Human Performance and Rehabilitation Centers, Inc.

Improve Your Running Through Better Mechanics

Do you feel like you aren’t getting the best results from your morning run?  Maybe you are having a little nagging pain afterwards?  This could be due to poor running mechanics.  Not running properly can lead to a variety of overuse and chronic injuries – Achilles tendonitis, plantar fasciitis, stress fractures, hip and low back pain, etc.  It can also slow down your pace and make your run less efficient.

Most often, we see a patient and learn that they have inefficient running mechanics through treatment of an injury.  We will first treat the injury to get them back to running health and then we will evaluate further to get to the root of the problem. We observe a patient running both on and off a treadmill, slow their pace down to observe their running style, look for compensations and to assess joint movement. We also take a look at their footwear to make sure they are in the proper shoe for their foot type and running style.  This process incorporates everything from their head to their feet.

If there is an issue with your running mechanics, it’s important to focus on correcting it while you are running.  Focusing on the adjustment will improve your mechanics more quickly and will lead to less energy expenditure, less overall fatigue and most importantly less pain, resulting in a decreased chance of injury or reinjury.  Quite often, we have to spend time on running education to discuss running surfaces, road camber, speed and distance training plans, as well as establish frequency and intensity guidelines while making adjustments. Usually after a couple of weeks performing specific exercise techniques and focusing on the change in form, patients are able to report a positive difference in how they feel before and after a run.

Keep in mind, poor running mechanics don’t just show up in adults.  You can spot it in your children as well.   If your child complains of pain while running, anywhere in the body, it can be a sign they have poor mechanics, unless of course, they have pushed their limits in a race or speed workout.  Pain caused by running can present in places one might not expect such as the lower back, shoulders, feet and knees.  Observe their shoulders, hips and knees and also look at their feet.  Having high arches or flat feet can lead to injury in a runner, if not in the proper footwear.   If there is something that just looks a little off, it wouldn’t hurt to have a running assessment done to prevent injuries in your child.

Knee Pain Explained

Knee pain is something nearly every person experiences at one point or another, usually related to a particular injury or provocative activity, such as lots of kneeling for spring planting in the yard or playing the occasional game of basketball. How do you know the difference between a serious injury versus simple overuse? The causes of knee pain typically fall into one of three categories: traumatic, overuse, and degenerative.

Traumatic is self-explanatory; a fall, collision, twist, or awkward landing can create enough force to damage the structures inside the joint. When this type of damage occurs, the person may experience severe and immediate swelling, severe pain, a loss of ability to move the joint, and an inability to bear weight through the limb; a safe bet is when two of the three exist, the person should seek medical attention from a physician and/or physical therapist immediately. Attempting to “walk it off” is not recommended.

An overuse injury can be a little tougher to recognize. Starting a fitness program or a dramatic change in a person’s activity level (more or less) can provoke this type of pain. So can rapid increases in body weight, such as pregnancy. Adolescents who are going through growth spurts will often have pain in the knees because of changes in the way the muscles and joint function together. The pain may show up immediately or gradually, appearing more and more frequently until it is constant. Swelling may appear but is typically not severe and disappears overnight. Depending on the structure inside the knee that is taking the abuse, surgery may be needed, but many times this is treated quickly and effectively with a short course of rest, stretching and strengthening.

“Degenerative” describes the normal changes our joints experience with aging, specifically thinning of the articular cartilage and the loss of quality in the soft tissue of the joint. Knee pain from degenerative changes generally does not produce swelling and is provoked by remaining in one position for a great deal of time.

Besides pain, a problem within the knee (or any joint) will also cause the muscles around the joint to stop working effectively. Over time this will produce a loss of muscle size as well as a loss of control of the joint. The longer the joint remains untreated, the more severe the muscle atrophy and loss in function will become. Other joints may become painful as a result, particularly the areas above and below the injured joint or the opposite side. Medical treatment should begin before the body learns bad movement patterns.

Unless severe structural damage is present, a course of physical therapy will often be successful in getting rid of pain and restoring a person’s usual activity level. Any physician can refer to physical therapy and in many states no referral is required; in most cases, the therapist can make an accurate assessment of the problem and begin treatment immediately. If the problem is severe enough that a specialist should be involved, the therapist can facilitate the referral and also make recommendations for any diagnostic testing.

Are young female athletes at greater risk for ACL injuries?

Young female athletes are five times more likely to sustain an ACL tear than their male counterparts. This is especially common in explosive multidirectional sports like soccer or basketball. It’s important for girls to learn how to jump and land properly in order to prevent an ACL injury from occurring.

Female athletes from about 14-18 years of age are at greater risk than boys of injuring the anterior cruciate ligament (ACL). This is largely due hormonal changes. An increase in estrogen during puberty causes relaxation of the ligaments and the natural widening of the hips causes changes in biomechanics. A female athlete is likely not conscious of these new structural changes as she continues to snag rebounds or bolt across the soccer field. She may inadvertently land or stop stiff-kneed or in a locked position, and she might have a greater tendency to internally rotate the knee due to weakness of the developing outer hip.

In addition, a female athlete may be accustomed to using only the quadriceps instead of her developing hamstrings to control movements. All of these factors can put the ACL at risk.

It’s important to teach young women early on how to adjust the way they run and jump in competition in order to prevent an ACL tear. A physical therapist can screen an athlete to evaluate body mechanics, potential weakness and faulty movement patterns. Prevention is key. And it’s time well spent since a young athlete who has suffered an ACL tear is 70% more likely to suffer a re-injury.

Here are some strategies:

  • Young athletes should be in shape for the demands of their chosen sport. This includes both cardiovascular capacity and muscular strength. During fatigue or exhaustion, even a small weakness or poor body mechanics can become a bigger problem.
  • A good strengthening program will encourage better hamstring-to-quad strength ratio, which will help reduce reliance on quads only.
  • Good lateral hip strength and hip abduction control will help maintain proper knee position so that a girl doesn’t experience what we call a valgus collapse, or the extra internal rotation of the femur and the knee falling inward.
  • Proper proprioception is key. When the foot hits the ground, the knee should be properly positioned over it. This allows for strong core-hip stability during lunges, running and multidirectional activities.

Physical therapists don’t just treat patients after an injury. They also work with patients to prevent one from occurring.

Front of knee pain: How to treat Patellofemoral Pain Syndrome

If you’ve experienced pain in the front of your knee around the kneecap, it’s probably a condition called Patellofemoral Pain Syndrome. Known also as “runner’s knee” or “jumper’s knee,” this condition can occur at any age, but it’s most common in teenagers, young adults, athletes and those who have recently hit puberty.

Patellofemoral Pain Syndrome is typically not caused by trauma; instead, it can seem to just appear. Because no single incident is the culprit, a person experiencing it may be inclined to work through the pain, or keep participating in sports or activities. When the pain doesn’t resolve, and, in fact, it gets worse, everyday knee flexion and extension can become intolerable.

Younger athletes are particularly vulnerable to Patellofemoral Pain Syndrome. During puberty, a young person’s bones grow fast –  outpacing the growth rate of ligaments, tendons and muscles and putting more stress on the joints. In addition, females have wider hips compared to their male counterparts and this can change the alignment of the knee and impact the patella’s movement in the trochlear groove. Athletes who engage in running, soccer, volleyball, cheerleading and dancing could experience this kind of knee pain.

Other causes for Patellofemoral Pain Syndrome include muscle weakness, stiffness, fatigue, improper shoe wear and poor movement patterns. Other contributing factors include overtraining or poor training techniques. And, prolonged sitting behind a desk during the week coupled with extreme “weekend warrior” activities can create an opening for Patellofemoral Pain Syndrome.

Patients should avoid irritable activities and apply ice two-to-three times daily to decrease inflammation. Physical therapy plays a big part in getting back to normal. In PT sessions, we work with patients on improving flexibility, stretching the hamstrings and strengthening the quads and hips by using very specific exercises. I usually like to see patients with this condition twice a week for four to six weeks.

Because of the multitude of contributing factors for each individual experiencing Patellofemoral Pain Syndrome, it’s important to let an experienced PT evaluate your case and develop a therapy plan that fits.