The Biomechanics of Running

This New York Times article brings up a short section on preventing injury while learning how to run. It briefly mentions that there is little evidence to support stretching prior to running and offers an anecdotal report of a few exercises that may be beneficial instead. Read the rest of the article here: https://www.nytimes.com/well/guides/how-to-start-running

In the past five years of regularly treating injured athletes, many of whom were runners or cyclists that compete in marathons and triathalons, I have learned that there are some common pathways by which the body breaks down. These are also the same ways that we need to address building it back up and preventing injury from the outset. I agree that light stretching prior to a run is unlikely to dramatically change your biomechanics if the real reason you are tight is due to weakness in another area.

Strength training on the other hand, takes time and dedication and cannot be simply incorporated into a pre run workout. There are many variables that effect the ability to activate weak or injured muscles including severity of the injury to the tendon of that muscle, other weak or injured muscles that support that injured muscle, as well as structural alignment and ligamentous laxity of the joint or the neighboring joint. When I evaluate patients, I assess each of these areas osteopathically as well as on ultrasound. There is no magic formula to treat every one but this type of assessment can reveal where the dysfunction is in any given case. The correct treatment requires an integrated approach of structural realignment, strength training, therapeutic stretching, neuromuscular education and on occasion regenerative injection therapies like Prolotherapy, Platelet Rich Plasma, Stem cell or Neural Prolotherapy. Regenerative injection therapies are required when ligaments become overstretched because ligaments have a limited capacity to heal themselves. They may also be required if the muscle or tendon injury is too severe or chronic or if the damage is to other soft tissue areas such as cartilage, meniscus or labrum.

Neural-Prolotherapy treats the superficial nerves that feed back into the underlying tissue where the pathology is located. This in turn supports a healthy neurologic environment for the tissue to heal. More evidence has accumulated that soft tissue injuries can be mediated by inflammation in the fat pad adjacent to them where small nerves release the mediators of inflammation and start the process of creating adhesions and scar tissue. Treating both the injured structure and the overlying neurologic environment helps to address this problem from both directions. Aside from a robust biomechanical assessment, many times these biomechanical dysfunctions are simply a manifestation of more systemic inflammation. Addressing digestive imbalances, which may mediate chronic immune stimulation and thus chronic inflammation, as well as hormone imbalances, which may be predisposing the patient to injury can be the most important dimension of healing.

How do I prevent injury while learning to run or running long distances as a more seasoned athlete? The answer is not orthotics and it is not simply to work on activating your gluts through clams, or rolling out your IT band. It certainly is not what the New York Times suggested anecdotally doing a few squats and lunges prior to running. If you want to get serious about preventing injury, come let a professional assess your biomechanics and look a bit deeper at your overall health with a functional medicine analysis. In order to prevent root causes, we need an assessment of those root causes prior to recommending a generic prescription.

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