Running Mechanics for Clinicians

Original Editor - Mariam Hashem

Top Contributors - Mariam Hashem, Kim Jackson, Tarina van der Stockt, Jess Bell and Robin Tacchetti

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Overview of Running Injuries

Lower extremity running-related injuries range from 19.4 to 79.3 percent. The most common injnuries are:

• Patellofemoral pain
• Medial tibial stress syndrome (shin splints)
• Achilles tendinopathy
• Iliotibial band syndrome
• Plantar fasciitis
• Stress fractures of the metatarsals and tibia

Hamstrings and calf problems were reported by men marathon runners, while hip pain problems were common among women. Most of these injuries have a high recurrence rates.

A 2015 systematic review of 15 studies identified different risk factors for women and men:

	Women	Men contributing factors to tissue stress
	Age	History of previous injury
	History of previous sports activity	Running experience for 2 years
	running on a concrete surface	History of previous injury
	Participating in a marathon	Average weekly running distance (20–29 miles)
	weekly running distance (30–39 miles)
	wearing running shoes for 4 to 6 months

Stress Frequency Model

Running Injuries are caused by an inter-relation of multiple factors. A simple injury causation model using the stress frequency curve can help us to develop an idea on the contributing factors and how to address them in the management plan.

A tissue is influenced by the applied stress and the frequency of application. If the stress and it's frequency are below the injury threshold, the tissue will function normally within it's capacity. However, if either or both of these factors exceeded the injury threshold, the tissue is moer likely to be injured. This explains why some runners may not experience injury for long time and develop one as soon as they increase their frequency of training such as training for a marathon.

Considering stress and frequecny is important to understand individual tissue's capacity.

Running mechanics influence the stress applied to the body, magnitude, type (bending, shear or tension) and the speed of application on each foot contact. Assessing running mechanics leads us to think about the stressed structure and explains the presented symptoms. For example; landing on toes -forefoot strike- results in greater stresses on achillies tendons and the calf muscle forces.

Assessing frequency of running and training volume to understand the effect of the accumulated tissue stress . If falling below the tissue's threshold the likelihood of developing injury will be low and vice versa. Subjective examination can help us to understand the frequency, ask your client about them about their weekly training and what is your standard trainig like? How much running they do? what wa the frequency of applied stress before the injury occured?

the next thing is wehre is identifying the injury threashold which refers to the interaction between the tissue capacity to tolerate the stress an the tissue capacity to tolerate the frequncy of the applied stress. Tissue capacity refers to the functional capabilities of a specific tiussue to cope with stress type and frequency. A muscle capable of producing high peak force may be able to tolerate high level of stress on an individual foot contact. On the contrary , if the mscule's capability is low, applying stress with high frequency the muscle may not be able to cope well leading to injuries. To translate this into practical application, when assessing a runner we should think of adjusting the mechanical pattern or push up the tissue's endurance to tolerate the applied load. Lowering the applied stress by reducing the amoint of running can be a method of off-loading the injured tissue while building up the tissue resileince to cope with the functional aspiration.