Tom Goom’s Post

It’s very common to hear runners being told they must switch from a rearfoot to a forefoot strike when running. They’re told “it’s more efficient”, “it reduces injury risk” or “it’s more natural” (whatever that means!) but this is not supported by the research and there are risks involved… …Any big change in running gait, such as switching foot strike, is likely to increase the load on tissues that aren’t used to it. With moving from rearfoot to forefoot strike this is likely to be the calf and Achilles. In forefoot running Achilles load increases by around 15% which is the equivalent to 48 times body weight per mile (Almonroeder et al. 2013)! It’s no surprise then that I see many runners with Achilles or calf pain as a result of switching foot strike. One argument for switching to forefoot is that it can reduce stress on the knee. There is evidence to support this but increasing step rate by 5 to 10% can also achieve this without a large increase in calf/ Achilles load. As ever when treating runners we need to be careful to avoid one size fits all recommendations and reason through the risks and benefits for the individuals in our care.

5 ways to reduce tibial load when running. These can be really useful for runners with shin pain and Medial Tibial Stress Syndrome (AKA #ShinSplints). Individual response will vary so a ‘test is best’ approach is recommended - try a tip while running and see if pain reduces. For gait changes (like modifying step or stride width) it’s best to start with a gait analysis to determine a runner’s retraining needs. Please like and share if you find this helpful and reply in the comments if you have any questions

🗣️ Our online course is open for enrolment. Visit https://lnkd.in/eg4FYB_a to find out how it will help you assess and treat runners of all levels 🏃🏽♀️🏃♂️🏃🏾♂️🏃♀️

What causes running injuries? 🤔 A new umbrella review from Correia et al. (2024) tried to find the answer. They did a systematic review of previous systematic reviews and meta-analysis. 13 studies met their criteria and were included. Within these 207 outcomes were assessed in 148 primary studies! They found evidence of 6 main areas that may be associated with increased risk of running injury: 1. Running or training characteristics 2. Health and lifestyle factors (including previous injury) 3. Morphology (such as pronation/ navicular drop) 4. Individual attributes (e.g. sex and age) 5. Running kinetics (e.g. peak breaking force) 6. Functional movements kinematics (such as drop squat or active straight leg raise scores) However, it should be noted that systematic reviews that were included were of low or ‘critically low’ quality so the exact causes of running injury remain unclear. From a clinical view point I would say it’s often big changes that lead to running injury. So when we’re trying to identify possible causes look for changes in training or recovery, in running gait or footwear, and ask about changes in general wellbeing or mental health. Often running injury is multi-factorial and related to changes in several of these areas. Reference: Correia CK, Machado JM, Dominski FH, de Castro MP, de Brito Fontana H, Ruschel C. Risk factors for running-related injuries: An umbrella systematic review. J Sport Health Sci. 2024 Nov;13(6):793-804. doi: 10.1016/j.jshs.2024.04.011. Epub 2024 Apr 30. PMID: 38697289; PMCID: PMC11336318.

Downhill running may decrease Achilles load but increase stress on the Patellofemoral joint and Tibia. Speed and step rate will also influence load and can be adapted to help symptoms.

4 key ways to strengthen the hamstrings! 🏋️Using these approaches helps to address knee flexion and hip extension weakness plus prepare the hamstring for the demands of top speed running! 🏃🏽♀️Sprint training has been found to increase both eccentric hamstring strength and maximum running speed (Freeman et al. 2019). We know how beneficial Nordic Curls are for the hamstrings, but Mendiguchia et al. (2020) found sprint training to be superior for increasing Biceps Femoris fascicle length (an important factor in hamstring injury). ⚠️ One word of caution though - running speed should be increased gradually for injured runners, especially following hamstring injury. Sprinting should be added at the appropriate time in healing and rehab. Often a period of strength training and power work is needed first to prepare the hamstrings for the high peak loads in top speed running. References: Freeman BW, Young WB, Talpey SW, Smyth AM, Pane CL, Carlon TA. The effects of sprint training and the Nordic hamstring exercise on eccentric hamstring strength and sprint performance in adolescent athletes. J Sports Med Phys Fitness. 2019 Jul;59(7):1119-1125. doi: 10.23736/S0022-4707.18.08703-0. PMID: 31332988. Mendiguchia J, Conceição F, Edouard P, Fonseca M, Pereira R, Lopes H, Morin JB, Jiménez-Reyes P. Sprint versus isolated eccentric training: Comparative effects on hamstring architecture and performance in soccer players. PLoS One. 2020 Feb 11;15(2):e0228283. doi: 10.1371/journal.pone.0228283. PMID: 32045411; PMCID: PMC7012429.

Prone or seated leg curl for Proximal Hamstring Tendinopathy? 🤔 #PHT #proximalhamstringtendinopathy #Running #RunningRehab #RunningInjury #Tendinopathy

Hamstring peak force increases with running speed from approximately 2 times body weight at endurance speeds (4:46 per km) to 9 times body weight when sprinting (1:51 per km)! 🏃♂️ We need to bear this in mind when rehabbing hamstring injuries in sports that require athletes to sprint: 1️⃣ Athletes need to be strong enough to manage these high-peak forces 2️⃣ Training at slow and medium intensity does not prepare for the demands of sprinting 3️⃣ Power impairments should be addressed during rehab 4️⃣ A graded exposure to faster running and sprinting is essential! Reference: Dorn et al. (2012) Muscular strategy shift in human running: dependence of running speed on hip and ankle muscle performance. J Exp Biol 1 July 2012; 215 (13): 2347 #running #runningrehab #hamstrings #hamstringinjury #PHT

The solution to our tendinopathy question - which is important psychosocial factors or pathology?… Now I know I was a bit sneaky on this and asked you to just pick one! In reality of course it will depend on the patient but in my experience psychosocial factors are often more important than pathology in management of tendon pain. Let’s look at how our assessment might help us identify the key priorities for someone with persistent Achilles pain: A thorough subjective history and tools like the Pain Catastrophising Scale (PCS) and Tampa Scale of Kinesiophobia (TSK) can be really helpful in assessing psychosocial factors. For example the PCS helps us to identify rumination (the inability to stop thinking about the injury), magnification (exaggerated appraisal of pain as a threat) and helplessness (the patient feeling they are incapable of controlling pain). These factors can greatly increase distress and provide a barrier to progress. High scores in the PCS and TSK would suggest psychosocial factors may be a key driver. If a patient scores low in these tests and isn’t fear avoidant or concerned about damaging the tendon then psychosocial factors may be less important (especially if other factors like stress and sleep are well managed). Identifying that pathology as a clear driver is challenging but we might expect our assessment and investigation findings to be consistent with that specific pathology. So, in the example of plantaris involvement for the question we’d expect medial Achilles pain that’s worse when loaded into dorsiflexion and hasn’t responded well to a loading programme. Investigation search as ultrasound or UTC may then reveal plantaris tendinopathy that’s consistent with these symptoms.

‼️NEW STUDY JUST PUBLISHED‼️ Hip Strength Normative Data in FEMALES 🧠Adductors are arguably the most versatile and exciting muscle group of the lower limb. When it comes to sports related injuries involving this muscle group, it is essential to fully understand the interchangeable roles of each of the adductors. 🧠 Now throughout the years research has continued to highlight the role of strength deficits and ratio asymmetry between the adductors and abductors when it comes to ARGP (Adductor Related Groin Pain). However often where things fall short is often when we’re trying to understand what ‘normal’ is for certain sporting populations. Paucity of research is then even further apparent when diving into the literature for female footballers, so new data like this is fantastic to see. 🧠 For anyone dealing with any of the population whether it be general pop to elite athlete, I’d urge you to read this paper. It’s great to see studies like this published where we can use it and apply it straight into clinic. 🤝 Thanks so much to Mehmet @the.hip.physio for the collaboration with this. He’s the brains behind it! Make sure you follow Mehmet for anything hip related! Heijboer et al (2024), Normal hip strength and range of motion values in youth and adult female national football teams: Data from 504 assessments, Physical Therapy in Sport, Tyler T, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002;30 (5):680- 683. PubMed ID: 12239001 doi:10.1177/03635465020300050801