by Joshua J. Stone, MA, ATC, NASM-CPT, CES, PES, FNS

I have been looking for something to blog. No idea surfaced that said, “Yes, that is a great blog idea.” That was until yesterday’s tragic Boston Marathon bombing. Runners are a rare breed. You cannot keep them down. A runner’s passion for sport, resilience to challenge, and unique characteristic to rise above is unparalleled by any other athlete. I am not a runner. In fact I am the antithesis of a runner. I go in to anaphylactic shock just hearing the word aerobic exercise, but have many friends who are passionate runners. I dedicate this blog to my running friends, competitors of the Boston Marathon, the friends and family of those impacted by yesterday’s events, and runners everywhere from the competitive to non-competitive. I will keep it true to my blog site and remain sports medicine focused. I hope you find the information useful.

Running is one of the most popular recreational sports in the US. Race events can be found in almost every town. My town – Champaign, IL – has 2 events in the next 4 weeks. Some estimates say 20% of the population is runners and 10% of these people participate in race events. The benefits of exercise are well documented. Running has shown to build confidence and character, reduce stress and improve mood. However, the due to their very nature – the unwillingness stop – running does bring about an increased incidence of musculoskeletal injury.

You don’t need to be an astrophysicist to know running injury is secondary to cumulative overload. Running injuries are multifactorial; neuromuscular imbalance, poor arthrokinematics and other things such as age, nutritional status and environment are to blame. From a biomechanical point of view frontal plane knee adduction moments play a significant role in lower extremity injury. Q-angle – a measure of knee alignment – can indicate risk for running injury. An increased Q-angle can be a result of many neuromusculoskeletal inefficiencies from poor muscular hip control to limited ankle dorsiflexion and excessive forefoot pronation.

Running brings about many injuries, but the most common are Patellofemoral Syndrome, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome / Tibial Stress Fracture, Achilles Tendinitis, Plantar Fasciitis, and Sacroiliac Joint Pain. What is interesting is that all of these injuries can be caused by biomechanical breakdown and neuromusculoskeletal inefficiency. The good is the dysfunctional patterns are identifiable, preventable and correctable. Below is a sample 15 minute injury prevention program from a blog I wrote in Sept 2012. Yes, 15 minutes is all you need to prevent many running injuries.

Step 1: Decrease neurological drive to hypertonic tissue – 3 minutes

• Self-Myofascial Release (foam roll) or Manual Trigger Point Therapy
  • Gastrocnemius/Soleus – 60 seconds
  • Adductors – 60 sec
  • TFL/IT-band – 60 sec

Step 2: Lengthen hypertonic muscle or joint tissue – 3 minutes

• Static stretch or joint mobilization
  • Gastrocnemius/Soleus Stretch – 1 set @ 30 sec
  • Kneeling Hip Flexor Stretch – 1 set @ 30 sec
  • Adductor stretch – 1 set @ 30 sec
  • Posterior joint mobilizations at the ankle – 90 seconds

Step 3: Increase neurological drive to hypotonic tissue – ~ 6 minutes:

• Exercise: Isolated Strengthening or positional isometrics
  • Resisted Ankle Dorsiflexion – 2 sets x 15 reps (slow) (2 minutes)
  • Resisted Hip Abduction and External Rotation- 2 sets x 15 reps (slow) (2 minutes)
  • Resisted Hip Extension – 2 sets x 15 reps (slow) (2 minutes)

Step 4: Integrated Dynamic Functional Movement – ~ 3 minutes

• Box step-up with overhead dumbbell press – 2 sets x 15 reps (slow)

Beyond the correction of movement dysfunction there are alternatives to treat running injuries which are effective and gaining popularity. This table highlights a few.

I prefer preventing and rehabilitating injury through correcting neuromuscular inefficiencies and dysfunctional movement. The problem with the above treatments is that they are treatments. If an injury is caused by dysfunctional movement patterns and those patterns are not corrected it is likely the above treatments will simply serve as a Band-Aid because the true problem was not fixed.

If the person(s) responsible for the Boston Marathon bombing were looking to put fear in people, they chose the wrong population to target. Runners are the most stubborn and prideful athletes. No means yes, and yes means do more. If you took a graphical representation of marathon registration numbers from last night through the end of this week I would bet you’d find a spike, rather than a decline. Social media is exploding with a rise of the runner. A quote from a friends Facebook page: “If you’re trying to defeat the human spirit, marathoners are the wrong group to target” –unknown. Other movements like, wear a race shirt tomorrow, donations, and wear yellow and blue (Boston Marathon colors) have already begun. So, thank you runners for inspiring this blog post!

Find more of Josh’s work here.