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Exertional Lower Limb Pain: A biomechanical approach to load distribution in running
Journal of Science and Medicine in Sport 20S (2017) 9
Contents lists available at ScienceDirect
Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams
Exertional Lower Limb Pain: A biomechanical approach to load distribution in running
20 Exertional Lower Limb Pain: A biomechanical approach to load distribution in running A. Franklyn-Miller Sports Surgery Clinic, Ireland Exertional Lower Limb Pain is a common presentation to clinicians in sports medicine by competitive and recreational athletes, but the existing literature remains heterogeneous using catch all terms such as Overuse Lower limb injury (OLLI), Exertional Lower Limb Pain (ELLP) and specific conditions with less than clear pathological mechanisms such as Medial Tibial Stress Syndrome (MTSS) and Chronic Exertional Compartment Syndrome (CECS) along with the colloquial term “shin splints” widely used to group and differentiate many of the same clinical presentations. Incidences vary widely in the literature between 25% and 65%. And he associated morbidity with overuse lower limb injury is significant, and time away from training is important both in the military and for the recreational athlete, in terms of not only financial cost but also an individual’s physical and mental health. In particular, Chronic Exertional Compartment Syndrome (CECS) was first described in 1956, but little research has been performed since then to confirm the pathological physiology. An assumption is made that elevated subfascial or intramuscular pressure during exercise causes tissue hypoxia and subsequent ischaemic pain due to decreased blood flow. To date, no conclusive evidence exists to demonstrate cellular hypoxic damage or decreased capillary perfusion. Further supposition is made regarding muscle hypertrophy, reduced compartment volume due to a decreased fascial compliance, and shorter periods of muscle relaxation as the underlying pathophysiology of CECS. There are many questions over whether the technique of intra-compartmental pressure measurement is reliable. Intrinsic factors such as foot anatomical morphology and lower limb anthropometry abnormality are commonly cited in the search for risk factors but the extrinsic factors such as an increase in weekly running mileage is the most common trigger for exertional leg pain.
1440-2440/
Alternatively, short-term sudden changes in intensity, distance or running surface can be responsible and in military personnel the sudden need to march in squads at set speeds are further risk factors. One extrinsic factor that the recreational runner, but not the military trainee has control over is that of running shoe selection. Recent trends for minimal drop training shoes offer a muchreduced angle from heel to toe (commonly referred to as ‘drop’) compared to traditional cushioned running shoes. In a standard running shoe this can be as much as 14 mm fall from heel to toe, but now 3–5 mm drop shoes are common alongside zero drop shoes. These shoes are designed to promote a “lifestyle” style. There is nothing particular about the shoe which alters running kinematics or style, Understanding the muscle activity and joint angular changes is necessary to understand the kinematics of running, and understanding the kinetics of loading is vital before examining the patient with lower limb pain. To fully understand potential sources of overload, we need to appreciate the whole lower limb, and many of the changes need to be made proximally in order to affect a distal change. Changing the range of motion or angle of a joint not only has an immediate effect on the activity of the surrounding musculature, but also changes the direction in which the force is applied and distributed. This force has to go somewhere and will lead to increased load at other joints which must be accommodated Recent reviews and qualitative research has identified the willingness to consider the coaching of running mechanics as a means, to alter the segmental linkage and load distribution of runners but as yet, prospective trials are lacking with the kinetic changes accompanied by coaching adaptation, though kinematic evidence. The common feature of all causes of Exertional leg pain is the maladaptation to load that is potentially modifiable by altering running kinematics as their common feature. This keynote will explore both running kinematics and associated kinetics, and the evidence base on which alteration to biomechanics and coaching can be used to modify lower limb pain in a clinic based intervention. https://doi.org/10.1016/j.jsams.2017.09.372
Contents lists available at ScienceDirect
Journal of Science and Medicine in Sport journal homepage: www.elsevier.com/locate/jsams
Exertional Lower Limb Pain: A biomechanical approach to load distribution in running
20 Exertional Lower Limb Pain: A biomechanical approach to load distribution in running A. Franklyn-Miller Sports Surgery Clinic, Ireland Exertional Lower Limb Pain is a common presentation to clinicians in sports medicine by competitive and recreational athletes, but the existing literature remains heterogeneous using catch all terms such as Overuse Lower limb injury (OLLI), Exertional Lower Limb Pain (ELLP) and specific conditions with less than clear pathological mechanisms such as Medial Tibial Stress Syndrome (MTSS) and Chronic Exertional Compartment Syndrome (CECS) along with the colloquial term “shin splints” widely used to group and differentiate many of the same clinical presentations. Incidences vary widely in the literature between 25% and 65%. And he associated morbidity with overuse lower limb injury is significant, and time away from training is important both in the military and for the recreational athlete, in terms of not only financial cost but also an individual’s physical and mental health. In particular, Chronic Exertional Compartment Syndrome (CECS) was first described in 1956, but little research has been performed since then to confirm the pathological physiology. An assumption is made that elevated subfascial or intramuscular pressure during exercise causes tissue hypoxia and subsequent ischaemic pain due to decreased blood flow. To date, no conclusive evidence exists to demonstrate cellular hypoxic damage or decreased capillary perfusion. Further supposition is made regarding muscle hypertrophy, reduced compartment volume due to a decreased fascial compliance, and shorter periods of muscle relaxation as the underlying pathophysiology of CECS. There are many questions over whether the technique of intra-compartmental pressure measurement is reliable. Intrinsic factors such as foot anatomical morphology and lower limb anthropometry abnormality are commonly cited in the search for risk factors but the extrinsic factors such as an increase in weekly running mileage is the most common trigger for exertional leg pain.
1440-2440/
Alternatively, short-term sudden changes in intensity, distance or running surface can be responsible and in military personnel the sudden need to march in squads at set speeds are further risk factors. One extrinsic factor that the recreational runner, but not the military trainee has control over is that of running shoe selection. Recent trends for minimal drop training shoes offer a muchreduced angle from heel to toe (commonly referred to as ‘drop’) compared to traditional cushioned running shoes. In a standard running shoe this can be as much as 14 mm fall from heel to toe, but now 3–5 mm drop shoes are common alongside zero drop shoes. These shoes are designed to promote a “lifestyle” style. There is nothing particular about the shoe which alters running kinematics or style, Understanding the muscle activity and joint angular changes is necessary to understand the kinematics of running, and understanding the kinetics of loading is vital before examining the patient with lower limb pain. To fully understand potential sources of overload, we need to appreciate the whole lower limb, and many of the changes need to be made proximally in order to affect a distal change. Changing the range of motion or angle of a joint not only has an immediate effect on the activity of the surrounding musculature, but also changes the direction in which the force is applied and distributed. This force has to go somewhere and will lead to increased load at other joints which must be accommodated Recent reviews and qualitative research has identified the willingness to consider the coaching of running mechanics as a means, to alter the segmental linkage and load distribution of runners but as yet, prospective trials are lacking with the kinetic changes accompanied by coaching adaptation, though kinematic evidence. The common feature of all causes of Exertional leg pain is the maladaptation to load that is potentially modifiable by altering running kinematics as their common feature. This keynote will explore both running kinematics and associated kinetics, and the evidence base on which alteration to biomechanics and coaching can be used to modify lower limb pain in a clinic based intervention. https://doi.org/10.1016/j.jsams.2017.09.372