[ editorial ]

Always On the Run

BRYAN HEIDERSCHEIT, PT, PhD
Downloaded from www.jospt.org at Bird Lib/OUHSC Rm 490 on December 17, 2014. For personal use only. No other uses without permission.

Associate Editor
Department of Orthopedics and Rehabilitation,
University of Wisconsin-Madison, Madison, WI.
J Orthop Sports Phys Ther 2014;44(10):724-726. doi:10.2519/jospt.2014.0113

“We joggers have one set of answers, the doctors another. pronation relative to injury risk has been
Those who are uncommitted or undecided might do well to increasingly challenged.11,14 Although it
remains a factor to consider, foot type
consider what jogging actually is. Better yet, they might try it.”
is only a part of the picture. We must
embrace a more holistic approach to
—George Sheehan, MD, Running and Being: The Total Experience running-injury management, one that
Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

(New York, NY: Rodale; 1978:140) encompasses the individual’s physical

abilities, goals, nutrition, sleep habits, as

R
well as training-related behaviors. Train-
unning. Something most of us begin by the age of 3 years, with ing errors (eg, running too often, too fast,
many of us never stopping, as evidenced by the more than 35 or too long) have been estimated to ac-
count for over 70% of running injuries,10
million people in the United States who run for exercise or
clearly highlighting the importance of
sport.21 Clearly, that number covers a wide spectrum of runners: training habits in regard to injury man-
from those who run a few kilometers per month to those who cover agement. But this also suggests that
Journal of Orthopaedic & Sports Physical Therapy®

several hundred kilometers in the same period. But the 2 commonalities safe training habits are well established,
when, in fact, this remains an active area
they all share are the likelihood of expe- interventions to improve flexibility, of study.12
riencing a running-related injury and the strength, and neuromuscular control. Assessing the individual’s running
desire to avoid it. Indeed, addressing the injury itself and mechanics remains an integral part to
With injury incidence ranging from associated tissue-level impairments is the management process, as certain
26% to 92%,22 runners are continually typically a necessary part of recovery biomechanical faults may contribute
seeking the next great cure that will keep and something that most of us are very substantially to risk of injury.2,15 Gait re-
them injury free. And the information comfortable handling. But if running is training to correct such faults has grown
they receive is often conflicting: land on the underlying cause of the injury or the in popularity in recent years, with a va-
your heels, land on your toes; stretching primary provoker of symptoms, then it is riety of approaches being promoted and
makes you faster, stretching makes you also important to understand what run- investigated. For example, changing from
slower; wear supportive shoes, do not ning is, relative to the individual patient. a rearfoot to a forefoot strike pattern has
wear shoes at all. As practitioners, we are Running demands are certainly different been used to successfully manage runners
often guilty of the same search for a com- for the adolescent cross-country runner, with chronic exertional compartment
mon cause of all running injuries: foot the novice recreational runner, and the syndrome,5 a rather challenging condi-
pronation, impact forces, excessive hip masters-level ultramarathoner. To best tion. Reducing excessive hip adduction
motion, and so on. It is a confusing time treat each of these individuals, we must during stance of running has improved
for runners, as well as for those of us who know the specifics of his or her training symptoms and function in runners with
treat them. habits and running mechanics. Simply chronic patellofemoral pain.16 Last, a
Common management approaches put, we cannot effectively manage injured subtle increase (5%-10%) in running step
for running injuries borrow heavily from runners without knowing running. rate has been shown to reduce hip and
general clinic practice, including rest, in- Long considered a primary cause of knee joint loads, and has been suggested
flammation control, and exercise-based running injuries, the importance of foot as a simple strategy to treat running-

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44-10 Editorial-Heiderscheit.indd 724 9/16/2014 4:21:37 PM

 related injuries to these joints and sur- years. Following the editorials are 11 in- shoe and helps to define the features of
rounding tissues.7 But is there one best vited papers pertaining to various aspects the modern (partial) minimal shoe.4 As
pattern that fits all runners? Probably of running, with the first providing a many of us are frequently asked, “Am I
not.6 qualitative description of runners’ beliefs wearing the right shoe?” a review of key
There is too much heterogeneity and opinions regarding the risk factors of military studies is provided that requires
among runners to believe that one run- running injuries.18 Although some beliefs us to strongly reconsider a common ap-
ning pattern is universally ideal. So, persisting among many runners are con- proach to running-shoe prescription.8
Downloaded from www.jospt.org at Bird Lib/OUHSC Rm 490 on December 17, 2014. For personal use only. No other uses without permission.

rather than showing people how to run, trary to what the science tells us, runners By covering a diverse range of run-
perhaps we should also be showing them clearly recognize the importance of train- ning topics, we hope this issue of JOSPT
how not to run. Two such characteristics ing habits to injury risk. To better define improves our understanding of what run-
to avoid might include excessive vertical this risk, an epidemiological study is in- ning is and takes us one step further to-
displacement of one’s center of mass, or cluded that demonstrates an increased ward having common answers for those
“bounce,” and landing with the foot well injury risk when running distance is rap- on the run. t
ahead of the center of mass, or “overstrid- idly progressed among novice commu-
ing.” Neither characteristic likely adds a nity runners,13 while another identifies
competitive or biomechanical edge for summer training habits associated with REFERENCES
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Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

still allowing the individual to self-se- adolescent runners, are thoroughly dis- org/10.2519/jospt.2014.5500
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Journal of Orthopaedic & Sports Physical Therapy®

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Wille CM, Ryan MB. Effects of step rate manipula-
a compilation of editorials and papers trunk lean on patellofemoral joint stress tion on joint mechanics during running. Med Sci
focused on expanding our knowledge of is explored, with reduced stress accompa- Sports Exerc. 2011;43:296-302. http://dx.doi.
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Injury-reduction effectiveness of prescribing run-
community. To begin, 3 guest editorials ics, a brief report reveals that sagittal ning shoes on the basis of foot-arch height: sum-
are included from respective experts, plane kinematic variables can estimate mary of military investigations. J Orthop Sports
representing the views of a runner, a several important metrics of ground re- Phys Ther. 2014;44(10):805-812. http://dx.doi.
org/10.2519/jospt.2014.5342
coach, and a physician. Each was asked action force and knee joint kinetics.24
9. L enhart RL, Thelen DG, Heiderscheit BC. Hip
to provide his thoughts on the causes and Finally, in an issue devoted to running, muscle loads during running. J Orthop Sports
management of running injuries, and to it would be remiss not to discuss shoes. Phys Ther. 2014;44(10):766-774. http://dx.doi.
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 [ editorial ]
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Copyright © 2014 Journal of Orthopaedic & Sports Physical Therapy®. All rights reserved.

Med Sci Sports Exerc. 2013;45:1120-1124. http:// during running. J Orthop Sports Phys Ther. org/10.2519/jospt.2014.5367

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