Daily Tips and Advice
The Biomechanical Cliff
Posted 5 years ago
We are really pleased to be able to bring you this article from our good friend and great Physiotherapist Simon Lack. Hope you enjoy the piece.
How far can our body go with all our compensatory movement patterns until break down?
By Simon Lack, Physiotherapist and PhD student
You only need to look at the Kenyan Olympic marathon runner Priscah Jeptoo, who finished second in London 2012 and then won the London marathon in 2013, to realise that you do not need wonderful mechanics in order to be a world class athlete and run injury free. Possibly more interesting, however, is that some people have been hanging on for such a long time with such poor mechanics without injury, and others with great mechanics are still getting hurt.
It therefore raises the question, what are the reasons behind some people falling off the biomechanical cliff and getting injured, and others hanging on? Furthermore, should we be intervening in a preventative fashion to address these suspected biomechanical faults and does screening for biomechanical faults aid injury prevention? .
The reason for writing this article and thinking about this problem is that over the last couple of months a unique handful of serious runners have come into my clinic. Guys (yes they were all men) who over a 3-4 year period, have been competing in marathons, ultra marathons and ironman events, but who have all ended up seeing me as their world has coming crashing down around them (metaphorically speaking…in most cases at least) after having picked up some sort of significant lower limb injury.
On all of these occasions the injuries have been exacerbated through ‘repetitive overload’, where there was not one single, large event, but a cumulative build up of discomfort, which on one run resulted in a tip from tolerable to unbearable. Or, from non-performance affecting, to significantly impacting on the athletes ability to train let alone race. Following an examination that looked at movement patterns, running styles, muscles strengths and lengths, on every single occasion, I was genuinely shocked as to how poor these guys biomechanics were. p>
It made me therefore wonder several things….
- 1. If we had optimised their biomechanics from an early stage in their running career, could these injuries have been prevented?
- 2. Is it in fact just a problem with training load, as all these recreational athletes had been running with these mechanics for many years without problems?
- 3. If runners have been surviving with these mechanics for so many years without problems, do we really know what optimal mechanics really are?
The scientific literature is definitively out there in the public domain indicating that certain movement patterns do predispose you to developing lower limb injuries. Furthermore, neuromuscular warm-ups, designed to assist in encouraging good lower limb alignment pre-running, have been shown to reduce the risk of injury.
Despite these findings, to my knowledge, no robust study has investigated the effects of an intervention programme designed at optimising biomechanics and subsequently looked at its ability to reduce injury risk. It does seem logical however, that doing what you can to improve your biomechanics relevant to your sport will help you to perform.
With running being a combination of hops from one leg to the other repeated multiple times, your ability to control the body during this activity is essential. Using sessions in the gym to train aspects of single leg stance and associated balance and control can be time well spent.
Training load and volume is in my opinion as critical, if not more so, than optimising biomechanics. If Ms Jeptoo is anything to go by, biomechanics might not need to be perfect, but if you go too hard too soon, ramp up too quickly or don’t recover effectively, you are opening yourself up to potential injury. Every body has a threshold. A tipping point.
The determinants of this threshold are multiple and specific to the individual, but volume and intensity are large components of the equation. The ability to listen to your body, modify your training to allow for appropriate adaptation to occur and then sensitively grade your return to normal training or racing can be the difference between injury or injury free running.
Structure represents a further component of the athlete that needs to be considered if you are breaking down. Compared with mechanics and volume, structure is less capable of change. How your bones are formed, how strong your ligaments are and how resilient your cartilage is to load is largely underpinned by genetics.
Dependent on how much you wish to attribute your athletic successes or failures to your parents, gene expression is not only biology, but represents a combination of biology and environment, nature and nurture. Bone, ligaments and cartilage do all have the capacity to adapt to load given the right environment, but this capacity does appear to vary between individuals.
Providing an environment for optimal loading comes back to the biomechanical and volume elements we have discussed earlier. Time is critical, compared with muscle these more dense tissues require longer for adaptation to occur. Being patient, building slowly, sleeping well, eating well and drinking well all play their part in helping this process to occur.
The premise of what represents poor biomechanics, and thus where a biomechanical cliff may exist, has stemmed from the observation of individuals who get injured and comparing them to those who are injury free. The overriding average of these observations is athletes who exhibit muscle weakness, poor control of lower limb alignment, decreased flexibility and reduced awareness of the limbs position in space, are at significantly greater risk of getting injured compared to those who demonstrate none of these characteristics.
As with all things that we don’t fully understand, but believe we at least have a better understanding of than no understanding at all, the problem is likely to be contributed to by a multitude of factors…finding which factors are the key ones for you comes down to the skill of being able to listen to your body, or the skill of somebody being able to listen to you and you being receptive to take the advice they offer on board and act on it appropriately. In doing so you have the ability to prevent falling off the cliff and continuing to enjoy your running and achieving your goals.
Food for thought by a man who knows his stuff.
We’re off to London for more learning on the art of running, so our foot and ankle specialist Eric is holding fort.
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Simon Lack is a PhD student at Queen Mary University London (QMUL), studying the interaction of hip and foot biomechanics in the presentation and management of patello-femoral pain. He graduated from Brunel University in 2005 with a degree in physiotherapy, and has gone on to study an MSc in Sports and Exercise Medicine at QMUL in 2010. Simon works as a physiotherapist in two London based private clinics, having previously worked over in New Zealand with professional golfers, local rugby and football teams.
For more information:
Simon's great resource and running rehab App Rehabrunning