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Running Does Not Cause Injuries
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Soon after I started running and began having injuries, I made an important discovery: Running does not cause injuries. Some people run a lifetime without injury. Every one of my injuries had its roots in a structural weakness I was born with, a postural weakness I developed through training, or other stresses due to shoes and terrain. Once the problem was corrected, I was assured of pain-free running. Runner after runner has found this to be true. In time, it became accepted dogma among runners. Unfortunately, the biomechanical approach was a creed unsupported by scientific proof. We knew attention to biomechanics worked, but we had not yet gotten around to proving it. At the time, no studies had been done showing the biomechanical approach-attention to human engineering-is more effective than anti-inflammatory drugs, cortisone shots, and electric therapy devices. Sometimes, paying attention to human engineering includes the use of orthotics. Orthopedic physicians among my colleagues have chided me about my obsession with attributing every injury to events occurring at footstrike. One time at the hospital table, when discussing the treatment of a patient with a brain tumor, an orthopedic surgeon asked me, "George, have you tried orthodics?" And whenever I broached the subject of using orthodics, or suggested that the whole spectrum of foot and lower leg injuries was due to faulty biomechanics, they looked at me as if I were a "dropout" from orthodox medicine. "Prove it, "they said. But I'm not a scientist, I'm a practitioner. I rely on faith, logic, and experience to arrive at my "proof." I had proved this theory to myself in hundreds of ways. I had testimony after testimony from runners. But scientific proof is another matter. A protocol that will satisfy entrenched skeptics is hard to come by. So the years slid by. My theory was accepted by the runners. Podiatrists who dealt in biomechanics of the foot became the sports physicians for those of us out on the roads. But there was still no acceptable study proving the value of what they were doing. Now there is. And not one but two such studies exist. The first comes from Timothy Noakes, M.D., and his colleagues in Cape Town, South Africa; the second, from Douglas Clement, M.D., and his associates in Vancouver, British Columbia, Canada. The Cape Town team reported on 196 running injuries treated solely by correction of biomechanical abnormalities. Within eight weeks after the start of treatment, nearly 77 percent of the runners were training completely pain-free. Only 13 percent were not helped at all. Most of these had not adhered to the prescribed regimen or had iliotibial band syndrome, an injury with cause or causes that are still conjectural. The most significant structural weaknesses were foot abnormalities and disparities in leg length. Practitioners detect foot abnormalities by observing the runner as he or she stands and runs and by examining wear patterns on the runner's shoes. Wear at the midfoot and forefoot indicate either pronation (the foot rolls inward) or supination (the foot rolls outward). Wear at the heel is a sign of a discrepancy in leg length, measured while the runner is standing. The Cape Town team found the following treatments to be most effective: 1) Prescribing appropriate running shoes. 2) Prescribing in-shoe orthodics (corrective devices) for more treatment- resistant injuries. 3) Inserting heel lifts or other corrective footwear devices for leg length discrepancies. 4) Devising a built-in midsole wedge for runners not helped by orthodics. 5) Scheduling deep massage for all chronic muscle injuries. Unlike the Cape Town team, the Vancouver researchers focused in one specific running injury-Achilles tendinitis. Their program differed only slightly from the one in South Africa, and their findings were almost identical. They attribute their success to the following: 1) Muscle retraining (that is, strength and flexibility exercises for the calf muscle). 2) Control of over-pronation (a tendency in 95 out of 109 studied). 3) Heel lifts (in both shoes where there was no leg length discrepancy). 4) Well-designed running shoes, preferably with a snug heel counter, a flexible sole that gives under the metatarsal heads (between the instep and the toes), and a heel wedge of 12-15 millimeters (with 7-15 millimeters additional lift during the toe-off phrase). These two groups arrived at the same basic conclusions: Biomechanical factors play an important part in running injuries. Physicians who treat runners need to know three things: which running shoes are appropriate for different running injuries, how to detect subtle structural abnormalities in the legs, and when to prescribe in-shoe orthodics. The Vancouver team states, "We believe that virtually all cases of Achilles tendon injury appear to result from structural or dynamic disturbances in normal lower leg mechanics." So there you have it. Your running injury is not due to running. It has specific cause, an error that must be corrected. If you cannot find the cause and detect the error, seek help from someone who has studied the biomechanical approach to injuries and knows how to apply it.