SRLA 26.2
Injury Prevention
Keys for Coaches
Strengthening & Stretching
Normal & Abnormal Motion
Catching Problems Early
Developing the 4 types of fitness
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1. muscle strength
(how powerful is one step?)
2. muscle endurance
(how many powerful steps?)
3. Cardio-respiratory endurance
(a.k.a. aerobic fitness)
(how many steps before you’re “winded”?)
4. Flexibility
(how many degrees of joint motion?)
Youth Vs. Adult Tissues
Youth: a stretchy band
 Growth Spurts Temporary imbalances possible
 Strain (elongation) injuries
 Active Bone Growth plates & age
of closure:
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Foot 14-21
Heel 12-22
Ankle 16-18
Knee 16-19
Hip 16-18
Adult: a braided rope
 Protein Cross linking
 Tendons- decrease length but
increases pulling strength
 Ligaments- decreases joint
range of motion
 Sprain (tear) injuries
 Over age 22: No growth plate
injuries possible
But we all train together….
 Remember…
 Pain in the same place may not be the same problem
 Calcaneal apophysitis vs calcaneal stress fracture vs
insertional achilles tendonitis… all are “heel pain”
 A limit in 1 or more of the 4 types of exercise fitness will
impact the runner’s training, and point to what the
problem is. (Overweight youth do more aerobic work to
oxygenate their tissues: 1 lb fat has > 1 mile capillaries)
 Training for a marathon requires all 4 types of fitness- the
goal is to complete 4-8 hours of vigorous exercise in March
2014
 Strengthens bones
 Cyclical loading
 Strengthen muscles
 Especially front and back of
the hips and legs
 Increased aerobic function
 Oxygen delivery to cells
 Improved organ efficiency
 Liver, pancreas, brain
 The body may put some organ
works “ on hold” such as
digestion in the stomach and
GI Tract during distance
running
 Aerobic exercise requires
WATER, Glucose and OXYGEN
to run efficiently.
 (50% food energy goes to
making ATP, 20% to muscle
action, 30% lost as heat)
 Hydrate!“ drink till you pee”
Flexibility The 4th Fitness
Why Stretch?
Youth
 Maintain full range of motion
 Overcome growth spurt
imbalances
 Prevent tendon & ligament
strain injuries
 Increase energy efficiency
Adult
 Maintain full range of motion
 Prevent ligament and tendon
tears and sprains
 Prevent focal joint damage
“wear and tear arthritis”
 Increase energy efficiency
Hamstrings need to stretch more?
 Hamstrings Tight
 Run with pelvis straight
or tipped back (normal is
anterior tilt of 15 deg)
 Knees don’t extend fully
 Back, hip, knee pain
 Quads over work / cramp
Where is the piriformis?
And why do I care?
 The piriformis runs at an
angle across the buttock.
 A tight piriformis can
cause debilitating sciatica.
Recurrent piriformis spasms
can stop a runner
completely.
 Stretch the piriformis by
pulling the knee up and
towards the opposite
shoulder with both
hands, while lying on your
back.
 The knee should be bent
and foot relaxed.
 The arms are doing the
work.
Groin need to stretch more?
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Groin muscles tight
Short stride
Decreased hip flexion
Inability to clear hurdles
Decreases running
efficiency
 Increases aerobic
exercise demands
Quadriceps need to stretch more?
 Quadriceps tightness
 Crouching tiger….unable
to stand in place without
pelvic tilt anteriorly.
 Unable to bend knee back
while standing erect.
 Patella, hip, back pain
Calf (gastrocnemius & soleus) tight?
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Calf tightness/ cramping
Knee hyperextended
Toe walker
Bouncing heel
Can’t stand and lift ball of
foot off floor 20 degrees
 Achilles tendonitis, plantar
fasciitis, tendon rupture,
collapsing flat foot,
posterior tibial tendonitis
I can’t tell degrees….
You probably can and
don’t realize it!
clock face = 360 deg
A pie slice of time:
1 minute= 6 degrees
5 minutes= 30 degrees
(on the clock, the pie
slice from 3 to 2 is 30
degrees)
Posterior muscles Towel Stretch
 Plantar fascia, long toe
flexor tendons,
gastrocnemius, soleus,
hamstrings
 Prevent: posterior tibial
tendonitis, metatarsalgia,
shin splints, tight calf,
torn achilles, torn
hamstrings, and strain
 Start seated on floor, back upright,
towel around ball + arch, arms in a
sawing position, ( no “ stage coach
driving, no chicken dance), with
knee locked, gradually pull foot
towards body with arms. The foot
goes for a free ride, pull till tension
,hold till tension relaxes, pull again
to tension and hold till relaxed.
Gradually lie back and bring the foot
and leg up as one till the hip is flexed
( your toes are over your body ) to
tension, hold till relaxes.
 Sit up & Do other side
Cross Training
 Any forward LINEAR exercise other than running IS
NOT cross training.
 Examples of not cross training for running: bicycle,
elliptical, stair stepper.
 There are muscles NEEDED TO RUN EFFICIENTLY that
are minimally strengthened or stretched by running.
 (Hip abductors and adductors)
 Cross training requires Non linear motion ( SIDE TO
SIDE, CIRCULAR, UP & DOWN)
Cross training Muscles
SIDE TO SIDE
 Soccer, tennis, dancing,
racquetball, martial arts,
swimming (especially frog
kick), chasing (dog, or kids,
such as playing tag, capture
the flag,) hockey, skating (ice,
roller or in-line), calisthenics,
wrestling, wii, ddr,
Up & Down
 Hopscotch, jump rope,
basketball, volleyball, musical
chairs, rock climbing / climbing
walls
Functional Genu Valgum
 Standing the
knees are
straight, aligned,
kneecaps facing
forward
 Walking, the
knee appears to
move toward or
past the midline
& this increases
with pace, on the
leg with the body
weight.
Problems of functional genu valgum
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IT band syndrome
Patella tracking pain/ problems
Knee pain
Over-pronation with foot/ ankle pain
Abnormal knee joint (excessive focal) wear
Testing for functional genu valgum
 One leg deep knee bend. Does the leg stay aligned or
does it become a > or < sign?
Training tips to decrease/ resolve
functional genu valgum
 Strengthen abductor of hip (
gluteus medius)
 Doorway exercise: gently &
slowly lift leg to side,
keeping body aligned to
doorway, toes pointed
directly forward ( no
external rotation) and
slowly lower leg.
 Side lying on floor and
raising leg, toes pointed
forward.
 Stretch hip adductors
 Sitting cross legged and
gently lowering the knees
toward the floor
 Sitting legs extended and
gradually widening the V
of legs. Keep toes
pointed straight up.
Ankle Problems
 Sprains: somewhere
there is a pothole with
your name on it….
 If they can’t put weight
on it, it needs to get an X
ray.. Don’t run through
the pain.. Rest & ice and
call for help.. It may be
broken not sprained
 Mild sprains:
 Taping or soft compression
bracing till recovered.
 Rest, ice, elevate initially and
after 1st week contrasts of
heat and cold, “ the 25 minute
treatment”
 5 cold +5 warm + 5 cold+ 5
warm + 5 cold= 25 min.
treatment.
 Avoid uneven ground initially
until the sprain is healed.
Foot Sprains
 Same rules as ankle sprains apply- if they can’t bear
weight, they need an X ray.
 Taping helps, often, just a good arch supportive insole
can do a lot and allow you to keep running.
 Over the counter, soft support from gel to spenco
polysorbs, firmer support such as Powerstep and foot
soldiers, and hard support such as Superfeet.
 Stretching toes may be necessary.
Foot problems
Skin shear
 Friction in shoes is the enemy
 Blisters are from too much
SHEAR force between the skin
and the tissues deep inside.
 Calluses are the skin response
to low level friction, that is
recurrent. The skin makes
more, tougher, skin.
Athlete’s foot
 Wicking socks, gore tex vents
and allowing shoes to air out
after runs
 Antifungals for at least 2
weeks.
Foot skin Problems
 Skin problems: do not poke and drain the blisters with your
dirty finger nails!!
 Running with Blisters and calluses? Grease them up! ( plant
based products like cocoa butter, olive oil, shea butter,
sesame oil do not clog pores)
 Avoid petroleum based products like mineral oil, vaseline,
baby oil which can clog pores, leading to more problems.
 Surf wax on the shoe spot, or teflon patch on the shoe
spot, often decreases friction.
Temporary support : taping
High dye, J strap
 Elastoplast ( less expensive)
 Kinesiotape ( pre cut)
 How to is online at K-tape
website
 Athletic tape
 Pre- tape ( spray)
 Under tape ( wrap)
Basket weave
 Immobilizes motion at the
midfoot, fat pad of heel,
insertion of achilles, and inside
and outside tendons from the
foot to the calf, increase it
above the ankle and
immobilize the ankle joint
Temporary support: taping
 IT Band / Patellar tracking
 Any runner who thinks they
need a brace needs to see a
doctor to prescribe the correct
one.
 Often a brace is the last thing
they need, and isolated
balancing exercises maty be
prescribed.
 Taping is a temporary
alignment guide that provides
neuromuscular re-education
just by being there.
 Athletic taping maintains
its strength for about 20
minutes in vigorous
exercise.
 K tape and elastoplast
last longer due to their
ability to stretch.
Coaching out bad form…
Cardio/ aerobic
 Keep the upper body relaxed
to prevent chest muscle wall
tightness. Shoulder shrugs,
neck rolls, “limp doll”
 Keep the arms from crossing
or “closing off” the chest.
Muscle endurance
 Your training program is
excellent, follow it. If you have
a runner who just can’t keep
up in the early weeks,
intermittent running and
power walking will help them
build muscle endurance.
 For more detail…..
 “ Couch to 5K”
Coaching out bad form
 New research:
 Athletes advised to change form based on external cues
do better than those advised on internal cues…
 For example- that functional genu valgum runner will
improve more being told to point each knee forward and
have them see themselves run on a treadmill in front of a
mirror, than to tell them to hold the knees straight as the
foot lands, or feel the knees coming out from where they
were, with no visual cue, real or imagined, to guide them.
Muscle aches
Hydrate! electrolytes!
Ice, Heat & massage
 Post run care : refill, refuel, refresh,
replace
 Refill: the water tank
 Refuel & refresh: healthy balanced
meals with food based vitamins,
minerals, proteins and complex
carbohydrates (veggies, fruits and a
protein source)
 Replace: lost electrolytes –Especially
if you are a heavy sweat-er, that
white stuff on your black t shirt is
your lost electrolytes!
 Ice pack massage, Foam rollers,
frozen tennis balls, Cold soak before
the hot shower
 all help decrease tissue congestion,
clear the tissues of excess fluid.
 Then adding warmth after these
cold treatments helps bring in new
nutrients from the circulation to
heal and repair micro damage.
SLEEP: You’ll Need a LOT
Sleep
 Prime cellular time to rebuild and restore?
 10 pm to 2 am
 Lack of sleep releases hormones that make you crave
simple carbohydrates- even 1 night’s lack of sleep!
 Some muscles cramp “ charley horse” at night as a
response to overuse ( imbalance overuse) and any
muscle cramping can ruin a good night’s sleep.
 Ask your runners if they get cramps and if so whereuse this to guide any extra stretching they may need.
THANK YOU!
I Look forward to seeing you wave as you effortlessly run
past the medical tent