Sunday, August 29, 2010

Evidence based and common sense approach to prevention of repetitive use injury

Damien Howell PT, DPT, OCS – 965-9990 –

A group of healthcare professionals 29 researchers, clinicians, training officers, and epidemiologist representing the 4 U.S. military services critically reviewed the scientific evidence related to physical training-related injuries (Bullock SH, 2010). Their conclusions have specific applications to the prevention of repetitive use injuries (running injuries).

They critically reviewed over 328 research papers, and identified 31 interventions. The interventions were categorized into 3 levels according to the strength of the recommendation either recommended not recommended, insufficient evidence to recommend or not recommended. Some of the 31 interventions are applicable to preventing running injuries.

The 29 healthcare experts recommended:
• Avoid exercise volume and intensity that exceeds the injury threshold. Exercising at a volume above injury threshold there is minimal or no improvement in fitness level, and a significant risk of injury. There is a significant amount of research showing that running a lot of miles will increase the risk of injury. Signs of over training are an increase in resting heart rate, insomnia, irritability, infections, and decreasing performance, or slower running times.
• Training should follow a gradual systematic progression of running distance and speed. This is especially true for individuals just starting an exercise program. For example instead of initiating a marathon training program 6 months before the event initiate training 9 months before the event.
• Run for a specified time periods not distance. This will allow the least fit to run shorter distances than the most fit, thus accommodating low and high fitness groups simultaneously. Runners will often record the metric of miles run. Consider using the metric of time exercised rather than miles run.
• Replace some distance runs with interval running. This increases speed and stamina more rapidly than distance running while limiting the total running miles.
• Avoid exhaustive training maximal efforts on successive days. Allow adequate recovery time between maximal efforts. Muscle soreness peaks at 48 hours post exercise. Three to 5 days between exhaustive maximal efforts is recommended.
• Injuries are reduced by increasing the amount of cross training with exercise that are in multiple planes; involve coordination, balance, and agility. Strengthening exercises involving free weights, polymetric drills, calisthenics type exercise are better as compared to weight machines which stabilize the body while the extremities move on a single plane of motion.

The 29 healthcare professionals did not recommend taking ant-inflammatory medication prior to exercise. There is insufficient evidence to support its use and the potential for harm out weigh any potential benefits. The potential for harm includes stomach ulcers, kidney damage, joint cartilage degeneration, slower muscle protein synthesis after exercise, and impaired healing processes.

There is not sufficient evidence to recommend stretching exercise as a means to prevent injury. There is good evidence that stretching is ineffective as an injury prevention strategy. While the working group does not endorse stretching as a method to prevent injury, there is insufficient evidence that it may cause harm in those who perceive a benefit. Additionally, studies to date have not specifically targeted individuals with limited range of motion.

A large amount of products, services, and training advice is proffered as a means of preventing injury. Unfortunately most of what has been proffered is based on opinion not evidence. This working group of experts did a good job of critically reviewing available evidence. They provided a common sense approach to preventing repetitive use injuries.

Prevention requires an individualized approach, and plan. The individual plan should be based on self assessment of previous experiences. Include the advice of experts in the plan. Keep a log or journal documenting time exercised, race times, and signs of over training. This information can be used to develop a training plan. The data in the training log and your training plan can be shared with coaches and healthcare professionals.

Becalming Yourself

By Sally Young

The path to personal happiness, the Stoics of ancient Greece believed, comes by way of living in agreement with nature and pursuing things that promote well being. Nothing should be done that harms the body, over which one has dominion. Inner peace is kindled by extinguishing all thoughts and desires to change things beyond one's influence, being mindful of only the present.
What would it be like to run in this state of "stoic calm"?

Meditation, the development of quietude, concentration, and insight, also goes back thousands of years. Contrary to popular belief, it doesn't take you through the fairy ring into a thick cloud of amnesia. It's a relaxation response that reduces oxidative stress, blood lactate levels, and
pro-inflammatory reactants. Respiration and heart rate are lowered, and a preponderance of alpha waves floods the brain, indicating a state of relaxed awareness.

For a few minutes prior to your run, sit quietly; put away active thoughts, and focus on being absolutely passive. Find a word repetition or object to dwell on. Breathe in deeply through your nose; exhale through your mouth, letting your body go limp. You¹ll begin your run released from tension, breathing as easily as a Buddhist monk. Perfect your breathing by visiting
Do As One at

Born to Run - a quick review

“Born to Run: A Hidden Tribe, Superathletes, and the Greatest Race the World Has Never Seen” by Christopher McDougall started with McDougall trying to find a way to run that didn’t hurt. He found two discoveries. First was that form matters and he learned the Evolution running method. (see Second he found that modern scientific running shoes cause problems with your form and therefore with your body. He looks at the history and marketing techniques of Nike. Who knew that the higher priced and more padded the shoe, the more likely one is to be injured. Caveat emptor in the free market. Try to find good evidence (not always easy) and follow it. (You can find some evidence based practice on foot strike and running barefoot or shod at The support and padding weakens the foot and encourages heel striking which is not in keeping with how your body’s natural shock absorption works according to what McDougall found. Along the way we learn about a tribe in Africa that can still hunt by running and exhausting the prey and anthropologists who theorize that homo sapiens was able to outlast Neanderthals because of our running ability. We meet an amazing cast of ultra-marathon characters including Scott Jurek and Cabello Blanco, who is an amazing story by himself, and the Tarahumara Indians of the Copper Canyon in Mexico. The race referred to is between the Indians and the American runners and embodies the best of sportsmanship and running out of love for the sport. The book is an amazing set of stories and a must read for runners.