{"id":7994,"date":"2018-08-29T17:23:35","date_gmt":"2018-08-29T16:23:35","guid":{"rendered":"https:\/\/blogs.bmj.com\/bjsm\/?p=7994"},"modified":"2018-08-29T17:23:35","modified_gmt":"2018-08-29T16:23:35","slug":"deload-the-runner-la-trobe-sem-run-science-symposium-review-july-6th-7th-part-2","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bjsm\/2018\/08\/29\/deload-the-runner-la-trobe-sem-run-science-symposium-review-july-6th-7th-part-2\/","title":{"rendered":"Deload the runner: La Trobe SEM Run Science Symposium review July 6th-7th [PART 2]"},"content":{"rendered":"

By Luke Nelson @sportschiroluke<\/a>, Brad Beer @Brad_Beer<\/a> and Hamish Vickerman @Hamishvic<\/a><\/span><\/strong><\/em><\/p>\n

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<\/strong> here<\/a>). In this blog, we add in plenty of clinical pearls and a link to all of the speakers\u2019 slides!<\/p>\n

We heard a number of talks on managing the older runner. In his talk Managing the runner with knee OA,\u00a0<\/em>\u00a0Dr Christian Barton @DrChrisBarton<\/a>\u00a0<\/em>addressed the age old myth \u201crunning wears out your knees\u201d 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 [13]. 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 [16].<\/p>\n

Rich Willy discussed the challenges faced by the older runner in \u201cThe Master Runner: maintaining durability\u201d.\u00a0<\/em>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 [17]. This decrease in power is NOT compensated for at the knee or hip.<\/p>\n

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 [18]. 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.<\/p>\n

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\u2019 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 [19].<\/p>\n

When to add plyometrics to a runner\u2019s rehab program?<\/p>\n

    \n
  1. When they can easily do heel raise with 20% bodyweight, 3 sets of 8<\/li>\n
  2. The runner is plateauing with strength training<\/li>\n<\/ol>\n

    Ebonie Rio @tendonpain<\/a> was next with \u201cAchilles tendons, pain, rehabilitation and neuroplasticity\u201d\u00a0<\/em>where she discussed: the various loading programs for achilles tendon injuries, the importance of establishing the injured runner\u2019s current capacity, and having an understanding of their required capacity in order to prescribe an appropriate tendon rehab intervention. \u00a0The 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.<\/p>\n

    It wouldn\u2019t be a running symposium without a discussion on running shoes, with Rich Willy \u201cRunning shoes: minimalist, maximalist, or stand alone shoe prescription\u201d<\/em>. Shoes? Shoes don\u2019t tend to matter….until they do. Traditional shoe prescription based on arch type likely doesn\u2019t 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? [22] Habitual minimalist wearers do have thicker & more stiff Achilles\u2019 tendons but this study is cross sectional and it could be prone to survival bias [23]. Heavy slow loading is still the best way to improve Achilles tendon properties [18].<\/p>\n

    Mel Smith @MelindaM_Smith<\/a> concluded the day with a discussion of intrinsic foot muscles: Rethinking the foot: what about exercise rehab?\u00a0<\/em>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 [24], chronic ankle instability [25], hallux valgus [26], [27]and diabetes mellitus [28, 29]. Strengthening of these muscles should begin in isolation, and then move to more integrative weight bearing positions [30].<\/p>\n

    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!<\/p>\n

    LaTrobe SEM and all speakers have generously offered open access to the slides for the 2 days, click below to access them!<\/p>\n

    Run Science Symposium 2018- Presentations<\/a><\/p><\/blockquote>\n