Outline

The running cycle Spatial parameters Runner’s varus? Impact forces Incidence of overuse injuries & risk factors for runners Do running shoes cause injury? Orthoses and running Summary

Biomechanics of Running
Adam Bird

References
Assorted articles mentioned… Nigg BM (1986) Biomechanics of running Human Kinetics Publishers, Illinois, Chapter 1 *Cavanagh PR (1989) The biomechanics of running and runnning shoe problems. In: Segesser B, Pforringer W (eds). The shoe in sport. Yearbook Medical Publishers, p 3-15 *Novachek TF (1998) The biomechanics of running (review paper) Gait & Posture 7: 77-95 CD-ROM “Running & Sprinting: a dynamic analysis”
BUND AV 612.76

The running cycle
no double support phase three phases
– stance (40%) – float (30%) – swing (30%)

stance consists of
– contact, midstance, propulsion

‘float’ phase
– body airborne, no foot contact – consists of forward swing and foot descent

The running cycle
the duration of each phase is relative to the speed of running
– jogging: stance > swing – distance: stance = swing – sprinting: stance < swing

Running gait cycle

From: Subotnick SI. Podiatric Sports Medicine. Futura, New York, 1975

Spatial parameters
step and stride length much greater than walking stride width much narrower no double support phase uphill running
– shorter stride length – increased stride rate

Spatial parameters

downhill running
– longer stride length – decreased stride rate

WALKING

RUNNING

Spatial parameters
at any given running speed, each individual has an optimal combination of stride length and rate to minimise energy requirements increased speed leads to – increased hip flexion – increased knee flexion – increased forward trunk lean – increased float phase duration – decreased support phase

Running style variations
80% distance runners are rearfoot strikers (Kerr et al, 1983) Elite sprinters have only forefoot contact

Runner’s varus
foot must be placed under CoG, due to lack of double support requires adduction of femur in the acetabulum increased varus position at heel strike this varus position may favour increased STJ pronation, particularly in females

Impact force
F=MV, therefore running will result in greater impact force than walking two peaks: – heel strike (2 X BW) – midstance (3 X BW) joint compressive forces in the foot may reach up to 10 X BW
– high potential for stress fracture

rapid STJ pronation and knee flexion

Impact force

Impact force
Passive force Peak - shock of contact with the ground

Due to active Muscle forces Marks end of Deceleration & Beginning of acceleration

“There’s no evidence that biomechanical research in load analysis has contributed to a decreased frequency of running injuries”
(Nigg, 1990)

Overuse injuries
massive increase in number of joggers in last 25 years estimated thirty million joggers in the USA (Nigg, 1986) Between 25-50% of runners will sustain an injury that is severe enough to cause a change in practice or performance (Renstrom, 1993) the knee is most common site of injury

Incidence of running injuries
OTHER 35% KNEE 30%

ACHILLES 10% MLA 10%

TIBIA 15%

From: Nigg BM. (ed.) Biomechanics of running shoes. Human Kinetics Publishers, Illinois1986.

Incidence of marathon running injuries
Ultramarathon injuries
– Westfield Syd-Melb, 1990 – Knee (31.3%), ankle (28.1%) – Most common
Retropatella pain Achilles tendonopathy Medial tibial stress syndrome (Fallon, 1996)

Clinical / Historical Factors associated with overuse injuries*
impact force hard surfaces – stress fractures downhill running – shin splints, patellar tendonopathy lack of flexibility – esp. achilles and hamstrings overstriding – hamstrings, knee pain Shoes (last, stability, age to replace) running on one side of road – environmental LLD

Risk factors: 1st time participation, illness less than 2 weeks before, current use of medication, drinking alcohol once a month or more
(Satterwaite et al, 1999)

Aetiological factors that are strongly associated with injury
Previous injury Lack of running experience Running to compete ‘Excessive’ weekly running distance
(van Mechelen, 1992)

Aetiological factors that are unclear as to whether associated with injury
Body height Muscular imbalance Restricted range of motion Stability of running pattern Running on one side of the road Biomechanical malalignment … Warm up/stretching exercises… Shoes/orthoses...
(van Mechelen, 1992)

Aetiological factors that are strongly not associated with injury
Age Gender Body mass index Participation in other sports Time of year/time of day
(van Mechelen, 1992)

Do running shoes cause injury ?
Evidence:
large increase in overuse injuries over the last 20 years a Boston marathon study found that there was a higher incidence of overuse injury in subjects who wore more expensive shoes very low incidence of injury in barefoot runners

Do running shoes cause injury?
Robbins-Gouw hypothesis: running shoes cause injury due to creating a perceptual illusion of lower impact force excessive cushioning decreases proprioceptive feedback body unable to judge severity of impact reduced innate impact moderating behaviour increased impact
(Robbins & Gouw, 1991)

Shoe factor associated with overuse injuries?

Use of orthoses with running injuries
At least 70% of runners who experience lower extremity symptoms
– eg. knee pain, plantar fasciitis, shin pain, iliotibial band tendinitis

… report marked improvement with orthotic use
A large lateral flare provides ground reaction forces with a longer lever arm for pronating the STJ. This will increase the velocity of contact phase pronation and may predispose to injury (Nigg & Morlock, 1987)
(D’Ambrosia, 1985, Donatelli et al., 1988, Gross et al., 1991, James et al., 1990)

Early 2D studies looking at effects of orthoses when running
Reduction in
– maximum pronation/calc eversion (Clarke,
1984)

Foot orthotics effect on 3D kinematics of lower limb during running
20 recreational runners Semi-rigid foot orthoses Significant change in:
– Decreased amount (2°) of internal tibial rotation (in first half of stance)

– Maximum pronation velocity (Novic, 1990) – Time-to-max pronation (Bates, 1979) – Total rearfoot motion (Novick, 1990)
Differences in footwear, orthoses, test surfaces, only 2D analysis?

No change in frontal plane rotations (ie. calc inv/ev)
(Nawoczenski, Cook & Saltzman, 1995)

General principles for running orthoses
Semi-flexible? Aware of greater forces being placed through devices - discomfort/fracture? Rearfoot posting? Competitive athletes = weight of devices?

Long term sequelae of running?
Knee Osteoarthritis?
– 117 former athletes, now 45-68 years old – No – (Factors that do: previous knee injuries, High BMI at age 20, participation in heavy work, kneeling/squatting work, previously played soccer/heavy weightlifting)
(Kujala et al, 1995)

Summary
significantly altered mechanics due to: – floatation phase – impact forces up to 3 X BW – rapid contact phase pronation – increased varus heel strike – not necessarily heel to toe pattern increased incidence of injury
– Know risk factors

‘Case Study’ lecture
Please read (Keenan, 1997) in your POD21PBM manual
– Summarises some of the issues Craig spoke about in his lectures so far this year – Talks about integration of traditional and newer theories of foot function

different orthotic requirements… Importance of early recognition of symptoms of overuse & complete rehabilitation

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