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April 15th, 2010 at 2:08 AM

Dr McCauley says:

Spring is here. Training is kicking into high gear and I am beginning to see more and more repedtive strain injury. To help I am going to offer an artical I have written to help and manage those problems.The facts: The foot strike of a runner generates 300% of body weight per step. In the course of a mile, the average 150lb runner will absorb 220 tons of force. With these facts in view, the strength and resiliency of the human body should command awe, particularly in the athlete. On the other hand, it should be no surprise that repetitive strain injury can be the bane of the athlete’s existence. Continually challenging their physical limits insures that there will be a constant struggle to maintain the balance of building the body up and breaking it down.
Repetitive strain injuries or Cumulative Trauma Disorder is a description of injuries that occur through repeated muscle recruitment patterns. For the runner the most common of these injuries can include plantar facitis, achilles tendonitis, patellar tendonitis, illiotibial band syndrome, snapping hip syndrome, trochantric bursitis, and many more. If you are a runner of even modest intensity, chances are you are intimately familiar with at least one and maybe more of these problems. What all these conditions have in common is that they are the result of a repetitive motion compromised by either an improper biomechanic, insufficient recovery, or all too often both. The most effective approach for treating these problems is to address the biomechanical issues, treat the damage and change the training pattern to reduce the level of strain. Without addressing all of these, the problems tend to come and go, or go from bad to worse. And nothing takes the joy out of running quite like pain.
Biomechanical Issues: Probably the most common example of this in the running athlete is Achilles tendonitis/tendonosis. The beginning signs are pain and tenderness 2-6 cm up the calf from the bottom of the foot that is worse when running hills or climbing stairs. The first of two biomechanics that most commonly contribute to this problem is a lack of ankle flexion (dorsiflexion), (The motion opposite of the foot pushing down on the gas.) caused by tight calves or soleus and gastrocs. 10-15 degrees are required for normal gait and 20 degrees for running.. This decreased range of motion shortens the stride by not allowing adequate ankle flexion which normally absorbs the energy like a spring, storing it for pushoff. With the lack of range of motion, that energy is transmitted through the elasticity of the tendon, challenging it at its weakest point and that is where the pain is felt.
A quick self test to determine if the calves are too tight is to perform a full squat, meaning butt to heels, while keeping both heels planted on the ground (fig 1.) A positive sign would be a tendency to lift the heels or fall backward before reaching full flexion (so be careful and go slow!) indicating a calf too short for proper running.. Lifestyle factors that can contribute to short, tight calves, can’t be overemphasized. These include sleeping on the stomach or sleeping on the back with heavy blankets or tucked in sheets, both of which force the feet into a tiptoe position shortening the calves for hours at a time. Helpful modifications of sleeping habits should include sleeping in a side position and loosening the sheets when sleeping on the back. One helpful orthotic is a night splint that holds the foot in 15 degrees of dorsiflexion and can be worn at night to lengthen calves and prevent plantarflexion (toes pointing downward). These can be found at better running stores everywhere or are easily ordered on line. Wearing high heels can also shorten the calve muscles creating considerable tension on the Achilles tendon when a flatter shoe is worn. A slow transition to a lesser heel over the course six to eight weeks can ease the lengthening of the muscle while reducing the strain on the tendon.

The remedy of course for short, tight calves is stretch; and the single most effective, is a doorway stretch (fig2.). It should be performed after running and 6-8 times daily with modest intensity for a count of 5-10. For therapeutic stretching and stretching in general, it’s more important to do it often and consistently than hard.
Overpronation is the collapse of the inside of the foot and arch which alters weight bearing, putting a kink in the Achilles tendon and creates a “bowstring effect’ as the stride follows through. Besides pain due to pull on the inside of the tendon, this also creates a wear pattern in the running shoe on the inside and bottom forefoot because of the tendency to push off on the inside. Another identifying feature of overpronation can be seen statically when standing barefoot. Keeping the knees locked one should be able to slide a finger under the center of the arch at least to the first joint deep. Less than that indicates a low arch and possible pronation issues.
Although less common supination (or underpronation) can also cause abnormal bend in the achillies tendon in the opposite direction of pronation, causing strain in the outside of the tendon. The wear pattern for this can be seen on the outside forefoot of the shoe because of the failure to fully toeoff (or pronate). This is usually associated with a high arch and like pronation can be grossly tested by sliding a finger in at the center of the arch. If the finger slides more than two joints deep a very high arch is indicated and its possible there are supination issues. Other problems commonly associated with supination is plantar facsitis lateral ankle sprains knee pain and illiotibial band syndrome.
For the supinator a highly cushioned shoe for shock absorbtion is critical.
How ever orthotics are just one facet of treatment in overuse injuries, achillies tendonitis and most overuse injuries respond to rest , training modifications and correct running gear.


An examination of the wear patterns of the running shoes (Fig 3.), observing the foot while bare footed (fig 4.) and the wet test (fig 5.) can all provide the runner with information as to the biomechanical disposition of the feet. When looking for signs of pronation in the wear pattern the bottom inside of the sole will show wear. Looking at the bare foot while standing in the inside of the shoe tends to be worn


And These problems in and of themselves would only be problematic in the extreme. However, combine and compound this with poor training techniques such as running on hard or uneven surfaces, sudden changes in training intensity, frequency or duration or a return to a full training program too quickly after an injury and it becomes easy to see how the tendonitis/tendonosis can develop and be perpetuated. Add to all this the well

documented lack of blood supply to the Achilles tendon and you have a recipe for pain and frustration for the athlete.

March 4th, 2010 at 9:32 AM