Running injury season is back!

Competitors are starting to ramp up their mileage, people are

getting outdoors now that the mud and cold are on hiatus. Running injuries or fear of injuries,
their management and prevention sell running shoes and magazines so what kind of insight is
going to be offered here?
Running biomechanics commentaries focus on extremes of bone structure, muscle imbalances,
foot strike analysis, and how to support the foot with shoes or orthotics, all of which are
important. It is unrealistic for people with extreme knock knees or bow legs, significant leg
length discrepancy, flattened or excessively high arches who train for speed and distance to
expect to avoid injuries. There is, in most of the articles I have read in the lay press an
assumption that the runner in question has body parts that work normally and from an
osteopathic stand point that is an assumption that needs to be questioned.
The foot is an amazing architectural structure. It must absorb shock yet at the same time
conserve energy by converting horizontal forces moving forward to vertical forces that allow for
push off. The foot has three arches, lateral, medial, and transverse. Each of these arches has 2
functional pillars and a keystone which holds the shape of the arch. Each arch is supported by a
windlass made up of muscles and tendons or ligaments which tighten to absorb shock and to
maintain the arch. The medial half of the foot is designed to adapt to terrain and absorb shock
and the lateral part of the foot is rigid for purposes of stability and conservation of energy.
Forces change form horizontal to vertical as they wrap around the heel and ankle. They are
absorbed and stored in the muscles and connective tissue of the legs, knees, hips and pelvis. The
typical running magazine assumes that all the pieces are in alignment and working order for this
to happen. Fourteen bones are found in the toes, five in the forefoot, five in the midfoot and two
in the ankle that have to be in appropriate relationships for this to occur. Those bones have the
potential to be twisted inward or outward, to be knocked superiorly or to fall inferiorly. When
that happens, the arches become destabilized and the muscles, tendons and ligaments suddenly
face increased demands in directions they are not designed to meet.(plantar fasciitis,
inflammation of ligaments, tendonitis of the foot) Foot strike adapts and forces change in the
lower leg, the connective tissue is stressed where the fascia inserts onto the bone (shin splints),
the membranes between the bone stiffen and the origin of muscles stabilizing the foot changes it
position sense input and lymph and deep venous blood flow is compromised. Stresses change at
the knee and hip and again local inflammation may occur (iliotibial band syndrome,
patellofemoral syndrome, hip pain, back pain).
Now complicate the situation by thinking in reverse. If there is a problem with the pelvis, the
muscles that hold the femur in place in the hip socket, some of which cross the knee joint, will
have their tone altered, some becoming tighter and others becoming inhibited. If the knee
cartilage is stuck somewhere other than a neutral position, or the knee cap is stuck to the fat pad,
or the joint between the tibia and the fibula is shifted up, down, front or back, position sense may
be compromised and coordination and balance may be disturbed.
The old ankle sprain that wasnt properly rehabilitated (including mobilization), the misstep that
jarred the ankle or the foot, the twist of or the fall on the knee, the slip and near fall with a bit of
low back or S-I discomfort, these are common everyday events that potentially disturb the
linkages that are essential for normal coordination and balanced movement of the legs as they
carry you down the road or trail.
Pay attention to your body. Pain is the tip of the iceberg and seldom tells the whole story.
Taking ibuprofen to allow the next run is akin to painting an iceberg the color of the sea. The
problem is still there it is just tougher to recognize before real damage occurs. Mechanical
problems when recognized are reversible. Treating them will help you keep putting one foot in
front of the other.