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Conference -- Day 3

Posted By: KP
Date: Saturday, 13 October 2007, at 12:36 a.m.

Conference Day 3

Dr. Karl Fields, MD // Director Sports Medicine Fellowship, Professor and Associate Chairman, University of North Carolina

Dr. Fields has been a runner for 45 years and is a former team mate of Frank Shorter. (Frank still runs 10 miles a day).

Running and run injuries:

Cadence is largely the same in the 9min mile athlete and the 6-7min mile paced runners. Speed comes from power and the distance of your airborne “leaps” (meaning power to weight ratios. Estimates are that 7% of running effort is air resistance.

-- Elite runners don’t bounce up and down – their heads remain level.
-- 40-60% of runners are injured yearly
-- 25% of runners are injured at any given time
-- knee injuries are #1 in frequency (ITB and PFS)
-- in the over 40 age group it moves to calf and Achilles
-- surprisingly, Q angle and leg length differences are not good predictors of injury
-- cavus feet (high arch / my own case) is a significant risk for injury (6x greater)
-- stress fractures in men are see most at the tibia / in women at the ankle and foot
-- after volumes of over 30 miles a week, injury escalates quickly
-- personality difference between type A and type B: 1st injury incidence is the same; however, multiple yearly injuries are seen in type A as they fail to stop running.

PFS – you can reduce knee pain by adding simple leg strengthening (terminal knee extensions). VMO atrophy can cause lateral tracking of the patella and pain.

ITB – change your pace and an athlete can often continue to train as they are being treated. Impingement occurs at or below 30 degrees and when weight bearing. Often you can cross train the bike. Sometimes bike set-up will irritate the ITB but pain is felt on the run. Check bike set-ups as well.

More ITB – lateral leg raisers are often quite effective for ITB treatment as a gluteus weakness strongly correlates to ITB pain. Look at a runner’s gait from straight on. If the knee crosses the midline (genu varus) it is a strong predictor of ITB eventually.

Achilles Tendonosis – best treated with eccentric exercises. Stand on a step and raise your body weight. If you can do 3 sets of 30 reps you are likely ready to run again. Ultrasound may also help return the AT to normalcy on MRI.

Shin Splints – 62% of beginner female runners get shin pain.
Signs of tibial stress fracture: direct tenderness / positive tuning fork for discomfort / positive hop test (10 one foot hops) / swelling.

Tx of tibial stress fracture – long air cast can significantly reduce recovery time.

Navicular fx. – arch or anterior ankle pain. You are able to rule out tendon problems through muscle testing. Only 60% of navicular fractures are able to return to the sport full time.

Running shoes with a promise may not be for you: it is a mistake to think that all runners benefit from a shoe promoting forefoot strike. Forefoot runners need a flexible shoe. Heel strikers need a support shoe.

When running, we land with 3-4x our body weight. Strength training is a good way to help prevent injury, along with eccentric exercises for AT prevention.

Shoulder injuries – usually trauma or overuse; labrum, capsule, biceps tendon.

Rotator cuff is a stabilizer // greater ROM usually sacrifices stability.
Rotator cuff fatigue: allows humeral head to move within the glenoid fossa, causing labral wear and tear.

Shoulder pain anterior with a decrease in ROM may be adhesive capsulitis.

Elbow – 5-10% of shoulder dislocations also show fracture.


Female ACL tears are epidemic.
Up to 60% of ACLs also have meniscal tear (pain w/rapid swelling.

MCL – stabilizer and attaches to the medial meniscus
LCL-- tear is not as common (varus stress w/hyperextension
PCL – often a direct hit to hyperextension
Meniscus -- painful catching / can’t fully extend the leg
Always preserve as much meniscus as possible


80% of us are heel strikers
Heel strikers get impact injures
Forefoot strikers get stress fractures more often
1) bruised fat pad in the heel
2) PFS – often hurts in morning / aches mid day.—usually continue to run with PF. Stretching will help. Night splints – not much help.

Mid Foot – tarsal tunnel (burning pain that radiates into foot / retrocalcaneal bursitis (located below AT and can be very painful).

Navicular fx needs to be 8wks non weight bearing.

Cavus foot – (KPs foot) (high arch, wide toe box) pushes metatarsals through the capsules. When metatarsuls drop, hammer toe results with tearing of connective tissues.

coach KP

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