By The Numbers: Injury Risk In Runners

Running is a tremendously popular sport, with approximately 40 million people running regularly in the United States. This is not particularly surprising given all of the well-documented health benefits of this form of physical activity. Unfortunately, running also carries with it a high rate of injury, with up to half of runners experiencing an injury on a yearly basis. While many factors play into this high rate of injury among runners, two primary risk factors stand out: history of previous injury and overtraining. With these in mind, here are some important numbers to be aware of when designing or following a training program.

• 40

  • Multiple studies have shown that running greater than 40 miles per week significantly increases the risk of injury

• 13

  • Runs longer than 13 miles should be done no more than once every 14 days, as exceeding this significantly increases the risk of injury

• 10%

  • While this number is hotly debated due to inconsistent evidence, it is generally accepted that increases in weekly training mileage should not exceed 10% per week, as doing so increases the risk of injury

• 6

  • Running 6 or more days per week significantly increases the risk of injury

• 4-5

  • With respect to injury, most regular runners do best when training no more than 4-5 days per week, with at least 1 day of rest and 1-2 days of cross-training built in

• 2-3

  • Runners should limit themselves to no more than 2-3 marathons per year

Keep in mind that these are numbers from a variety of prospective and retrospective studies on specific populations of runners and may not directly apply to you. However, they do help provide metrics for you to use when evaluating your own training program, whether it be for your first 5k or your attempt to qualify for the Boston Marathon. In general, most training programs should progress slowly, incorporate rest days, and include cross-training exercises that promote improved strength and stability. It is difficult to enjoy running when injured so keep these numbers in mind, as they may help you lower your overall risk of injury when training for your next race.

Run safely!

-Grant Hennington, DPT

Blood Flow Restriction Therapy

High load - high intensity training has been shown time and again to be one of the most successful ways to make significant strength gains and muscle hypertrophy. However, there are many conditions and pathologies (post-operative, osteoarthritis, chronic pain, etc.) that require strengthening, but are unable to tolerate the demands of a high load - high intensity workout in order to achieve the desired results. Blood Flow Restriction Therapy (BFRT) is a method of training that allows a person to make significant strength gains through low load training, thus reducing overall stress on the body.

BFRT utilizes pneumatic cuffs that are applied to the extremities and in turn provide external pressures occluding venous outflow while maintaining arterial blood flow. This leads to the release of hormones, hypoxia (reduction of oxygen to the muscles and ultimately leading to the production of lactate), and cellular swelling. Ultimately, these physiological effects lead to strength gains and muscle hypertrophy, which are all desired effects of high load -high intensity training, but accomplished through the completion of low load training. 

A typical BFRT workout includes 3-5 exercises at a training volume of 75 repetitions over 4 sets (30 reps, 15 reps, 15 reps, 15 reps) with a 30-60 second rest break between sets. As stated above, BFRT should be performed at a low load, with studies showing a load of 20-40% of an individual’s 1 repetition max being most efficient. The pneumatic cuffs should be left on for the entirety of the workout (maximum of 20 minutes at a time) in order to get the desired physiological effects. 

For more information about the effects, application, and safety of Blood Flow Restriction Therapy, CLICK HERE or contact us through our Ask A PT feature.

-Brian Collins, DPT

References:

• https://www.physio-pedia.com/Blood_Flow_Restriction_Training

• https://www.apta.org/patient-care/interventions/blood-flow-restriction/what-to-know-about-blood-flow-restriction-training

• Patterson SD, Hughes L, Warmington S, et al. Blood Flow Restriction Exercise: Considerations of Methodology, Application, and Safety [published correction appears in Front Physiol. 2019 Oct 22;10:1332]. Front Physiol. 2019;10:533. Published 2019 May 15. doi:10.3389/fphys.2019.00533

FIFA 11+ : A Warm-Up Program for Soccer Players to Decrease Injury Risk

Soccer is one of the most popular sports in the world and in the city of Seattle.  Like most sports, participation in soccer comes with an increased risk of sport-related injury.  Most soccer injuries occur in the legs, especially the ankle, knee, and thigh.  These injuries might include sprains, strains, and contusions.  Soccer players may be at an increased risk of injury when they have not warmed up properly, are fatigued, and have strength imbalances (1).

The FIFA 11+ program is a soccer warm-up that was designed by international sports medicine experts to decrease injury risk in soccer players aged 14 or older.  It was designed to be a comprehensive warm-up that incorporates jogging/running, strengthening, balance, plyometric, and agility exercises to decrease risk of injury during practice and games.    

Scientific studies have shown that youth soccer teams who used the FIFA 11+ program had lower rates of injury compared to teams using normal warm-ups (2).  

In fact, regular weekly performance of the FIFA 11+ warm-up program over a 2-3 month time span reduced the risk of injury in soccer players by 30% (2).   

Performing the FIFA 11+

The FIFA 11+ program should be performed on a soccer field with 6 cones, placed 5-6 meters apart.  The program consists of three parts: 

Part 1 - Warm-up running and active stretching exercises - approximately 8 minutes

• Running straight ahead

• Running, hip out 

• Running, hip in 

• Running, circling partner/cones

• Running, shoulder contact 

• Running, quick forward and backward 

Part 2 - Core and leg strengthening, balance, plyometrics, and agility exercises - approximately 10 minutes 

The exercises in Part 2 are broken into three categories: Level 1 (Beginner), Level 2 (Intermediate), and Level 3 (Advanced) based on athletes strength and conditioning, form, and comfort with the exercises.

• The Bench/Plank: Level 1, 2, or 3 

• The Sideways Bench/Plank: Level 1, 2, or 3 

• Hamstring Exercise: Level 1, 2, or 3

• Single Leg Stance: level 1, 2, or 3 

• Squats: Level 1, 2, or 3 

• Jumping: Level 1, 2, or 3 

Part 3 - Higher speed running, cutting, and pivoting exercises - approximately 2 minutes 

• Running, across the pitch 

• Running, bounding 

• Running, plant and cut 

Click here to download a print copy of the FIFA 11+

It is important to maintain proper form when completing the warm-up exercises.  Athletes should focus on good posture and body control, proper leg alignment, and soft landings with jumping. 

The FIFA 11+ warm-up program is a great warm-up program for organized soccer teams and recreational soccer players alike.  Coaches and trainers of organized teams who understand and utilize the FIFA 11+ program exercises can help decrease risk of injury in their soccer athletes.        

-Sean Tyler, DPT & Brian Collins, DPT

References:

1. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011 Jun;45(7):553–8.

2. Sadigursky, D., Braid, J.A., De Lira, D.N.L. et al. The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Sci Med Rehabil 9, 18 (2017). https://doi.org/10.1186/s13102-017-0083-z
   
   
   
   

Pregnancy-Related Sacroiliac Joint Pain

The sacroiliac joint (a.k.a. “S.I.” joint) is located at the junction where the spine meets the pelvis. Pain in this joint is often described as a shooting, stabbing, and occasionally burning. Pain may be felt in the back of the pelvis, buttock(s), groin, or inner thigh(s). Pain typically worsens with activities such as standing on one leg, walking, stair climbing, prolonged standing, rolling in the bed, and/or getting up from a low chair.

The pregnancy hormone Relaxin is responsible for increasing the laxity (looseness) of ligaments in order to accommodate the growing fetus and prepare the body for childbirth. Consequently, increases in this hormone can lead to instability in the joints. This instability may be more pronounced in women with already existing hypermobility. The altered biomechanics and muscle imbalances that occur during pregnancy further contribute to the symptoms listed above. Approximately 16-25% women experience pelvic girdle pain (PGP) during pregnancy, with some studies revealing rates as high as 76%. It is estimated that 93% of women with pregnancy-related pelvic girdle pain experience recovery six months postpartum[1].

POSTURES RELATED TO SI JOINT SYMPTOMS:

• Excessive anterior pelvic tilt

• Shallow breathing with flared ribs

• Forward head posture

• Jaw clenching

• Butt clenching

• Supinated or pronated foot/feet

• Sway forward

• Sway to one side

ROLE OF PHYSICAL THERAPY

• Prevention of the symptoms

  • Maintain good breathing pattern

  • Shallow breathing is a sign of inefficient diaphragm function

  • Maintain the strength in the core, hip and pelvic floor muscles

  • Maintain thoracic mobility

  • Avoid sudden and drastic change in the footwear or supports

  • Avoid single leg standing exercises especially if the SI joint symptoms start to appear

• Treatment

  • Patient education regarding the condition and prevention of the aggravating factors

  • Assessment of the breathing pattern and teach appropriate corrections

  • Guide the patient in proper muscle balance around the SI joint. Due to altered biomechanics, some muscles need to be activated whereas some may need to be relaxed or temporarily shut down while doing particular movements.

  • Foot assessment with subsequent arch strengthening and foot mobility exercise as they can have an impact on the hips and thereby influence the SI joint.

  • Manual therapy in the form of myofascial release and muscle energy techniques (MET) may be beneficial.

  • Use of SI joint stabilization belts have been shown to improve the symptoms[2].

  • Heat or ice packs for local pain relief.

If you are experiencing similar symptoms, please get in touch with a women's health physical therapist. Together, we can make your pregnancy a comfortable experience.

-Ishi Upasani, PT, MS

References

1. Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Medicine.

2. https://www.ncbi.nlm.nih.gov/pubmed/16214275

A Physical Therapist's Guide To Meditation

Meditation is an effective way of cleansing the cluttered mind. Time and again, we all must have come across the importance of including meditation in our daily lives, but somehow it finds a way of slipping out of our to-do lists. Let's go through the benefits of meditation and learn how to get started before making it a part of our regular self-care routine.

BENEFITS:

• Increased self-awareness

• Increased concentration and attention span

• Streamlined thoughts, thus helping in getting a better perspective in problem solving

• Increased productivity

• Increased patience and tolerance

• Meditation has also been found to aid in the management of the following conditions and more

  • Chronic Pain

  • Anxiety

  • Insomnia

  • Hypertension

  • Irritable Bowel Syndrome

  • Depression

  • Cardiovascular Diseases

  • Asthma

  • Cancer

  • Headaches

  • Pregnancy and postpartum period

It should be noted that meditation is not a standalone treatment for managing the conditions listed above. Rather, meditation can play an effective role as a part of the overall management program for a variety of chronic conditions. From a neuromuscular perspective, meditation can improve breathing patterns, which can help in allowing the core to function more effectively. A strong core is the foundation of most daily and recreational activities, so addressing your core has the potential to improve quality of life.

GETTING STARTED

Finding a quiet and comfortable place is the first requirement. Try to keep all external distractions, including the phone, away before starting the process. Initially, it may be more difficult than you expect to convince your body and mind to sit still in one place, trying to focus all of your attention on one thing. Start with 5 minutes of meditation, once per day and gradually increase the duration to 15 minutes of meditation or more, per your preference. It may take a couple of weeks for the mind to learn the process of focusing on yourself or barring all the negative thoughts so try to stick with it.

There are several forms of meditation out there to choose from. Here are a few:

• Mindfulness. This is a big umbrella, covering a lot of sub-types of meditation involving the same purpose of being present in the moment. It can be as simple as being aware about one's breathing. To begin, try counting each breath, as this a great method for assessing one's breathing pattern. Remember to not breathe too rapidly (hyperventilate).

• Transcedental / Mantra Meditation. This involves repeating a calming word or phrase while focusing deeply on the sound and ignoring every other (distracting) thought.

• Body Scan Meditation. Begin with choosing a comfortable position. Going from distal to proximal (or toes up towards the head), attempt to feel every segment of the body relax. This involves bringing awareness to the entire body, one segment at a time.

• Guided Meditation. This is performed with the help of a teacher/instructor guiding you through the process. One is required to paint a calming mental picture, such as a place or situation one enjoys being in. It is meant to pull your attention away from the distracting thoughts and towards the calming visualization.

-Ishi Upasani, PT, MS

REFERENCES:
1. https://www.mindful.org/10-things-we-know-about-the-science-of-meditation/
2. https://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858