I attended a 2 day course on current trends in running injuries this weekend in Calgary - put on by the Running Clinic, from QC. 18 hours of continuing medical education! An ultra marathon of learning, but great to back in the classroom! The facilitator/educator - JF Esculier, a physiotherapist at that clinic, was a font of knowledge. If a trial has been done to investigate some intervention, he can quote it! And this course was awesomely entertaining too, and free from any commercial interest or bias. We even squeezed in a group run at the end of day 1.
Here are the key take away messages I learnt this weekend:
1) regular running decreases the risk of death by up to 63% ! The number one message. Run!
2) the ideal running shoe, is lightweight, flexible and has a low drop (as per recent ACSM recommendations)
3) pronation control footwear and other such technologies, are gimmicks, provide no advantage, likely increase the risk of injury, and do not do what they claim to do. eg. Do not decrease forefoot pronation, and in some studies increase it!
4) Shoe sellers who choose shoes for you based on your foot type, are kidding themselves that they're doing you any kind of favor.
5) measuring such 'installed' anatomical factors such as Q angle or navicular drop has no value. You cannot change these things.
6) such anatomical factors do not predict injury risk.
7) when trying to provide gait cues, the best advice is to run at a cadence of 170-190, and to 'run quiet'
8) vary your running surface to minimize injury risk
9) the human body is remarkable at adapting. Chronic tendon injuries respond best to progressive loading.
10) stretching is rarely beneficial
11) foot orthoses are for specific injury management of foot/ankle injuries. They do not help with knee, hip or back pain
12) placebo effect is huge! A lot of modalities and therapies offered have no science to back them up
13) endurance runners do not suffer from knee osteoarthritis more frequently. In fact, there is evidence that regular running strengthens articular cartilage
14) the single biggest cause of running injury is poor load management - too much, too soon.
15) being barefoot and running in more minimal shoes is the most specific strength program for runners. Progression into minimal shoes takes patience if we are to avoid plantar fasciopathy, Achilles tendinopathy and calf strain
16) keep rehabilitation exercises functional
17) you cannot stretch an IT band. Obvious, but I find myself telling this to patients over and over. It bears repeating! Quit rolling that ITB !
18) patellar tracking is a myth
19) taping is effective in injury management, but we have no idea why it works!
20) NSAIDs have little role in the management of injury, and may well limit tissue adaptations to acute injury and training load.
21) don't allow someone to tell you to stop running as it's rarely the right advice! See a professional who is a runner and who manages running injuries.
This is obviously just a brief Coles notes type summary. For more information, www.therunningclinic.com has some great resources for runners and health professionals. Read their blog, it's fantastic.