Despite the best attempts of March’s winter weather to block travel, I made my way to Charlottesville, VA a few days ago for the Running Medicine conference they have every spring. UVA consistently does a great job of recruiting well known, excellent speakers for this event.
Here was this year’s agenda for the Friday lectures:
Knee Osteoarthritis: A Case Approach - Robert Wilder, MD, FACSM and Eric Magrum, DPT, OCS, FAAOMPT
Clinical Decision Making for Footwear - Jay Dicharry, MPT, SCS
An Update on Hydration Guidelines - David Hryvniak, MD
Post-Operative Guidelines: Return to Running after Knee Surgery - Bryan Heiderscheidt, PhD, PT (Keynote)
Gait Retraining: Finding the Right Balance - Bryan Heiderscheidt, PhD, PT (Keynote)
Regenerative Therapies for Osteoarthritis of the Knee & Hip - Fran O’Connor MD, MPH, FACSM
Nutrition: Controversies and Guidelines - Patti Deuster , PhD, MPH, FACSM
And the Saturday labs:
Systematic Video Gait Analysis - Bryan Heiderscheidt, PhD, PT
Rebuilding the Foot - Jay Dicharry, MPT, SCS
Dynamic Pre- and Post-Run Exercise - Anne Dunn, MS, CPT & Jason Dunn, MEd
Running Shoes 2018: Where are we now? - Mark Lorenzoni
There was so much great information presented, I could write for hours, but let’s just go with a few highlights.
Runners with known symptomatic knee osteoarthritis may benefit from a 3-4 month trial of one of the following: glucosamine/chondroitin, omega-3 fatty acids, fish oil, krill oil, or avocado/soybean unsaponifiables (ASU). There is a not an abundance of research to support each of these interventions but they do appear useful in some cases and have a low risk. It is not advised to start taking all of them simultaneously.
Once again, running does not cause osteoarthritis when performed at reasonable low to moderate mileage and intensity. There may be a potential relationship of higher mileage (>65 miles/week) and high intensities to developing knee OA. Overall though, runners tend to maintain a higher quality of life for more years without limiting knee pain than their non-running counterparts. That’s why running is actually believed to lead to protective cartilage changes, if anything. Let’s crush this myth.
Those darn medially posted motion control and stability running shoes (the ones with the harder inner sole material) can contribute to extra load at the medial (inner) knee joint, which is the side where most people with knee osteoarthritis acquire their degenerative issues. In other words, they probably aren’t going to help existing inner knee pain and may even exacerbate it.
Speaking of medially posted shoes, the location of the post continues to make no sense. The midfoot (navicular bone) drops maximally into pronation after the heel has lifted from the ground. How is the harder material that is no longer touching the ground going to stop this movement? It can’t. It won’t. Time to move on from your poor science, shoe industry. Let me take a moment to remind everyone that pronation is not necessarily an evil problem that even needs corrected with a shoe in the first place. But that’s not what sells shoes now is it? And one more thing, just because the inner foot arch appears to collapse while standing doesn’t mean that it does that same thing while running. Nor does it move any significantly extra amount beyond the amount every other foot type moves.
There are a couple new things coming along in shoe design. You will see a new trend of placing greater densities of foam across the forefoot region of a running shoe while the heel will have a slightly lower density. We need a stable surface to push off. Also, there are now straight lasted cushioned shoe models. The general shape of the shoe is based on the last and can be curved, semi-curved, or straight. Straight lasts were previously found only in the motion control and stability shoes, which, as I just mentioned, tend to further overload the the medial compartment of the knee. That overload is less likely in a cushioned model that doesn’t have the ridiculously hard inner heel material.
Following ACL reconstruction, runners and other athletes are returning to running before they have best function of their quadriceps muscle. These deficits, which are neurological in nature, are lingering for huge amounts of time, easily one year and even two years after surgery. While an athlete may demonstrate full strength of the quadriceps in a muscle test, and even good jumping technique, their ability to rapidly activate the quad muscle remains at a deficit, which leads to running gait changes, abnormal loading of knee joint, and potentially ongoing pain. Typical ACL protocols bring running back at 12 to 16 weeks post-surgery. Is that too early or are we just not appropriately getting the quad back online?
Though they are far from perfected and minimally researched, regenerative medicine methods such as platelet rich plasma injections and stem cell therapies are showing promise in helping athletes recover from long-standing tendon and joint injury. They aren’t going to create a brand new tissue for you but are probably a worthy treatment option to try prior to surgeries like joint replacement. Research will tell us more in the next few years.
Carbohydrate periodization may be beneficial in some runners to enhance fat oxidation and decrease carbohydrate dependence. With this method, which is actually how I personally train, you perform slower runs without any carbohydrate supplementation and maybe even do some of your shorter easy runs in a fasted state. That works great for early morning runs before breakfast. Your faster or harder runs would still have more carbohydrate intake prior and/or during.
There are three running gait factors that consistently show the best relationships to injury in the research: overstriding forward of the body’s center of mass, excessive bounce (vertical oscillation), and excessive compliance (body instability) at mid-stance of the running stride.
The gluteus medius muscle actually generates more force to stabilize the pelvis during mid-stance than the gluteus maximus when running on a flat surface at endurance speeds. Which is why it’s so important to get it functioning appropriately in endurance runners. The gluteus medius is notoriously weak and underactive in endurance athletes and that is reinforced by the repetition of moving in a single direction. You need to learn what it feels like to keep the pelvis level and stable while running and if you can’t do that, please come see me. I always prefer to teach people how to use their hip muscles in standing because the Jane Fonda leg raises lying on your side are typically performed incorrectly, and the leg raises don’t transfer into the actual way we use these muscles.
Any coach or clinician that thinks they are accurately measuring joint angles on a two dimensional video or image is doing their client or patient a disservice. The angle values they are measuring are likely incorrect, especially if they aren’t using body markers.