How To Prevent Running Injuries from a Singapore Sports Chiropractor Perspective

If you are active on Instagram and Facebook, there are lots of “wellness”  or “holistic lifestyle” programs going around in Singapore. Do they work? Would correcting the “issues” you currently have reduce your risk of injury? Find out what an evidence-based sports chiropractor has to say.

If you are active on Instagram and Facebook, there are lots of “wellness”  or “holistic lifestyle” programs going around in Singapore. Do they work? Would correcting the “issues” you currently have reduce your risk of injury? Find out what an evidence-based sports chiropractor has to say.

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Wellness and holistic lifestyle practitioners are the in thing now, does research support their claims?

How does wellness or holistic injury prevention program work?

The wellness or holistic programs we typically see are organised in two stages:

  1. An assessment to look at your functional strength or movement patterns
  2. What programs you can sign up with them to correct the issues found in the assessment.

The idea is that if you have “problems” as is, these would eventually become causes of pain or injuries in the future. This sounds completely biologically plausible (a fancy way of saying it’s totally possible in academic terms). However, it’s really hard to examine such claims and, as of now, there are no assessments or screens that we know of that can accurately prevent injuries.

Research on running injury prevention

Today we want to look specifically at running because Christopher et al. just published a systematic review earlier in February titled Do alterations in muscle strength, flexibility, range of motion, and alignment predict lower extremity injury in runners. The reason why we are such a stickler for research, data, and hard science is because it’s easy to sell a product or service based on possibilities but real numbers will show if they work. At Square One, we really don’t sell (false) hope. We sell results. And these results are only possible because we keep ourselves up to date with the latest research and we engage in evidence-based discussion to provide best clinical care.

Alright, enough of the ranting. 

So Christopher et al’s paper looked at objective clinical assessments that may translate to injury prediction. The factors they identified are:

  1. Hip strength
  2. Hip range of motion
  3. Hip alignment
  4. Hip flexibility
  5. Knee strength
  6. Ankle alignment
  7. Ankle range of motion

Stronger hips doesn’t always mean less running injuries … or does it?

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Is stronger always better? Does strength translate to less injuries?

So this is where things get interesting. The review looked at two papers – in one of them stronger hip abductors (the muscles that bring your legs sidewards away from the midline) were associated with more patellofemoral pain while in the other study weaker hip abductors were associated with increased anterior knee pain! To make things even more confusing, Mucha et al’s systematic review in 2017 (not included in the current study) looking at hip abductor strength found an association between hip abduction weakness and iliotibial band syndrome but not patellofemoral pain syndrome.

Hierarchy of evidence pyramid showing the strongest studies to the weakest based on research design.

In terms of hierarchy of evidence, Mucha’s findings trumps the other two studies because systematic reviews are more generalisable than cohort studies.

Regardless, we don’t know if stronger hips lead to less (or more) injuries or pain. There is just too many variables to account for and – at this point – we don’t have any studies that replicate similar findings to establish a true relationship. If we can’t ascertain a relationship, it’s impossible for anyone to claim stronger hips will prevent future injuries.

In fact, some may argue it will cause future injuries. 

Hips range of motion matters – but not in the way you think

We do see a lot of clients with hip pain after running. Too often we get clients telling us their massage therapist, chiropractor or physiotherapist, coach, etc pointed out that they have “tight hip flexors” or “hip flexor injury” because of a perceived reduction in range of motion. They also usually claim that this alleged “tightness” is causing them pain and/or injuries. Is this true?

We already know range of motion matters. We previously blogged about how relative differences in shoulder range of motion could potentially cause injuries. What about hips? Does it matter?

Well, maybe.

A study by Yagi et al. (2013) found that an increase in internal rotation of the hip was significantly associated with an increased the risk of medial tibial stress syndrome (shin splints). Yet an earlier study by Buist et al. (2011) found no association between hips range of motion and running injuries.

Assuming range of motion had a role to play, too much internal rotation is the issue. This is a far cry from the “tightness”-causing-injuries claim other therapists have been (falsely) reiterating. Excessive hip internal rotation is well discussed in academic literature. Souza et al. (2009) found an association between increased internal rotation and patellofomeral pain. The same study and Synder et al. (2009), theorised that the lack of control in the lower limb due to excessive movement may be a contributing factor to running injuries.

Conclusion: we do not have enough data to determine if range of motion has a role to play in running injuries. If there is indeed such a relationship, too much movement is a larger concern than the more commonly discussed “tightness”.

Alignment, alignment, alignment!

To keep it short, simple, and sweet: The review found no relationship between Q angle or leg length discrepancy and running-associated injuries.

Enough said!

Ankle alignment, flat foot, or overpronation must surely must cause running injuries, right?

That’s what you would like to think! Out of the three studies in the paper looking at navicular foot drop (colloquially also known as flat foot), only one study found a decreased in navicular foot drop to be associated with running injuries. A fourth study looking at foot posture also found no relationship between foot posture and running injuries.

Which leads us to our previous blog entry Nine Truths You Should Know About Your Running Health. In the paper we cited, there was no significant differences in injury risk between those who wore lightweight or minimalist shoes vs. those who preferred stability or motion controlled shoes.

Not so surprisingly now huh?

So, how do we prevent running injuries?

The truth is we do not know! Don’t let anyone fool you into buying a program or service that claims to prevent future injuries. The reality is that we do not know enough about the variables that may contribute to injuries. Unless that can be conclusively ascertained, it is not possible for anyone to develop an injury prevention program.

Furthermore, the findings of this paper should give you insight into what we know and do not know from an evidence viewpoint. Truth is, again, a lot of what is shared and sold to us by mainstream media and other pain/injury-associated businesses are not based on data or hard science.

Where do we go from here?

Keep running. Don’t let anyone fear-monger you into believing you are not good enough. Your body is a lot more resilient than you think.

If you need help, seek out a evidence-based professional!

This entry is written largely based off the systematic review Do alterations in muscle strength, flexibility, range of motion, and alignment predict lower extremity injury in runners published in February 2019. For full text or to read more about the other factors discussed, follow the link above. For more running-related writings:

To learn more about Square One and how we are disrupting the musculoskeletal care industry:

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