Brian Schiff’s Blog

Unearthing the cause of anterior knee pain and ridding our patients and clients of it is one of the never ending searches for the “Holy Grail” we participate in throughout training and rehab circles.  I honestly believe we will never find one right answer or simple solution.  However, I do think we continue to gain a better understanding of just how linked and complex the body really is when it comes to the manifestation of knee pain and movement compensations.

We used to say rehab and train the knee if the knee hurts.  It was simply strengthen the VMO and stretch the hamstrings, calves and IT Band.  Slowly, we began looking to the hip as well as the foot and ankle as culprits in the onset of anterior knee pain.  The idea of the ankle and hip joint needing more mobility to give the knee its desired level of stability has risen up and seems to have good traction these days.

Likewise, therapists and trainers have known for some time that weak hip abductors play into increased femoral internal rotation and adduction thereby exposing the knee to harmful valgus loading. So, clam shells, band exercises and leg raises have been implemented to programs across the board.

Single Leg Resisted Hip External Rotation

As a former athlete who has tried his hand at running over the past 5 years, I have increasingly studied, practiced and analyzed the use and importance of single leg training and its impact on my performance and injuries.  As I dive deeper into this paradigm, I continue to believe and see the benefits of this training methodology for all of my athletes (not just runners).

As a therapist and strength coach, it is my job to assess movement, define asymmetries and correct faulty neuromuscular movement patterns.  To that end, I have developed my own assessments, taken the FMS course, and increasingly observed single leg strength, mobility, stability and power in the clients I serve. Invariably, I always find imbalances – some small and some large ones.

What are some of the most common issues I see?

Continue reading…

Whether you are for or against running, its popularity is likely at an all time high.  People run to lose weight, stay fit, compete or simply escape from the stress of the world.  Unfortunately, running often brings injuries for its participants. 

So, what are the risk factors directly associated with injury?  Researches in the Netherlands recently performed a prospective study with 532 novice runners (306 females and 226 males).  The runners trained for a 4 mile event and were advised to run 3 times per week (Monday, Wednesday and Saturdays) at a comfortable pace.

They were randomized into 8 and 13 week training programs.  There was no difference in findings among the different training groups so they were counted as one for the puprose of the study results.  The results are interesting.  Risk factors for running related injuries (RRI) in males included:

1. Higher BMI
2. Previous injuries – those with previous injuries are 2.6 x more likely to suffer an injury
3. Type of previous sports activities – those participating in axial loading sports were less likely to be injured than those who participated in non axial loading sports (cycling and swimming for instance)

Predictors of RRI in females were:

1. Increased navicular drop – this in turn leads to increased pronation and femoral internal rotation thereby increasing the risk of developing medial tibial stress syndrome

Some hypothesize that limited joint mobility leads to injury with the repetitive nature of running as force is dissipated unevenly along the kinetic chain.  Interestingly enough, lack of range of motion in the ankle and hip were not found to be related to RRI in novice runners.  Type ‘A’ personality influence in terms of pain resistance was also ruled out as contributing to sustaining an injury in this study.

What are the takeaways here? 

• The key thing to see is that males and females have different risk profiles. 
• Males that carry more weight may be comparatively at a greater risk for injury than females. 
• Pronation and proper foot mechanics may be a bigger issue in females as they are much more prone to develop stress fractures
• Further research is needed to better predict female risk factors
• There are several limitations in this study such as: inconsistent training days, different running surfaces, different running speeds/intensity and weather to name a few

In my mind, it also further illustrates the need to fully rehabilitate injuries, prepare the body for events thru smart progressive axial loading and to target the hips with strength and power work in runners to better control femoral internal rotation and reduce ground reaction forces.

For more info, read the full article in the February 2010 edition of the American Journal of Sports Medicine.  Stay tuned this week, as I will review another running research article discussing the impact of slope (hill) running on the body.