As any athlete knows, nothing is more frustrating than being kept from training or racing because of an injury. Unfortunately, this is especially frequent with runners, because running injuries are among the most common of all sports injuries. To make matters worse, many running injuries become recurrent and are often slow to respond to traditional types of care. This means that even after their symptoms go away, many runners find themselves hampered by those same issues down the road, starting the whole process all over again. Now for the good news: a relatively new treatment technique known as Active Release Techniques® (ART®) is proving to be a very effective method for treating many common running injuries and is helping to get runners back to training and racing quickly and effectively. But before we talk about why ART® works so effectively, you need to understand how running injuries occur in the first place.

It is important to know that there are two major types of injuries: acute and repetitive. Acute injuries occur following a single event, such as a fall or collision. Fortunately, these types of injuries are rare in running. By far the most common type of running injury is a repetitive injury. As the name implies, repetitive injuries occur slowly over time as a result of performing the same motion over and over again. When examining the running stride, you can easily see that it falls into the category of repetitive activity. For example, the average runner takes 800-1000 strides per mile. This means that over the course of a five-mile run, each heel strikes the ground 5000 times. This high level of repetition is bad enough on its own, but making matters worse is the fact that each of these heel strikes is associated with a tremendous amount of impact force. Studies have shown that each heel strike produces a force equal to three or four times your body weight. For a 150-pound runner, this means that each heel strike generates approximately 600 pounds of pressure. Over the course of a five-mile run, this adds up to over 1300 tons of pressure. This force doesn’t act just at the foot. As the heel strikes the ground, the impact force travels up the shin, through the knee, up through the thigh and hip, and into the pelvis and trunk. To ensure that the body is able to offset this force, it is absolutely critical that there is proper mobility at the lower extremity joints, and adequate strength, endurance, and balance of the muscles that control the leg, pelvis, and trunk. As long as the muscles and joints are working properly, the chance of injury is greatly reduced; however, as you will see, because of the repetitive and high-impact forces associated with running, even minor problems will greatly increase the chance of pain and injury.

As a result of the interconnection of the foot, knee, hip, pelvis, and trunk, proper running technique requires not only proper function of individual muscles and joints, but also requires that each body segment work in an integrated manner. This integration is known as the kinetic chain. If a minor problem such as excessive tightness, weakness, joint restriction, poor muscle balance, or bad posture exists, it can cause a problem not only in that area, but can also impacts on the entire kinetic chain, as it causes the body to move in an inefficient manner in an effort to compensate for the problem area. In running, this alteration in body movement is referred to as a “stride fault” or “stride compensation.” Stride compensation occurs when altered or excessive motion in one area is caused by a movement problem in another area. Even minor movement problems are greatly magnified by the high-force repetitive motion of running, and can prevent the runner from properly controlling the impact forces and generating the propulsive forces associated with each stride. As a result, instead of being transferred effectively through the muscles and joints of the kinetic chain, the forces become concentrated at a particular area, usually the area of the stride compensation. As a result of the cause-effect relationship between stride compensations and running injuries, it is critical that the entire kinetic chain be evaluated to ensure all areas are functioning properly, not just in the area of pain. Failure to identify and correct stride compensations not only prolongs the injury process, but also leads to injury recurring.

Running is a highly repetitive activity that creates a tremendous amount of impact force. Over time, these repetitive forces can accumulate in the body and lead to straining of the muscles, ligaments, and joints, a process that is greatly magnified when movement restrictions and stride compensations are present. As time goes on and the runner continues to train and compete, the strain imposed on the body develops into micro-trauma. Initially this micro-trauma is not painful, but may be perceived as a mild ache or tightness in the muscles or joints. Although small, this damage needs to be repaired. The body responds to tissue injury in a very predictable way: by laying down new tissue to repair the damaged area. With micro-trauma, the body repairs the strained tissue by laying down small amounts of scar tissue in and around the injured area. The scar tissue itself is not a problem; in fact, it is a normal and necessary part of healing. The problem occurs as the body is exposed to the same repetitive, high-impact forces of running day after day. This causes the same muscles to become strained and subsequently repaired over and over again. Over time, this scar tissue builds up and accumulates into adhesions. As these adhesions form, they affect the normal health and function of the muscles. In fact, they often lead to pain, tightness, stiffness, restricted joint motion, and diminished blood flow. As these scar-tissue adhesions accumulate, they will more and more strain on the muscles of the foot, knee, hip, pelvis, and trunk, because the muscles must stretch and contract against these adhesions with each stride. This places even further strain on the kinetic chain, which leads to more micro-trauma. Essentially, a repetitive injury cycle is set up, causing continued adhesion formation and progressive movement dysfunction. As the cycle progresses, the ability of the muscles to contract properly is affected and the stability of the foot, knee, hip, and pelvis becomes compromised. At this point it is not uncommon for the muscles to give way, producing a more severe pain. In fact, many runners come into our office explaining that they have had an injury, but have not done anything different to cause the pain. These runners almost always describe some mild pain or tightness that has been building over time. This type of injury builds up over time, and the more acute injury is just the straw that broke the camels back.

In an attempt to treat running injuries, a variety of treatment methods are used, either alone or in combination with other methods. Some of the more common approaches include an6ti-inflammatory medication, rest, ice, ultrasound (US), muscle stimulation (E-Stim), steroid injections, stretching, exercise, and when all else fails, surgery. Unfortunately, most of these traditional techniques generally require a long period of time before they provide any significant relief, and in many cases provide only temporary relief from symptoms instead of fixing the underlying cause of the problem. This can be a big problem for runners, because they often want and need to get back to training and competition as soon as possible. The main reason that these approaches are often ineffective is that they fail to address the underlying scar-tissue adhesions that have developed within the muscles and surrounding soft tissue. It is these adhesions that are binding the tissues together, restricting normal movement, and interfering with the normal flexibility and contraction of the muscles in the kinetic chain. Passive approaches such as medication, rest, ice, and steroid injections all focus on symptomatic relief and do nothing to address the muscle restrictions and movement compensations. More active approaches such as stretching and exercise are often needed for full correction of the condition and to restore full strength and function of the muscles; however, they do not treat the underlying adhesions. In fact, without first addressing the scar-tissue adhesions, stretches and exercise are often less effective and much slower to produce pain relief or recovery from running injuries.

ART^® stands for Active Release Technique^®. It is a new and highly successful hands-on treatment method to address problems in the soft tissue of the body, including the muscles, ligaments, fascia, and nerves. ART^® treatment is highly successful in dealing with running injuries because it is specifically designed to locate and treat scar-tissue adhesions that accumulate in the muscles and surrounding soft tissue. Locating and treating the soft-tissue adhesions with ART^® allows the practitioner to:

1. Break up restrictive adhesions
2. Reinstate normal tissue flexibility and movement
3. More completely restore flexibility, balance, and stability to the injured area and to the entire kinetic chain

You can think of an ART^® treatment as a type of active massage. The practitioner first shortens the muscle, tendon, or ligament, and then applies very specific pressure with the hands as the patient actively stretches and lengthens the tissue. As the tissue lengthens the practitioner is able to assess the texture and tension of the muscle to determine if the tissue is healthy or contains scar tissue that needs further treatment. When scar tissue adhesions are felt, the amount and direction of tension can be modified to treat the problem area. In this sense, each treatment is also an assessment of the health of the area, as we are able to feel specifically where the problem is occurring. An additional benefit of ART^® is that it allows us to further assess and correct problems not only at the site itself, but also in other areas of the kinetic chain, which are associated with movement compensations and are often contributing factors to the problem. This ensures that all the soft tissue that is dysfunctional and is contributing to the injury is addressed, even if pain has not developed. One of the best things about ART^® is how quickly it provides results. In our experience, the majority of running injuries respond very well to ART^® treatment, especially when combined with the appropriate stretching and strengthening exercises. Although each case is unique and several factors determine the length of time required to fully resolve each condition, we usually find that significant improvement can be gained in four to six treatments. The results are the reason many elite athletes and professional sports teams have ART^® practitioners on staff, and why ART^® is an integral part of the Ironman triathlon series.

To book an appointment to see if ART^® can help with your running injury, call our office at (248) 477- 2100.