Two days of action-packed learning at the LaTrobe Run Science Symposium last month led us to write up a Part 2 to our initial blog (Check out PART 1 here). In this blog, we add in plenty of clinical pearls and a link to all of the speakers’ slides!
We heard a number of talks on managing the older runner. In his talk Managing the runner with knee OA, Dr Christian Barton @DrChrisBarton addressed the age old myth “running wears out your knees” with the recent review and meta-analysis concluding that both a more sedentary lifestyle and long exposure to high-volume and/or high-intensity running are associated with hip and/or knee OA . However, despite any potential increase in OA, running is effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions [14,15]. Dr Barton compelled the audience to do whatever is possible to keep people running. Dr Barton then discussed running retraining and his RISK approach to injuries: Reduce overall load, Improve capacity to attenuate load, Shift the load,and Keep adapting to the injured runners goals and capacity .
Rich Willy discussed the challenges faced by the older runner in “The Master Runner: maintaining durability”. Unfortunately in the older runner, the plantarflexors take the biggest hit with increased age, with a 15% reduction in physiological cross sectional area, 17.1% reduction in achilles tendon stiffness & 31% less plantarflexion power during running . This decrease in power is NOT compensated for at the knee or hip.
So, how do we improve achilles tendon stiffness in the ageing runner? Running alone will not improve the stiffness of the achilles tendon. Go heavy with resistance training! >70% maximum voluntary contraction (8RM) seems to work best . Resistance training in the runner should be performed in the offseason twice per week, with in-season 1-2 per week. Regular treadmill running, hill repeats & speed work sessions can also be used to target the plantarflexors.
Rich later continued with the key elements in returning to running post Achilles tendon injury. Contrary to what many think, the achilles tendon compression is greatest in midstance NOT at push off, therefore rehab shoulder consider this phase of gait. Should you consider gait retraining for Achilles’ tendinopathy? Caution with this, as an increase in cadence by 7.5% only results in small 0.6-3% decrease in achilles tendon load, and if you are increasing loading cycles by 7.5% you will have a NET increase in load .
When to add plyometrics to a runner’s rehab program?
- When they can easily do heel raise with 20% bodyweight, 3 sets of 8
- The runner is plateauing with strength training
Ebonie Rio @tendonpain was next with “Achilles tendons, pain, rehabilitation and neuroplasticity” where she discussed: the various loading programs for achilles tendon injuries, the importance of establishing the injured runner’s current capacity, and having an understanding of their required capacity in order to prescribe an appropriate tendon rehab intervention. The key takeaway being that rest is detrimental to tendon capacity. When managing these patients you need to remove provocative loads (but not ALL loads), and then add analgesic loads.
It wouldn’t be a running symposium without a discussion on running shoes, with Rich Willy “Running shoes: minimalist, maximalist, or stand alone shoe prescription”. Shoes? Shoes don’t tend to matter….until they do. Traditional shoe prescription based on arch type likely doesn’t work [20, 21]. The use of minimalist shoes and the recent rise of maximalist shoes were then discussed. Minimalist shoes have been shown to reduce knee loads, but it this worth the increased injury risk?  Habitual minimalist wearers do have thicker & more stiff Achilles’ tendons but this study is cross sectional and it could be prone to survival bias . Heavy slow loading is still the best way to improve Achilles tendon properties .
Mel Smith @MelindaM_Smith concluded the day with a discussion of intrinsic foot muscles: Rethinking the foot: what about exercise rehab? This is often a neglected area in rehab, and there are many questions yet to be answered in the research in regards to assessment and strengthening of these muscles. Mel introduced the concept of dynamic foot function: an interplay between active, passive, and neural elements. Intrinsic foot muscle deficits have been shown in plantar heel pain , chronic ankle instability , hallux valgus , and diabetes mellitus [28, 29]. Strengthening of these muscles should begin in isolation, and then move to more integrative weight bearing positions .
Overall it was a fantastic 2 days of running related info, a big thanks to LaTrobe SEM and all the speakers for putting on such a great event!
LaTrobe SEM and all speakers have generously offered open access to the slides for the 2 days, click below to access them!
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: firstname.lastname@example.org. 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
PART 2 References
16. Barton, C.J., Managing RISK when treating the injured runner with running retraining, load management and exercise therapy.Phys Ther Sport, 2017.
17. Stenroth, L., et al., Age-related differences in Achilles tendon properties and triceps surae muscle architecture in vivo.J Appl Physiol (1985), 2012. 113(10): p. 1537-44.
18. Bohm, S., F. Mersmann, and A. Arampatzis,Human tendon adaptation in response to mechanical loading: a systematic review and meta-analysis of exercise intervention studies on healthy adults.Sports Med Open, 2015. 1(1): p. 7.
19. Willy, R.W., et al., Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running.Journal of Orthopaedic & Sports Physical Therapy, 2016. 0(0): p. 1-31.
20. Knapik, J.J., et al., Injury Reduction Effectiveness of Prescribing Running Shoes on the Basis of Foot Arch Height: Summary of Military Investigations.J Orthop Sports Phys Ther, 2014: p. 1-25.
21. Nielsen, R.O., et al., Foot pronation is not associated with increased injury risk in novice runners wearing a neutral shoe: a 1-year prospective cohort study.British Journal of Sports Medicine, 2013.
22. Sinclair, J., et al., The Influence of Minimalist and Maximalist Footwear on Patellofemoral Kinetics During Running.J Appl Biomech, 2016. 32(4): p. 359-64.
23. Histen, K., et al., Achilles Tendon Properties of Minimalist and Traditionally Shod Runners.J Sport Rehabil, 2017. 26(2): p. 159-164.
24. Cheung, R.T., et al., Intrinsic foot muscle volume in experienced runners with and without chronic plantar fasciitis.J Sci Med Sport, 2016. 19(9): p. 713-5.
25. Feger, M.A., et al., Diminished Foot and Ankle Muscle Volumes in Young Adults With Chronic Ankle Instability.Orthop J Sports Med, 2016. 4(6): p. 2325967116653719.
26. Lobo, C.C., et al., Ultrasound evaluation of intrinsic plantar muscles and fascia in hallux valgus: A case-control study.Medicine, 2016. 95(45): p. e5243.
27. Stewart, S., et al., Ultrasonic evaluation of the abductor hallucis muscle in hallux valgus: a cross-sectional observational study.BMC Musculoskelet Disord, 2013. 14: p. 45.
28. Bus, S.A., et al., Intrinsic muscle atrophy and toe deformity in the diabetic neuropathic foot: a magnetic resonance imaging study.Diabetes Care, 2002. 25(8): p. 1444-50.
29. Andersen, H., et al., Muscle strength in type 2 diabetes.Diabetes, 2004. 53(6): p. 1543-8.
30. McKeon, P.O., et al., The foot core system: a new paradigm for understanding intrinsic foot muscle function.British Journal of Sports Medicine, 2014.