Deload the runner: La Trobe SEM Run Science Symposium review July 6th-7th [PART 1]

By Luke Nelson @sportschiroluke, Brad Beer @Brad_Beer and Hamish Vickerman @Hamishvic

Organised by La Trobe Sports and Exercise Medicine, the Running Science symposium in July saw a multidisciplinary line up of speakers discussing management of the running athlete. There was a wealth of information covered over the two days, and here’s a taste of what was offered!

Rich Willy @rwilly2003 kicked off proceedings with “Restoring load capacity in the injured runner”. Running participation has increased almost 300% since 1990 [1], with female participation seeing the greatest growth (25% of race finishers in 1990, 57% in 2013). Injuries in running are high with incidence in the literature varying from 19.4%-79.3% [2].

Management of the runner is a matter of balancing tissue tolerance & the ability to adapt (ie, strength, fitness, psychosocial factors, previous injury history, sleep) with biomechanical loading factors (ie, training loads, proximal & distal mechanisms) [3-7]. Often neglected factors in the treatment of the runner are psychosocial factors: patient education and an understanding of how important running is to the injured runner’s life are a must! [8-12]

Modifying Load

The overarching theme throughout the two days was modifying load in the runner. We probably under load our runners in rehabilitation. Unlike what many think, running is not all about the gluteals! The soleus is the powerhouse for runners; it takes 6.5-8.0x body weight of force during running. Therefore during rehab, body weight exercises just don’t get it done when trying to improve achilles tendon stiffness and triceps surae capacity. Loads during running are MUCH higher than what bodyweight exercises can replicate. Heavy load resistance training is a must for runners and Willy concluded that we must load runners more to improve their overall load tolerance.

Next up was sports physician Dr Danielle Hope on: “Managing the Female Runner”. Dr Hope began by discussing energy availability and its relationship to bone health, general health and athletic performance. Dr Hope discussed Relative Energy Deficiency in Sport (RED-S) and causes of low energy availability focusing on its impact on menstrual dysfunction and bone health, with relative risk of stress fracture being 2-4 x greater in amenorrhoeic athletes. It is important to realize that low energy availability can be present with normal body weight, but this occurs at the expense of health. Also, covered in this presentation was: management of the uncomplicated pregnant runner, optimal loading for bone strength, urinary incontinence and breast pain/support during running.

Sports and Exercise physician, Dr Peter Brukner @PeterBrukner then discussed his current passion educating people about the perils of high carb low saturated fat diets, and the health benefits of adopting a ketogenic diet. He  spoke of the unhealthy society that we live in with high rates of obesity, type 2 diabetes and many other ‘modern’ illnesses and talked about the lack of scientific basis of the dietary guidelines and food pyramid that we followed for over 40 years.

Dr Brukner also looked at the importance of diet in the running athlete. Some of his key points were:

  • The jury is still out on carbs vs ketogenic on athletic performance
  • It likely takes up to 6 months to adapt to a keto diet
  • There is considerable individual variation with different diets

Dr Brukner’s key tips to a healthy diet:

  1. Basic diet should be low-carb, healthy fat, real food, avoiding sugar, processed foods & seed oils
  2. Give yourself plenty of time to adapt to the change of eating patterns
  3. You may find that you need to top up with some carbs before &/or during higher intensity activity
  4. Everyone is different, find what works for you!

With too many clinical pearls to fit into one blog, we just had to make this a two-part series!

In part 2, we discuss management of the older runner, achilles tendons, foot strength and running shoes PLUS a link to all the presentation slides! Stay tuned!

***

Luke Nelson @sportschiroluke is a Sports Chiropractor in Melbourne, Australia. He works in private practice at Chiropractic Solutions, Bentleigh East where his interest lies in the running athlete. He is currently the President of Sports Chiropractic Australia and serves on the Victorian Committee of Sports Medicine Australia. Email: luke@chirosolutions.com.au. You can follow him on twitter and instagram @sportschiroluke or www.thesportschiro.com.au

Brad Beer @Brad_Beer is a Physiotherapist on the Gold Coast, Australia. He is the Founder of POGO Physio, Author of best-selling You CAN Run Pain Free!, and host of the popular and iTunes top ranking The Physical Performance Show podcast. You can follow him on Twitter and Instagram @Brad_Beer or via www.pogophysio.com.au

Hamish @Hamishvic is a Physiotherapist in Melbourne. He works for himself at Hamish The Physio in Camberwell and Balwyn. You can follow him on Twitter @hamishvic, Instagram @hamishthephysio or www.hamishthephysio.com.au

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Competing interests

None declared

References

  1. US Road Race trends.https://www.runningusa.org/2017-us-road-race-trends, 13/7/2018.
  2. van Gent, R.N., et al., Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review.Br J Sports Med, 2007. 41(8): p. 469-80; discussion 480.
  3. Nielsen, R.O., et al., Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury.J Orthop Sports Phys Ther, 2014. 44(10): p. 739-47.
  4. Noehren, B., J. Hamill, and I. Davis, Prospective Evidence for a Hip Etiology in Patellofemoral Pain.Med Sci Sports Exerc, 2012. 45(6).
  5. Rauh, M.J., Summer training factors and risk of musculoskeletal injury among high school cross-country runners.J Orthop Sports Phys Ther, 2014. 44(10): p. 793-804.
  6. Rauh, M.J., et al., Epidemiology of musculoskeletal injuries among high school cross-country runners.Am J Epidemiol, 2006. 163(2): p. 151-9.
  7. Milewski, M.D., et al., Chronic lack of sleep is associated with increased sports injuries in adolescent athletes.J Pediatr Orthop, 2014. 34(2): p. 129-33.
  8. Ivarsson, A., et al., Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention.Sports Med, 2017. 47(2): p. 353-365.
  9. Luedke, L., et al., Perfectionist Concerns Predict Injury Risk In Collegiate Distance Runners – Preliminary Findings From A Prospective Study: 2354 Board #190 June 1 9. Vol. 50. 2018. 580.
  10. Fields, K.B., et al., Prevention of running injuries.Curr Sports Med Rep, 2010. 9(3): p. 176-82.
  11. Moran, G.M., et al., A systematic review investigating fatigue, psychological and cognitive impairment following TIA and minor stroke: protocol paper.Systematic Reviews, 2013. 2: p. 72-72.
  12. Messier, S.P., et al., A 2-Year Prospective Cohort Study of Overuse Running Injuries: The Runners and Injury Longitudinal Study (TRAILS).The American Journal of Sports Medicine. 0(0): p. 0363546518773755.

 

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