Dysfunctional movement patterns, injuries and reduced performance with James Dunne | EP#45
James Dunne is a Sports Rehab Therapist with a passion for identifying and correcting dysfunctional movement patterns that cause overuse injuries or impair efficiency in endurance athletes.
In this Episode you'll learn about:
- How a little and often goes a long way to preventing injuries and reducing movement inefficiencies
- What prehab, mobility, strength and conditioning, etc. you should to stay fast and injury-free
- How to identify and correct dysfunctional movement patterns that are the root causes of your injuries
About James Dunne
- Sports Rehab Therapist and running coach at Kinetic Revolution
- He helps and particularly in endurance athletes in overcoming overuse injuries.
- Overuse injuries stem from some sort of biomechanical overload that has come about as a result of movement patterns that places an undue amount of stress or strain on a certain tissue and is exacerbated by training volume.
- He identifies what those underlying movement patterns are, what it is that starts to result in the increased amount of stress and strain on a particular tissue.
- And from there, he helps in strengthening, mobilising, and stabilising all the important areas around that joint or tissue.
- He also helps from a technique perspective, to try and improve how you are moving or running, so that you can get back to your training and overcome the injury or stop the injury from becoming a recurring problem.
Should dysfunctional movement patterns be corrected with running form and technique?
- Absolutely. Many runners dealing with a chronic injury when running is their main exacerbating factor for the injury or the cause of the injury have been to a lot of specialists. But nobody has ever actually looked at them run on the treadmill or on the field to see what they are actually doing when they’re running that is leading to the injury.
What are the most common injuries that you see in runners and endurance athletes?
- Starting from the ground up, plantar fasciitis, achilles tendinopathy, recurring calf strains, shin splints, runner’s knee (patellofemoral pain), ITB syndrome, patellar tendinopathy, high hamstring tendinopathy, piriformis syndrome, low-back pain, and another handful of common injuries that lie in this overuse category.
- These injuries can be characterized by some sort of overload that is exacerbated by training volume.
What is the prevalence of these injuries?
- If you look into the research, you’ll see some papers say between 19-20% of runners getting injured in a 12-month period, all the way up to some papers that suggest up to 90% of runners get injured within a 12-month period.
- In my workshops of 20-60 runners, two-thirds say they have been injured in the last 18 months.
- There was a meta-analysis done in 2015 which looked at incidence of running injuries per 1000 hours of running. It said that in novice runners there was an average of 17.8 injuries per 1000 hours. Whereas in recreational runners there was 7.7 injuries per 1000 hours of running.
- So there seems to be more injuries during this novice period than as we get more experienced as runners, mainly due to doing too much too soon in beginners.
What are the most common dysfunctional movement patterns that cause these overuse injuries?
- If we think about common dysfunctional movement patterns, it is the interplay between stride length and stride frequency.
- Because people are running with a very low cadence, the only way they can adapt to a given pace is to increase stride length and start to overstride.
- Cadence is stride frequency. It is the number of time your leg turns over per minute.
- Running pace is stride length times stride frequency. So how long do you cover post stride and how many times are you doing that every minute. Now this is hopefully in balance.
- For example, in a given pace let’s say you’re running 5 minutes per 1 kilometer, for a given pace, you will be covering enough ground per stride so that you can maintain the pace and you’ll be turning your legs over at a cadence that matches that which means you don’t have to over stride.
- Now, if your cadence is too low and if you want to keep running at 5 minutes per kilometer, your only option is to increase the stride length. You’re making less strides in a minute, then those strides better be longer for you to maintain that speed over the ground.
- The problem is as you start to make those longer strides, you start putting the foot down in the ground in front of you which makes it inefficient.
- Because when that foot hits the ground in front of the body, the more decelerative ground reaction force your body is going to deal with which essentially is a braking force, slowing you down stride by stride and a lot of impact is coming back at you. It comes back up through the system, if we think about the major joints from ground up – the ankle, knee and hips.
- In basic terms, it’s going to increase the amount of pounding that your body has to deal with per stride.
- If we think in triathlon terms about the interplay between stride length and stride frequency, the way I often talk to triathletes in terms of trying to relate it to cycling is that cadence is cadence. So whether we are talking about the number of pedal strokes you make in a minute or the number of times you turn your legs over when you’re running in a minute, it’s just a frequency.
- And gearing is the same as stride length in this context or the other way around. So overstriding is the same as pedaling too slowly and selecting a higher gear and making it harder for yourself rather than lowering your gear to pedal faster and making it easier for you.
- So it is better to make small, quick strides instead of long, slower strides. This is all about trying to get away from over striding, getting the landing foot underneath the flexing knee, closer to the center of mass.
Other problems of dysfunctional movement patterns that cause overuse injuries?
- Another big one that is very pertinent among triathletes because of the time spent on the bike is that you are spending a lot of time in a very flexed hip position. Even if your bike fit is set up brilliantly, even if you’re trying to keep the hip angle as open as you can, it’s still going to be very much a flexion dominant movement on the bike.
- You’ll be getting into a position where potentially the quality of hip extension - which is the movement from the hip of driving the leg backwards – is undermined by all this time spent sitting down.
- So what we end up with is a position of not being able to use our glutes effectively as the prime mover into extension, the prime source of power into the push-off or drive phase. From the point where you go from mid-stance, where the foot is under the hip to the point where you drive that foot off the ground, ideally, that power should come from the hip. And if we can’t get enough power from the glutes because of the constant hip flexing due to a long time sitting down from cycling, what we end up doing is finding a compensatory way that the body can still produce that propulsion. And the compensation in this instance usually comes from having to work harder through those plantar flexor muscles around the ankle and the lower leg, those calf muscles.
- So we see lots of triathletes who struggle with recurring calf strains, achilles problems, even plantar fasciitis.
- As much as you need to do all the appropriate rehab for the injured tissue, you also need to look further up the chain and understand that if the hips aren’t moving properly it’s just not going to cause problems locally to the hip. That can also have those related effects in terms of overusing the muscles in the lower leg.
What can you do in your prehab or maintenance routine?
- A great place to start is to get a decent screening/assessment done. It is important that you can have someone who - especially if you have a history of injuries - gives you areas you can work on which is specific to the imbalances and the dysfunctions that they can potentially find in you.
- Ideally, that person should have a background in exercise therapy. So they can think from a rehab and prehab perspective having a sense of how you move individually.
- If this resource is not available for you, what you can do is use your smartphone and use an app like Hudl or Coach’s Eye and other similar apps that provide you the same functionality where you can capture the footage of you running and review it in slow motion on your phone.
- As an absolute baseline, we can start with running in the same way that traditionally triathletes think about swimming.
- From a triathlon point of view of what can we do to help ourselves when it comes to putting together a decent prehab routine, maintenance routine, or injury prevention routine there a few key areas that are very similar to a marathon runner.
- As a constant, we will be looking at things like hip mobility, the ways that we can offset the time spent sitting down by improving the quality of movements around those hips and learning to activate those important gluteal muscles.
- We can also think about proprioception and ankle stability with running as the big load bearing aspect of triathlon. In the studio doing the same exercises barefoot seem to give far more comprehensive workout to the ankles and the intrinsic muscles within the foot.
- Core stability is more about actually controlling the position of particularly your lower back, pelvis and hips when the extremities are moving. The power that we are looking to create, the stable base is the most important part of the whole conversation, and creating good quality control of movement through that lumbar, pelvic and hip region.
- Shoulder health for triathletes is really important as well. Poor thoracic mobility is going to cause shoulder problems. Thoracic mobility is the mobility of the mid and upper spine. We need to work on getting you into a position where you’re able to display good quality thoracic extension and rotation. The scapula of the shoulder blade needs to be able to move around the rib cage.
If you are completely healthy at the moment, what general guidelines for a maintenance routine can one do?
- I am a big fan of little and often. It is more likely that I can get a triathlete to say yes to doing 3-4 15-minute workouts in the week instead of saying I need you to change your whole routine and do a long gym session twice a week.
- With the whole idea of short and sweet workouts, I would definitely prioritize some mobility work like working on foam rollers which is more stretch based. I want to get some activation work and I want to get some strengthening work.
- From a mobility point of view there’s all sorts of exercises we can do. We can do some regular calf foam rolling, some foam rolling and tennis ball work around the hips.
- We can then do some glute activation work. Then we can do some resistance bands later on. This is a really practical and versatile tool. You can check out my video on how to do it.
- Then you can move on and do strengthening work like split squats or static lunge. This is a fantastic exercise because it will isolate out the left leg and right legs in comparison to the symmetric double-leg squat. This can then be built into a Bulgarian split squat or into single leg squat variations.
- From a core perspective as I said it’s not just being able to do a 7-minute plank. This doesn’t mean that planks are bad but I would rather have you do dynamic planking exercises rather than just holding a static position. Some examples are a side plank with a leg raise, reverse plank with alternate leg raise, side plank with running man action.
Final important points from James
- Resistance bands are super versatile. There's so much that you can do with them. It is well worth investing.
- General guidelines for injury rehab: Whatever your injury is you need to see a physio. You need someone who can look at you, assess you, and tell you what you need to specifically do from a rehab perspective.
- Once you are in a rehab plan, the most critical place to get it right first time is in your return to running phase. There are 3 main components that we are dealing with and that’s volume, frequency, and intensity. And this is the order that we bring back your running in a return to running program.
- I get people back to running by just gradually increasing volume, and it starts very low. It starts at 1-minute run, 1-minute walk times 10, then go home. That’s the first session, done. And you’ll be doing this in the first week three times on no consecutive days. This is really important, you don’t want to run back-to-back days at this point, and you need to give your body time to adapt because the tissue that has been injured is beginning again to get stronger.
- This is when you’ve been away from running for about 6 weeks. Or you’ve tried to get back into running once and failed already and you’ve had to have a longer period completely off.
- You can certainly speed up the process if it’s been just a week or two weeks off. It’s not going to be a 12-week return to running program. But the principle would still be the same.
Favorite book, blog, or resource related to running, triathlon, or endurance sports:
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