Journal of Back and Musculoskeletal Rehabilitation

The runner who presents with pain in the hip and pelvis, all too often is approached from a one-joint or soft tissue injury concept. Since most injuries to this region are related to overuse and, in particular, overload injury, a biomechanical approach to identify significant muscle imbalances and joint dysfunctions must be sought. In addition, their relationship as predisposing factors to soft tissue injury will be emphasized in this article. A thorough understanding of the relationship between the lumbar spine, pelvis, hip and thigh, and, in particular, dysfunctions and imbalances in the lumbo-pelvic movements, are the most essential. Evaluation and treatment focusing on this concept will more likely lead to a successful long-term result and prevention of re-injury in a runner who is at high risk for recurrence.

Ever greater numbers of children are participating in running sports at earlier ages. These children will encounter many of the same problems seen in adults, but will also have many unique concerns. This article was written to provide information to primary health care providers on the differences in risks, injuries, treatments, and general health concerns of the pediatric running population.

There are a number of physiologic and anatomic differences between males and females which affect performance and the rate of injury. In addition, there are several disorders which occur with some frequency in female runners – eating disorders and amenorrhea, which warrant review. Most pregnant runners should be encouraged to remain active, with appropriate medical supervision. Providing good medical care for female runners requires a working knowledge of their unique features

Understanding the principles of cross-training and periodization will assist the coach and team physician in designing training programs that maximize performance while minimizing risk of injury. Cross-training is defined as simultaneous training for two or more sports or the use of multiple modes of training to enhance performance in one particular sport. This manuscript will review the benefits of three commonly used forms of cross training, deep water running, cycling and swimming, on running, training and performance. Periodization refers to the process of designing a progressive and appropriate training plan in order to optimize performance, yet minimize injury related to overtraining. The main structural components for periodization are macrocycles, mesocycles and microcycles. Physiological determinants for distance running performance, including VO₂ max, lactate threshold and running economy, are presented as key components for the design of endurance training programs. Training intensity can be prescribed or monitored using running speed, heart rate, and rating of perceived exertion (RPE). The clinician must often make recommendations regarding the appropriate level of training or offer an alternative. By understanding the principles of cross-training and periodization, the clinician can assist the coach or athlete in preventing injury as well as assisting the attainment of peak performance.

There has been a dramatic increase in endurance race participation, which has led to the need for medical coverage during these events. Organization and preparation for the event are essential to providing thorough medical coverage. The medical director coordinates medical coverage and works closely with the race director to develop a safe and efficient race plan. Education of staff and participants is done before race day, as well as during the event. Triage and prompt treatment of injuries are the major components of race day activities. This chapter discusses the needs and development of medical coverage for an endurance event. It also describes commonly seen injuries and their initial treatment. Finally, it gives suggestions for staff and participant education.

The proper selection of running shoes and judicious use of orthoses are two key components in addressing the intrinsic and extrinsic abnormalities that often result in running injuries. Sports medicine practitioners need to know how the function of the running shoe is effected by its components, shape, and construction. Shoes must fit a runner's foot type as well as size. The proper use of orthoses can favorably alter biomechanical abnormalities. This article presents a practical approach to both the selection of running shoes and the use of orthoses.