THOUGHTS ON:
Training, Rehabilitation,
&
Best Care Practices
Youth Running: Benefits, Risks, & Considerations
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Running is one of the best (coming from a runner) and easiest sports to take up in the world. Running is a major part of nearly every sport on the planet, making it an excellent option for our school-aged athletes. In 2017, almost 500,000 runners ran XC, and over 1 million athletes ran track. With the ease of access and a million different training techniques and training theories comes the risk of adverse effects. Over the last 10 years, we have seen a 34% increase in injuries incidence among runners.
Shin splints can be an precursor to stress fractures in young runners. Check out our MTSS Blog Series to prevent and rehab this common injury.
It is estimated that 20-80% of runners will experience an injury in a given year. Random range, right? You try to find two studies that can agree on this! However, we do know that more than 50% of all pediatric sports injuries are due to overuse. We also know that overuse has is signs and symptoms and can be prevented.
What do we know about youth running? A lot actually. Let’s look at the facts and discuss how we can prevent future injuries so our young runners can enjoy a life-long relationship with this wonderful sport.
BENEFITS OF RUNNING FOR YOUTH ATHLETES
Great Cardiovascular Health.
Improved Cognitive Development.
Exercise increases metacognition, behavior regulation, and accelerates behavioral and emotional engagement.
Bone Health - Increased Bone Density
Positive Self Image & Emotional Wellbeing
Aids in Development of Total Athleticism.
Running injuries are common in youth-aged runners, but the benefits from frequent exercise, competition, and camaraderie far outweigh the risks. Learn more about beginning running for health and fitness here.
CURRENT TRENDS IN YOUTH RUNNING: INJURY RISKS
Accelerated Growth.
Peak height velocity (when children grow fastest, resulting in bones lengthen faster than muscles and tendons can keep up with) occurs around 12 for females and 14 for males.
Just before this rapid growth, bone mineral content is at its lowest, making bones and growth plates vulnerable to the load and stress of running.
Low Bone Mass For Age.
Affects 39% of female youth runners.
Might be the more likely cause of stress fractures than training load.
Low Energy Availability, Relative Energy Deficiency in Sports
Adolescence is a time of rapid growth with unmet energy demands…inadequate calorie intake with increased running demand can lead to abnormal menstrual function in females, bone mass depletion, and high risk of musculoskeletal injuries and stress fractures.
Males Commonly Suffer From Low Bone Mineral Density As Well.
Risk factors include being less than 85% weight for height, running over 30 miles per week, a history of stress fractures, and having a diet lacking in calcium-rich foods.
Answering ‘YES’ To The Following:
‘do you believe that being thinner leads to faster running performances?’
BIG RED FLAG
Increased Anxiety or Avoidant Coping Strategies Such As Denial.
Perfectionism-related thoughts are associated with higher rates of depression, anxiety disorders, obsessive-compulsive disorders, and eating disorders.
History Of Previous Running Injuries.
Strong indicators for in-season injuries are injuries during summer training (female) and history of previous running injury (males).
HOW CAN WE PREVENT INJURY IN YOUTH RUNNERS:
To prevent injury, cross training is necessary. Recent data suggest that shorter intense bouts of activity like sprinting, other sports, and neuromuscular training are better for developing motor skills compared with endurance running. Remember, though they grow, they are still kids and need time to play. Play outside, play other sports, rest from play. Don’t forget that.
Strength Training #1 - Improved Core And Pelvic Strength Led To Faster Race Times.
A 6 week strength program aimed at pelvic and core strength led to improved race times. Strength training also leads to better weight control, improved motor performance skills, improved cardiovascular health, and enhanced psychosocial well-being…oh, and less sports-related injuries.
Strength Training #2 - Spine & Hip Strengthening.
Exercises aimed at the spine and hip muscles helped injured youth runners rehab from injury faster and prevented future occurrences of common running injuries such as Achilles tendinosis, iliotibial band syndrome, runner’s knee, plantar fasciitis, and shin splints.
Strength Training #3 - Strength Training For Runners Program.
We have developed an instructional series around some of the best strength exercises for runners. You can check those out here.
Set Realistic Expectations - Know Age & Developmental Stage Capabilities.
Unrealistic expectations lead to athlete frustration, low self-esteem, burnout, and injury! This can lead to reclusiveness, depression, and loss of enjoyment.
Monitor Youth Runners For Signs Of Burnout.
Students athletes who withdraw from activities they previously enjoyed may be experiencing chronic stress and burnout from their sport. This leads to more complicated issues if unaddressed, like depression, obsessive-compulsiveness, and eating disorders.
If an athlete becomes more irritable, anxious, or struggles with perfectionism, they are demonstrating signs of burnout. They need time off or decreased self, coach, and or parental pressures related to their sports.
Coordination Of Care For An Athlete.
Extrinsic risk factors for injury include improper training volume, intensity, or progression, early sports specialization, poor footwear, and inefficient running form. These factors are better addressed when the athlete, parent, coach, and healthcare provider have open communication with the athletes BEST INTEREST at the forefront.
Modify Training Program To Allow Rest Periods
Injury can be reduced by developing a training plan that limits weekly and yearly participation time to reduce repetitive movements and increase scheduled rest periods within each week, season, and annual training cycle.
Suggested rest is at least 1 day per week, 1-2 weeks every 3 months, and participation limited to 9-10 months per year.
Avoid Early Sports Specialization (Bolded Based on IMPORTANCE)
Highly specialized youth athletes (those participating in one sport more than 8 months of the year) report more injuries than their peers, independent of age, sex, or training volume.
Early Sport Specialization is associated with unidimensional identity with the sport leading to the athlete feeling as like they lack control with their participation in that sport. This leads to burnout.
All Credit To The Authors & AJSM. No Copyright Violation Intended. Click Here To Access Full Article.
When To Seek Treatment
Now that we are aware of injury risks, YOU have to take preventive measures. For some, this means a little time off before training ramps up again. For others, it’s time to hit the gym, toss a ball around, shoot some hoops, and spend some time at the pool.
Early Care Is Crucial To Retruning To Running In a Resonable Time-Frame. Schedule Today.
Shin Splint Pain Relief -> CLICK HERE
IT Band Pain Relief -> CLICK HERE
Runner’s Knee Pain Relief -> CLICK HERE
When it comes to injuries, we know two things.
(1) Rest is rarely beneficial for sports injury recovery. Rehab needs to be active!
(2) The sooner you seek care with an injury, the sooner you will be back out and running.
If you or your child has been training for the upcoming cross country season but are continually being sidelined by injury and illness, it’s time to find help and get back on track. If you are a runner in the Salt Lake City area, Revive Sport & Spine is your go-to clinic to get you back up and running quickly, giving you the tools to help you run faster, farther, and more efficient than before.
Krabak et al. Youth Distance Running: Strategies for Training and Injury Reduction. American College of Sports Medicine. 2019. Current Sports Medicine Reports. www.acsm-csmr.org.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management for the great people and adventurers of the Salt Lake City Valley.
Iliotibial Band Syndrome: Self-Care & Training Modification
As we work our way through this series, let not forget what we have learned so far.
Iliotibial band syndrome is a common overuse injury plaguing runners of all abilities. The most common offense is trying to increase your volume too soon while also increasing the intensity without cross-training or varying surfaces.
The Iliotibial band DOES NOT STRETCH! The tension we feel is caused by the muscles that support the IT band, Tensor Fascia Latae and Gluteus Maximus.
The stabbing pain we experiences as runners suffering from IT band syndrome is thought to be caused by the band itself shifting forward and backward as the knee flexes and extends. The research is out on that one…if we ever reach a consensus, I will let you all know!
Where are we now? Well…if you have made it this far, you are probably dealing with IT band syndrome and wondering if it will ever go away and let you get back to running the way you would like.
For this, we are going to discuss self-care. What you can do about the knee pain and tight hips at home while also mentioning a few stretches you can do at work or out on a run. Our goal is simple - Allow you to continue to train, modified while improving your IT band syndrome pain week-to-week.
What we are talking about today, where the real work takes place, the day in and day out self-care. And the big question….can you continue training?
As we work our way through this series, let not forget what we have learned so far.
Iliotibial band syndrome is a common overuse injury plaguing runners of all abilities. The most common offense is trying to increase your volume too soon while also increasing the intensity without cross-training or varying surfaces.
The Iliotibial band DOES NOT STRETCH! The tension we feel is caused by the muscles that support the IT band, Tensor Fascia Latae and Gluteus Maximus.
The stabbing pain we experiences as runners suffering from IT band syndrome is thought to be caused by the band itself shifting forward and backward as the knee flexes and extends. The research is out on that one…if we ever reach a consensus, I will let you all know!
Where are we now? Well…if you have made it this far, you are probably dealing with IT band syndrome and wondering if it will ever go away and let you get back to running the way you would like.
For this, we are going to discuss self-care. What you can do about the knee pain and tight hips at home while also mentioning a few stretches you can do at work or out on a run. Our goal is simple - Allow you to continue to train, modified while improving your IT band syndrome pain week-to-week.
What we are talking about today, where the real work takes place, the day in and day out self-care. And the big question….can you continue training?
SELF CARE PART 1 - START WITH A BETTER WARM-UP
I can not stress this enough! As you are working through an injury, maintaining some kind of load (training volume) is important, but you are better served spending time on a proper warm up, running just a few miles, then spending a good amount of time on the cool down. With just about every running injury we deal with, runners have a dismal warm-up if one at all. Most are so pressed for time, they lace up the shoes, run out the door, only to return and head straight to work. Most of us are not teenagers anymore, our bodies just can’t do this…not for long periods anyway. Start with a thorough warm-up - we will emphasize this again in our next article where we talk rehab and return to running so prepare yourself!
SELF CARE PART 2 - SELF MYOFASCIAL RELIEF
Understanding that foam rolling and stretching of the IT band itself is ineffective, where do we focus our attention? The hips…it is always the hips! But some attention at the knee can be beneficial while appropriate rest and recovery are always suggested after an acute flair-up or long run.
Rest & Recovery:
Traditional pain relievers for running related pain include ice, heat, topical creams like biofreeze, and some good old-fashioned rest. Today we have an array of tools that can aid in recovery, one we like to use frequently are compression boots from Rapid Reboot. We don’t expect everyone just to have these lying around, but they sure feel great after some dry needling, IASTM, and manipulation in the clinic.
Rolling & Stretching:
Now that we understand what anatomy we need to address, it is time to get your roll on! If we are able to continue to train, we suggest rolling and stretching 4-5 times each day. Before you lose it, these sessions are only 3-4 minutes each. If you are a frequent runner, or just starting out, here are the basics.
Rollers should be in your home, office, and car. You should have at least 3 lacrosse balls around, purse, cup holder in your car, in your desk, and your gym bag.
Roll in the morning, pre and post run, after your lunch break, when you get home, and then a good session before bed.
Cupping & Flossing:
These may not be tools accessible to all, but they help you achieve stretching in ways that are difficult to do on your own. One of my personal approaches to provide relief to the knee pain we experience with IT Band syndrome is to place a few cups (I have a few sets of these) around the lateral knee and lateral quadricep muscle, walk about for a few minutes, perform a few squats, rinse and repeat 2-3 times per week.
SELF CARE PART 3 - TRAINING MODIFICATION
Training modification is the hardest part to address. For most, the ability to continue training toward your race is almost as important as fixing the injury. While maintaining some load is ideal, there are instances where a total shut-down is necessary for a few weeks. If you are a typical runner, meaning that you are going to run through the injury, we must modify. Here are the basics. Remember that Iliotibial band syndrome is the result of too much mileage or intensity, too soon in your training plan. Not having a proper base as you head into a 20-week marathon training plan is a recipe for disaster.
Our first suggestion is to cut your volume by 50% and decrease your intensity for the next 2-4 weeks. Our goal is to maintain some running, but the speed work and downhill bombs need to take a backseat for a while.
Please, cross-train! As runners, we think that running is it, period. When we are injured, and more so when we are not so that we can prevent injury, we must cross train. If you have been battling IT band syndrome for more than a few weeks, it is time to work in some biking, swimming and weightlifting. This allows you to maintain most of your cardiovascular capacity while taking out the pounding associated with running.
Lastly, look at your running form. Can it be cleaned up a bit? For most of us, that is a very strong, Yes! I’m not saying to go out and get an extensive running evaluation to change the subtle nuances of your stride, most of us just are not at that level, but shortening your stride, increasing your cadence, and working on your running drills can provide a needed boost in your running efficiency.
Cadence should be upwards of 170-180 steps per minute.
Perform drills on a soft surface (track or field) 2-3 times per week.
More on this in the rehab portion next week.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in the Greater Salt Lake City Area of Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Iliotibial Band Syndrome: Why Runners? Understanding Biomechanics & Common Risk Factors.
Knowing more about the anatomy associated with the Iliotibial band (IT Band Article #1) is a great start, but that alone will not decrease the stabbing feeling you had on the outside of your knee as you attempted a long run this past weekend.
We are moving forward with our IT Band Syndrome Relief series. This time we aim at the biomechanics (boring for some, but very important) of the Iliotibial band and why it is causing you pain. From there, we are going to look at some common risk factors and other things you are doing every time you go out to run that is making it worse.
Knowing more about the anatomy associated with the Iliotibial band (IT Band Article #1) is a great start, but that alone will not decrease the stabbing feeling you had on the outside of your knee as you attempted a long run this past weekend.
We are moving forward with our IT Band Syndrome Relief series. This time we aim at the biomechanics (boring for some, but very important) of the Iliotibial band and why it is causing you pain. From there, we are going to look at some common risk factors and other things you are doing every time you go out to run that is making it worse.
BASIC BIOMECHANICS
When we look at the function of the Iliotibial Band, it primarily assumes the role of lateral knee stability. Understanding that it originates from the Iliac crest and inserts on the tibia (Gerdy’s tubercle, remember?) we realize that it is a two joint muscle. When a muscle crosses and acts on two joints, in this case, the hip and knee, the likelihood of injury dramatically increases, especially when it is subjected to overuse overload.
With this setup, the IT Band also acts to extend, abduct (raise the leg out to the side), and externally rotate out the hip. As we will discuss in our next article about self-care for the IT Band, we know the muscle of the hip are the primary culprit and where we will focus our attention during clinical and home care.
BUT WHY THE PAIN AT THE KNEE?
While the Iliotibial band crosses the knee to attach to the tibia (fibular and patella according to some studies) providing stability to the outside of the knee, it moves as the knee bends and extends during walking and running.
When we bend our leg, the IT Band moves anterior to, or forward, across the lateral condyle of the femur bone (SNAP!), then, when the knee nears 30 degrees of bend, it moves posteriorly, or back over the lateral condyle of the femur (SNAP!).
Now, think about how many steps you take on your average 5-mile run. If you have tightness in the hip musculature, namely the TFL and Glute Max muscles, they are pulling tension through the IT Band causing an up close and personal relationship between the band and the femoral condyle we just mentioned. When we work through the running gate cycle, we cross the 30 degrees of flexion and extend back out of it over and over….SNAP, SNAP, SNAP!
Take this friction, and add force. The force from each and every foot slap on the ground while running has to be dispersed through the muscles, ligaments, tendons, and joints. While not proven, my own personal ‘journey’ with IT Band Syndrome led me to find that when I trained on softer surfaces, my knee pain was less severe.
Either way, this force, friction, and the magic number of 30 degrees do not play well together. As you can see in this video, if you run with somewhat decent form, your foot strikes the ground somewhere between 20 and 30 degrees of knee flexion (SNAP!) and when you follow-through the gait cycle to push off and bring your leg forward, you near full extension (SNAP!) and back into bending of the knee (SNAP!).
COMMON RISK FACTORS & RUNNING MISTAKES
Common Risk Factor #1: Too Much, Too Hard, Too Soon
We have all done it…try to pick up where we left off either from an injury, vacation, or some much needed time off after a goal race. However, this typically affects the newer runner. You find a plan online, it looks fun, doable, but you soon find out it was too much. Increasing your intensity and volume at the same time spells disaster for the most veteran runner, for the newbies, this is the quickest way to stop running. Take it slow, slower than you want to. Build up your volume, EARN YOUR BASE, then maintain that volume and slowly increase your intensity. THERE IS NO OTHER WAY!
Common Risk Factor #2: Not Taking The ‘Road’ Less Traveled
Do you always run on the road? I mean ALWAYS? How about sticking to one side of the road on every run? We all know that roads are banked, but if you are always running on the right side, your body will adapt to that slight lean, causing problems down the road (pun intended there). With that, try the track, trails, aqua jogging, a treadmill. Just like shoes, you need variety. Note: Watch the video above, and look for pt 3, we talk on this more.
Common Risk Factor #3: “What Is Strength Training?” -Runners Everywhere
One of the most common causes of IT Band Syndrome is weakened hip muscles. It will come as no surprise when we discuss clinical and home care that strengthening the hips is a GIANT part of the rehab and future prevention process. It’s okay runners, I was scared of the weights at one point in time too!
Common Risk Factor #4: Who Has Time To Warm-Up?
The next significant change we make during care is the Warm-Up. If you just said, “The What?” Then we just found the cause of your IT Band Syndrome Pain. Warming up not only helps prevent injury, but it makes you a better runner. There, I said it, now start doing it.
Common Cause #5: Developmental & Gait Abnormalities
Overpronation, leg length discrepancies, bow-leggedness, poor hip mobility due to underlying causes. These are all challenging, and for most, they just add to the problem. A perfect example is that I personally found that I have a 1.5 cm short leg. I found this out when I was over 30, my body was adapted to it. Putting a lift in or selecting a supportive shoe would have only worsened my condition. I did, however, have to be strategic in my strength training, mobility work, and where and how I trained. If you fall into this category, call our office, or someone near you that understands running injuries as you do need help from a professional to find the right rehab exercise and mobility drills to help you run pain-free.
SUMMARY
Tight and weak hips lead to poor function and support of the IT Band. This allows the band to SNAP at the knee, producing overuse friction, and long-standing pain.
Risks come in all varieties, some you are doing every day. Take your training slow, work in strength training, vary your training surfaces, and warm up before running!
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in the Greater Salt Lake City Area of Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
Iliotibial Band Syndrome: Anatomy & Symptoms Of The Most Common Running Injury
You are out on another long run. It is a mid-Saturday morning, the weather is a cool 50 degrees, clear skies, and your focus is on the audiobook or podcast playing through your headphones. All of a sudden, out of nowhere, you get this sharp, STABBING, pain on the outside of your knee. Where did this come from? Did you do something wrong? What the heck is happening?
If this is your first time dealing with Iliotibial band syndrome, or you are remembering your first experience with it right now, the feeling is all too real. IT Band issues are a frequent occurrence for runners of all abilities, one of the most common conditions we relieve in our office and feel so prevalent that it is almost a ‘right of passage’ of sorts for new runners.
You are out on another long run. It is a mid-Saturday morning, the weather is a cool 50 degrees, clear skies, and your focus is on the audiobook or podcast playing through your headphones. All of a sudden, out of nowhere, you get this sharp, STABBING, pain on the outside of your knee. Where did this come from? Did you do something wrong? What the heck is happening?
If this is your first time dealing with Iliotibial band syndrome, or you are remembering your first experience with it right now, the feeling is all too real. IT Band issues are a frequent occurrence for runners of all abilities, one of the most common conditions we relieve in our office and feel so prevalent that it is almost a ‘right of passage’ of sorts for new runners.
In this series, we are going to dive into the details of IT band issues, what causes this dreaded running injury, what you can do about it when it happens to you (It Will!), and when you need to seek care to help get your training back on track. I can tell you from experience, as a past sufferer of IT band issues myself, it can be stubborn, frustrating, and damaging to your confidence as a runner…but it does not have to be.
I tell patients daily that IT Band syndrome is a relatively easy condition to treat…but it requires time, effort, and a change of routine. We start here today by understanding what it is and move through this series to self-treatment and prevention.
WHAT MAKES UP THE IT BAND…
… and why you can’t just stretch the Iliotibial band and make it better.
IMPORTANT ANATOMY:
Insertion Points: Iliac Crest, Knee
Muscles Involved & To Know:
Tensor Fascia Latae
Gluteus Maximus
Gluteus Medius
The Iliotibial tract runs from the hip (iliac crest) to the knee with insertion on the tibia at Gerdy’s Tubercle (trivia!) and is believed to also span some fibers to the outside of the kneecap and head of the fibula. The IT band itself acts as a stabilizer of the lateral knee while also extending, abduct, and laterally rotate the hip when the associated muscles are functioning properly.
If you notice, the band itself is fibrous, meaning…
it is not designed to stretch.
Attention must be given to the muscles that make up and act on the IT band. Those would be the Tensor Fascia Latae (TFL) and the Gluteus Maximus (G. Max). If attention is not given to these essential muscles for running that are involved in stability, pelvic balance, and propulsion, they will slowly tighten up, eventually leading to a - multiple month long - process to rid yourself of the stabbing knee pain it can cause. We will discuss the biomechanics and how to address these muscles later in this series, but this is the basics that you must know to help relieve Iliotibial band pain while running. Focus on the muscles…not the band and the site of pain.
SIGNS, SYMPTOMS, & PREVALENCE
As described at the beginning of this article, Iliotibial Band Syndrome has a very distinct presentation of pain and discomfort. While the hip tightness is often not recognized, appreciated, or correlated until after we exam someone and describe the nature of their injury, the pain at the side of the knee is unmistakable. So that we have a more tangible understanding of this pain, here is a more succinct description.
sharp or burning pain at the lateral joint line of the knee.
How common is Iliotibial Band Syndrome? With injury prevalence in runners nearly 50% (Studies suggest 25-65%), IT Band Syndrome is the most common lateral knee injury.
IT Band Syndrome makes up nearly 15% off all running injuries.
Studies suggest it is slightly more common in male runners, new runners, and higher volume runners.
Clinical experience suggests it is one of the most common injuries runners present to a sports chiropractic office with.
Now that we have some understanding of the anatomy and prevalence of Iliotibial Band Syndrome in runners, we will progress our conversation to risks, common causes, and the biomechanics associated with ITBS.
Dr. Reheisse is a Board Certified Chiropractic Sports Physician practicing in Cottonwood Heights Utah. Revive Sport & Spine provides evidence-supported chiropractic care and conservative sports injury management.
