Dr. Tom Kano, Chiropractor

As the number of participants in recreational and competitive running continues to increase, so does the number of chiropractic patients who need treatment for running-associated injuries. Some researchers have estimated up to 60 percent of runners will experience an injury that will limit their activities. While some of these injuries are due to actual trauma, the vast majority fall into the category of overuse syndromes.

Conditions Lead to Injuries
Most running injuries are not the result of recent acute injury; they develop gradually, over a period of weeks or months. These “overuse” or “misuse” conditions are caused by excessive and/or repetitive motion. The end result is a microtrauma injury – the body is unable to keep up with the repair and re-strengthening needs, so the tissue begins to fail and becomes symptomatic. If it is not particularly painful (or if the pain is eliminated by painkilling drugs), the runner continues to run, eventually leading to complete failure, such as a stress fracture or ligament tear. The causes of these types of injuries are often categorized into extrinsic and intrinsic sources.

Extrinsic factors. Causes of microtrauma injuries external to the runner are often the easiest to modify, and should be addressed immediately in treatment. Extrinsic factors include the training program (such as mileage per week, number of speed or hill workouts, recent mileage increases, and amount of rest time); running surfaces (such as asphalt, artificial track, or natural trails); and equipment (design and materials of running shoes). Research has shown that exposure to a high training load (duration, frequency, or running distance) increases the risk of injury; thus, modification of the training schedule can reduce the incidence of injury. Modifications in the running routine (such as less mileage on more forgiving surfaces) and newer, better shoes should be introduced at the start of the rehab program for any running injury. One often-overlooked extrinsic source of problems is caused by repetitive running on a banked surface, such as along the sides of roads that have a pronounced slant for water run-off.

Intrinsic factors. The individual variables associated with overuse injuries are either muscle imbalances or structural alignment problems. These factors are more difficult to modify, but a good rehab program should be able to make significant progress once the problem has been identified. In fact, this is actually the most difficult part – recognizing the intrinsic source of the runner’s symptoms. A thorough examination is necessary to investigate the structural, biomechanical and dynamic aspects, searching for evidence of muscle imbalances, misalignments and dysfunctions. Frequently, several intrinsic factors combine to interfere with a runner’s musculoskeletal efficiency and performance. When the runner tries to push harder, the system breaks down and becomes symptomatic.

This type of categorization, however, is oversimplified. When a runner possesses sound alignment and muscle balance, even a strenuous training program is well-tolerated. Runners with biomechanical problems, however, can’t withstand even a moderate training program without developing various types of overuse injuries. A change in running surface or shoes may bring out the fact that a runner has an underlying foot or leg alignment problem that had previously gone unrecognized. In other words, the intrinsic and extrinsic factors are closely intertwined, and both contribute significantly to most running injuries.

Help for the Running Patient
Overuse injuries in runners are a good example of the individual interacting strenuously with the environment. Problems can arise from the environment (extrinsic factors) or the individual’s biomechanics (intrinsic factors). Rehabilitation should consider both sources of structural stress and strain, then apply cost-effective treatments. Immediate treatment should include modifications of training and improvements in muscle balance – stretching of tight muscles, and strengthening of weakened areas. For long-term improvement, biomechanical alignment problems will need to be addressed, often with the addition of custom-made orthotics. Failure to recognize these intrinsic complicating factors may result in a patient suffering recurring – and possibly variable – complaints. A comprehensive approach to the rehabilitation of running injuries provides the best hope for many years of recreational and competitive enjoyment.

The Importance of Proper Foot Function

Normal gait causes predictable, repetitive motions to occur from the feet to the head. The accurate timing of the many muscle contractions required depends on stimuli from a symmetrical gait. Abnormal or asymmetrical foot biomechanics will interfere with these carefully orchestrated movements, causing postural imbalances and problems throughout the musculoskeletal system.

    We now know that a smooth and symmetrical gait has a significant effect on the pelvis, and is closely tied to proper spinal function. During walking there is a fine interplay between the movements of the feet, the hips, and the pelvis. Our feet have both structural and neurological effects on posture and musculoskeletal alignment.

Structural effects

The feet provide structural support for the pelvis (and the spine) during the stance phase of gait- from heel strike through foot flat to toe-off. The foot and leg must bear the full weight of the body and keep the pelvis in normal alignment. The stance portion of the gait cycle is therefore the most critical for posture, and it is the longest (60% of each step), as well.
If one or more of the foot’s arches is not able to provide the necessary support, or if there has been a breakdown of the plantar fascia, abnormal postural adaptations develop. Additional stress is then placed on all of the joints, ligaments, and muscles involved in helping to maintain upright posture.
Whenever there is an unequal amount of support from each leg during weight-bearing stance (due to either anatomical or functional causes), posture will definitely suffer. This results in an uneven foundation for the pelvis, causing various postural shifts in response.

Pelvic misalignments

When a foot pronates during the stance phase of gait, there is a normal inward (medial) rotation of the entire limb and pelvis. In persons who have excessive or prolonged pronation, this twisting movement is accentuated. The increased rotational forces are transmitted into the pelvis, and especially the sacroiliac joint.
In response, various compensatory pelvic subluxation complexes develop. These include pelvic tilts (usually anterior or to one side), innominate (think hip) rotations (usually back and down), and other complicated adaptations.

Neurological effects

With many interconnected joints, lots of connective and articular (joint) tissues, and both intrinsic and extrinsic muscles, the lower extremities are very well supplied with proprioceptive nerve endings.
Mechanoreceptors in the feet and ankle joints, along with the muscle spindles of the foot and lower leg muscles, are responsible for the positive support reflexes and a variety of automatic reflexive reactions.
The position receptors in the lower extremities, pelvis, and spine (and especially the neck/head-righting reflexes) must coordinate smoothly in order to maintain postural equilibrium. Difficulty in achieving or keeping optimal postural alignment, or problems with excessive postural sway, are frequently caused by inaccurate information sent by spindle sensors in chronically strained muscles or aberrant joint mechanoreceptors in the feet.
In addition, much of the neurological coordination of the body is based on a balanced, rhythmic lower extremity movement and gait.
The “cross crawl” pattern organizes many fundamental musculoskeletal functions at the spinal cord level, permitting smooth performance of daily physical activities without the need for conscious thinking about posture or planning out movements. This includes factors such as balance, stability, and center of gravity.
When one or both feet spend too much time in pronation, many of the muscles throughout the body (and around the spine) don’t turn on and shut off in proper sequence. This affects posture, raises the work effort for all activities, and even increases the amount of oxygen consumed during normal walking.

Conclusion

While the feet may seem to be located far from the spine, they are immediately connected in several ways. Both structural and neurological factors clearly reveal this inter-related and integrated system. Posture, as well as balance, coordination, and efficient musculoskeletal function, all depend on the smooth functioning of the foot and ankle complex.
Researchers are now beginning to understand the intricate relationships that many doctors of chiropractic have treated empirically (and successfully) for decades. Whenever a patient demonstrates a postural imbalance, Dr. Kano always considers the importance of the lower extremities, and the feet in particular.

Piriformis Syndrome
Low back pain with or without sciatica is a common condition seen in chiropractic practice. In the majority of cases, pain is caused by classic conditions, such as degenerative disc disease, spondylosis, and entrapment of the lateral recess. In less common cases, sciatica is caused by arthritic changes in the sacroiliac joint or the existence of a trigger area in the piriformis muscle.
The signs and symptoms of sciatic neuritis, as exemplified by piriformis syndrome, are distinct from those of sciatic radiculitis. The most important distinction in the differentiation of sciatic pain caused by piriformis syndrome is the lack of a true neurological deficit. In piriformis syndrome, the positive sign is point tenderness over either end of this muscle. It may be found near its origin just lateral to the mid-sacrum, with its insertion just medial to the greater trochantor. Deep palpation exemplifies the pain. With myofibrosis, or contracture of the piriformis muscle, this may produce resulting pressure on the sciatic nerve that traverses the muscle. The pressure or irritation of the nerve may derive not from the muscle itself, but from a complex inflammatory process set into motion by the piriformis spasm.

Treatment
I have found that a combination of chiropractic manipulative treatment with myofascial release of the piriformis muscle is an effective therapy for piriformis syndrome. The piriformis is stretched manually by applying steady pressure perpendicular to the muscle’s long axis and tangential to the buttocks, until the muscle is felt to relax. The goal is to separate the articular facets and restore lumbosacral mobility. Chiropractic adjustments allow the facets to move more freely and reduces irritation of the spinal column, which could result in compensatory muscle splinting and spasming.
Piriformis syndrome, a common cause of low back and leg pain, can be relieved with conservative chiropractic care. If you are experiencing low back pain that radiates into the leg, come in for a consultation to have Dr. Kano evaluate you.

Chiropractic is a branch of the healing arts which is based upon the understanding that good health depends, in part, upon a normally functioning nervous system (especially the spine, and the nerves extending from the spine to all parts of the body). Chiropractic stresses the idea that the cause of many disease processes begins with the body’s inability to adapt to its environment. It looks to address these diseases not by the use of drugs and chemicals, but by locating and adjusting a musculoskeletal area of the body which is functioning improperly.

The conditions which doctors of chiropractic address are as varied and as vast as the nervous system itself. Your spinal column is a series of movable bones which begin at the base of your skull and end in the center of your hips. Thirty-one pairs of spinal nerves extend down the spine from the brain and exit through a series of openings. The nerves leave the spine and form a complicated network which influences every living tissue in your body.

Accidents, falls, stress, tension, overexertion, and countless other factors can result in a displacements or derangements of the spinal column, causing irritation to spinal nerve roots. These irritations are often what cause malfunctions in the human body. Chiropractic teaches that reducing or eliminating this irritation to spinal nerves can cause your body to operate more efficiently and more comfortably.