ZEREN PT & Performance

  • Services
    • Physical Therapy >
      • Forms
    • Running Analysis
  • contact
  • Disclaimer
  • Services
    • Physical Therapy >
      • Forms
    • Running Analysis
  • contact
  • Disclaimer

Simple Return to Running Program for Injured Runners

10/27/2015

2 Comments

 
Picture
Access Now
One of the first research projects that I worked on during my undergraduate studies at the University of Delaware (UD) was a return to throwing program for baseball players. After tennis practice, I used to sit at the home UD baseball games while recording pitch counts before handing the data over to one of the PhD students for analysis. This information was then used to develop a data-based interval throwing program to help injured pitchers return to the mound by gradually exposing them to the performance demands of throwing. Mike Reinold and colleagues also published a nice manuscript in JOSPT related to Interval Sport Programs (ISPs) that covered baseball, tennis, and golf. Surprisingly, however, there is no well accepted return to running program for medical and fitness professionals to apply to runners rebounding from injury. I therefore developed this simple return to running program, which couples an injury grading system with soreness rules, to foster improved decision-making as we prepare runners for a safe return to running. Please download and share it if you find it helpful. As always, any and all feedback welcome. Wishing you HAPPY, HEALTHY, and STRONG Running!
2 Comments

Common Denominators of Running - Let's Agree on Something

6/10/2015

0 Comments

 
Picture
Picture
Picture
As the debate rages on regarding strike pattern, shoes, and one universally best form to run, how about we first establish consensus regarding common denominators related to running. This past weekend I was fortunate enough to have my uncle, who is visiting Seattle and also happens to be a professional photographer, capture some footage of me running to highlight several key aspects of the running gait that we have to prepare injured runners for as we attempt to return them to daily training and beyond. Ive included three separate pictures to capture three distinct portions of the gait cycle which are as follows and listed from left to right: terminal stance, float phase, and midstance. As you look at these images, it's important to keep in mind that I'm running on level ground at 4:30 pace in the Brooks Launch (10mm heel to toe differential). Below, I've listed some key characteristics and takeaways related to the above images. I've also include footage from a few clips of me running on a treadmill to give you a more thorough perspective of the running gait to compliment the above images.

Terminal Stance
1. The runner has to progress through the forefoot and ideally the first ray which demands mobility at the first MTP.
2. The knee does not fully extend on the stance leg in the vast majority of cases.
3. Some hip extension is necessary on the stance leg though not nearly as much as some folks lead you to believe.
3. The trunk is erect and the head is held steady.
4. There is a good deal of shoulder extension that occurs on the contralateral side relative to the stance leg.
5. The pelvis and shoulders remain relatively square.
6. A moderate amount of hip flexion is necessary though definitely less than 90 degrees.

Float Phase
1. The brachium (upper arm) never breaks the plane of the torso despite sometimes giving the appearance of doing so. 
2. There is a distinct float phase that is inherent to the running gait. 
3. A small amount of torso rotation occurs during the running gait. 
4. The tibia of the left or more anterior lower extremity is positioned relatively vertical and the foot is positioned close to level with the ground.
5. Although it appears as if I may be overstriding, the foot winds up landing almost underneath my body by the time it contacts the ground (easier to see in the video below).
6. The trunk is erect and the held is held steady.

Midstance
1. The quadriceps act eccentrically during the stance phase.
2. The leg must progress over the foot thus demanding ankle dorsiflexion
3. There is minimal hip ADDuction that occurs during the stance phase.
4. There is minimal ipsilateral trunk lean towards the stance leg during this phase.
5. The trunk is erect and the head is held steady.
6. The knee of the non-stance leg flexes to ~120 degrees though in most recreational runners this value is ~90 degrees while with world class sprinters it can reach 135+


Based on this information, I thought it would be helpful to list my prerequisites to safely return injured runners to regular training and beyond.

1. No use of NSAIDs or narcotics
2. No signs/Sx of inflammation
3. Ability to fully wt bear through the affected region(s)
4. Adequate toe dexterity (flex-ext of the great toe and lesser toes, splaying, and adduction
5. Ability to balance in a wobble free manner for >30s such that there is no reliance on an arm nor trunk strategy.
6. @ least 35+ degrees of isolated extensions of the 1st MTP extension in a WB position at terminal stance.
7. Ability to progress the leg over the foot (~22 DF)
8. Tolerance to open and closed chain contractions of the lower extremities
9. Good frontal plane stability esp @ hip & trunk
10. Tolerance of fitness walking (3.5mph) in a defect free shoe
11. Tolerance of a progressive walk-run routine
12. Ability to hop in multiple directions on each leg

0 Comments

3 Simple Reminders for Injured Runners

4/1/2015

0 Comments

 
Every day I have the privilege to work with injured runners, who are in distress over their inability to train in a consistent manner. In the vast majority of cases, most runners seeking my services have already tried everything under the sun (to no avail) as they desperately attempt to keep training before they break down, accept their situation, and come knocking on my door. Before delving in to my physical therapy evaluation, I always make it a point to first speak with them about their injury and unique presentation in an effort to help them reconceptualize their situation while mitigating threat to their livelihood as a runner. To this end, I thought it would be helpful to share three simple reminders that I often bring up in conversation while working with injured runners.

1. MOST RUNNING RELATED INJURIES ARE NON-TRAUMATIC
When considering the injury patterns among runners, the research clearly demonstrates that the vast majority of running related injuries (RRIs) are non-traumatic in nature. This is great news because it's not as if you were tackled and sustained an ACL injury or that you dropped a heavy weight on your foot. So put your mind to ease and realize that things are not that bad considering the fact that there was no overt trauma.  

2. THE BODY HAS A REMARKABLE AFFINITY TO HEAL -
As a runner, chances are that you are in relatively good health as a function of your training and active lifestyle. With that said, your body has a remarkable affinity to heal irrespective of your age. While some runners may possess certain co-morbidities that may delay the recovery process, most runners will rebound from injury in a timely manner provided that they remain pro-active, work with a running injury specialist, and make good decisions during the recovery process.

3. RUNNERS ALMOST ALWAYS RESPOND TO CONSERVATIVE TREATMENT
In providing care for hundreds if not thousands of injured runners at this point in my career, I've never personally worked with a runner, who went on to require surgery to address a RRI that was non-traumatic in nature. This is good news provided that you connect with a rehab professional, who specializes in managing injured runners and prepares you for a safe return to training. If surgery, pills, and injectables are offered as a viable solution or long term fix, make sure to get a second opinion. While such measures can provide short term relief, they typically worsen the situation and only serve to prolong an otherwise timely recovery.

See you on the streets!

Picture
0 Comments

How To Avoid Buying Defective and/or Ill Fitting Running Shoes

3/30/2015

0 Comments

 
Picture
Picture
Picture
One of the beauties of running as a sport is that there are relatively few equipment considerations and barriers to participation. All most runners need are shorts (or leaf), a t-shirt or sports bra, and perhaps socks and shoes unless you prefer to go barefoot. As a physical therapist, coach, avid runner, and triathlete, Im well aware of the potential threat that ill-fitting or defective shoes pose to your livelihood as runner. In an effort to help you ensure proper fit while avoiding a lemon, I thought that it would be helpful to provide you with a relatively short video (see below) that goes over several key concepts related to shoe fit and screening. Hope this helps you find your ideal pair of kicks.  
0 Comments

Return to Running Checklist for Runners Rebounding from Injury

3/18/2015

1 Comment

 
Running is a repetitive plyometric activity that involves a specific set of performance demands. Therefore, clearing injured runners for a safe return to training following injury should be premised on such demands. In the event a rehab professional fails to adequately prepare a runner for a safe return to training, the runner will invariably blow up only to find themselves hobbling home. In an effort to safeguard against such a situation, I thought it would be helpful to share my criteria/checklist to help rehabilitation professionals return injured runners to training in a safe and timely manner. Hopefully this provides you with a simple and objective framework in helping injured runners seeking your services. 
                                     STRONGER - FASTER - TOGETHER

1. BASIC UNDERSTANDING OF PAIN SCIENCE 
2. NO SIGNS NOR SYMPTOMS OF INFLAMMATION
3. ABILITY TO FULLY WEIGHT BEAR THROUGH THE AFFECTED EXTREMITY 
4. ADEQUATE TOE DEXTERITY
5. ABILITY TO BALANCE ON EACH LEG IN A WOBBLE FREE MANNER
6. IDEALLY 30+ DEGREES OF ISOLATED EXTENSION AT THE 1ST MTP
7. ABILITY TO PROGRESS THE LEG OVER THE FOOT (>20 DEGREES OF DF)
8. TOLERANCE TO OPEN & CLOSED CHAIN LOWER EXTREMITY CONTRACTIONS
9. GOOD FRONTAL & TRANSVERSE PLANE CONTROL AT THE TRUNK & HIP
10. TOLERANCE TO FITNESS WALKING (3.5MPH)
11. TOLERANCE TO A PROGRESSIVE WALK-RUN ROUTINE
11. ABILITY TO HOP ON EACH LEG IN MULTIPLE DIRECTIONS
Running Check List

Injured Runner
1 Comment

Top 10 Sayings I Use In Working with Injured Runners

3/16/2015

0 Comments

 
Every day I find myself working with injured runners in an effort to return them to a float phase. During my treatment sessions, I inevitably sound like a broken record. Below is a list of the things I commonly find myself saying to clients seeking my services. Drum roll please....

1. Don't worry, you are just suffering from a simple case of RSS..."Runner's Stupidity Syndrome."

2. Believe it or not, running is a skill that needs to be learned.

3. Novice runners are more fragile.

4. Stiffness is your friend and enemy.

5. Eccentric & concentric actions work in a complimentary manner.

6. Forefoot or reafoot strike pattern isn't much of a concern to me provided that you don't overstride.

7. You are only as good as your last injury and the extent that you rehabbed it. 

8. Expect strike asymmetry with track runners. 

9. Gluteus medius timing is more important than strength when it comes to running.

10. If you have phenomenal ROM you better have phenomenal strength and control.

0 Comments
    ​OUR LATEST
    E-BOOK for RUNNERS
    Picture
    DOWNLOAD HERE!
    ​

    MIKE REINOLD & ERIC CRESSEY'S FUNCTIONAL STABILITY PART 4
    Picture

    Archives

    January 2018
    June 2017
    May 2017
    February 2016
    December 2015
    November 2015
    October 2015
    August 2015
    July 2015
    June 2015
    May 2015
    April 2015
    March 2015
    December 2014
    November 2014

    Categories

    All
    Biomechanics
    Core Strengthening
    Exercise Library
    Injury
    Ironman 70.3
    Kettlebell
    Pain
    Pain Science
    Performance Exercises
    Physical Therapy
    Professional Advice
    Redcord
    Running
    Skill Acquisition
    Speaking Events
    Triathletes

    RSS Feed

     347-433-6789
info@zerenpt.com
                © Zeren PT LLC 2014-2022
PHYSICAL THERAPY
RUNNING ANALYSIS
DISCLAIMER: This site is oriented to my opinions and thoughts regarding various performance and rehabilitation subject matter. Please keep in mind that application of this material is a personal choice, and in no way is the author responsible for those choices. Readers are encouraged to only operate within their scope of practice. Examination, treatment, intervention, and rehabilitation for athletes should only be performed by a licensed medical professional.