Chiropractic and running: preparing your patients for maximum benefits, fewer injuries

Chiropractic and running are a natural fit when it comes to providing patients with proper technique and footwear, in addition to other lower-body exercises

Everyone is aware of the health benefits of regular exercise. It can help control your weight, reduce the risk of heart disease and diabetes, and strengthen your bones and muscles. As a community concerned with the health, well-being and quality of the lives of our patients, there are steps we can take to help them by guiding and monitoring them with chiropractic and running footwear, technique and their exercise goals.

Patient red flags

If our patients are new to exercise or there are health concerns, they should consider speaking to their doctor of chiropractic before beginning a new exercise regime. Some red flags that should be revealed are any symptoms that are related to heart, lung or other serious diseases like type 1 or 2 diabetes, kidney disease, being treated for cancer or having high blood pressure.

Other considerations are pain in the chest, neck or jaw with exertion, dizziness, lightheadedness or fainting with exercise. Additional factors are shortness of breath, a rapid heartbeat, a heart murmur, or leg pain with walking that goes away with rest and uncontrolled arrhythmias. With potentially serious consequences of exercise ruled out, we can now focus on the physical status of the patient.

Begin with an examination of the lower extremities

Since the most common exercise activity involves the lower extremity in the form of either running or walking, it is essential to perform a comprehensive examination of the lower extremities. It is imperative to focus on the alignment of the lower extremity, including calcaneal valgus, and identify overpronation or a pes cavus foot.

Other considerations with chiropractic and running include the location of callus formation, painful areas and other abnormalities of the foot, ankle and toes. Carefully examine active, passive and joint play ranges of motion of the lower extremity as well as muscle testing for muscle strength and the balance between the tonic and phasic muscle groups, paying particular attention to patterns such as the upper- and lower-crossed syndromes. Also include leg length evaluation and neurologic testing.

Be certain to make vital signs part of the examination. The same basic procedure is to be repeated for the upper extremities and the axial skeleton. Carefully document examination findings to establish a solid baseline to compare future examination outcomes. It is important to do as much as possible to correct abnormal findings such as malalignment of the joints and muscle imbalances before beginning an exercise program.

Loading the joints and muscles with the skeleton in an abnormal position, and muscles overly shortened or lengthened, can cause excessive stress to the structures, discomfort, and result in strain, sprain and excessive fatigue of the exercised structures leading to injury.

Chiropractic and running: stabilizing the foundation

A simple, quick and effective strategy to improve posture and skeletal alignment and reduce postural stress is to fit the patient with custom flexible orthotics that support all three arches of the foot. This intervention may go far in our patients maintaining their exercise resolutions.

Now we have performed a history, done a physical examination and identified areas of imbalance. We have initiated procedures to correct those imbalances by adding custom three-arch orthotics.

After beginning evidence-based muscle balancing procedures, it is time to look at other recommendations we can make to help our patients maintain their New Year’s resolutions of exercising more and increasing physical activity in 2023.

Proper technique helps reduce the risk of injury

It seems that squatting has become a cornerstone in fitness classes and exercise programs. Proper squat performance and safety are key factors in avoiding injury.

There are many considerations while performing the squat. I will discuss a common concern over deep squats where the knee is flexed beyond 90 degrees of flexion. Squatting beyond 90 degrees of knee flexion has been implicated in the development of knee instability. It appears imbalances of motor control, muscle strength and prior injury also play into the development of knee instability. There may be other reports of deep squats placing increased loads on the femoral cartilage, knee and posterior cruciate ligament in that way that increases injury risk. People with previous knee injuries seem to be at increased risk.

With that being stated, the squat exercise is a functional movement that can contribute to improving coordinated muscle function at the hip and knee for recreational use and everyday activities. Here are the basic ideas to look for while doing a squat: trunk is upright, back is straight, knees track over (not past) the toes, femurs dip to parallel to the floor, and weight is in the heels. This position requires motor control and lower extremity alignment. The use of custom orthotics may assist the patient in maintaining better lower extremity alignment and muscle balance.

Another exercise movement that requires mentioning is exercise that involves forward flexion. Since many of the people we serve have had or have back pain, there are a few considerations to keep in mind. Forces that need to be considered are compression and shearing forces.

When the spine flexes forward, eccentric muscular contractions and flexion of the vertebrae increase compressive loads on the discs. If excessive, these forces could cause injury or exacerbate previous injury. Shear forces also increase with loading forces. The key to reducing these damaging forces is having the patient perform forward flexion with the spine in a neutral position. It is believed with the spine in neutral position there is less load on the posterior ligaments and contraction of the back extensor muscles assist in keeping the spine neutral, and may decrease the harmful effects of shearing forces.

Considerations for exercise could be to avoid flexion movements early in the morning when internal pressures of the disk are at their greatest due to hydration. Avoid full spinal flexion, and a prolonged spinal flexed position. Also, avoid exercising the back to fatigue as this is where the spinal muscles are weakest and least able to provide support.

It is obvious that with the assistance of the doctor of chiropractic supervising patient goals of increased fitness and exercise, the patient will be more accountable and better prepared to begin and maintain an exercise program that is safe, successful, comfortable and effective.

MANUEL DUARTE, DABCO, DABCSP, DACBA, MSAc, MS, is an international lecturer, author and researcher. He is a graduate of Long Island University and the National University of Health Sciences (NUHS), and a professor emeritus at NUHS. He is the previous owner of Body Fitness Physical Medicine and Sports Injury Clinic.

References

J Strength Cond Res. 2013 July ; 27(7): 1765–1774. doi:10.1519/JSC.0b013e3182773319. Knee Joint Kinetics in Relation to Commonly Prescribed Squat Loads and Depths

journal of Rehabilitation Research and Development Vol . 34 No . 4, October 1997 Pages 448-458 Distribution of tissue loads the low back during a variety of daily and rehabilitation tasks

Randomized Controlled Trial Arch Phys Med Rehabil. 2017 Sep;98(9):1752-1762. doi: 10.1016/j.apmr.2017.03.028. Epub 2017 Apr 30.

Shoe Orthotics for the Treatment of Chronic Low Back Pain: A Randomized Controlled Trial Jerrilyn A Cambron 1, Jennifer M Dexheimer 2, Manuel Duarte 3, Sally Freels 4