This presentation provides the most current research related to running mechanics and how to train to prevent some of the most common running injuries.

1. Running Mechanics in
the Tri-athletes
Don’t let bad mechanics sideline your
training

2. Triathlons are so physically
demanding that it comes
down to who is the
smartest.”
—Peter Reid
Three-time Ironman World Champion
Two-time Ironman Canada Champion

3. The Research
• ~75% of all competitors have sustained at least one
overuse injury during their training (1,3)
• Most injuries occur during training for the running
component of triathlon (1,2,3);
• Risk of injury is heightened with higher training
mileage.(3)
• Running generates the greatest impact and stress to
the muscles, tendons, bones and ligaments of the
triathlete’s lower limbs.(1,3,4).
1. Egermann M, Brocai D, Lill CA, and Schmitt H. Analysis of injuries in long-distance triathletes. International Journal of
Sports Medicine 2003; 24(4):271-6.
2. Shaw T, Howat P, Trainor M, Maycock B. Training patterns and sports injuries in triathletes. Journal of Science Medicine
and Sport 2004; 7(4):446-50.
3. Burns J, Keenan AM, Redmond AC. Factors associated with triathlon-related overuse injuries. Journal of Orthopaedic &
Sports Physical Therapy 2003; 33(4):177-184.
4. Cipriani DJ, Swartz JD, and Hodgson CM. Triathlon and the multisport athlete. Journal of Orthopaedic & Sports Physical
Therapy 1998; 27(1):42-50.

4. Most Common Orthopedic Injuries
• Low back
– SI Joint & L5/S1
• Hip
– Hamstrings, stress fractures,
bursitis
• Knee
– IT band, meniscus, PF
syndrome
• Lower Leg/Foot/Ankle
– Shin splints, anterior
compartment syndrome,
plantar fascitis

5. What are the causes?
• Improper conditioning/poor
mechanics
– Preseason
• Improper training
– Mileage progressions
– Strengthening progressions (g.med
endurance)
• Inappropriate warm-up
– Warm up
– Stretching
• Nutrition/hydration
– Water recommendations
• .5 oz to 1.0 oz./lb BW
– Caffeine
• 420 mg/day – avg. 1600 mg/day
Micheals, K; Wolk, A. A prospective study of
variety of healthy foods and mortality in women.
Journal of Epidemiology. 2002; 31 847-854.

6. What are the causes?
• Crossed Pelvis Syndrome
– Muscular Imbalance
– Tight: Hip Flexors and Erector Spinae
– Weak: Gluts and transverse abdominus
– Adds to abnormal force attenuation at
knee, hip and spine
– Must address entire system
• Solution:
– Stretch:
• Hip Flexors
• Standing IT band
– Strengthen
• Transverse abdominus
• Glut Medius/Maximus
Described by Janda, 1996
Evaluation of Muscular
Imbalances: Rehabilitation of the
Spine.

7. What are the causes?
• Core Weakness
• Lumbar Spine is very complex
– ~30 muscles indirectly/directly
associated with stability of lumbar
spine
• Hx of pain results in ~25%
decrease in cross sectional area
of multifidus, must be trained
to return
– Previous pain results in continued
weakness (must provide stimulus to
get growth and return of baseline
function).
1. Thoracolumbar Fascia 2. Gluteus Maximus
3. Latissimus Dorsi 4. Glut medius
5. Internal Obliques 6. Multifidus
4
5
6
Hides, Julie A. PhD; Richardson, Carolyn A. PhD; Jull, Gwendolen A.
MPhty. Multifidus Muscle Recovery Is Not Automatic After
Resolution of Acute, First-Episode Low Back Pain. Spine.
21(23):2763-2769,1996

8. What are the causes?
• Poor Balance
– Static vs. Dynamic
– Core balance vs. lower limb balance
• Impaired core proprioception, predictor of
knee and hip injury risk in females
Zazulak, B, et al. The Effects of Core Proprioception on Knee Injury. A
Prospective Biomechanical-Epidemiological Study. American Journal
of Sports Med, Vol 35, No. 3, 2007
• Factors related to core stability predicted risk of
hip, knee, and ligament, with high
sensitivity
Zazulak, B, et al. Deficits in Neuromuscular Control of the Trunk
Predict Knee Injury Risk: A Prospective Biomechanical-
Epidemiological Study. American Journal of Sports Med, Vol 35, No.7,
2007
SEBT – measures dynamic balance and
indicates asymmetries – here a 19 degree
difference

9. What are the causes?
Abnormal movement patterns at foot, ankle,
knee, hip, pelvis and lumbar spine adding to
increased stress in Knee – 38 degree difference
• Abnormal movement patterns
• Components of pathokinematics
(abnormal movement)
– These add to abnormal force
distribution along the entire kinetic
chain
• Why sometimes your knee pain may
be related to hip weakness
– Combination of weakness/tightness
+
– Poor motor programming
• Retraining must be a component of
the overall training program
Zazulack, B; Hewett, T; Reeves, P; Goldberg, B; Cholewicki, J. The Effects
of Core Proprioception on Knee Injury : A Prospective Biomechanical-
Epidemiologic Study. Am J Sports Med; 35:368-373.

10. A Dart Fish Assessment: Pathokinematics in Motion
• What is dartfish?
• Steps:
– Video (demo):
• Running
• Functional testing
– Import to dart fish
– Analysis of
movements
• Frame by frame
• Degrees of variation
College football player returned to sport by
another provider, comparison of B results

11. Running Mechanics in Motion
• Subject:
– 40 y/o Marathon Runner, 5
year history of running,
complains of R PF issues
and low back pain
Decreased terminal hip ext @ TO
Trendelenburg @ MS RCalcaneal pronation at MS

12. Running Mechanics in Motion
• What does it mean?
– Decrease in THE, decrease knee
ext & increased trunk rotation
with TO (assymetries)
• + thomas for IS tightness
• + hamstring tightness (100L/80R)
• Poor grade on TA
• Poor grade on g.med MMT
• Poor grade on g.max MMT
Decreased terminal hip ext @ TO
Trendelenburg @ MS RCalcaneal pronation at MS

13. Functional Testing in Motion
Squat: adduction/IR w/ ascent, L
lateral shift at end ROM Step-up: add/IR with ascent
SL Squat: sig
adduction/IR, pes
plantus
Squat: Sig lateral shift with
ascent > 3 inches

14. Functional Testing in Motion
Squat: adduction/IR w/ ascent, L
lateral shift at end ROM
Squat: Sig lateral shift with
ascent
•What does it tell us?
•Add/IR – indicates weakness of the g.medius
•Phase of motion indicates strengthening focus – eccentric vs. concentric
•Lateral shift – multifactorial
•Pain, limited ROM, quad weakness or poor motor patterns
•Phase of motion indicates strengthening focus

15. Functional Testing in Motion
SL Squat: sig adduction/IR, pes
plantus
SL Squat: sig lateral sidebending,
trendelenburg, add/IR
•What does it tell us?
•Add/IR – indicates weakness of the g.medius
•Number of joints involved can indicate degree
•Should assess foot mechanics and if orthotic indicated
•Trunk sidebending and trendelenburg
•Should assess core weakness – TA, multifidus, etc.

16. Program Design
• Core Basics
– Designed to address
the common deficits
– Individualized based on
assessment
Dynamic Stretches
•Benefits
•Dynamic Lunge
•Sumo

17. Program Design
• Exercise selection based on:
– Proven in the research
– #1 exercise for
• Multifidus
• G.med/Obliques
• Lower abs

18. Program Design
• Exercise selection based
on:
– Focus on all components
adding to poor mechanics
– Component of supersets
– Dynamic balance

19. Contact Information
Trent Nessler, PT, DPT, MPT
Area Vice President
Champion Sports
Medicine/Physiotherapy
Associates
Owner – A.C.L. – Accelerated
Conditioning and Learning
For more information contract us at
info@aclprogram.com

20. References
1. Deyo, RA. Practice variations, treatment fads, rising
disability: Do we need a new clinical research paradign?
Spine 1993; 18: 2153-2162.
2. DeRosa, CP; Porterfield, JA. Mechanical Low Back Pain:
Functional Anatomy and Treatment Perspectives. Saunders.
1993.
3. Frymoyer, JW. An overview of the incidence and cost of low
back pain. Orthopedic Clinics of NA 1991; 22:262-271.
4. Frymoyer, JW. Epidemiological studies of low back pain.
Spine 1980; 14: 419.

21. References
5. Agel, J., Arendt, E. A., and Bershadsky, B.: Anterior Cruciate
Ligament Injury in National Collegiate Athletic Association
Basketball and Soccer: A 13-Year Review. Am J Sports Med.
33:524-531, 2005.
6. Arendt, E. and Dick, R.: Knee injury patterns among men and
women in collegiate basketball and soccer. NCAA data and
review of literature. Am J Sports Med. 23:694-701, 1995.
7. Boden, B. P., Dean, G. S., Feagin, J. A., and Garrett, W. E.:
Mechanisms of anterior cruciate ligament injury. Orthopedics.
23:573-578, 2000.
8. Caraffa, A., Cerulli, G., Projetti, M., Aisa, G., and Rizzo, A.:
Prevention of anterior cruciate ligament injuries in soccer. A
prospective controlled study of proprioceptive training. Knee
Surg Sports Traumatol Arthrosc. 4:19-21, 1996.

22. References
9. Chappell, J. D., Yu, B., Kirkendall, D. T., and Garrett, W. E.: A comparison of knee
kinetics between male and female recreational athletes in stop-jump tasks. Am. J.
Sports Med. 30:261-267, 2002.
10. Chappell, J. D., Herman, D. C., Knight, B. S., Kirkendall, D. T., Garrett, W. E., and Yu, B.:
Effect of Fatigue on Knee Kinetics and Kinematics in Stop-Jump Tasks. American
Journal of Sports Medicine. 33:1022-1029, 2005.
11. Chaudhari, A. M., Hearn, B. K., and Andriacchi, T. P.: Sport-Dependent Variations in
Arm Position During Single-Limb Landing Influence Knee Loading: Implications for
Anterior Cruciate Ligament Injury. American Journal of Sports Medicine. 33:824-830,
2005.
12. Ford, K. R., Myer, G. D., and Hewett, T. E.: Valgus knee motion during landing in high
school female and male basketball players. Med. Sci. Sports Exerc. 35:1745-1750,
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13. Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., Garrick, J.
G., Hewett, T. E., Huston, L., Ireland, M. L., Johnson, R. J., Kibler, W. B., Lephart, S.,
Lewis, J. L., Lindenfeld, T. N., Mandelbaum, B. R., Marchak, P., Teitz, C. C., and Wojtys,
E. M.: Noncontact anterior cruciate ligament injuries: risk factors and prevention
strategies. J. Am. Acad. Orthop. Surg. 8:141-150, 2000.

23. References
14. Hewett, T. E., Lindenfeld, T. N., Riccobene, J. V., and Noyes, F. R.:
The effect of neuromuscular training on the incidence of knee injury
in female athletes. A prospective study. Am. J. Sports Med. 27:699-
706, 1999.
15. Leetun, D. T., Ireland, M. L., Willson, J. D., Ballantyne, B. T., and
Davis, I. M.: Core stability measures as risk factors for lower
extremity injury in athletes. Med. Sci. Sports Exerc. 36:926-934,
2004.
16. Lephart, S. M., Ferris, C. M., Riemann, B. L., Myers, J. B., and Fu, F.
H.: Gender differences in strength and lower extremity kinematics
during landing. Clin. Sports Med.162-169, 2002.
17. Mandelbaum, B. R., Silvers, H. J., Watanabe, D. S., Knarr, J. F.,
Thomas, S. D., Griffin, L. Y., Kirkendall, D. T., and Garrett, W., Jr.:
Effectiveness of a Neuromuscular and Proprioceptive Training
Program in Preventing Anterior Cruciate Ligament Injuries in
Female Athletes: 2-Year Follow-up. Am J Sports Med. 33:1003-
1010, 2005.

24. References
18. McLean, S. G., Lipfert, S. W., and van den Bogert, A. J.: Effect
of gender and defensive opponent on the biomechanics of
sidestep cutting. Med. Sci. Sports Exerc. 36:1008-1016, 2004.
19. McLean, SG., Huang, X., and van den Bogert, A. J.: Association
between lower extremity posture at contact and peak knee
valgus moment during sidestepping: Implications for ACL injury.
Clinical Biomechanics. 20:863-870, 2005.
20. McNair, P. J., Marshall, R. N., and Matheson, J. A.: Important
features associated with acute anterior cruciate ligament injury.
N Z Med J. 103:537-539, 1990.
21. Pantano, K. J., White, S. C., Gilchrist, L. A., and Leddy, J.:
Differences in peak knee valgus angles between individuals with
high and low Q-angles during a single limb squat. Clinical
Biomechanics. In Press, Corrected Proof.
22. Sigward SM and Powers CM: The Influence of gender on knee
kinematics, kinetics, and muscle activation patterns during side-
step cutting. Clin Biomech. 2005. In press.

25. References
23. Traina, S. M. and Bromberg, D. F.: ACL injury
patterns in women. Orthopedics. 20:545-
549, 1997.