BNAC Comrades Novice Talk 2022

Comrades!! What a privilege for me to be able to share some of my thoughts with you, that I hope will in some small way, help to equip you for the amazing challenge and unforgettable journey leading up to August 28th.

 

I would like to talk from a biokinetic stand point. For those of you who don’t know what Biokinetics is, it is the use of exercise as a form of therapy. Given the nature of the profession we see many sports related injuries. There are many potential injuries that long distance runners encounter and I felt that this evening instead of lecturing on the various injuries, that I would rather talk about the common thread which leads to many of the more common injuries.

 

You guys are embarking on a journey of a lifetime as you take on the mountain that Comrades is and there are some important considerations when it comes to your training. Comrades, being an ultra-distance run with considerable elevation gain, requires training that adequately equips you not only to arrive at the start line intact and injury free, to run the race of your dreams, but to also enjoy the journey in getting there.

 

Regular injury and set back after set back in the months leading up to this special day has a negative effect on one’s psychology. Injury instils panic and disruption. This is where we see runners making poor decisions under pressure to try to make up for lost time, train through injury or cram in additional mileage under the effect of pain killers and anti-inflammatories. When it comes to running and long distance running in particular, one of the leading causes of injury’s including muscle strain, tendinitis, and other inflammatory and repetitive use conditions, is OVERLOAD. Overload put simply, occurs when the forces exerted on a structure are greater than what the structure can handle. With repetitive loading on a weak structure, the structure denatures and becomes irritated. This frequently results in pain, inflammation, compensation and athlete frustration.

 

What are the factors that predispose an athlete to overload:

Muscle weakness, poor biomechanics, unusual posture, running gait abnormalities, joint stiffness, muscle tightness, poor support and repetitive loading. Other considerations include inadequate tissue healing or recovery time, incorrect shoe ware, aggressive training schedule resulting in doing too much training too soon by hastily increasing speed, frequency or duration prior to the body being ready to cope with the changes.

 

Running gait pattern, as mentioned, is a critical component when assessing injury potential and these factors should be considered:

1] Where you make initial contact on the foot, heel strike with increased ankle dorsiflexion, mid foot strike, keeping the foot in a fairly neutral position or toe strike where contact is made through the forefoot and the calf complex is placed under consistent concentric contraction. The strike pattern will determine which structures are heavily loaded and will contribute to the amount of ground contact time, which equates to the amount of time spent with structures under stress. It’s not necessarily that one strike pattern is better than another. What it does mean that depending on the pattern, different structures will be loaded to different degrees.

2] Cadence. Low cadence equates to below 135-145 strides per minute and will increase ground contact time and increase the probability of injury. The slower our cadence and the less efficient the movement, the greater the injury potential.

3] Another consideration is stride length, with over stride leading to potential overload in joints, through breaking forces with your center of mass potentially situated behind your point of foot contact.

4] Joint angles whilst weight bearing, such as rotations through the ankle and varus or valgus angles through the knees.

5] Wide and small base of support effecting vectors and moment arms and contributing to where the load is placed.

 

Examples of injuries arising from a combination of these 5 gait traits include:

 ITB, often occurs when one sees a combination of a small base of support or crossover gait, excessive hip drop, low cadence, resulting in increased ground contact (demonstrate)

Interestingly studies show that changing running gait has a profound effect on ITB recovery and prevention.

 

Medial Tibial stress syndrome, Shin splints.

Wide base of support, external foot rotation.

 

Tibial Stress fracture

Running with your center of mass behind your point of contact. Heel striking with ankle dorsiflexion and an extended tibia. High impact breaking forces and vertical forces creating excessive load in the tibia

 

So, what can we do about this?? We can be proactive by going for an assessment, where the Biokineticist will evaluate your muscle strength, muscle length and factors such as joint stability, posture and gait. They will then prescribe a scientifically formulated exercise plan based on their clinical findings. You could implement your own strength training either home based or at a gym.

 

The program should create balance, homeostasis and adequate preparation and conditioning of the various muscles and structures to enable efficiency and control through the movement task. When it comes to strengthening it’s important to understand what you are trying to achieve.

 

What to do if you are looking to strengthen a muscle: You are aiming to fatigue the muscle within 8-10 repetitions and 3 sets. This means that the resistance or weight needs to be high enough to take the muscle to the point where it may be stiff the following day.

 

One needs to first establish a strength foundation and increase weight or resistance conservatively and incrementally whilst ensuring and prioritizing good posture, proper form and control of movement. If you are unable to maintain these critical components then your choice of resistance is to high. The same can be said for rehabilitation. If exercise results in increased pain or swelling of the effected structure, then the structure is being over loaded and the program should be modified accordingly.

 

In order for a muscle to get stronger, it needs to have adequate recovery. It is in this recovery where the muscle heals and in healing becomes stronger. Too often people make the mistake of punishing the muscle with further loading before the muscle stiffness has subsided from previous workouts and in doing so place load on a vulnerable muscle which will increase inflammation and lead to muscle degeneration. Instead of strengthening the muscle, inadequate recovery time will break the muscle down.

 

In long distance running we have potentially high vertical and breaking forces acting on your body for long periods of time. So how do we prepare for this and how do we prevent over load? We, if necessary, change where the load is and we adequately strengthen the involved structures to be able to easily handle the load.

 

The calf muscle for example:

When we run, loads of up to 3-8 X your body weight is absorbed by your skeletal system. The calf complex is the primary contact point and has a significant role in dissipating the force and propelling us forward. When our muscles are not strong enough to manage and absorb this repetitive force, the structure becomes overloaded. We may begin to compensate, the soft tissue, bone or joint may become injured, the inflammatory response begins, we experience pain and the brain inhibits muscle activation leading to further compensation and weakening of the associated muscle. Weaker calf muscles for instance place runners at a higher risk of Achilles tendon overuse injuries as there is greater stress being placed on the tendon. Adequately strengthening helps the muscle to perform its primary and secondary functions optimally and to cope with the high demands placed on them whilst absorbing, in the case of the calf muscle complex, up to 8 times your body weight. In push off, the calf is responsible for up to 60% of the work. This requires a program geared towards graded increase in loading, simulating movements required and optimizing the muscles ability to function under stress. If the forces are still too high for the structure, one can reduce the stress by making gait related changes to change where the load is.

Not only do strength gains reduce injury risk but have also been shown to improve performance. Studies show that adherence to strength programs show improvements in running performance. So, less injuries and a faster performance sound pretty good.

Now, pre-season, the equivalent of what would be November in the running calendar of old, is the right time to implement an effective strength training program. So that when the time comes to start increasing distance, your muscles are adapted well to survive the increased expectation.

 

Quick Recap

You should be conscious whilst running regarding your joint angles whilst in contact with the ground. Be careful not to over stride, you want your central mass to be close to your point of initial contact. Base of support, you want your initial contact to be in line with the center of your hip. Cadence above 145 strikes per minute to reduce ground contact time. Strike pattern, aggressive heel strike, mid foot strike or forefoot strike? Landing softly to reduce ground contact forces. You can pretend you are running on egg shells to practice softer landing. Strengthening the muscles to maintain good joint positioning, decrease stress on the bones, muscles, tendons and joints and reduce overload in the muscles and tendons resulting in repetitive use injuries.

 

It should be noted that strength and stretch training will not automatically transfer to your running or change the way you run. You run in a preferred gait pattern. If changes are needed, such as increased posterior chain activation through hip extension, then this needs to be actively applied to the running gait, incorporating appropriate drills to teach the body what to do. The drills install the mental and physical “software” required to change the pattern.

 

Recovery

As mentioned recovery is a critical component of your fitness and your comrade’s success. If your muscles do not have adequate recovery, you will get injured. More is not always better. Often less is more as long as the less involves quality and thoughtful, purposeful training. On the market these days are fantastic tools to assist recovery. Electromagnetic stimulation systems like the home use power dot which is a devise where one places electrodes and pods onto the muscles needing recovery and then a current is delivered into the muscle to increase blood flow and flush out metabolic waste.

Massage is another very useful tool to speed up recovery.

Heat is another useful tool, also increasing blood flow, flushing out metabolic waste and maintaining elasticity to the muscles for improved joint range of motion.

Stretching, foam rolling, all these tools can be used to your advantage. Why is it important to recover? So that we don’t get injured and to allow the training effect to take place by which the muscle will strengthen. Why is it important to speed up recovery? So that you can get back to training sooner, with reduced injury potential.

 

Non-steroidal Anti-inflammatory’s

NSAID’s are commonly used in sport in the treatment of soft tissue injuries such as muscle strain and are also commonly used to prevent the onset of soreness after exercise.

Some commonly used NSAIDs include:

• aspirin such as Disprin
• ibuprofen such as Nurofen
• Voltaren
• Celebrex

 

The indication for use is as an analgesic, anti-inflammatory in sports injury treatment, anti-platelet, Migraine treatment etc.

 

I was blown away when I saw the figures of prevalence of use of NSAIDS in sport. According to world renowned sports medicine physician Dr Louis Holtzhouzen, at the FIFA WORLD CUP between 2002 and 2018 NSAID’s were the most frequently prescribed medication. 30,8% of players took NSAID’s before matches.

 

In the Swiss Olympic teams during 1996; 1998; 2000, the use of NSAID’s was 6-10 X higher than the population.

 

5.5 Million people per day take NSAID’s in USA alone.

 

UK Park run: 57% of respondents took NSAID’s before a run. 87.8% took NSAID’s in the past month.

 

It was reported that the respondents had a poor awareness of the adverse effects.

 

The respondents took NSAID’s to reduce inflammation and swelling of soft tissue injury, increase their pain tolerance, continue running through injury, treat an injury, reduce muscle soreness such as DOMS, prevent the onset of muscle soreness and treat chronic pain.

 

There is much concern that these drugs are prescribed for inappropriate indication. They are often requested by patients and prescribed by doctored as a convenient way to keep the patients happy. Many of these patients receive these drugs before other treatments have been attempted.

 

So why is this a concern? In a nutshell, NSIAD’s do not promote tissue healing, they promote tissue breakdown. They interfere with the body’s natural processes of tissue healing through its ability as an inflammatory blocker and in addition have adverse effects on the body.

 

In blocking inflammation, which is part of the healing process we prolong recovery. We take away the body’s ability to tell us that there is something wrong and that we should stop. We risk renal damage which can be life threatening, especially when combined with dehydration and place unwanted stress on our gastrointestinal tract, renal function, central nervous system and other organs. We also interfere with the soft tissues’ normal response to injury and block coordinated recruitment of inflammatory cells to the injury site and interference to the cycle, prevents tissue healing in the affected structure. The ability of the cell to recognize and react to future damage is compromised and this way the structure becomes vulnerable, having a negative effect on training response and recovery.

 

Use of NSAID’s in Chronic inflammation effects the regeneration capacity of the cell, impairs skeletal muscle healing and leads to inappropriate repair mechanisms within the cell such as accumulated fat and fibrosis. The chronic inflammation comes from repetitive trauma and inadequate tissue healing.

 

Evidence shows NSIADS failed to improve the effectiveness of physiotherapy treatment following acute injury. It results in impaired skeletal muscle growth, delayed repair, and increased degeneration of the tissues. They compromise muscle strength as a result and hypertrophic adaptions to resistance training. These drugs should be avoided if the goal is to improve muscle integrity, growth and strength and maximize the training effect. Training effect is the effect exercise has on the muscle.

If we take the exercise effect away through the use of the drug, the point of the session is completely negated.

 

When taking these drugs, treatment priorities should be considered, and the type and severity of the injury established together with the athletes long and short-term goals.

 

So, in wrapping up, I want to leave you with 6 injury prevention PEARLS: The 6 C’s

-Clever training

-Conscious running, awareness of what you are doing and what you are using

-Crucial recovery

-Can the NSAID’s

-Critical Strengthening

-Counter injury through prevention, early detection and evidence-based treatment

 

Good luck, enjoy sharing this awesome chapter with the club that provides the most memorable and inspiring race lead up imaginable. Believe in yourself, work hard, dream big

and make it happen.

 

Reference and thanks to Arnold Vlok and Dr Louis holtzhouzen from which much of this content has been sourced