Maybe I was in a rush to post the Day 2 summary, I’m not sure.  I forgot to summarize the final presentation of the day.

Dr. Jeff Matthews: Running Injuries – The Big Picture

•  DC, CCSP, CCEP, 1996 USAT National Team, high school track coach
• Primary shock absorber of the body: FOOT PRONATION
  • Pronation isn’t a bad thing–it’s supposed to happen.
  • Posterior tibialis controls pronation via eccentric contraction
• Secondary shock absorber: knee flexion
• Aches & pains of the leg, foot and toes
  • Metatarsalgia
    • Pain at the metatarsal phalangeal joint as the heel leaves the ground too early.
      • Causes
      • limited ankle dorsiflexion
      • tight gastrocnemius
      • weak digital plantar flexors
    • Treatment
      • stretch gastroc with straight leg
      • increase distal plantar flexor strength
      • rigid forefoot in shoes
      • decrease stride length & employ heel strike
    • I have off and on metatarsalgia.  I’m going to work the toe flexors, particularly the flexor hallucis brevis.  I’ll use a band.
  • Hallux limitus and rigidus (aka Turf Toe)
    • Dancers and defensive backs get this as a result of doing a lot of stuff on their toes.
    • Loaded dorsiflexion of the big toe should be 42 degrees at toe off.
    • To check: Sit with knees bent at 90 degrees.  Lift toe with finger while foot is flat on the ground.  If it’s less than 30 degrees then you’ve got a problem.
    • Stretch toe flexors: Pull toe back 20-30x/day.
    • Restore joint motion to big toe.  I’ve been playing with this stuff quite a bit lately.  I’ve got a constantly tight left calf.  I’m wondering if restricted toe dorsiflexion is part of the problem.
    • I’m not only working to stretch the FHB, but also to strengthen it so my big toe can grip the ground.
    • Here’s a good big-toe mobility video:

• Insertional Achilles tendonitis
  • occurs near the base of the AI
  • common in high-arched, stiff feet
  • common with Haglund’s Deformity.
  • Seems I have a bit of this; more along the lines of a bursitis from what I cant tell.
  • Strengthen with eccentrics.
  • He says “Work on the front of the tendon,” as that’s where the blood flow comes from.
• Achilles Paratendonitis
  • He describes this as occurring with an audible squeak or creak–I’ve had that!
  • An inflammation of the sheath around the tendon
  • Work on the front of the tendon to increase blood flow.
• Achilles non-insertional tendonosis
  • degenerative non-inflammatory condition from repeated trauma
  • treatment
    • rest
    • muscle work to stimulate fibrolasts to remodel
    • when appropriate, strengthen posterior tibialis and flexor digitorum longus
    • How do we strengthen the FDL?  Here’s one way:

• Patellofemoral Pain Syndrome aka runner’s knee
  • comes from abnormal femoral movement
  • hip muscle weakness is the cause; increases with fatigue
  • Testing for PFS: 1-leg squat & check for 3 things:
    • leaning toward stance leg to maintain balance
    • knee caving in
    • falling
  • Treatment
    • retro patellar pain: recruit/strengthen the vastus medialis oblique (VMO)
    • stretch hips, foam roll quads, increase hip flexor strength
• IT Band Syndrome (ITBS)
  • strengthen hip abductors
  • decrease tension on the tendon with soft tissue therapies
  • stretch glute max and TFL
  • may take 6 weeks (Didn’t take me that long to overcome mine.)
  • Check out my post on IT Band issues for more help.
• Popliteus tendonitis
  • The popliteous unlocks the knee from the extended position.
  • inserts under the IT band and can cause lateral knee pain
  • if weak then knee may stay locked and send shock to the back
• Treatment
  • Strengthen the popliteous
  • soft tissue therapy
  • control pronation (probably with foot strengthening drills and more importantly, HIP ABDUCTOR exercises)
  • Here’s a video on recruiting and strengthening the popliteous

• Hamstrings
  • Hamstring strains have the highest recurrence rate and can take 4 months to resolve
  • Semimembranosus protects the medial meniscus during knee flexion
  • long head of biceps femoris helps stabilize SI joint and is most frequently injured in runners because of the long lever arm decelerates knee extension
  • more proximal the injury the harder to treat
  • Treatment
    • increase length, strength and flexibility
    • evaluate pelvis
    • strengthening abs/stabilizing pelvis can position pelvis correctly thus putting hamstrings at proper length
• Low back pain
  • Pain causes weakness/looseness
  • Internal or external femoral rotation may become problematic.
  • Treat hips
  • A TFL problem = a glute medius problem.  This is huuuuge to me!
  • Seems to me that sitting too much is maybe the main problem here.