Two correctives for common running injuries: A Public Service Announcement
This post was originally at Keynote at the Canadian Orthopaedic Manual and Fascial Therapy Division Conference on February 29, 2015 in beautiful Wawa, ON, Canada
Running is a complex event. Requiring exquisite balance and co-ordination. It involves single foot contact of less than 270 milliseconds and a float phase that stability, mobility, control and appropriate firing patterns. One 10km jog can take upwards of 10,000 steps so the repetitive nature of the task must be taken into account.
We have over 600 muscles and 200 bones that can all influence each other. Regional interdependence is best illustrated in running since the multitude of systems (neuro, immune, endocrine, biomechanical) can all influence the function of each other. You obviously need to earn the right to run. To work with a healthy runner is to truly understand that the whole person must be treated and finely tuned to respond to the intricate nature of the task and the inherent complexity of the human system. You need to assess all these areas, learn how the interact, measure joint stability, fibroblastic tension, neural signatures of movements and definitely make sure the motor engrams are firing in the right order.
#1 running flaw
One common flaw that I have been seeing lately is the use of arm bands with large smart phones only used on one arm.
When we consider the repetitive nature of running and its interconnectedness it is obvious how this asymmetrical banding for the sake of some lame podcast can create some serious compensations throughout the entire kinetic chain. The most common dysfunction I see and you will see:
- the lats will overcompensate to drive the arm backwards
- this will lead to a right trunk rotation and a right lateral bend
- due to the lats connection with the opposite glute max you will be increased force closure on the left SI joint
- that SI joint will undergo too much compression because it has stability that it doesn’t need
- you might manipulate the SI joint to get temporary relief but you won’t address the primary dysfunction so the pain will return
- the tight lat will know inhibit the opposite glute (we learned this thanks to Anatomy Trains) which will make the opposite hip flexor work even harder to compensate. This in turn could create a shortening of that muscle and a contralateral pelvic tilt which can lead to opposite hip adduction and knee valgus and too much pronation. The body is amazing isn’t it?!!
- breathing will be compromised because of the lat tightening and possible fibrosis will restrict efficient diaphragm movement. Performance will suffer and the diaphragm dysfunction will now not be able to balance the pelvic floor function and a host ailments could result.
- the lats will torque the ribs and cause them to become improperly stacked. You might think that ribs are strong and robust because they are there to protect your lungs but that is false. Think of the ribs as more paper mache that surrounds balloon. The paper is just hardened glue and if you’ve ever sat on your daughters paper mache unicorn you know that its inherently weak. The ribs probably function more like an emitting antenna to warn you not to have to much stress through them.
#2 running flaw
Very much related to the arm band flaw is the credit card in the back/right rear pocket. A similar dysfunction in that it induces asymmetry in the system that due to the repetition can not be adapted to. But this time its due to a different mechanism.
Consider the edge of the card consistently rubbing with every stride. This edge like myofascial release can end up loosening the gluteus maximus fascia and leads to instability through posterior pelvic girdle. Its not something you even notice but that constant intervention probably detunes the ruffini corpuscles so that they become desensitized and the fascial contractions on that side will lessen. But no such release is occurring on the left. So if you also have an armband on the right arm the left SI joint gets cinched down and the right SI joint gets released. We have some pretty good research that is the asymmetry in SI joint laxity that leads to dysfunction (link here). This is obvious what is happening here.
What this is similar to is the finding that people who are sedentary and sit a lot are such awesome deep squatters. The constant shearing stress through the posterior oblique fascial sling of the buttocks (caused by sitting) leads to a lengthening of that structure. So its way easier to squat beautifully because sitting creates a shear release through that mysofasical continuum. If you add slumped posture you get even more static shearing through the posterior fascial slings so its even easier to squat. Add in the naturally tightening of the hip flexors and you now have greater hip stability when you squat deep because those tight hip flexors help “pull” you into the squat and keep the femoral head snug in acetabulum where it should be. Anyways. Sorry for the aside, I just love teaching this stuff.
This is where things get complex. We are dealing with a complex human system that is incredible interconnected. With many factors causing the problem and then new factors now perpetuating the problem. Heck, the original latissimus dorsi dysfunction might have resolved but a slew of biomechanical faults replaced it and caused more problems. Here is where skill matters (Why we should have new name for those of us doing this – PhysioSkillerati). We can match the complexity of the patients system with our own complexity of our skilled therapist system. Its the only way. So we use all of our systems to assess and treat. Don’t just palpate. You need to feel, look, understand – open yourself to their rampant dysfunction. Get close to the joint and even take a really deep breath. Its not the smell per se its that the nose has sensors too beyond smell. Ever sneeze when you go in the sun? That’s your photic sneeze reflex (link here). You can take advantage of that if you train yourself.
Some Caution is Needed
The concern with these dysfunctions is that you need to know exactly what to release, what to stabilize, what firing patterns to change (timing is everything – it is a precursor to all healthy movement). And if you get it wrong you can create a greater cascade of dysfunction. I’m even hesitant to talk about this here because I worry about the power I would unleash to therapy world. Fortunately, I’ve developed a Level 3ci Masters level course in this (there is no link yet because I need a logo with a brain on fire). So stay tuned.
The main take home point here is that you need to treat the whole person. Recognize how complex we are and have intervention that matches that complex-interconnectedness (CI therapy systems for short)
This is a real game changer. With this type of training we can change the world. Or I’m full of shit. Yes. Its the latter. I’m full of shit.