Chiropractic and the Runner
By Dr. Daniel C. Batchelor
As a chiropractor, you’re likely to see running injuries in some of your
patients. Based on my experiences as a chiropractor for runners and as a competitive
athlete myself, I have presented information on care for many common running-related
injuries that you are likely to see.
Running in a forward direction places three to four times your body weight on
each leg as you impact the ground with your foot. In comparison, walking only
places 1.2 times your body weight on each leg as impact occurs.
Basically there are four phases involved in the running stride:
During the impact, compression and power phases of running is when most running
related injuries occur. If you happen to be 10 pounds overweight and you run,
it would be as if you were carrying 30-40 pounds of extra weight on your frame.
This is one reason why so many 5’6”, 110-pound genetically gifted
runners are so successful and tend to stay so injury free. Less impact, near
perfect biomechanics and less compression means fewer injuries.
One of the first world-class runners that I treated was Craig Virgin. He won
the World Cross Country Championship and the Peachtree Road Race (the world’s
largest 10K) several years in a row. When he came in for treatment, I was surprised
that he was so structurally well balanced. He was able to tell when he was even
just slightly out of balance. He was so in touch with his body that he could
tell exactly when he needed a tune-up.
Another world-class runner that I treated and whom I also became great friends
with is John Tuttle-Olympic, a U.S. marathon runner. John could repeatedly run
very quick 400 meter (one lap) repeats on a track. Each of those lap times would
be within 1/20th of a second of one another. His form was near perfect, but
he also knew when it was time for his tune-ups. He sought chiropractic care
so that he could reach his full potential.
Of the many world-class runners that I have treated over the past 24 years,
most have had a more balanced musculo-skeletal system that the average jogger.
This more perfect balance allowed them to achieve such a high level of athletic
performance. For example, the average jogger has a stride angle (the angle between
both femur bones during maximum extended stride) of less than 90 degrees. In
comparison, the average world-class runner has a stride angle greater than 90
degrees. Covering greater distance with less effort is an advantage. Combine
this greater than 90 degree stride angle with a neutrally balanced foot, a symmetrically
balanced and well-toned musculo-skeletal system, a large VO2, proper genetics,
a motivation to excel, and a doctor of chiropractic to maintain that balance
and you have a world-class runner.
These types of world-class athlete patients do not need to be reminded of when
they need to be cared for with chiropractic. They will in your office each week
to maintain their fine tuned system.
Due to the forward running motion, various muscle groups tend to overdevelop.
The calf muscles develop more than the anterior shin muscles; the quadricept
muscles develop more than the hamstrings and the lower back muscles tend to
develop more than the abdominal muscles. Eventually the most used muscles become
overdeveloped in relationship to the least used muscles. As a result, various
running related overuse syndromes can occur.
After personally experiencing many running-related injuries over the past several
decades and learning how to problem solve them, I have developed a greater understanding
of runners. The ability to relate to a patient that is a runner and to pass
beneficial information on to them has been priceless. I suggest, however, that
you learn from my experiences and not from your own injuries.
Due to space contraints, we have chosen to focus on problems that occur from
the knees to the lower back.
Inner Knee Pain—The most common painful condition among runners is inner
knee pain. It has many causes but a very common one develops from a condition
called overpronation.
Overpronation is a condition in which more than 60 percent of the weight bearing
of the foot is placed on the inside of the foot, and the foot rolls in excessively.
As a result, foot stress increases. This in turn allows the kneecap to slide
off center and rub against a portion of the knee joint that it should not rub
against. The shoe will eventually warp according to the abnormal stress applied
to the shoe by the foot. As a person pronates excessively, the shoe leans in
excessively due to this imbalance. As this excessive pronation occurs, increased
stress is directed into the undersurface of the kneecap. As a result, the body
reacts to this increased stress by depositing calcium underneath the kneecap.
When this deposition occurs, the calcium begins to dig into sensitive nerves
in the area; pain is often the result when your patients run. This knee condition
is called chondromalacia or runners knee and you don’t have to be a runner
to suffer from this condition.
Treatment involves stretching quads while standing and leaning back while one
leg is forward and one leg is in back of the patient. Avoid a hurdlers-type
stretch or stretching your quadricept muscles while bending your knee. Correction
of the abnormal pronation with straight lasted shoes and/or semi-rigid orthotics
with varus wedges is paramount. A common correction is the use of a 2-degree
to 6-degree varus wedge. Many exceptions exist but the most common correction
involves a 2-degree to 6-degree wedge. Advise your patient to ride a bike at
least three times per week with toe straps at 80 rpm with low resistance. Check
to make sure they’re creating a 15-degree bend in knee at bottom of pedal
arc.
Outer Knee Pain—The second most common knee pain that runners suffer from
is outer knee pain. Most commonly it is caused by an oversupination condition.
This is the opposite of overpronation. The foot does not roll in enough with
oversupination and as a result, the kneecap slides off to one side repeatedly.
Pain begins first, and if uncorrected, causes premature degeneration much like
unbalanced tires on your car cause excessive tread wear.
Treatment involves correction of the abnormal supination with valgus wedge flexible
orthotics.
Many runners that supinate have come into my clinic with orthotics that were
manufactured by foot doctors. More than half of them had orthotics that were
designed for an overpronater. As a result, the patient did not get well and
but continued to get worse as a result of the improperly made orthotics. Since
90 percent of knee conditions are caused by overpronation, many rushed doctors
assume that the patient automatically needs an orthotic with a varus wedge.
The 10 percent that supinate will get worse if they wear this type of wedge.
Careful evaluation must be done to avoid this problem. I always tell the patient
to bring me the oldest running shoes they have with the highest mileage and
wear pattern. Much like looking at the tires on your car after they are worn
out, shoes will also tell a story. Using this method, you will not mistakenly
prescribe anti-pronation orthotics for the oversupinater. The shoes will clearly
show which if any imbalance the runner has.
When you look at the wear pattern on the running shoe, the outer heal should
be slightly worn and the center of the forefoot should be slightly worn. Any
deviation from that signifies the need for a prescription orthotic with modifications
that address those imbalances.
In addition to orthotics, I advise my patients to bike at least three times
per week using toe straps or clips and to pedal at a cadence of 80rpm with low
resistance.
If you are supinating when you run, your shoes will eventually wear out on the
lateral outsole area. Likewise, if you continue to run this way, then your ankles,
knees, IT band syndrome, bursae and hips will also eventually experience dysfunction
and premature wear.
Many runners develop bursitis as a result of oversupination. The IT band crosses
over your outer hip bone (the greater trochanter of your femur). If the band
is too tight, then excess friction will be created at the point where the tendon
crosses over the hip bone. If the band is too tight, the bursae will swell and
pain will result. This pain is simply nature’s way of telling your patient
to eliminate the cause, which may be oversupination and a tight IT band. Correct
the supination and develop flexibility of the IT band.
There are no shoes that have been designed to correct severe supination.
We can, however, make orthotic devices specifically designed to correct this
condition. These orthotic devices simply incorporate a custom designed valgus
wedge. This specific wedge will change and balance the center of gravity in
your lower extremities. An orthotic that reduces your supination will many times
solve a lower extremity imbalance as well as a bursae/IT band syndrome.
Patellar Tendon Pain—Much like a lever and a fulcrum, when the quadricept
muscle contracts, the patellar tendon is placed under tremendous stress. When
the quadricept muscle is inflexible, it will place the patellar tendon under
an increased workload and it will begin to microscopically tear and swell up.
Treatment involves iontophoresis and ultrasound. After healing has occurred,
a program of quadricept flexibility is to begin.
Piriformis syndrome—Many runners report gluteal pain when running. Pain
may sometimes go down the back of the leg.
Have the patient lie down. Flex the knee to 15 degrees and then have the patient
externally rotate the leg against resistance. Direct tenderness will be found
in piriformis are over the buttock region.
If the straight leg lift test is positive and causes sciatic pain, externally
rotate the leg to see if this lessens the pain. This could indicate compression
of the sciatic nerve by the piriformis. Check the sacroiliac joint also.
Treatment should be directed at the cause of the pain and not at treating the
symptoms. Possible contributing imbalances are weak abductors, tight adductors,
tightness of anterior portion of ITB (tensor fascia lata), leg-length difference,
tight hamstrings, pronation of foot, etc. Other contributing factors can be
running on side-angled surfaces, increasing the stride angle, and running downhill
too fast.
IT Band Syndrome—The IT band is the illiotibial band structure on the
outer upper leg that travels from the outer illium to the outer knee. IT band
syndrome is fairly common in runners and it almost always occurs on the side
of the short leg. To maintain upright posture, the IT band is our lateral stabilizer.
Running tightens this IT band. Over time if the band becomes too tight, it will
cause excessive friction on the greater trochanter of the femur. This friction
can cause the bursae to swell and the tendon to inflame.
Treatment involves correcting the leg-length discrepancy and stretching two
different ways to develop flexibility of the band. Avoid the IT band stretch
depicted in running magazines when the runner is standing with one leg crossed
over another while he or she stretches laterally. Its fine for the IT band but
it wreaks havoc on the lower back. To correct one condition and to cause another
condition is not logical.
To stretch the right IT band, have the patient sit in a chair and put their
right foot on the opposite knee. Then they should place their right hand under
the right knee and the left hand under the right ankle. They will then lift
both of them gently while trying to keep the tibia parallel to the ground. For
the next stretch of the right IT band, your patient should put the right foot
on the opposite knee ,and then, with their left elbow, they should contact the
outer part of the right knee and gently push it to the left as they rotate your
upper body to the right.
Lower Back Pain—Causes are weak abdominals, tight lower back and hams,
leg length discrepancy, rotational misalignment of the lumbar vertebra, muscle
imbalance.
For treatment, the runner should be doing 10 sit-ups (pelvic tilts) for every
mile that they run. Hamstring stretches are mandatory chiropractic manipulation
of the lumbar vertebra along with specific one-sided bending exercises to correct
muscle imbalance.
There are many possible causes of lower back pain. A pre-existing imbalance,
carrying kids on one hip, wearing high heels, sleeping on one side, carrying
a heavy purse, posture at work, etc., can cause lower back muscle imbalance.
Repeated lifting, leg-length discrepancy, IT band syndrome, overpronation, improper
biking form, running on uneven terrain, etc., can add further insult.
Most runners have a leg-length discrepancy. It may have developed from running
facing traffic on angled highways or sidewalks or from running counterclockwise
on tracks. The leg-length difference may also be pre-existing with causes unrelated
to running. In addition to the chiropractic adjustments, you should design specific
exercises so that these patients can stretch one side of their body and strengthen
the other side to restore lost structural symmetry.
About the author: Daniel C. Batchelor, D.C., is a graduate of Wayne State
University and Life University College of Chiropractic. He has practiced in
Roswell, Ga., for 24 years, where he treats musculo-skeletal ailments of athletic
as well as non-athletic patients. Batchelor, a competitive runner, has been
a consultant for Runner’s World and Running Journal. He can be reached
at (770) 823-8186 or via drbatch@aol.com.
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