular time to rebuild and restore? • 10 pm to 2 am • Lack of sleep releases hormones that make you crave simple carbohydrates- even 1 night’s lack of sleep! • Some muscles cramp “ charley horse” at night as a response to overuse ( imbalance overuse) and any muscle cramping can ruin a good night’s sleep. • Ask your runners if they get cramps and if so where- use this to guide any extra stretching they may need.

31. THANK YOU! I Look forward to seeing you wave as you effortlessly run past the medical tent