Several weeks ago, I had the opportunity to attend the Mountain Land Running Summit in Park City, UT. I enjoyed my time there as I find topics regarding running and sports performance especially fun. There were many topics with overall great information to apply to runners in clinic. What I found especially encouraging is how many of these principles my clinic has already applied. Don’t get me wrong, it is exciting to learn new information, but as a PT, it is almost more exciting to already be applying best practice to your patients.

One big takeaway to address running gait is to first change cadence. Cadence, for those who may not know, is simply the number of steps you take in a minute. Current research uses an increase of 5-10% in cadence with an overall decrease in injury but many of the researchers clinically are using 2-3% increase in cadence and still seeing similar decreases.

In simple terms increasing cadence:

• Reduces heel to center of mass (COM) distance, which addresses overstriding
• Reduces COM vertical displacement, which addresses excessive bounce
• Increases lower extremity stiffness, which in turn addresses excessive compliance

Research shows

• 15-27% decrease in negative work performed by knee per kilometer (5-10% increase step rate)[1,2]
• 9-12% decrease in patellofemoral joint kinetics per kilometer (10% increased step rate)[3]
• Increased gluteal activation during late swing w/increased step rate with decrease glute load in stance phase[4]

One statistic that was especially interesting to me was that just an increase of 1step/min for cadence was associated with 5% decreased risk of a bone stress injury (BSI)![5]

Another great reminder was to be mindful of what you are rehabbing and remember proper loading for each area. The example for this topic was that hills have an inverse effect on the knee compared to the achilles load.[6]

• With downhill running: patellofemoral stress is high, while achilles stress is low
• With uphill running: patellofemoral stress is low, while achilles stress is high

Know what you are rehabbing and make sure to apply proper loading

Along with these nuggets of wisdom, the topic of rehabbing after a BSI and loading for bone health was emphasized.

Running does not build a healthy skeleton

• Need heavy squatting (fast and heavy) for bone health[7]
• Load the lumbar spine with barbell back squats
• Make sure to be fueling appropriately

You can’t out-jump or run under-fueling

In one of the discussion panels there were also several articles discussed on how important carbohydrates are for bone remodeling. Usually when we think of remodeling muscle or bone we default to protein, however strong cases for increased carbohydrates at the same calorie intake are becoming more apparent in research[8].

So how can a running conference apply to any of my non-running patients? I was able to have the opportunity to discuss with one of my non-runner patients this week regarding her osteopenia diagnosis and share with her the research regarding lifting heavy, proper nutrition, and point her to the direction of current practice guidelines[9]. She told me how her medical doctors have been managing the hormone and nutrient deficits aspect of her care, but no one had specifically talked her through how to go about physical activity and proper heavy loading for bone health. I am grateful to have recently been exposed to topics regarding bone health which allowed me to give her the opportunity to feel confident in her ability to go about physical activity and overall better her health. My time at the running summit was well worth it.

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References

1. Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296-302. doi:10.1249/MSS.0b013e3181ebedf4
2. Willy RW, Buchenic L, Rogacki K, Ackerman J, Schmidt A, Willson JD. In-field gait retraining and mobile monitoring to address running biomechanics associated with tibial stress fracture. Scand J Med Sci Sports. 2016;26(2):197-205. doi:10.1111/sms.12413
3. Lenhart RL, Thelen DG, Wille CM, Chumanov ES, Heiderscheit BC. Increasing running step rate reduces patellofemoral joint forces. Med Sci Sports Exerc. 2014;46(3):557-564. doi:10.1249/MSS.0b013e3182a78c3a
4. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when running step rate is increased. Gait Posture. 2012;36(2):231-235. doi:10.1016/j.gaitpost.2012.02.023
5. Kliethermes SA, Stiffler-Joachim MR, Wille CM, Sanfilippo JL, Zavala P, Heiderscheit BC. Lower step rate is associated with a higher risk of bone stress injury: a prospective study of collegiate cross country runners. Br J Sports Med. 2021;55(15):851-856. doi:10.1136/bjsports-2020-103833
6. Van Hooren B, Van Rengs L, Meijer K. Per-step and cumulative load at three common running injury locations: The effect of speed, surface gradient, and cadence. Scand J Med Sci Sports. 2024;34(2):e14570. doi:10.1111/sms.14570
7. Mosti MP, Carlsen T, Aas E, Hoff J, Stunes AK, Syversen U. Maximal strength training improves bone mineral density and neuromuscular performance in young adult women. J Strength Cond Res. 2014;28(10):2935-2945. doi:10.1519/JSC.0000000000000493
8. Fensham NC, Heikura IA, McKay AKA, Tee N, Ackerman KE, Burke LM. Short-Term Carbohydrate Restriction Impairs Bone Formation at Rest and During Prolonged Exercise to a Greater Degree than Low Energy Availability. J Bone Miner Res. 2022;37(10):1915-1925. doi:10.1002/jbmr.4658
9. Hartley GW, Roach KE, Nithman RW, et al. Physical Therapist Management of Patients With Suspected or Confirmed Osteoporosis: A Clinical Practice Guideline From the Academy of Geriatric Physical Therapy. J Geriatr Phys Ther. 2022;44(2):E106-E119. doi:10.1519/JPT.0000000000000346