Sport Health Volume 38 Issue 1 - Running

Sport

health VOLUME 38 ISSUE 1 2020

Running FEATURING • Running Hot: Preparations and Considerations for Running in the Heat • Runners’ Perspectives on ‘Smart’ Wearable Technology • Nutrition for Runners

Contents REGULARS

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Impact-Related Ground Reaction Forces

From the Chair Chair, Professor Gregory Kolt talks about the future ahead for SMA on the way back from the COVID-19 pandemic

Post-doctoral Fellow, Caleb Johnson discusses the advancement and treatment of running related musculoskeletal injuries.

03 From the CEO In this edition of Sport Health, CEO Craig Knox brings light to the impact of COVID-19 on community sport

16 Running Hot: Preparations and Considerations for Running in the Heat Accredited Sports Dietitian, Alan McCubbin, shares his expertise and unique insights for endurance and ultramarathon runners on how to maintain their level of performance and reduce their risk of adverse health outcomes when running in hot environments

FEATURES

04 Dispelling Myths Around Strength Training for Endurance Runners APA Sport and Exercise Physiotherapist, James Alexander unpacks some common myths around the interplay between strength training and endurance running.

12 When We Run Athlete, Scarlett Duncan, highlights the value in running specific drills.

22 Runners’ Perspectives on ‘Smart’ Wearable Technology Sports Science Experts talk all things ‘Smart Wearable Technology’.

Dr Blayne Hettinga, Dr Christian Clermont, Dr Linda Duffet-Leger, Dr Reed Ferber

Opinions expressed throughout the magazine are the contributors’ own and do not necessarily reflect the views or policy of Sports Medicine Australia (SMA). Members and readers are advised that SMA cannot be held responsible for the accuracy of statements made in advertisements nor the quality of goods or services advertised. All materials copyright.

On acceptance of an article for publication, copyright passes to the publisher.

VOLUME 38 • ISSUE 1 2020

Publisher Sports Medicine Australia Sports House, 375 Albert Rd Albert Park VIC 3206 sma.org.au ISSN No. 1032-5662 PP No. 226480/00028

Copy Editor Kristen Butterworth Manager – Marketing and Communications Cohen McElroy Design/Typesetting Perry Watson Design Cover Photography Gettyimages/wavebreakmedia Content Photography Author supplied; www.gettyimages.com.au

Volume 38 • Issue 1 • 2020

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INTERVIEWS

Running Drills as Part of Hammy Injury Management.

The nuts and bolts…

48 5 minutes with… Dr Nirmala Perera

Musculoskeletal Physiotherapist and Australian Army Officer shares her insight into running drills for injury management.

34 Is Running the Best Form of Physical Activity?

Neil Ames, avid runner talks about the impact that ParkRun has had on communities and individuals.

40 Sports Medicine Around the World: Austria

30 Nutrition for Runners In this feature, Jessica Rothwell, National High-Performance Nutrition Lead for Athletics Australia, shares expert knowledge on nutrition for runners.

Hofrat University Professor Dr. Ernst Raas highlights sports medicine in Austria.

50 People Who have Shaped SMA – Dr Peter Nathan

42 Developing the Guidelines: Returning to Running Postnatal In this feature, Sport Health discusses the guideline for post-natal running.

Emma Brockwell, Gráinne Donelly, Tom Goom

53 Sports Trainer Spotlight – Russel Henry Read all about Russel Henry’s Sports Medicine career, which has taken him all over the world.

NEWS

46 Sports Medicine Community News

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FROM THE CHAIR

FROM THE CHAIR

Running with the times SMA BOARD CHAIR PROFESSOR GREGORY KOLT LOOKS BACK ON 2020 AND TURNS HIS ATTENTION TO THE EXCITING FUTURE AHEAD FOR SMA ON THE WAY BACK FROM THE COVID-19 PANDEMIC. HE DISCUSSES THE IMPORTANCE AND BENEFITS OF RUNNING FOR BOTH PHYSICAL HEALTH AND WELLBEING.

W

elcome to the final issue of Sport Health for 2020!

It has been a year that no one could have predicted but we have been encouraged by our ability to transition future plans into immediate actions that have provided benefits for our members.

Sport Health is no exception, we know that members look to each edition of Sport Health to keep them informed about SMA’s direction and for the latest information regarding contemporary practice and research, and this issue on running includes that and more.

As an organisation it is great to see SMA’s COVIDSAFE Safer Sport Program courses have recommenced in most regions around the country, launching a new and exciting format that includes both face to face and online learning modules. The transition to online Professional Development events has continued to be an added member benefit, drawing international speakers to complement leading Australian Sports Medical professionals presenting their latest research and best practices.

I would like to take this opportunity to acknowledge the contributions made

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As a multidisciplinary organisation, SMA understands the importance of running and other forms of physical activity at all levels of participation.

by Craig Knox in his time as CEO of Sports Medicine Australia. Craig left the organisation earlier this month to pursue other opportunities. I also thank Michael Kenihan for stepping into the role of Interim CEO to ensure that our great work continues over our transition to new leadership. The wonderful support of all of our SMA staff, our State and Territory Councils, and other volunteers is incredibly important to our organisation, and your commitment and expertise puts us in a strong position for the coming years.

As a multidisciplinary organisation, SMA understands the importance of running and other forms of physical activity at all levels of participation. The benefits for both physical and mental health and wellbeing are well established, and as such, we must continue to

promote participation in these activities in a safe and encouraging way.

This issue of Sport Health focuses on running and how the different sports medicine and sports science disciplines can influence performance and safety during such activities. Features in this edition include nutrition – how to fuel your body for running, guidelines for post-natal running, strength training, running technology and even practical drills to help aid your technique.

Enjoy this issue, and I urge you to take the opportunity to get out there and experience the health gain afforded by your participation in running and other physical activity. Have an enjoyable and safe summer.

Professor Gregory Kolt

FROM THE CEO

FROM THE CEO

Running to a New Normal AS WE NEAR THE END OF 2020, A YEAR LIKE NO OTHER, WE HAVE BEEN CONSISTENTLY REMINDED OF THE VITAL ROLES THAT SPORT, EXERCISE AND PHYSICAL ACTIVITY PLAY IN OUR COMMUNITIES. BOTH FEDERAL AND STATE GOVERNMENTS HAVE HIGHLIGHTED THE IMPORTANCE OF DAILY PHYSICAL ACTIVITY AS PART OF SOUND PERSONAL AND COMMUNITY MANAGEMENT OF THE RESTRICTIONS IMPLEMENTED DURING THE COVID-19 PANDEMIC.

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n the context of the pandemic, some people have sought out, adapted and benefited from their regular exercise while others have conversely noticed and struggled with the absence of opportunity to play sport or exercise without limitation.

This new dynamic has directly impacted our members, forcing them to re-evaluate and reforecast for the way in which services and practice can be best applied into the future.

The role of SMA has been to support our members by providing the most relevant and useful information available and to provide this through channels that allowed for ease of access. Over these past months we have changed our professional development offer to include online formats and will extend this further through more advanced online functionality in the future. Similarly, we have converted our Sports Trainer courses to an online format to ensure the most contemporary education remains highly relevant, adaptable and sustainable for those who participate.

We have also updated guidelines both independently and in collaboration for

This new dynamic has directly impacted our members, forcing them to reevaluate and reforecast for the way in which services and practice can be best applied into the future. the benefit of our members and the general public. Accordingly, this issue of Sport Health has again successfully profiled the most current information and perspectives on a key activity.

This edition of Sport Health focuses on running and the multitude of factors that can influence safety and performance in running. This includes feature articles on vertical impact forces and musculoskeletal injury, running in the heat, strength training, nutrition, wearable technology, postnatal running, the popularity and community impact of Park Run and wonderful contemporary information on planning and drills for running.

Our regular international profile article focuses on Sports Medicine in Austria. We also profile the career of Dr Peter Nathan and his long term involvement and influence at SMA and the careers of SMA Sports Trainer Russell Henry and Dr Nirmala Perera.

I’d like to thank all contributors for their input to this edition and to our internal team for creating another high quality publication. I hope that you enjoy this special running edition of Sport Health and that it helps to further inform and connect you to the SMA community network as we continue to adapt to a new normal.

Craig Knox Chief Executive Officer

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DISPELLING MY THS

Dispelling Myths Around Strength Training for Endurance Runners

James Alexander – APA Sport and Exercise Physiotherapist APA SPORT AND EXERCISE PHYSIOTHERAPIST, JAMES ALEXANDER UNPACKS SOME OF THE COMMON MYTHS AROUND THE INTERPLAY BETWEEN STRENGTH TRAINING AND ENDURANCE RUNNING.

‘S

trength’ is defined as the maximum amount of force that a muscle group can produce under specific conditions. Every movement we make is dependent on the ability of our muscles to contract and produce force during a co-ordinated movement pattern. To complete an activity such as running, the human body requires the capacity to be able to produce large amounts of force

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force which is dependent on both the size of the muscle contributing to the movement and the efficiency of the nervous system to activate as many muscle fibres as possible.

as rapidly as possible. The speed at which we can run is therefore directly related to the magnitude of force a runner can produce against the ground in a short period of time. With this in mind, it makes sense that if a runner wants to run faster, improving the muscular strength will assist their performance significantly.

Increasing a muscles’ size or ‘bulking up’ may have a negative impact on endurance running performance.

Therefore, maximising strength gains without adding extra mass should be the goal of a strength training program for endurance runners.

Prescribing strengthening exercises in a specific manner to maximise nervous system adaptations, and minimising muscle hypertrophy is important.

The goal of strength training is to improve the muscles’ ability to produce

There are different types of strength that are important for a runner to

DISPELLING MY THS

the efficiency of forward propulsion, reducing the requirement of muscles to contribute to force development and therefore delaying fatigue. Each of these strength qualities are highly trainable in endurance runners.

What are the benefits of strength training for runners?

While endurance running performance is primarily limited by cardiovascular and metabolic factors, there is a significant amount of research reporting the physiological and performance benefits of varying strength training modalities. These include heavy resistance, explosive resistance, and reactive/plyometric training for middle and long-distance runners. The key performance benefits runners can obtain from a strength training program include: 1. Improved running economy 2. Faster time trial performance 3. Faster maximal sprint speed.

develop. These include relative strength, explosive strength and reactive or plyometric strength.

Relative strength is the maximum amount of force a muscle can produce per kilogram of body weight.

Explosive strength, otherwise known as muscular power, is the ability of a muscle to generate a high magnitude of force as rapidly as possible. This is critically important for endurance runners, as the short amount of time spent in contact with the ground leaves a limited time to produce force. Finally, reactive or plyometric strength is the ability to effectively use the elastic properties of tendons (e.g., the Achilles) to store and release elastic energy. Much like a stiff spring, reactive strength improves

Strength training interventions lasting 6-20 weeks, when added to the training program of an endurance runner with greater than six months running experience, have been reported to enhance running economy by 2-8%.

Running economy is the amount of oxygen used while running at any given submaximal speed (below VO2 max).

Improvements in running economy will theoretically enhance endurance running performance by enabling a runner to run at a lower oxygen or energy cost while training and racing.

These benefits have been reported in runners from recreational through to elite level athletes and can be achieved with each strength training modalities.

Importantly for runners, faster time trial performances ranging from 2-5% over middle (1500m-3000m) and longer distance events (5km-10km) have also been reported in groups who undertake strength training.

Improvements in muscular strength are thought to result in a lower level of force production per stride, therefore

delaying the recruitment of higher threshold muscle fires, and prolonging the onset of fatigue. This results in an improved performance in the later stages of endurance events.

Faster maximal sprint speed is another benefit for distance runners following strength training. This can give the strength trained endurance runner an edge during mid-race surges or when battling it out in a sprint finish. It is important to note that the performance benefits of strength training can be lost in as little as six weeks if removed from a program. Staying consistent with an appropriately periodised program leading into goal events may therefore be needed to maximise performance gains.

Does strength training reduce injury risk?

Another proposed benefit of strength training for runners is that it will lower the risk of developing running-related overuse injuries.

Targeted and appropriately prescribed strength training will cause positive physiological adaptations to strengthen the musculoskeletal system including bones and connective tissues (e.g., tendon and muscle).

These adaptations will enhance the capacity of these tissues to withstand the high magnitude and volume of load experienced during endurance running. Theoretically, this should make a runner less susceptible to injury.

Unfortunately, the cause of runningrelated injuries is often complex with multiple contributing factors. While there is evidence that consistent heavy resistance training, when combined with other exercise interventions, may reduce the risk of overuse injuries in other sporting populations, the effect on injury risk in runners currently remains unclear. Because of this, further research is needed in this area.

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DISPELLING MY THS

What is the most effective type of strength training for runners?

Whilst each of the strength training methods are capable of improving endurance running performance, no one method has been definitively reported to be more superior than another. In endurance runners with little strength training experience, when programmed appropriately, any strength training stimulus will likely lead to positive short-term adaptations and improved running performance.

That being said, studies comparing strength training techniques have reported that heavy resistance and explosive resistance (power) programs are more beneficial to performance than a muscular endurance style program. This contrasts with the widely common belief that strength training should be high in repetition (e.g., three sets of 20+ repetitions), low resistance (e.g., <60% of one repetition maximum) to mimic the endurance demands of running.

Improvements in muscular endurance are achieved specifically by running and should not be the primary focus of a strength training program.

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It is important for runners without strength training experience to gradually progress training loads to reduce risk of injury and overtraining.

Supervision from a qualified coach should also be an important consideration. Studies implementing supervised programs have reported greater performance benefits compared to unsupervised strength training interventions. In nonstrength trained endurance runners an initial period of heavy resistance training, prescribed appropriately to the individual, is recommended to maximise training effects. In the longer term, including a variety of training modalities in a program appears to be most effective. This will provide the variety required to ensure that the neuromuscular system is continually overloaded and challenged.

What type of exercises should be used?

Exercises which require force to be generated from the leg extensor muscles in a closed kinetic chain position or triple extension pattern are most likely to improve running

performance. For the lower limb, closed kinetic chain exercise are those in which the foot remains in constant contact with an immobile surface (e.g., the ground or the base of a machine) during the performance of the exercise. Triple extension refers to the simultaneous extension of the hip, knee and ankle joints which occurs during the propulsion phase of the running gait. Examples of exercises commonly used in heavy and explosive resistance training programs for runners include: ٚ Barbell squats ٚ Deadlifts ٚ Step-ups ٚ Lunge variations ٚ Calf raises Plyometric exercises should emphasise short ground contact times (<0.2s) to maximise the specificity and transfer to endurance running.

Exercises recommended include: ٚ Depth jumps (from a 20-30cm box) ٚ Skipping ٚ Hopping ٚ Speed bounding Reps, sets, recovery and strength training frequency?

SECTION HEADER

Completing exercises with moderate resistance, for example 60-80% of one repetition maximum for 3-5 sets of 5-15 repetitions, under supervision for 2-3 times per week has been reported to benefit running performance. For endurance runners, lifting to repetition failure is not recommended as this leads a high level of metabolic and neuromuscular fatigue. Avoiding repetition failure, along with the appropriate exercise dosage will assist to maximise neuromuscular adaptations, dampen the muscular hypertrophy response, and reduce the likelihood of post session Delayed Onset Muscle Soreness (DOMS).

It is important to remember that there is no one size fits all approach when it comes to strength training for endurance runners. Exercise selection, weight, sets, reps, and recovery times all depend on the individual’s needs, injury history, the timing of goal races, ability and training experience.

The TREK (Translating Research Evidence and Knowledge) exercise website developed by researchers from La Trobe University’s Sports and Exercise Medicine Research Centre (LASEM) is a great resource on all things exercise. The website offers evidence-based guidelines for prescribing resistance training exercises to develop muscular strength, power and plyometric qualities which can be applied to endurance runners. More information can be found here https://exercise.trekeducation.org/resistance-training/.

Where should a strength training session take place within a running program?

A well-planned strength training program should not negatively impact running sessions and therefore considering the timing and placement of a strength session within a running program is important. In order to maximise gains from strength training, it is recommended that at least three hours of recovery is allowed after high intensity running before completing strength training. To reduce the impact of fatigue on subsequent training performance following strength training, it is recommended to allow at least 24 hours of recovery before another high intensity running session is scheduled.

About the Author James Alexander is an APA Sport and Exercise Physiotherapist based in Port Stephens, NSW. As an avid distance runner himself, James has a clinical interest in the diagnosis, rehabilitation and prevention of running related injuries. In pursuit of this interest he is currently undertaking a research masters through La Trobe

Conclusion Endurance runners can gain significant performance benefits and possibly reduce the risk of overuse injury by undertaking a consistent strength training program. It is recommended that runners seek the assistance of an experienced health professional or strength coach to ensure they start out safely and get the most out of their strength training program.

University guided by experienced supervisor’s Dr Christian Barton and Dr Adam Culvenor. His research will investigate the prevention and management of knee pain in distance runners, with a specific focus on runners at risk of or with existing knee osteoarthritis.

References available on request VOLUME 38 • ISSUE 1 2020

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FEATURE: INJURIES IN RUNNING

ImpactGround Are More Strongly Associated with Some Running Injuries Than Others

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FEATURE: INJURIES IN RUNNING

-Related d Reaction Forces T

he general mission of the Spaulding National Running Center, as a running injury clinic and research laboratory, is to advance the prevention and treatment of runningrelated musculoskeletal injuries. More specific to our research laboratory, our main interest is identifying biomechanical factors that contribute to running-related injury.

One of these factors, that has been well published on, is vertical ground reaction force loading rates. Ground reaction forces are the forces exerted by the ground on a body that is in contact with it. When a body is completely still, these forces will equal a personâ&#x20AC;&#x2122;s body weight. However, when a body is in motion, like when a person is running, these forces increase due to the acceleration of the body. This is one of the reasons that sports and physical activity can lead to lower-body musculoskeletal injury, with movement-related increases in ground reaction forces placing higher stress or strain on the joints and musculoskeletal structures of the lower-body.

We can also measure ground reaction forces in several directions: vertical, anteriorposterior, and medial-lateral (see figure to the right). During running, and most activities,

forces in the vertical direction are, by and far, the largest. Peak vertical forces during running are generally over ten times higher than either anterior-posterior or medial-lateral forces. For this reason, the vertical forces often receive the most attention, relative to injury risk.

Vertical ground reaction force loading rates describe the rate of increase in the vertical forces directly after the foot contacts the ground during running. In essence, this variable describes how quickly vertical forces are applied to the lower-body. This is important for injury, because certain musculoskeletal structures have been shown to be more susceptible, in terms of injury risk, to high rates of strain/stress versus high magnitudes or peak strains/ stress. However, as noted in a recent systematic review by Henk van der Worp and colleagues, there have been inconsistencies in the literature regarding the association of vertical loading rates and running injuries.

With this study, we wanted to explore a potential reason for this inconsistency; the grouping of all types of running injury together. This is commonly done in past literature, where instead of investigating specific types of injury (e.g., patellofemoral

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FEATURE: INJURIES IN RUNNING

pain, iliotibial band syndrome, hamstring muscle strains), all injuries are grouped together to increase the sample size of the injured group. We wanted to see if specific injuries are more or less associated with loading rates, and therefore grouping them all together has the potential to wash out these injury-specific associations. Our study included 125 injured runners who presented to our clinic with one of five types of running injury: patellofemoral pain, tibial bone stress injury, plantar fasciitis, Achilles tendinopathy, or iliotibial band syndrome. We chose these injuries because they are five of the most prevalent injuries in runners. We compared the injured runners, as a whole group and as separate groups by injury type, to 65 healthy controls.

Our main finding was that, like we hypothesized, specific injuries were driving associations between runningrelated injury and vertical loading 10

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whole group versus healthy controls.

Although, when looking at specific injury types, only means for the patellofemoral and plantar fasciitis groups were statistically higher.

rates. These specific injuries included patellofemoral pain and plantar fasciitis, which have been associated in the past with higher vertical loading rates. We found that mean vertical loading rates were statistically higher in the injured runners as a

We also developed Receiver Operator Characteristic curves (ROC curves) to attempt to identify general and injury-specific thresholds for vertical loading rates. We found that levels of 58-67 BW/s (vertical instantaneous load rate) were the best separators of injured vs uninjured runners for specific injuries. Additionally, looking at several criteria used to evaluate how well a variable can identify injured versus uninjured runners, associations were much stronger for specific injury groups versus grouping all injuries together. This further supported our original hypothesis.

One surprise was that we did not find an association between vertical loading rates and tibial bone stress injuries, which has been found in

FEATURE: INJURIES IN RUNNING

One surprise was that we did not find an association between vertical loading rates and tibial bone stress injuries, which has been found in previous literature. previous literature. One potential reason for this is that we included all bone stress injuries, along the spectrum of early grade stress injuries to full stress fractures. Most previous literature has focused only on full stress fractures. A second surprise was that we found several associations with a variable called vertical stiffness, which is an estimate of the amount of vertical forces being absorbed by the lower extremities over the early stance phase during running. Along with patellofemoral pain and plantar fasciitis, we found associations with Achilles tendinopathy and vertical stiffness. Additionally, using the ROC curve analyses described above, we found that vertical stiffness may be a better identifier of plantar fasciitis than vertical loading rates. This variable has not been reported on frequently in past literature, so it is something to look further into in future research.

may be inappropriate when attempting to identify biomechanical factors related to injury. Different types of injury involve different musculoskeletal tissues, in different anatomical locations, with different alignments, etc. Therefore, it makes sense that not all types of injury would have the same association, or degree of association, to a given biomechanical risk factor.

It is also important to note that while these variables were associated with injury, based on mean differences and odds ratios, the area under the

curve for ROC curve analyses and sensitivity/specificity of the selected thresholds were not overly high. Along with the fact that we only looked at ground reaction force variables, and with a retrospective design, our work cannot support the notion that vertical loading rates are the dominating cause of patellofemoral pain and plantar fasciitis. We can only say that our works supports it as a contributing factor.

Click here to access Calebâ&#x20AC;&#x2122;s full research article in The American Journal of Sports Medicine.

About the Author Caleb Johnson is a Post-doctoral Fellow under Dr. Irene Davis, at the Spaulding National Running Center and Harvard

To conclude, this work provides evidence that there is a role of reducing vertical loading rates on the management of several specific running injuries; plantar fasciitis and patellofemoral pain. In this effort, we also identified specific values that appear to be good targets to reduce vertical loading rates below. There are a number of gait retraining methods for reducing the rate of vertical loading that have been well supported in previous literature, including foot strike angle modification and biofeedback with wearable sensors. Our study also provides evidence for the notion that grouping all types of running injuries

Medical Schoolâ&#x20AC;&#x2122;s Department of Physical Medicine and Rehabilitation. He did his PhD at the University of Pittsburgh, in Rehabilitation Science. His research focuses on the causes of, and successful treatment strategies for, musculoskeletal injury. This includes injuries in various populations, including runners, athletes, military personnel and US Special Forces Operators. His most current research focuses on the use of wearable sensors to capture measures of cumulative mechanical loading during running in a real-world environment, and how these measures relate to the risk for injury.

References available on request

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FEATURE: WHEN WE RUN

“when we run, our spirits fly” D dopamine O oxytocin S serotonin E endorphins

AS THE FOUNDER OF DOSE RUNNING, I AM FORTUNATE ENOUGH TO DEDICATE EVERY SINGLE DAY TO NOT JUST COACHING, TEACHING, AND EDUCATING, BUT ALSO TO LEARNING.

‘Fixing’ someone’s technique can be costly, so be wary when altering someone’s biomechanics/running gait.

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learn not only from my athletes, but from studying the research and knowledge of Doctors, Physiotherapist, Sports Bio Mechanists, Podiatrists, Exercise Physiologists, World Champions and more. Taking the learnings of experts and applying the evidence to my coaching is integral, and today I am going to stress the importance and value of running specific drills.

Stop stretching. Stop doing butt kicks You can do better than that.

In a typical week I get to coach over 200 different runners, that’s 200 unique bodies! Age varies from six years through to my eldest client of 60 years. I work with deconditioned and/or injury susceptible bodies in my ‘Learn & Return’ to run classes, to fiercely fit recreational athletes running ultra-marathons to sub 36 minute and ten kilometres and everyone in-between. I coach runners with varying anatomical make ups and alignment, varying hormones, strengths, goals and experience. What they do all have in common is a primarily sedentary day-to-day due to their careers.

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Running specific drills should be used for movement preparation, maintaining and developing health, range of motion, movement and alignment, efficient recruitment of muscles and allowing tissue to adapt while refining run technique so that they can transfer these skills into intervals, threshold, tempos and long runs.

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Firstly, assess their load and ability to adapt to that load/programming, that they’re conditioned to tolerate applied loads of force when running or performing drills. When we run, external force is anywhere between 1.5 times body weight to three times your body weight, whilst internal tissue load can be up to 14 times. When you change someone’s technique, you are shifting the load somewhere else. If they don’t have the ability to tolerate that load yet, you’re increasing their risk of injury rather than reducing it.

The graph below lists 30 reasonably common running drills and exercises, along with their key benefit for running. If you’re incorporating running specific drills for a runner or a group of runners, ask yourself what is the goal of this drill? Someone who feels unstable in their ankle is likely to benefit from glute med activation exercises pre-run rather than ankle circles, whilst someone who has a slow cadence and sinks heavily into the ground is likely to benefit from cadence drills prompting

FEATURE: WHEN WE RUN

recruitment of elasticity. A runner who reaches out in front of their centre of mass might benefit from incorporating some drills barefoot for enhanced proprioception to improve their running gait. The key is to identify their vulnerabilities and mindfully incorporate running specific drills to improve running efficiency, performance and reduce risk of injury.

Pre-run, go for variety, start with alignment, mobility, stability or activation as appropriate to the athlete, then progress into more cadence and coordination drills.

About the Author Scarlett Duncan

ٚ BSc Preventive Health Specialising in Exercise and Sport Science ٚ Athletics Australia qualified coach ٚ State-Champion ٚ Ultramarathon runner ٚ 10+ years of coaching experience Scarlett Duncan’s career highlights include running a 36.05 10kilometre at 19 years of age, and more recently running the Tarewera Ultramarathon 2020

Post-run, I emphasis mobility. Although there is very little evidence of stretching, if it feels good and it’s not harmful, then allow the runner to enjoy it.

(50km) in sub five hours (3rd in age category/ 35th out of over 1000 men and women). At 20 years of age I was diagnosed with Rheumatoid Arthritis, a condition that has taught me a lot of compassion and empathy, especially when working with the recreational runner. I know what it feels like to experience chronic pain and feel 100 years old, and that it is possible to work through that. Coaching career highlights include developing the DOSE Running & Pilates 8 Week Programs, resulting in injury free runners obtaining PBs in 5 kilometre, 10 kilometre, half-marathon and full marathon. I also love the challenge of private running coaching the injury-stricken runner, it’s incredibly rewarding transforming someone’s ability to run efficiently and pain free by assisting them to move better and gradually tolerate and adapt to increased load.

Running coaching has typically been programming and load progression, however my approach places much emphasis back on movement, and the results have been outstanding.

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FEATURE: WHEN WE RUN

“when we run, our spirits fly” Refining Running Gait Drills

Strength & Stability Drills

Mobility Drills

Drills that encourage optimal movement in contact time (such as stance phase) and flight time (such as swing phase)

Running is more like flying than walking, you're in the air or on one leg, which requires single leg strength and stability

Motion is like lotion for your connective tissues. Mobility improves your joints ability to actively access your full range of motion. Injury occurs at end of range. Range of Motion is valuable for unlocking strength and power.

Traffic light

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Pulls (a merge of high knee with butt kick)

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Quick skips, A skips, B skips

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Barefoot running

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Single leg smooth transition, Knee hug from, quad stretch, number 4 stretch, tree pose Soleus squat to tippy toes

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Alternating high knee hug Alternating high knee clap

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Sprinting

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Scissor bound

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Sumo Squats Duck walks

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Invisible hurdles

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Spinal roll down to forward fold

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Low Leg Skip

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Ankle circles

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Backwards running

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Backwards skipping

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3-5 sprints to bound

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Hop off one leg then on to the other (eyes closed for challenge)

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Dynamic hamstring scoops

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Side steps

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Grapevine

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Quadraped

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Deadbug

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Wall 4 (standing isometric holds with ball & other variations)

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Resistance band exercises

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Lateral bounding

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Mini hurdles Single leg exercises (deadlifts etc) 14

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FEATURE: WHEN WE RUN

Activation & Alignment Drills/ E ercises

Cadence Drills

Coordination Drills

Activation exercises engage important muscles such as gluteus maximus and gluteus medius that need assistance recruiting for use, whilst dynamic alignment exercises encourage efficient, coordinated and healthy movement for the individual. Remember that people have anatomical differences, therefore the shape of their pelvis and femur for example will influence their squat, or even their running gait pattern. There is no one correct way to run.

Cadence refers to the amount of steps we take per minute, and in a very general sense that’s 180 steps per minute, or over 10,000 steps in a 60 minute run. A slow cadence (i.e. 150 steps per min) results in high ground contact time, and high ground contact time is associated with increased risk of injury. A quick cadence makes accessing elasticity (stored energy) more attainable, making you more efficient.

One's ability to organise and execute multiple elements/ movements to work together effectively and smoothly.

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Running FEATURE: RUNNING IN HEAT

Preparation and considerations for running in the heat ACCREDITED SPORTS DIETITIAN, ALAN MCCUBBIN, SHARES HIS EXPERTISE AND UNIQUE INSIGHTS FOR ENDURANCE AND ULTRAMARATHON RUNNERS ON HOW TO MAINTAIN THEIR LEVEL OF PERFORMANCE AND REDUCE THEIR RISK OF ADVERSE HEALTH OUTCOMES WHEN RUNNING IN HOT ENVIRONMENTS.

P

lacer High School, in California, The United States takes great pride in their football team, the Hillmen. Their field is perfectly manicured in alternating shades of green and a giant letter ‘H’ proudly painted in the centre.

But one night each year in June, it’s the surrounding athletics track that gets all the attention. June 23rd 2012 was extra special. That evening, course records were shattered in the Western States Endurance Run, a 100-mile ultramarathon starting in Squaw Valley and finishing on the Placer athletics track in Auburn.

and he was regularly consuming significant amounts of carbohydrates throughout the race itself. What was lost in all the low-carb mania, was the weather conditions on that day – at least 10 degrees cooler than most of the previous editions of the event.

Ask any endurance runner, and the vast majority will intuitively know that hot weather makes them slower. These endurance runners may not be aware of the variety of ways they can prepare for the heat in order to minimise this effect on their performance and reduce the risk of any adverse health outcomes.

The position statement, which is free to download in the International Journal of Sport Nutrition & Exercise Metabolism, explains the effects of heat on athletes during exercise, and provides practical strategies to mitigate these effects.

In the weeks that followed, online discussion and analysis centred on the men’s winner, Timothy Olson, who became the first runner to break the 15-hour barrier for the race. Olson became a poster boy for the low-carb, high fat diet movement, with many crediting his eating habits for the course record. Subsequent interviews and Olson’s own blog however, soon showed that his diet wasn’t nearly as low carb as many had claimed,

At the beginning of January, Sports Dietitians Australia published a position statement on nutrition for exercise in hot environments with a view to the upcoming 2020 Tokyo Olympics, expected to be the hottest in modern history. The position statement was the result of a multidisciplinary collaboration of 18 co-authors, including Associate Professor Ollie Jay, a thermal physiologist at the University of Sydney, who created the heat index for

The physiology of heat stress The body’s temperature during exercise is a balance of heat gained and lost. Heat is generated from muscle contractions during exercise (the greater the running speed, the greater the rate of heat production), as well as any heat gained from the environment (radiant heat from sun exposure, and convective heat gain if air temperature is greater than skin temperature).

Conversely, heat can be lost by

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Cricket Australia and Tennis Australia, including the 2019 Australian Open, Dr David Hughes, Chief Medical Officer at the Australian Institute of Sport, and Professor Louise Burke OAM, Medal of the Order of Australia, Head of Nutrition Strategy at the Australia Institute of Sport amongst others.

Hot

FEATURE: RUNNING IN HEAT

Ask any endurance runner, and the vast majority will intuitively know that hot weather makes them slower.

convection when the air temperature is lower than skin temperature, but the main cause of heat dissipation during exercise is the evaporation of sweat from the skin surface. The effectiveness of sweat evaporation as a means to cool the body is highly variable, and depends on humidity, airflow (eg. increased speed on a bike compared to running, outdoor (moving) vs treadmill (stationary) running, the use of fans indoors, etc.), clothing and equipment (which can impede evaporation).

Because of this combination of factors (exercise intensity, environmental conditions, clothing and equipment), it is impossible to give a single temperature, beyond which the level of heat stress increases.

What is clearer however, is the effect of heat stress on a runner’s body. Firstly, a rise in core temperature of just 0.2ºC results in blood flow redistribution away from vital organs and towards the periphery, which increases the ability of heat to be lost through convection and radiation when air

temperature is low enough. If this mechanism is insufficient, sweating is initiated to facilitate evaporative cooling. If these mechanisms cannot dissipate enough heat from the body, body temperature continues to rise, known as uncompensable heat stress.

Increasing body temperature has specific physiological impacts on the runner. Firstly, it is well documented that a higher body temperature results in cardiovascular strain, where reduced blood volume, combined with the increased activity of the sympathetic nervous system (a response to both exercise stress and increased body temperature), results in an elevated heart rate and reduced stoke volume (the amount of blood pumped from the left ventricle of a person’s heart in one contraction).

This cardiovascular strain, if significant enough, can lead to impairments in aerobic exercise performance.

Health effects of heat stress during exercise The health effect of heat stress on

runners during exercise, ranges from short-term and inconvenient, through to life-threatening. At the mild end of the spectrum, heat exhaustion is usually characterised by a rectal temperature of 38.5-40ºC, dehydration, sometimes hot dry skin due to an absence of sweating (brought about by severe dehydration), and often results in heat syncope (fainting), the most common cause of collapse in runners. This most commonly occurs just after crossing the finish line. While running, venous return is maintained by muscle contractions (particularly the calf muscles), which pump blood back towards the heart.

The increased blood flow to the skin in hot weather results in reduced venous return, exacerbated by dehydration and reduced blood volume. The cessation of running causes a sudden drop in blood pressure, causing the athlete to collapse.

Athletes experiencing heat syncope usually respond well to leg elevation and fluid intake.

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FEATURE: RUNNING IN HEAT

Heat exhaustion can occur during exercise and is caused by the inability to maintain cardiac output, due to the demands of exercise, often exacerbated by a loss of blood volume through dehydration. At this stage, some damage to internal organs or tissue can occur. As well as an elevated heart rate and reduced blood pressure, athletes can experience headaches, profuse sweating and gastrointestinal symptoms. Treatment includes reducing or ceasing exercise, cooling, and rehydration.

Exertional heat stroke represents the

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worst-case scenario for runners training or competing in the heat. A multisystem condition, and a true medical emergency, it is characterised by disturbances in central nervous system function, such as altered behaviour, delirium, seizures, coma, and organ or tissue damage. It is often but not always associated with a rectal temperature above 40ºC. Immediate medical treatment includes maintaining airways, breathing and circulation, rapid cooling (cold water immersion is the treatment of choice), intravenous fluids to maintain cardiac output and blood pressure, the use of ice packs, iced towels and fans to

aid cooling, and transferring the athlete to an emergency medical facility.

Gastrointestinal disturbances are frequently reported during endurance running and are more common and more severe when running in hot, compared to cool conditions.

This is because the two main physiological processes that can lead to this – reduced blood flow to the gastrointestinal (GI) tract and the increased activation of the sympathetic nervous system (SNS) – are both exacerbated by heat. The increased SNS activity reduces GI tract function

FEATURE: RUNNING IN HEAT

as well as movement of food and fluids through it, both of which can lead to problems for the runner. The reduced blood flow to the gut also increases the risk of damage to the cells lining the GI tract, which if severe enough can result in bacterial by-products (endotoxins) entering the blood stream, causing an immune response. Given there are multiple causes and contributing factors to GI disturbances during running, athletes are encouraged to see a comprehensive assessment to determine the specific cause/s, and tailor a solution to resolve the issue. This will often include the general strategies designed to mitigate the effect of heat on other health and performance outcomes, such as appropriate heat acclimation, hydration, and body temperature regulation.

Other proposed strategies that do not address these primary causal pathways, including the use of amino acid supplements, probiotics, hydrogel sports drinks, colostrum, and NSAIDs (Non-steroidal Anti-inflammatory Drugs), have in general failed to reduce the incidence or severity of GI tract symptoms to any significant degree.

Performance effects of heat stress during exercise The effect of heat on running performance depends on the intensity and duration of running. During sprinting, performance is actually improved through increased muscle temperature, which is thought to improve both metabolic and contractile function. However, repeated sprint efforts may be impaired due to reduced recovery between sprints. Middle-distance running appears relatively unaffected by heat, but beyond about 30 minutes of running, increased body temperature progressively impairs performance. As well as the issue of cardiovascular strain already mentioned, there is evidence of reduced voluntary drive (i.e. motivation and reduced pacing during running), and with longer events, the increased risk of gastrointestinal disturbances.

Given the potential health impacts, and reductions in performance for endurance running, much emphasis has been placed on practical strategies to mitigate the effect of heat stress on runners.

Strategies to mitigate heat stress Given the potential health impacts, and reductions in performance for endurance running, much emphasis has been placed on practical strategies to mitigate the effect of heat stress on runners.

The most obvious and beneficial strategy to runners is to ensure they are heat acclimatised or acclimated prior to running in hot conditions.

Acclimatisation is the normal process of adapting to a hot environment, such as travelling from a cool to a much warmer geographical location, or the transition from winter to summer.

Acclimation is an artificial process of adaptation, where the athlete exercises in a hot environment, or uses other methods of heating such as a hot tub or sauna. Repeated heat exposures, causing an elevated core temperature for at least an hour a day, results in a range of beneficial adaptions that help athletes perform in hot conditions.

These include the expansion of blood volume and subsequent reduction in heart rate at rest and during exercise; reduced core temperature at rest and during exercise; an earlier and greater rate of sweating, with a subsequent reduction in urinary and sweat sodium losses; and the reduced perception of effort in hot conditions. The timeframe

needed to achieve these adaptations varies, but takes up to 14 consecutive days of acclimation to achieve the full effect. It is important to note that the effects of heat acclimation appear to decline by around 2.5% per day if acclimation is interrupted (eg. by travel). Therefore, it is important to time heat acclimation around the athleteâ&#x20AC;&#x2122;s schedule and availability.

Hydration Given the role of sweat loss in maintaining core body temperature, appropriate hydration is an important part for running in hot environments.

However, recommendations for both fluid and sodium intake in athletes have often been controversial, with a polarised debate developing in recent decades. Regardless of this, all existing guidelines recommend that athletes should aim to begin exercise well hydrated. While urine colour, osmolality (the level of concentration per kilogram) or specific gravity have often been used for this purpose because they are easy and costeffective, these markers can often be unreliable, particularly during heat acclimation and/or consecutive days of prolonged exercise. This is because urine markers are not a direct measure of hydration status, and instead reflect recent action by the kidneys to maintain optimal hydration status, rather than the actual hydration status itself. Therefore, urinary markers are only considered valid in well rested athletes, using first-void urine samples.

Instead, a practical combination of urine colour, daily variation in body weight, and thirst combined may be a more reliable indicator; if body weight is reduced along with darker coloured urine and increased thirst, then hypohydration is likely.

Strategies have been employed for situations where large sweat losses occur during exercise that canâ&#x20AC;&#x2122;t be easily replaced, and there is a desire to reduce the fluid deficit that occurs during exercise. Combining fluid VOLUME 38 â&#x20AC;˘ ISSUE 1 2020

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RUNNING IN HEAT

with ingredients that reduce urinary fluid losses pre-exercise, can increase blood volume and total body water above resting levels (hyperhydration).

The most commonly studied hyperhydration strategies are preexercise sodium loading (to make a sodium concentration as close to plasma sodium as possible whilst still being tolerable) and the use of glycerol, combined with fluid intake of ~10mL per kilogram of body weight. Glycerol was banned by WADA (World Anti-Doping Agency) in 2010 as it was believed it could be used as a masking agent for other banned substances. However, the ban was lifted in 2018, and glycerol can now be used in competitive runners.

Both sodium and glycerol loading are complex nutrition strategies, and should be discussed with an Accredited Sports Dietitian with expertise in this area.

During running, debates about drinking due to thirst versus planned drinking are often academic, since fluid availability, opportunities to drink, and gut tolerance often dictate a runner’s fluid intake. Physiologically speaking, the majority of the research suggests that a 2-3% (or more) deficit in body mass caused by reductions in total body water increases rectal temperature, heart rate and impairs performance in moderate and high-intensity exercise.

Ultrarunners should be aware that substrate oxidation and glycogen depletion can result in significant body mass loss during prolonged running, and so the body water deficit will be less than indicated by weight change alone. Athletes should at least, plan to have access and opportunity to drink a minimum amount of fluid, based on prior assessment of sweat rate in similar conditions, whilst maintaining flexibility in their plan to adjust the rate of drinking depending on feedback (e.g. thirst and gut tolerance), and understanding that sweat rate varies up to 10% from day-to-day in identical conditions, and temperature, wind speed and humidity can all vary from hour to hour during endurance running events. Some runners cannot tolerate 20

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the fluid required to maintain adequate hydration status, and frequently suffer from exertional heat illness and/or gastrointestinal symptoms as a result. These athletes may require specific gut training to increase gastric fluid volume tolerance. This can be advised by an Accredited Sports Dietitian with expertise in this area.

Sodium replacement during exercise is also regularly debated. Currently, there are few studies on sodium intake and performance, and of those, most were not performed in hot environments, making practical recommendations difficult. The reason for consuming sodium during exercise is to balance water intake as a replacement for sweat losses, and therefore minimise shifts of fluid between the intracellular and extracellular spaces, as well as improve fluid retention by reducing the drive to excrete fluid through the kidneys.

Because of this, the most logical

approach to sodium replacement is to consume sodium in proportion to fluid intake, rather than replace based on total sodium losses (i.e. plan sodium intake in milligram per litre of fluid consumed, based on the anticipated sweat sodium concentration, rather than milligram per hour of sodium based on losses). This approach however, has not been studied in order to validate its use and incorporate it into sodium intake guidelines for athletes, which to date remain non-specific.

Post-exercise rehydration needs vary according to the exercise completed, the timeframe for recovery, and the needs of the next exercise bout. As a general rule, to achieve rapid rehydration, a volume of fluid of up to 150% of the fluid loss during the session should be ingested in the first four hours post-exercise. A “Beverage Hydration Index” was devised to rank the ability of different beverage types to be retained rather than urinated

FEATURE: RUNNING IN HEAT

slushies pre-exercise). While a variety of strategies can be effective, practical considerations will often dictate which can be used. It’s important to note that ice slushies sound like a great solution, but to achieve a meaningful reduction in core temperature, a large volume (i.e. >700mL) is required, which can be time consuming, and increase the need for a toilet stop whilst running. Then there’s the potential issue of “brainfreeze” (or “ice-cream headache”) – this can be resolved by warming the roof of the mouth by pressing your tongue against it. During running, drink temperature also appears to play a role in running performance, with drinks <10ºC having greatest benefit. This is not always easy to achieve in the real-world however, but strategies like partially freezing drink bottles, or storing drinks on ice until they need to be consumed can provide options in some scenarios.

out when consumed post-exercise.

However, recent work suggests that when food is consumed alongside fluids, then the choice of beverage becomes largely irrelevant, and the choice of beverage can therefore be based on the other nutritional needs of the athlete.

Cooling Strategies Other strategies to improve performance and minimise the risk of exertional heat illness during running include those that deliberately lower core body temperature, either before (pre-cooling) or during (per-cooling) running. These strategies are thought to be particularly useful in humid environments, where the evaporative cooling effect of sweat is limited. Precooling strategies include a variety of options, including external cooling (i.e. ice baths, cooling vests, water spray with fans, towels dunked in iced water, etc.) and internal cooling (i.e. consuming very cold water or ice

Thermal Perception Another strategy is to not actually lower body temperature, but instead alter the perception of body temperature.

A cooling sensation (despite no actual change in body temperature) can be achieved with the use of L-menthol, either with topical agents (gels, creams, etc.), or taken orally, usually as an ingredient in confectionary (e.g.

Fisherman’s Friend, Sour Patch Kids Freeze lollies). Whilst menthol solutions can be made from raw ingredients, it is strongly advised not to attempt this: the dose required is measured in milligrams, and overdosing can cause significant harm (e.g. internal burning) or fatality. It should also be noted that interfering with thermal sensation may increase the risk of exertional heat illness in some athletes, as they lack the increased perception of effort from heat stress that is designed to protect the body from harm.

be lower than adults, but will increase throughout adolescence. For this reason, a combination strategy of external cooling (e.g. iced towels) and adequate hydration may be more effective. The most significant factor with juniors however is logistical. Ensuring young athletes have adequate fluid availability (i.e. education for parents and coaches), and opportunities to drink (i.e. coaches and race officials) will significantly influence fluid consumption behaviours.

Summary Running in the heat adds additional physiological challenges that influence health and performance. However, taking steps to minimise the effect of heat, including heat acclimatisation/ acclimation, appropriate hydration practices before, during and after exercise, and potentially using strategies to either reduce body temperature or reducing the perception of heat, can all play a role in optimising outcomes for the runner.

About the Author Alan McCubbin is an Accredited Sports Dietitian and postdoctoral researcher at Monash University.

He has 15 years’ experience working with endurance and ultra-endurance athletes, from recreational to Olympians, and

Junior Athletes As a general rule, junior athletes sweat less than adults for the same level of heat stress but may be more effective at cooling through convection and radiation. Their fluid requirements during running are therefore likely to

in 2019 completed his PhD research investigating the sodium intake practices of endurance athletes, and the implications for health and performance.

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FEATURE: WEARABLE TECHNOLOGY FOR RUNNERS

Runners’ Perspectives on

‘Smart’ Wearable Technology

and its use for Preventing Injury (Postdoctoral Research)

F

or the past several years, wearable technology has been a top worldwide fitness trend and continues to be a multi-billion-dollar industry. Some of the most common products include activity trackers, smart watches, heart rate monitors, and GPS tracking devices. In fact, over 75% of runners use wearable technology and running-related apps to record their training on a consistent basis.

Therefore, with wearable technology collecting considerable amounts of important data, the market is poised to help runners improve performance and prevent injury by providing summarized reports about training and running patterns.

There are several products on the 22

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market that use scientifically justified data to capture running biomechanics, technique and training information in order to inform the runner about performance and injury. However, very little work has entirely explored the runners’ perspectives and preferences about the functionality and use of wearable technology. Understanding the user experience between runners and wearable technology is a crucial step for companies to design more personalized and meaningful products. To better understand this, we conducted a research study to: ٚ Gain insight into the characteristics of runners who use wearable technology;

ٚ Better understand runners’ attitudes and beliefs towards wearable technology; and ٚ Identify which wearable technology metrics were perceived to be the most important for preventing running-related injury.

Our research group designed a survey, entitled Wearable Technology for Runners, that asked runners several questions about their perspectives and preferences for wearable technology.

The survey was shared through social media, Running Room Ltd. magazine, and through word of mouth. 663 runners who use wearable technology completed the survey. Although most of the respondents included Canadian

FEATURE: WEARABLE TECHNOLOGY FOR RUNNERS

preventing running-related injuries.

As a result, this information could be used to make more personalized wearable technology that will be more meaningful depending on performance or experience levels.

The most common type of device for all runners was the GPS-enabled sports watch, but this trend was shown to be significantly more common in competitive runners. For recreational runners, mobile phones, apps, and wristband activity trackers were more popular. It appears more competitive runners, who train more frequently, prefer the more sophisticated, running-specific GPS sport watches compared to less advanced running apps and wristband activity trackers.

Most recreational runners reported that running was not their main form of physical activity, so it makes sense that these runners prefer wearable technology that can track more activities than just running.

As well as this, wearable technology purchases are clearly influenced by weekly participation and experience level, where competitive runners are more inclined to purchase more expensive and sophisticated running-specific GPS sport watches and recreational runners seem to prefer multi-sport activity trackers. residents, the sample’s characteristics line up well with the representation of the general running population.

Most respondents were female (63%), between 30-49 years of age (54%), and stated that running was their main form of physical activity (65%) by running at least 2-3 times per week.

Previous research has shown that different types of runners – recreational vs. competitive, for example – use different types of devices, so we decided to divide our runners into two groups based on whether they ran less than or greater than four days per week. We found important differences between recreational and competitive runners in the usage and perspectives on wearable technology and its role in

As sports scientists, it was interesting for our research team to find that body-worn sensors were the least used wearable device, despite the most common location for wearable devices in running-related academic research has been the foot, leg, and lower back. This result might be due to the low number of valid, reliable, and affordable body-worn wearable technology in today’s market.

Some companies are beginning to make advancements in this area, but the output delivered from many of these devices do not provide any high-level reports to characterize runner-specific ‘typical’ running patterns and predict how

and when these patterns become ‘atypical’ due to fatigue, performance decrements, or overuse injury.

More work is clearly needed to use the data from commercially available wearable devices in our research studies that can help scientists bridge the gap between the research community, wearable technology industry, and each individual runner. This type of research will help determine appropriate and meaningful information that can improve technology during training and rehabilitation in realworld running environments.

For the second goal of our study, we wanted to know the motives for runners using wearable technology data. We found that the overwhelming reason runners used wearable technology was to track training data, but competitive runners were much more interested in tracking personalised data related to training and running biomechanics.

Recreational runners preferred to use their wearable technology simply as a motivation to get out and run.

Evidently, certain features should be included or added in wearable technology devices depending on the runners needs. For more competitive runners, information related to training and running biomechanics is desired to maintain their interest and usage of wearable technology, whereas recreational runners want more features that help them stay motived and adhere to their running program.

When we asked runners, “What specifically motivates you from your wearable technology?”, most participants answered with “If I met my goal.” Moreover, many runners stated that their data influenced their plans almost all the time with the main reason being to improve performance and avoid injury.

Nevertheless, runners want more accurate data, personalisation,

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FEATURE: WEARABLE TECHNOLOGY FOR RUNNERS

meaningful outputs, and better comfort from their device as these were all important factors related to wearable technology. Along with the potential for real-time feedback, our research study provides strong evidence that these features with better personalized data tracking are crucial for ensuring long-term use of wearable technology in running.

Our final objective for the study was to find out which metrics runners believed were most important for injury prevention. Most runners chose more conventional, basic wearable technology derived metrics (e.g., distance, speed, time, and heart rate) to be important. On the other hand, more advanced, biomechanical metrics (e.g., joint motion, ground contact time, and centre of mass motion) were perceived to be either less important or the respondents were not sure how these metrics related to injury prevention, specifically.

However, we did find that competitive runners rated cadence (or step rate) with greater importance, stating that higher cadence would lower their risk of injury. This finding is encouraging because academic and clinical research shows a 5-10% increase in cadence can be a modifiable parameter to reduce the risk of running-related injuries, especially with knee pain. Regardless, running-related research consistently demonstrates the interrelationships between joint angles, ground reaction forces, and centre of mass motion are necessary to better understand the complex etiology of runningrelated injuries. We believe these findings are not only important for wearable technology companies to better implement these valuable measures in their devices, but it also means more effective knowledge translation practices are needed for researchers and clinicians to present scientific findings in a way that the runner will find meaningful.

To conclude, our study was the first to extensively examine the attitudes and beliefs about running-related wearable 24

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technology amongst a large cohort representative of the general running community. We identified certain areas in which preferences differ between competitive and recreational runners.

Encouragingly, runners believe wearable technology is important for tracking personalised data to improve performance and prevent injury, but more competitive and experienced runners prefer more advanced metrics and recreational runners mainly use fitness tracking devices to increase their motivation to run. Understanding these preferences between recreational and competitive runners can help wearable technology companies implement more personalized features with more meaningful outputs. This will help runners and clinicians ultimately improve performance and reduce the risk of injury at a more personal level.

Based on the data from this survey, we recommend that wearable technology companiesâ&#x20AC;&#x2122; partner with research scientists to validate their devices and incorporate effective data science methods to dive deeper into the running patterns.

These partnerships will create more meaningful data metrics and improve the user experience. Our research group at the University of Calgary

continues to develop novel data science methods using wearable technology data in order to identify typical and atypical running patterns in competitive and recreational athletes. Carefully understanding each runnerâ&#x20AC;&#x2122;s personalized data and their user experiences with wearable technology is crucial to help runners, clinicians, and scientists improve performance and prevent injury.

One way that we continue to improve wearable technology research is through the launch of the Wearable Technology Citizen Science program.

Launched in June 2020, we have built a Level-4 secure research web-portal to allow individuals to voluntarily upload their wearable technology data to a secure database at the University of Calgary. We are first focusing on Garmin, Fitbit, and Suunto wearable devices and will continue to add more manufacturers to this list. Overall, we seek to use the data for studies such as understanding heart rate and stress levels while cycling, improving urban planning, investigating sleep patterns and its effect on quality of life for clinical patients, and injury prediction for runners. We encourage you to become a Citizen Scientist by visiting www.wetrac.ucalgary.ca and contributing to this exciting initiative.

FEATURE: WEARABLE TECHNOLOGY FOR RUNNERS

About the Authors Dr. Christian Clermont

Dr. Blayne Hettinga

Dr. Christian Clermont is a Postdoctoral

Blayne Hettinga PhD is a Director Sport

Fellow in the Faculty of Kinesiology at the

Science within the Future department

University of Calgary researching the use of

at adidas. The Future department is

wearable technology for the collection of

responsible for research and innovation

human biomechanics data in the fields of health and sports

to fuel the future of the adidas brand through disruptive

science. He currently holds a research fellowship from the

new products. Blayne leads the Product Science team

Canadian Institutes of Health Research, and is a member of

specifically focused on identify and maximizing the

Sport Insight, conducting sports science and biomechanics

authentic functional benefit for the athlete of these new

research to develop, evaluate, and validate products to

products. Working in a collaborative environment with a

improve athletic performance and reduce the risk of injury.

team of diverse experts that are driven by curiosity makes

Dr. Clermont is also a trained professional in high level data

every day exciting. He is passionate about sport and truly

analysis, such as pattern recognition and machine learning,

believes that sport can make the world a better place.

to the quantify the complex nature of human movement.

Previously, Blayne completed his PhD in Sports He completed his PhD in Kinesiology at the

Biomechanics focusing on optimizing sports equipment

University of Calgary with the Running Injury Clinic.

for individual athletes at the University of Calgary.

His work focused on running biomechanics in

Afterwards, he was Director Research and Development

recreational and competitive athletes and the use

for the Running Injury Clinic where he was involved

of wearable technology and data science methods

in developing new methods to collect research

to detect typical and atypical running patterns.

quality gait biomechanics at multisite locations while populating a 3D running biomechanics database

Dr. Linda Duffett-Leger

and enabling subsequent research projects.

A registered nurse and certified user experience designer, Dr Duffett-Leger’s

Prof. Reed Ferber

program of research focuses on using

Professor Reed Ferber has joint

participatory design methods in the

appointments across the Faculties of

co-design of wearable and mobile technology solutions to solve real-world clinical problems. A key member of the Biomedical Engineering (BME) community at U of C, Duffett-Leger is co-lead of the BME Research focus in Health and Monitoring and Management. She is an active member of the STiMM (Sensor Technology in Monitoring Movement) program, funded through the UCalgary BME Strategic Health Research Initiative, and the Natural Sciences and Engineering Research Council (NSERC) CREATE We-TRAC (Wearable Technology Research and Collaboration) program — a unique training program focused on the biomechanics of

Kinesiology, Nursing, and the Cumming School of Medicine at the University of Calgary. He is the founder and director of the Running Injury Clinic and internationally recognized as a leading expert in biomechanics research using wearable technology for the prevention and treatment of musculoskeletal injuries and disease. Currently, he leads a team of UCalgary researchers in the NSERC Wearable Technology Research and Collaboration (We-TRAC) CREATE Training Program to train the next generation of wearable technology experts.

Click here to view the original research article

human motion, data science, visualization, knowledge translation and entrepreneurship for the wearable tech sector. Dr. Duffett-Leger has been actively involved in community-based research for over a decade, and has collaborated with the CHILD studies program since 2003, co-publishing several studies on the development of support interventions to ameliorate the impacts of postpartum depression on the family. Dr. Duffett-Leger is currently leading a Canadian Institutes of Health Research (CIHR) funded study to design two in-home/ in-clinic parenting interventions (CHILD studies) for virtual delivery in response to the COVID-19 pandemic.

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FEATURE: RUNNING DRILLS

Running dri as part of hamstring injury management.

The nuts and bolts…

H

amstring strain injury (HSI) poses a significant problem for sports involving high speed running. We know the cause of HSI is multifactorial and even with a goal-orientated, evidence-based rehab program, there’s still a reasonable chance HSI may become a recurrent issue.

You have addressed muscle strength and graduated speed exposure (in the rehab program). You have also likely considered fitness, power, motor control, stability, mobility, sleep habits, and fear avoidance. What else is there?

Preliminary research suggests a potential link between running biomechanics and subsequent technique variations and HSI. Trunk kinematics appear to play an important role, with lateral trunk sway being a recurrent finding across prospective studies. There is also emerging evidence indicating that athletes who sustain HSI generate less horizontal propulsive force. More research is needed to determine if these preliminary findings are either caused by or a consequence of HSI. Either way, the way an athlete runs could be a factor influencing HSI recurrence.

So how do we address running technique in our HSI rehab programs?

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A Skip

It’s hard to break old habits. You essentially need to make new habits that override them. Technical changes are difficult to focus on at high speeds. Running drills are a valuable gait retraining technique that allow a runner to create new habits through neuromuscular retraining.

Lauren Shelley and I presented the workshop ‘Learn to Drill like Bolt! Running Drills for Hamstring Injury Management’ at the 2019 ASICS SMA National Conference.

The findings we presented were informed by a recent systematic review undertaken, combined with extensive clinical experience working with high performance athletes.

The following is a synopsis of what was covered in the workshop.

Two types of HSI have been identified based on mechanism of injury; the stretch type and the high-speed running type. Stretching type HSIs occur when the hamstrings elongate, occurring during slow or fast end-range

FEATURE: RUNNING DRILLS

rills

Amateurs practice till they get it right.

Professionals practice till they can’t get it wrong.

Anonymous

movements. High-speed running type is typically more common and sustained during non-contact sprinting.

This information will mostly pertain to HSI of the highspeed running type.

Understanding the hamstring activity throughout the gait cycle is essential in order to appreciate the concept of what you aim to achieve when prescribing drills. The biceps femoris is the muscle most commonly affected by high-speed running HSIs. It endures an eccentric contraction double peak,

first during late stance, and secondly during late swing. The biceps femoris reaches maximal length during the second half of the swing phase whilst working eccentrically to decelerate hip flexion and knee extension in preparation for initial contact. Muscle actuated forward dynamic simulation and analysis of real-time HSI reveal the hamstring to be most susceptible to injury during terminal swing. Based on this, the tendency could be to focus on correcting ‘front side mechanics’; however, there are many other factors

to consider throughout the gait cycle that may be contributing to cumulative hamstring fatigue and ultimate strain.

Once the athlete has progressed to the stage in their rehab where they can run, the first step is to conduct a baseline assessment of their biomechanics.

Sports clubs don’t always have the money, resources, or time to employ research-grade methods of analysis (3D motion analysis, high sampling rate inertial measure units, etc.) so we must resort to more practical VOLUME 38 • ISSUE 1 2020

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FEATURE: RUNNING DRILLS

A RUN

methods, like video analysis or the trained naked eye. Your approach should aim to objectively assess sagittal (side on) and frontal (front on) planes of view, focusing particular attention on the following areas: ٚ Trunk. At top speed, are there any signs of excessive lateral deviation or trunk flexion? ٚ Pelvis. Most fast runners will normally have a certain degree of anterior tilt, but does it increase with fatigue? ٚ Front side mechanics. Is the athlete over-striding and landing too far in-front of their centre of mass at initial contact? In upright running, the lower limb should be close to vertical at initial contact to ensure maximum friction, minimising braking forces allowing for peak horizontal force propulsion. ٚ Back side mechanics. Inefficient swing mechanics can result in suboptimal late swing limb placement in preparation for contact. The phase of sprint is important here. During acceleration leg clearance should be low. In upright running there should be simultaneous hip and knee flexion. ٚ Foot placement at initial contact. Which part of the foot hits the ground first? The athlete should be on their mid-forefoot if running fast. Heel striking

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‘Toe up, heel up, knee up’ Emil Rizk

when sprinting is commonly associated with over-stride. ٚ Arms. A reflex linkage exists between the arms and legs. A common fault acknowledged by sprint coaches is poor control of elbow extension, which will affect turnover efficiency at top speed. After the initial drive phase, shoulder extension should be achieved by driving the elbow back (not forearm). Also, encourage closure of the forearm at the front. ٚ Ankle stiffness. To optimise the ‘stretch-shortening cycle’, the ankle needs to maintain dorsiflexion from mid-swing to initial contact. Landing on an excessively plantarflexed or ‘compliant’ ankle will increase braking forces, increasing hamstring load.

This list is not exhaustive but provides a start to biomechanical analysis. Your findings in these areas will direct the focus of your running drills. But first, reflect on the relevance of findings in a multifactorial context. Some technical variations may be protective, others maladaptive and mediating potential

ongoing symptoms. Some may have no relevance at all to your athlete’s HSI! Prioritise findings via careful critical reasoning on a case-by-case basis (preferably with a multidisciplinary performance team) before you consider changing anything.

If you determine that running technique may be a risk factor to address in your athlete, what drills do you prescribe to fix it?

The best drills to consider are those that the athlete is already familiar with and undertakes as part of their regular training. Your aim is to simply change the emphasis of the drill with a complementary objective in mind.

Ask the athlete to show you their ‘regular’ drills, then refine as you see appropriate. For instance, if you note excessive trunk sway, you may ask the athlete to concentrate on having a stable core. If the athlete is overstriding, you could ask them to focus their attention on push (not reach) or landing under their hips. You may consider prescribing additional drills with a specific objective in mind. For example, the ‘A Run’ drill can be great for correcting ‘back-side mechanics’.

Photos – common/ handy running drills.

After each drill, ask your athlete to do a ‘conversion’ run through over a distance that is reflective of their sport, focusing on the feedback received.

The type of start (standing, crouch, rolling, etc.) should also be sport specific. If you have knowledge of the

FEATURE: RUNNING DRILLS

B SKIP

mechanism of injury and the phase of sprint in which the injury occurred (acceleration, top speed, deceleration), place particular focus on that area.

As per the standard stages of skill acquisition, the goal would be that the ‘habit’ developed from conscious repetition would eventually evolve into unconscious mastery during running. The old saying that practice makes perfect is incorrect; only perfect practice makes perfect.

Quality repetition is key to success with these programs. If one verbal cue isn’t working, try another. If it can’t be corrected with a cue, step back into the clinic and consider addressing potential movement restrictions or weaknesses.

The following are other factors that should be considered: ٚ Feedback types. If the athlete isn’t responding to verbal feedback, try another form such as practical demonstration (just make sure you are competent!) or video review. ٚ Velocity. Initially, the drill may be conducted at low intensities in a tempo or ‘rhythmical’ style (or even start with a walkthrough), before progressing to faster speeds. Force propulsion can be cued at higher intensities. ٚ Range of motion. As coordination and outer range strength improve, you may increase the range of motion of the drill. The ‘B’ skip and straight leg drills are great drills to work on outer range hamstring

control but ensure the ‘claw’ or ‘pull back’ before contact. ٚ Distance. What distance does the athlete usually do drills over? What distance can they maintain form before fatigue?

About the Author Lisa Wolski is a

ٚ Surface. Are drills being completed on the same running surface as the competition goal?

Musculoskeletal Physiotherapist and Officer in the Australian

ٚ Shoes. What shoes would they normally wear for drills and competition?

Army working in the field of Human Performance Optimisation. She has extensive experience in the

ٚ Equipment. What equipment does the athlete use in their sport? Progress drills by adding a distraction, such as holding a ball.

field of sports physiotherapy, including travelling internationally with Australian Defence Force and civilian sporting teams. Lisa is a PhD

ٚ Direction. Most athletes complete their drills in a linear fashion; however, you may choose to progress drills by adding a change of direction.

candidate at the University of Sydney, investigating the relationship between running biomechanics and hamstring strain

Finally, there are many modifiable and non-modifiable risk factors for HSI. Running biomechanics may be a five percenter; it may be zero percenter, or it may represent a significant risk factor for HSI recurrence. A comprehensive case-by-case assessment is required to determine whether a particular running technique is relevant to address. If so, then refinement of running drills may be useful tool to utilise for running gait retraining. Who knows, with some specific running coaching, they could even end up running faster than they did before…

injury. She is also a trained sprinter, having competed at numerous Australian Athletics Championships and the prestigious Stawell Gift.

Acknowledgements • Lauren Shelley, Sports Physio HPNZ • Emil Rizk, Olympic Sprint Coach NSW Contact author for references

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FEATURE: NUTRITION FOR RUNNING

Nutrition for Runners

Nutrition Nutrition requirements will vary for runners according to their stage of lifespan, gender and the type of running they enjoy. For example, a sprint athlete will have different nutritional requirements to a middle - distance athlete and this athlete will have different requirements to an elite marathon runner or an ultra-endurance athlete and so on.

Running can be a physiologically demanding sport, with periods of moderate - high volume aerobic training, threshold running, strength, altitude and or heat acclimation training (i.e., heat specific preparation for competition climate). Athletes involved in running typically foster a lean physique, with greater strength 30

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in the lower body compared to their upper body. To minimise the risk of injury or illness, athletes should seek support from an accredited sports dietitian who can assist in safely monitoring body composition as well as identifying and or managing disordered or eating disorders.

Across a training and competition cycle, nutrition recommendations are periodised for the athlete to assist training adaptations including: ٚ Supporting mitochondrial biogenesis and or physique manipulation ٚ Supporting lean muscle development, power and speed ٚ Supporting adequate energy availability including micronutrient intake ٚ Helping to prevent or promote

recovery from injury, all whilst aiming to maintain great health and immunity In doing so, the athlete is able to train consistently, progress and embrace the targeted performance opportunities.

Compared to other track running based events, the energetic demands for middle and long-distance runners (e.g., 800m, 1500m, 10000m and marathon events) are much greater.

Within competition, middle distance athletes rely on anaerobic glycolysis and distance runners competing in marathons rely predominately on carbohydrate and planned hydration strategies to attenuate muscle and liver glycogen depletion as well as thermoregulatory changes. This assists in supporting sub – maximal

FEATURE: NUTRITION FOR RUNNING

Developing a performance plan specific to fuelling, hydration and recovery which can be well practised in training, is crucial to athletic performance.

energy expenditure in relation to fat free mass’, however in females, adequate energy availability has been described as achieving 45kcal/ kg/FFM and within males, although limited evidence, 40kcal/kg/FFM. Slightly easier red flags for allied health practitioners to identify and be aware of include: ٚ Weight loss ٚ Fatigue, lethargy ٚ Reduced training quality (even with adequate rest) ٚ Changes in mood ٚ Presentation or persistence of musculoskeletal injuries.

exercise intensity and enables the athlete to race hard into the end stages of the event. Developing a performance plan specific to fuelling, hydration and recovery which can be well practised in training, is crucial to athletic performance. The use of safe supplements to support performance is best discussed with an accredited sports dietitian.

Injury prevention Given the high energetic demands of running, the load on the musculoskeletal system and the challenges that can arise around individual’s physique, running athletes can be at risk of acquiring injuries such as stress reactions, fractures, tendon or muscle related injuries.

Whilst modification to biomechanics,

an appropriately designed training program with respect to load management and consideration for training age and lifestyle stressors should be taken into account to prevent injury, so to should prioritising adequate nutritional intake.

Relative Energy Deficiency in Sport (RED-S) Recognising the health consequences of RED-S (a cluster of impaired physiological changes) resulting from low energy availability is very important to protect the physical, emotional and mental health of the athlete, as well injury and illness prevention short and long term. There is currently no standardised protocol for assessing energy availability, defined as ‘energy availability –

Other factors that accredited sports dietitians will screen for with suspected low energy availability may include: ٚ Analysis of dietary intake including energy, protein and micronutrient intake in relation to training demands as well as the timing of meals and snacks ٚ Loss of libido, or delay and changes or the cessation of the menstrual cycle ٚ Biochemistry markers including low iron and other endocrine parameters such as elevated cortisol ٚ Reported episodes of dizziness, fainting during exercise or postural hypotension ٚ Changes in the gastrointestinal system or reported training quality.

It’s important to remember that an athlete with low energy availability may not experience all health and performance consequences of RED-S. VOLUME 38 • ISSUE 1 2020

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FEATURE: NUTRITION FOR RUNNING

Nutrition for Runners Key nutrients Carbohydrate: Fuel and recovery This food group plays a key role in fuelling sub-maximal and high intensity exercise, as well as refuelling and restoring muscle and liver glycogen stores. Daily carbohydrate requirements will vary for runners, with 3 – 10g/kg/BM recommended for athletes involved in low intensity training, moderate and endurance training, as well as tailoring these recommendations to the type of session completed. A periodised nutrition training plan which considers the purpose of the training phase/ session and the lifestyle demands of the athlete, should facilitate adequate energy from carbohydrate sources necessary for various metabolic adaptations and physiological functioning. Great quality carbohydrate foods include whole grain cereals such as rice, pasta and other pseudo grains, starchy vegetables, breads and fruit which also help to support a healthy microbiome and immune system.

Athletes with high energy needs including twice daily training, will also benefit from including simple carbohydrates such as: ٚ Honey

ٚ ٚ ٚ ٚ ٚ ٚ ٚ

Jam Dried fruit Flavoured milk Juice Low fibre cereals Muesli bars The addition of training supplements such as gels or sports drinks to assist meeting their overarching energy requirements and training goals

These suggestions may also be beneficial for an athlete experiencing appetite suppression following high intensity, heat and or altitude related training as well as returning blood flow and nutrients to the gut.

Protein and collagen: Resynthesis and recovery Protein foods and collagen contain unique combinations of amino acids that can play a key role in the synthesis, repair and maintenance of damaged muscle tissue, tendon, ligament and bone. It is important for runners, like most athletes to distribute their protein intake evenly across the day aiming for between 1.3-1.7g/kg/BM. Most athletes won’t have trouble meeting this quantity and may consume more due to the overall amount of food consumed to meet their daily energy requirements.

Typical recommendations for recovery protein after exercise include 0.30.4g/kg/BM which can be achieved through whole foods such as fruit smoothies made with milk and yoghurt or cereal and milk, flavoured milk or a well-balanced recovery meal that

includes a carbohydrate food, lean source of protein (meat, fish or eggs, cheese, tofu or legumes), as well as a healthy fat such as olive oil, avocado, nuts or seeds and antioxidant rich salad or vegetables. Masters athletes will benefit from a higher amount of protein (0.4g/kg/BM) after exercise due to the effects of ageing and musculoskeletal deterioration. Running athletes can also benefit from using collagen (with an advised protocol) for injury prevention or for rehabilitation from musculoskeletal injuries.

Athletes are recommended to follow a food first approach which will provide an array of micronutrients compared to protein shakes alone. Of course, recommendations may be tailored to consider lifestyle factors as well as individual energy intake and body composition goals relative to their phase of training and or competition.

Calcium: Support bone integrity Calcium, iron, phosphorus and Vitamin D (to list a few) play a key role in bone growth, repair and maintenance.

Running is a high impact activity which places greater stress on the skeleton and it is important athletes are at least achieving the minimum amount of calcium recommended for age and gender, by the Australian Dietary Guidelines. To optimise bone health in athletes with low energy availability or menstrual dysfunction, calcium recommendations increase until this is corrected. Calcium rich foods include, milk and flavoured milks, yoghurt, cheese, canned salmon and sardines (including edible salmon bones), dark green leafy vegetables, nuts and seeds, soy products as well as fortified whole grain products, juice or plant based milk alternatives.

Iron: Red blood cell production and collagen synthesis Iron plays a key role in the development and synthesis of haemoglobin – an integral component of red blood cells that deliver oxygen around the body including the working muscles. Iron also assists in the synthesis of collagen, important for tendon, ligament and bone tissue. Iron requirements for running athletes are particularly

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FEATURE: NUTRITION FOR RUNNING

important due to iron lost to menstruation, foot strike haemolysis and small amounts lost through sweat. Athletes with low iron or iron deficiency anaemia may present with low energy even after adequate rest, unexplained poor performance and loss of appetite. Athletes with low energy availability/ restricted energy intake or following a vegan or vegetarian diet are also at greater risk of low iron, deficiency and anaemia.

About the Author Jessica Rothwell is working at the Victorian Institute of Sport with the Athletics and Women’s Hockey Programs, is the National High Performance Nutrition Lead for Athletics Australia, the in – house Sports Dietitian at Sports Dietitians Australia (SDA) and is also working with the AFLW Richmond Football team. Outside of

In addition to key training nutrition principles, there are also a range of performance/ competition nutrition specific strategies recommended for different running events that take into account environmental conditions and specific race fuelling and hydration opportunities. Working with an accredited sports dietitian can assist running athletes with these strategies as well as addressing common issues such as ‘runner’s gut’ and trialling strategies across training to develop a performance plan that is well practised and executed to optimise performance goals.

For further information, head to www.sportsdietitians.com.au

these roles, she enjoys other consultancy work. excitement for supporting athletes as well as individual health stemmed from her experiences growing up on a dairy farm as well as competing internationally in the sport of race walking. Jess enjoys working with individuals of all ages to develop realistic and achievable strategies that are complementary to their lifestyle or training/ competition goals.

Jessica’s excitement for supporting athletes as well as individual health stemmed from her experiences growing up on a dairy farm as well as competing internationally in the sport of race walking.

References available on request VOLUME 38 • ISSUE 1 2020

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FEATURE: THE IMPACT OF PARKRUN

Is running physical the best form of

If so, does that make parkrun world leading industry best practice for physical activity programs?

NEAL AMES, MEMBER PARKS & LEISURE AUSTRALIA

I

n the running “fraternity” there is a book that is referred to in whispered reverence, Born to Run (Christopher McDougall). For running tragic’s it is our ‘raison de’ etre’ (our reason for being). It tells a story of a South American tribe who are experts at running, and the desire of a group of Americans to travel to their home and race them. For me personally, it is not that part of the story that is so powerful, it’s the evolutionary evidence that the author uses to explain our species connection to and fascination with running. Thankfully, being a curious person, I had already sought out the reasons that we run, and its impacts on our development as a species, many years back, but the book reaffirmed and reminded me of those reasons.

To put it simply, without our ability to run and more importantly our evolution as the best runners on the planet, we wouldn’t be here as a species. In the scheme of evolutions slow-motion pace of natural selection, we did not need to be the quickest, just

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the most efficient to achieve selection edge. Running, and our evolutionary quantum leap in exchanging hair follicles for sweat glands, allowed us to become marathon runners. Whilst every other species remained as mouth breathers, needing to regularly stop and pant to cool themselves, humans can run all day, cooling ourselves through the sweat on our skin. This makes for a great hunting advantage as its easy to catch dinner when it can’t run away from you.

Therefore, we are a species that evolved, and dare I say, were born to run! It may no longer be critical to our survival, but it is still in our genes, including the chemical responses that make it easier for us to run.

I still have endorphin highs when I run, a combination of chemicals that give runners that warm buzz.

Which brings us to the physicality of running. Earlier humans may have assumed that if something hurts, like running, then it is bad for you,

Nepean Parkrun in Penrith.

FEATURE: THE IMPACT OF PARKRUN

activity? and that is often the case. If running hurts they may have assumed, then it is bad. However, more recently science has been able to show that in fact running is good for our bones, our heart and our lungs. research shows that runners have increased bone mass density, greater lung capacity and stronger heart muscles; adaptations which result from the physical demands of this activity.

However, even up until a few years ago it was assumed that running was bad for other parts of our body, including our soft tissue, like cartilage and tendons, and it was benign for our most important organ, our brain.

A number of important research articles released in 2019 disproves those assumptions. We now understand that running actually strengthens our soft tissues and has profound neurological

effects, including heightened cognitive capacity and improved mental health Let me tell you a story. I have always struggled, somewhat, with depression.

Winston Churchill termed his battle with depression, the “black dog”.

I have run for the last 30 years, and I was always aware that it made me feel good, especially afterwards. More recently we have seen organisations

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FEATURE: THE IMPACT OF PARKRUN

Is running physical activity? the best form of

program, it is a successful community engagement program, and it activates or re-activates Australia’s iconic parks and open spaces. I will come back to unpack those answers in a wee little bit, but first...

In May 2016 Mark Band, CEO Parks & Leisure Australia (PLA) wrote to Parkrun Australia to congratulate the organisation on its outstanding success. Mark stated; “Parks and Leisure Australia (PLA) is writing to Parkrun Australia to congratulate your organisation on the significant success that you are seeing with your parkrun events.”

Australian parkrun statistics as at 16 March 2018

such as the Black Dog Institution appear. On my running vest I have a little pin of a black dog, to remind me of the benefits of running. One Sunday last year I did a long run in the Dandenong’s in Melbourne. When I got back, I posted about my experience on social media. To paraphrase I said, “went for a run in the Dandenong’s today, the black dog went with me, but about halfway through I left him behind, and at this point he hasn’t come home”. My brother responded by stating that he wasn’t aware that I had a dog. After educating him on the black dog we both had a laugh.

Just another benefit of running.

If you yourself are not a runner, hopefully I have sold you on the benefits of running. I have set out for the reader a layperson’s understanding

Launch of Dolls Point Parkrun, Botany Bay.

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of the benefits of running. And that brings me to ‘Parkrun’, as I put my recreation planner’s hat on. Parkrun was developed in London in 2003, by two intrepid computer geeks, and with just six original runners, it is now a world-wide phenomenon. It is now facilitated in more than 22 countries worldwide and has more than 350 different courses here in Australia. A couple of years ago I wrote an article, which sought to unpack the success of Parkrun, both as a physical activity program as well as a social experiment.

Our natural connection to running as a species sits as the bedrock of Parkrun.

I have heard many in the industry ask, “so why is parkrun so popular?”.

The response to that question has three separate answers. They are: it is an effective physical activity

At the time of writing that letter Parkrun had been operating in Australia for five years, and many working in the industry, within local government, state government or with the federal government had seen or heard of the growth in the “movement”.

Most parkrun’s are conducted in parks managed by LGA’s and parkrun need to seek permission to hold their events in each specific location. Council officers needed to be approached, applications submitted and in most cases councilors briefed by the local event coordinators.

As you can see by the latest statistics below parkrun has spread far and wide and so the interaction of local parkrun volunteers and government officers has led to an increase in parkrun’s profile with the industry.

FEATURE: THE IMPACT OF PARKRUN

Parkrun, in its simplest form, is a free five kilometre timed run, or walk, held each and every Saturday morning at local parks in 350 individual locations around Australia Mark, in his letter went on to state; “PLA and its members are very aware of the work being done by Parkrun both in providing a “best practice” physical activity program for individual communities but also in bringing awareness of Australia’s diverse parks to their communities.”

In writing to Parkrun PLA had already started to notice the three components that were leading to its outstanding success, its success as a physical activity program and its value in introducing Australians to their parks.

Now, let’s unpack the reasons for parkrun’s success.

Industry “Best Practice” Physical Activity Program Parkrun, in its simplest form, is a free five kilometre timed run, or walk, held each and every Saturday morning at local parks in 350 individual locations around Australia. Before running their first run a new participant obtains a unique barcode from parkrun’s website, which they present to the “scanner” at the end of the run/walk. Their time is recorded and normally within an hour an email arrives in the participants

Volunteers and runners at Bateman’s Bay Parkrun, pouring rain.

Wayfinding volunteer at St Peters Parkrun in Sydney Park. The backbone of Parkrun are the volunteers.

inbox with their time and their position compared to everyone else that participated, how many runs they have completed and an age grading, which compares their performance against their peers from around the world, based on the five kilometre distance.

The two guys that created parkrun, in Bushy Park in London, got the IT right, and everything else has flowed from there. Parkrun attracts world class runners, first timers, walkers, parents with prams, people with dogs, people in hairy suits, in Santa costumes and people in fairy outfits. They do it on Christmas Day, on New Year’s Day, in the rain, in the snow, in mud, and most importantly in very large numbers.

in the community through programs such as Yoga in the Park, Mum’s with Pram’s, and “Energise”. Local governments have been so committed to the cause that some of them have employed Physical Activity Officers to deliver programs. But in my 20+ years in the industry I have not come across one program that had the “stickiness” and the sustainability that saw it grow and be embraced by the community as a whole. That was until Parkrun.

Governments, of all stripes, have been trying to develop successful physical activity programs, that the community will engage in, and stay engaged in, for the last ten years at least. In the early 2000’s Peter Beattie, then Premier of Queensland, had called an “Obesity Summit” in Parliament House in Brisbane to try and work it out. I personally was involved in delivering programs such as the Club Development Program and the Active Inclusion Program whose focus was providing physical activity programs

The ongoing and sustained success has been noticed, most notably by universities and researchers. A number of research programs have been undertaken to examine Parkrun and its success. Researchers at Loughborough University in England have Completed a longitudinal study; ‘Study of Parkrun on Lifestyle and Exercise’, better known as SparkLE. The aim of the research was to “study participants in terms of demographics, current physical activity, the perceived impact of involvement and parkrun performance statistics”. The SparkLE research was published in the International Journal of Behavioural Medicine. The researchers observed; “The evidence suggests that parkrun is attractive to non-runners; with VOLUME 38 • ISSUE 1 2020

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FEATURE: THE IMPACT OF PARKRUN

Is running physical activity? the best form of

women, older adults and overweight people well represented. Fitness improvements were observed and there were many positive perceived benefits, suggesting parkrun may be an effective community-based intervention for improving public health.” In that short sentence are all the deliverables that millions of dollars of grant funding, being delivered by some of the smartest and most dedicated people, have been striving for, but unable to find.

(Authors Note: other more general research has been conducted, using both Parkrun’s massive dataset, and other running events data. Prof AstellBurt and Fung at the University of Wollongong have developed world leading findings based on running participation, to show not just the benefits of running, but also the benefits of being in nature whilst running. Most exciting is the research coming from major running events, such as City to Surf in Sydney, where 20 years of data, from one million runners per year is showing participation trends across different suburbs and demographics, and the connection between where you live, your physical activity and your propensity to have either good or bad health outcomes).

Socio-Cultural Community Engagement The second reason for Parkrun’s success is one that has received less attention, but is inherent and obvious, for those that participate, and that is the socio-cultural nature of parkrun.

This benefit is harder to put your finger on, so stay with me and I will try to explain it. Parkrun is a celebration of the social connections that we all crave. That connectedness that holds societies together and drives people to want to be involved, that provides the motivation to get out of bed and drive (in some cases) for up to two hours, often in the rain, for a 20-30-minute run. A component of Parkrun that is 38

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Parkrun is a celebration of the social connections that we all crave. That connectedness that holds societies together and drives people to want to be involved. celebrated is the volunteers. At each Parkrun there is a need for at least six volunteers, an event director, a scanner, turn-around person, marshals, pacers, tail-end Charlie, and others. A simple but unenforced directive from Parkrun is that each runner is expected to volunteer three times a year. It’s in the volunteers where the real value of community engagement is found. A large percentage of Parkrun volunteers do not actually participate in the run/ walk, they are there purely to volunteer.

Volunteer Australia, in its 2012 report “State of Volunteering in Australia” (Volunteering Australia, 2012) found that “Contributing to the community is important to the majority of volunteers.

We also know from research that people volunteer for diverse reasons,

including the personal satisfaction it gives them, the sense of belonging to community”. It is this simple observation that reveals the true value of Parkrun, “a sense of belonging to community”. The volunteers at parkrun don’t just perform their respective roles, they also create the community, the atmosphere, the motivation and the sense of belonging to something that is bigger than the individual, that draws not only the volunteers back, but also the participants. Throughout all my Parkruns there has not been one where I was not encouraged and congratulated by another participant or volunteer. You often see people cross the finish line to receive high fives and shouts of exhilaration.

At the pre-run briefing conducted by the event coordinator, milestones are celebrated, complete with cheers and claps. When I did my 100th run (in -3 degrees at Campbelltown in Sydney) there was more celebration from total strangers, than what I had ever experienced before. Milestone t-shirts are given out for 50 and 100 runs creating a constant cause for celebration. From a socio-cultural perspective it can sometimes appear religious in nature. Photos are also another key component of creating the Parkrun community that members embrace and utilise to showcase their efforts.

The author at Kamay parkrun on Botany Bay, with the heads, Cape Banks and Botany Bay National Park in the background.

FEATURE: THE IMPACT OF PARKRUN

Activating Australia’s Iconic Parks and Coastal Reserves Mark Band, in his letter to parkrun on behalf of PLA stated “The other value that parkrun brings to the Australian community is in the enhanced awareness of Australia’s fabulous parks. From the St Peters Parkrun at Sydney Park, Albert Park in Melbourne, the Gold Coast coastline at Kirra, the rugged coast at Shellharbour, the beautiful heritage listed Queens park in Toowoomba, Hobart, Kirwana coastal walk, Newfarm in Brisbane, the Hunter river foreshore development in Newcastle to Sandon Point at spectacular Bulli. One of the values of parkrun is the iconic locations in which they are conducted. Parkrun has done much for bringing ordinary Australian’s back into their parks or introducing Australian’s to parks that they had never visited before”.

To me, as a recreational & open space planner, this is where I see the real value of Parkrun; “where the rubber hits the road”.Parkrun is bringing people, who normally would not go to a park, back into our parks, our reserves, our coastal reserves and our council parks. A case in point is Panania Parkrun in Sydney. A park, often overlooked, along the George’s river, has been revitalized by Council, purely because Parkrun had started an event there. Parkrun often uncovers “hidden” gems, such as Newport Lakes Park in Melbourne, an old quarry, completely hidden in amongst suburbia, known only to the locals, unless you went there for Parkrun.

As an industry we strive to get government, and the community to value their parks, to value their provision and to ensure that they are protected. By having an event that brings people into parks we achieve our aim. Another worthy mention is St Peters parkrun in Sydney, an old disused brickwork and dumping site which has been converted

Shellharbour parkrun, Killalea State Park (an old coastal sheep farm)

into Sydney’s new showcase park

by Sydney City Council; St Peters Parkrun introducers Sydneysiders to this breathtaking achievement in open space planning.

Research shows that when people become aware of parks, and engage with them, they become advocates for those parks. Parkrun participants who engage with their local parks are now becoming “protectors” of those parks which is important from an environmental sustainability standpoint.

Conclusion Parkrun has grown exponentially over the last five years. There are now more than 350 individual parkrun’s being held around Australia every Saturday morning. Volunteers are engaging, runners are running, walkers are walking, land managers are providing support and parks, reserves, beaches, national parks, regional parks, dams and sporting

precincts are being activated.

Parkrun has proven that it is world best practice for physical activity programs, it is creating “community” and it is showcasing our open spaces.

PLA acknowledged that in 2016 when it wrote to parkrun and stated; “your organisation should be congratulated” Parkrun is not the cause of an increase in running, it is just merely the best example of our innate desire to run, to move through beautiful landscapes, and to see and experience new things.

Latest Ausplay data, released by Sport Australia, shows a significant increase in running for Australian’s. People are starting to rediscover what it is like to move, to challenge yourself, and to gain health benefits from that activity.

We as a species have not suddenly found running, rather we have rediscovered it and realised that we are born to run.

About the Author Neil Ames is a running enthusiast. Marathons and ultra-marathons are his thing. If you have a wry smile to that statement it probably means you’re one too.

Before COVID-19 lockdown he had completed 282 parkruns on 88 different courses in four different states. As a recreation planner, open space planner and with in-depth knowledge of parkrun he considers himself well placed to comment on running and parkrun from an industry perspective.

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FEATURE: SPORTS MEDICINE AROUND THE WORLD

Sports Medicine in Austria SPORTS MEDICINE AROUND THE WORLD IS A SERIES PUBLISHED IN SPORT HEALTH, TO LOOK AT THE STRENGTHS AND WEAKNESSES OF THE SPORTS MEDICINE SYSTEM IN VARIOUS COUNTRIES, PROVIDING IDEAS AND INSPIRATION ON HOW TO IMPROVE INFRASTRUCTURE IN THIS EMERGING SPECIALITY. IN THIS ISSUE OF SPORT HEALTH, HOFRAT UNIVERSITY PROFESSOR DR. ERNST RAAS HIGHLIGHTS SPORTS MEDICINE IN AUSTRIA.

T

he Austrian Society for Sports Medicine and Prevention, (Oesterreichische Gesellschaft für Sportmedizin und Prävention – Verband Oesterreichischer Sportärzte/Innen) was founded in 1950 and has 752 members and 742 certified sports doctors. Austria is also a member of the European Federation of Sports Medicine Associations (EFSMA). Whilst there are over 40 medical specialities such as Surgery, Internal Medicine and Paediatrics, at present sports medicine is not a medical specialisation within Austria.

Nevertheless, the Austrian Medical Chamber (Oesterreichische Arztekammer), which rules the

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FEATURE: SPORTS MEDICINE AROUND THE WORLD

About the Author Hofrat University Professor Dr.Ernst Raas can be considered one of the pioneers of Austrian Sports Medicine. As a trained Cardiologist, he founded the Landesinstitut fĂźr Sportund Kreislaufmedizin (State Institue for Sports and Circulatory Medicine) at the University of Innsbruck at the time of the Winter Olympic Games of 1964 held in Tyrolian City. He was the chief medical officer of these games. Very involved in Winter Sports, Raas was a long acting Chair of the Medical Committee of the International Ski Federation, of which he is a honorary member. He participated in 8 Olympic Games and 12 Ski World Championships. He was also very active in the International Federation of Sports Medicine (FIMS) and became an honorary member of this Organisation. He has written more than 300 scientific papers and held over 600 lectures about Sports Medicine, Cardiology or Internal Medicine.

medical profession, offers all physicians with a recognised medical diploma, the opportunity to undertake specific intersisciplinary training in Sports Medicine, upon completion of which they recieve a Diploma in Sports Medicine.

To be eligible for this Diploma, the candidate must complete various medical courses divided into three modules (40 hours each), over three years. The first module involves studying internal medicine, specifically physiology and paediatrics. The second module focuses on orthopeadics and traumatology. Finally, the third module is reserved for specilsied topics of the candidates own selection.

In addition to the theory modules, the candidate is also required to undertake 60 hours of practical learning, including 40 hours in seminar form and 20 hours of active, supervised practice.

Furthermore, it is expected that during the final six months of training, the candidate is active as a team doctor.

Once these requirements have been satisfied, the diploma is then awarded without examination. Currently, there are approximately 1,420 Doctors in possession of the Diploma of Sports Medicine which represents 4.2% of the total Austrian Medical Population.

For specialists in the fields of Training Physiology, Paediatrics,

Internal Medicine, Accidentology, Orthopaedics and Physiatry, an official complementary title in Sports Medicine, called Zusatzfach Sportmedizin is also available. To obtain this title the candidate must complete three years of Sports Medicine pracitice within the department of their aforementioned specialty, under the supervision of an accredited supervisor who will grant the accreditation.

Today, approximately 550 medical doctors are in posession of this title (346 Surgeons and Traumatologists, 104 Orthopaedic Surgeons, 27 Internal Medicine Specialists, 13 from the field of Physiatry and 6 Exercise Physiologists).

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FEATURE: RUNNING POSTNATAL

Developing the Guidelines Returning to Running Postnatal – Guidelines for medical, health and fitness professionals managing this population.

IN THIS FEATURE SPORT HEALTH DISCUSSES THE GUIDELINES CREATED FOR RETURNING TO RUNNING POSTNATAL WITH EXPERTS GRAINNE DONNELLY (ADVANCED PHYSIOTHERAPIST IN PELVIC HEALTH), EMMA BROCKWELL (SPECIALIST WOMEN’S HEALTH PHYSIOTHERAPIST) AND TOM GOOM (MUSCULOSKELETAL AND SPORTS PHYSIOTHERAPIST) AND HOW THEY ARE BEING PUT IN TO PRACTICE AROUND THE WORLD.

What factors contributed to the development of the guideline?

GD: We realised there was an absence of official or recognised guidance out there for the postnatal population.

There were several publications to support and guide exercise during pregnancy, but nothing to advise how to return to exercise safely following childbirth. We decided to review the evidence and put together some advice. This was initially intended to be an informal blog or advice sheet however, the more we looked into it the bigger the task became, and it ended up as a 40-page guideline.

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EB: The concept of the guidelines were initially, for me born, from my own personal journey. Having always been a runner, when it came to returning to running postnatally, it became very apparent that the information that did exist at the time for postnatal women was conflicting and confusing.

This confusion and lack of clarity was mirrored in clinic and the evidence base was poor. I was delighted to find out that Tom and Grainne planned to put together some guidance to open up the conversation around this subject, but also provide some advice so that we may all be singing from the same

song sheet and not only guide women but take into account rehabilitation, screening and assessment.

TG: Speaking as someone without specific experience in women’s health, I felt there was a gap in my knowledge and ability to guide women postnatally. Chatting to Emma and Grainne we realised that individually we all had our own areas of expertise, but together we could provide a more complete guide for women to return to sport. The more we discussed it the more we realised how much of a demand there was for

FEATURE: RUNNING POSTNATAL

accurate information, not only to guide women but also health professionals who care for them postnatally.

Prior to this guideline how were women supported in their return to running postnatally?

GD: The traditional concept surrounding the six-week postnatal GP check is one that has embedded the history of postnatal recovery. There is a presumption that at the six-week time point tissues are healed and the body is ready to resume normal activity. Some of the pregnancy exercise guidelines have a paragraph

or at the most one page at the end to advise on postnatal recovery. As we highlight at the beginning of our guideline, the messages are inconsistent and not detailed enough to serve a purpose in supporting postnatal women or the health and fitness professionals caring for them. In recent years, the media has highlighted that there is a widespread issue of poor support postnatally, particularly in high performance sports. For example: American middle-distance runner, Alysia Montano highlighted the pressures

she was put under at the hands of her sponsors and management. The athletics world has been unmasked for its long-standing approach or considering male and female bodies to the same performance standards and thankfully this is starting to change. EB: I would suggest that prior to this there has been little in the way of support simply because pelvic health and the need to rehabilitate postnatally has not been considered or respected to the extent they are now. There is an expectation that the body and mind of a woman will return to its VOLUME 38 â&#x20AC;˘ ISSUE 1 2020

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FEATURE: RUNNING POSTNATAL

pre-pregnancy state within the traditional six-eight week healing window that has been afforded to women. The ‘bounce back’ culture is responsible for this to some extent.

Until recently there has been little in terms of advocacy for required rehabilitation and guidance.

TG: I think in many cases women have received very limited support. We see regular examples of the impact this can have on people either returning too early and encountering problems or being afraid to return at all.

How is the guideline being used in practice?

GD: The guideline has been really well received, not just in the UK but around the world. Health and FitPros are reporting using it within their practice and finding it useful in supporting their clinical reasoning process. It has opened the traditional divide between Musculoskeletal/Sports Physiotherapy and pelvic health with non-pelvic health clinicians feeling empowered and more confident to ask about symptoms related to pelvic health.

There is also a lot more collaborative working between professionals.

The guideline has been translated (with permission) into Chinese, Dutch and Latvian. The accompanying infographics have been translated into eight languages and counting, demonstrating the interest and thirst for the information.

The recent infographic published in the British Journal of Sports Medicine (BJSM) has helped shed further information dissemination.

Our guideline aligns with the UK Chief Medical Officer (CMO) Physical Activity Guidance for postnatal women and members of the CMO team coauthored the Infographic publication with us. This has assisted the academic and research world to understand the paucity of research in this area and urgent need for new studies.

EB: I also think that women are much more proactive and aware of the need to support and protect their pelvic health throughout postnatal recovery.

Women are accessing the guidelines, (which are free to access) and being made aware of the fact that not only is pelvic floor dysfunction something to be considered but also that health care professionals exist to guide them back to running safely and effectively.

TG: One area where I’ve seen a huge amount of interest and dissemination of the guidelines is social media. This is very positive as they can reach women in the postnatal stage and health professionals interesting in guiding people in this stage.

Guidance for medical, health and fitness professionals to support women in returning to running postnatally. Grainne Marie Donnell, Alan Rankin, Hayley Mills, Marlize DE VIVO, Thomas SH Goom, Emma Brockwell 44

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How important is screening of post-natal women prior to return to high impact activity? And should this be undertaken for all women or only specific cases?

GD: We believe that this screening process should be a staple part of every woman’s postnatal evaluation.

We understand so much about the changes a woman’s body undergoes with pregnancy and childbirth as

FEATURE: RUNNING POSTNATAL

well as the risk factors that childbirth, particularly traumatic deliveries, can have. We need to approach postnatal health in a preventative and safeguarding manner, whereby we advocate and support maximal recovery in order to future proof every woman’s pelvic health. Common issues women face postnatal include incontinence (bladder and/ or bowel), pelvic organ prolapse, pelvic pain and sexual dysfunction.

The issues can significantly impact a woman’s quality of life and effect their exercise performance and ability to maintain physical activity levels.

In relation to high performance athletes, postnatal symptoms of pelvic floor dysfunction may be a limiting factor in their performance and the marginal gain needed to succeed.

About the Authors Gráinne Donnelly is an Advanced Physiotherapist in pelvic health. She graduated from the University of Ulster in 2008 with a Bachelor of Science Degree in Physiotherapy. She is a full member of the Pelvic Obstetric and Gynaecological Physiotherpy association in the UK. Gráinne is currently completing a Masters in Advancing Healthcare at the University of Ulster and is involved in research on postnatal exercise, diastasis and ultrasound imaging. She is an associate member of the Perinatal Physical Activity Research Group at Canterbury Christchurch University and on the specialist advisory board of the Active Pregnancy Foundation in the UK. Emma Brockwell is a Specialist Women’s Health Physiotherapist. She treats women of all ages with all women’s health related conditions. She is passionate about pre and postnatal rehabilitation. She specialises in enabling women back to exercise, particularly running if they have any pelvic health dysfunction or are postnatal. She has co-authored the first ‘Returning to Running Postnatal Guidelines’ and has spoken about this subject at many medical and exercise conferences. Emma has written

In an ideal world every woman will access a full evaluation as detailed in the guideline. Until then, even having access to the information will help many women and their health care providers to understand what is expected and the risks involved.

for many magazines including Women’s Running and Women’s Health magazine. Emma is also the co-founder of Pelvic Roar a physiotherapy led collaboration aiming to promote and unite all things ‘pelvic health’.

She is on the advisory board for The Active Pregnancy Foundation, Perinatal Physical Research Group and PANDAs. She works at The Halos Clinic in Oxted, Surrey and Body Logic Health in Battersea, London.

Tom Goom is a chartered Physiotherapist with over a

If you could give one takeaway from the guideline, what would it be?

GD: Recovery extends long beyond the six-week postnatal check. The postnatal check varies in accessibility and what it includes around the world. Most postnatal checks do not involve readiness for exercise or advice about how to safely return.

decade of experience. He qualified from Oxford Brookes University in 2002 with a BSc (hons) in Physiotherapy.

Since then he has gained a wealth of knowledge and skills working in a variety of clinics in the UK and overseas.

Tom has worked in semi-professional sport, lower-limb and spinal rehab. In 2005 Tom travelled to Sri Lanka to help victims of the 2004 tsunami. He did voluntary physiotherapy work in a hospital, teaching local staff, treating patients and fundraising for new equipment. Tom ran a chronic pain programme in Brighton, specialising in management of neck and back pain and he has an interest in managing long-term

EB: Postnatal rehabilitation should be offered to all women; it is not an indulgence and is a basic necessity for all women.

conditions such as, hypermobility, CRPS or chronic pain. He is a qualified acupuncturist and very much a “hands on” physio who values the importance of self-management and home exercise programmes.

Tom became a running injury specialist in 2012 and has gained a worldwide

TG: Returning to running can have many benefits for women postnatally both physically and mentally. As health professionals we must support and guide women throughout most natal recovery to help them enjoy these benefits.

reputation in the sports medicine community following the growth of his website – www.running-physio.com. Tom started the site in 2012 and since then it’s had over a million visitors! He’s written for Running Fitness, Cycling Weekly, Kinetic Revolution and a host other online sports sites and magazines. Tom now teaches other therapists on his popular Running Repairs Course and presents regularly around the country on a number of running related topics. His specialist areas of interest include running gait analysis and treatment of tendinopathy (previously

Returning to running postnatal –

called ‘tendinitis’) which is very common in sports men and women.

guidelines for medical, health and fitness professionals managing

While Tom does specialise in treating runners he is still very active in

this population’ (2019)

treating all manner of conditions in athletes and non-athletes alike.

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COMMUNIT Y NEWS

Sports Medicine @SMA_News sma.org.au • SMA Launches COVIDSAFE Safer Sport Education Program • SMA online event and content library – Upcoming Events, Webinar, Podcasts, Videos • Safer Sport Program: COVID-19 Safety Measures • NSW office of Sport Concussion Workshops returned throughout NSW in September

@ACSEP_ acsep.org.au • 20201 Annual Conference dates announced

@SportsDietAus sportsdietitians.com.au • Food for your sport – AFLW • Latest SDA blog • Latest SDA Recipes • SDA Resource Hub

APS • Media Release: Psychologists welcome Government’s decision to increase mental health service in aged care

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COMMUNIT Y NEWS

Community News @ESSA_News essa.org.au • ESSA position statement on exercise and chronic obstructive pulmonary disease (COPD) • ESSA Sports Science Twitter Conference 2020 • Webinar: Shoulder Injuries of Swimmers and Throwing Sport Athletes, November 2020 • Webinar: Cost of Injuries in Sport and the Potential for Their Prevention, November 2020 • Webinar: Fundamentals of Surfing: Bringing Science to Surf, December 2020 • Webinar: Thermal Stress During Team-sport Preparation and Competition, December 2020 • Latest eBook: Exercise Right for Kids • Exercise Right for Doctors Week: 23rd – 27th November

@APAPhysio australian.physio • APA Podcast series • Don’t go too hard, too soon: elite athletes join physios in injury prevention campaign

@AICE Sports & Exercise www.chiro.org.au/membership/aice/sport (formerly Sports Chiro Australia) • 2021 Sports Chiropractic Symposium • Webinar 28th October Michelle Bergeron “Fouettes, Flips and Flutes: managing the Performing Artist” • Webinar 25th November: Angus McEntyre “Managing Medial Elbow Injuries with Javelin Throwers” • Webinar 9th December: Nick Richardson- “Agility”

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5 MINUTES WITH

5 minutes with

Dr Nirmala Perera

IN THIS ISSUE OF SPORT HEALTH WE SPENT 5 MINUTES WITH DR NIRMALA PERERA, CLINICAL RESEARCH PROJECT OFFICER, AIS MEDICINE – AUSTRALIAN INSTITUTE OF SPORT

Tell us a little bit about your background Breath before depth – instead of specialising in one area, I sampled different roles in many fields. So I worked clinically in anaesthesiology to international health (maternal child health) including in a World Health Organisation (WHO) related project to public health (physical activity and public health nutrition), health promotion, before finally settling in sports medicine.

I received the prestigious Australia Awards Endeavour Fellowship in 2018 to work on the Sports Without Injury Programme at Linköping University in Sweden. In 2019, I was awarded the Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis post-doctoral fellowship at University of Oxford. In these roles, I contribute to injury and illness surveillance, injury prevention, workloads, youth and female athletes, osteoarthritis and the long-term impacts of musculoskeletal injuries, sport, health and wellbeing, athletes’ mental health, sleep in sports like biathlon, cricket, floorball, football, netball and rugby.In April 2020, I started working as the Clinical Research Project Officer at the Australian 48

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Institute of Sport. I am also an adjunct Research Fellow at the University of Canberra Research Institute for Sport and Exercise (UCRISE).

So in a nutshell, my work focuses on supporting safe lifelong sport participation, whether it be playing catch in the backyard or striving for the Olympic and Paralympic podiums.

My passion for science communication has led me to work on knowledge translation for years. In 2016, I was invited to establish the social media strategy for the International Olympic

Committee (IOC) World Conference on Prevention of Injury and Illness in Sport. I have also helped to organise conferences. I was the Scientific Committee Chair of the inaugural Sri Lanka Sports and Exercise Medicine Conference in 2018. I am also an Associate Editor for the Journal of Science and Medicine in Sport (JSAMS) and Frontiers in Sport and Active Living – Injury Prevention and rehabilitation Section, as well as an Editorial Team Member for Football Medicine and Performance.

Describe your role as Clinical Research Project Officer at the Australian Insitute of Sport AIS Medicine provides system leadership and clinical support to Australia’s high performance system, including National Sporting Organisations (NSOs), the National Institutes Network (NIN), coaches

5 MINUTES WITH

and athletes. As the Clinical Research Project Officer, I manage the development and implementation of position statements, evidencebased guidelines and contribute to plan, design and implement methodologically and ethically sound research projects on clinical matters affecting athletic performance, integrity and athlete safety and welfare.

In addition to this, I support the AIS CMO, Dr Hughes by providing evidence reviews on topical issues, contribute to research and education strategy for clinical services team. Together with the Clinical Research Project Panel, I contribute to the strategic planning of AIS Medicine research agenda. As a member of the Research Review Committee, a subcommittee of the AIS Ethics Committee, I peer-review ethics applications. Further, I support and drive efforts to promulgate best practice in sports medicine and physical therapies throughout Australian high-performance sport.

What does a typical day look like for you?

Fortunately, no day so far has really been typical (I know, I know, everyone says that, but it really does). Every day is different and I enjoy the challenges each day bring. I may spend a day working on a particular position statement, project work, peerreviewing ethics applications and manuscripts, developing resources.

Somedays, most of my day fills up with meetings. Somedays, I work on rapid research reviews on topical issues. The projects I work on range from AIS Framework for Rebooting Sport, to bushfire smoke, breath-hold training, epigenetics, Anterior cruciate ligament injury, ankle rehabilitation and blister management. The best part about what I do is that the majority of my time is spent working on exciting collaborative projects that deliver a useful outcome to help athletic performance, safety and welfare. There are many opportunities to upskill and as a lifelong learner, I enjoy participating in these.

I am also a member of the RAP Steering Committee and Working

Group. AIS will again be hosting Australia’s premium high-performance conference in February 2021 – World Class to World Best to cover themes of leadership, coaching and development, performance optimisation (wellbeing, technical innovation, science and medicine), and performance pathways. As a member of the conference planning committee, we are currently working hard to put together the conference program.

It takes a team to win a game – I enjoy working in a multidisciplinary collaborative team environment, within AIS Sport Medicine and the wider AIS team.

How did you get involved at SMA? My first interaction with SMA was in 2013, when I first started my PhD. It wasn’t until I attended my first SMA conference in 2016 at the MCG (I haven’t missed a national conference since then). I had a positive experience and had great connections with SMA staff.

I began working with the SMA Victoria office. I provided social media during the SMA national conference and Victorian seminars, and have presented lectures, workshops and webinars.

Excitingly, I was elected as a National Board member (2017 – 2019), as the first board member from an ethnic minority background. I also assisted organising the Play Like a Girl: Keeping Female Athletes Fit & Ready For Podium, 2019 SMA ACT Symposium.

Since I transition from public health to sport medicine, SMA has been a consistent part of my professional life.

For you, what is the biggest benefit of being an SMA member?

For me, the biggest benefits of being a SMA member is the people and the relationships formed. As a national multi-disciplinary member organisation, I get to meet individuals from sports exercise and medicine, sports injury, physical activity, sports exercise and science. I enjoy catching up with my ‘SMA buddies’ at the annual conference, and these connections built on mutual love of sport are the ones that last through the test of time. As an SMA member, I enjoy

contributing to the growth of Sports Medicine in Australia and support safe, lifelong physical activity participation to enjoy the benefits of an active lifestyle.

Sports Medicine. What is the best piece of advice someone has given you?

I’ve come across a lot of good advice; different pieces resonate during different time points in my life. The biggest advice is from my mum about gratitude. It’s something I have actively fostered over the years and now my ‘superpower.’ Gratitude helps me to be resilient and overcome adversity; it also has a positive effect on my family, friends, colleaguesand the wider network of people I interact with.

Breath before depth will help to find fulfilling carriers. If you haven’t guessed yet, I enjoy standing right at the edge of my comfort zone. I like to think and be outside the box. When something catches my interest, I do a quick selfassessment – here’s who I am at this point in time, here are my motivations, here’s what I found I like to do, here’s what I like to learn and here are the opportunities – is this opportunity the best match for me right now?

I was fortunate to work in Australia, Sweden, Sri Lanka, Finland and the UK, speak several lanuages, amassed and honed a versatile and unique skill set and a range of experiences.

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PEOPLE WHO SHAPED SMA

People Who Shaped SMA

Dr Peter Nathan What made you decide on a career in sports medicine?

Sports Medicine was really a new thing when I was at Auckland University in New Zealand in the 1980’s.

I had ruptured my anterior cruciate ligament (ACL) in my first year of high school and now for the first time I had access to a gym. One of my friends played professional basketball, I used to train with him and some of the other team members at the uni gym. I started to do a lot of my own research on different resistance training techniques and rehabilitation.

None of this was really in the syllabus at university at that time and I expect that may still be the case.

Orthopedics was really the closest discipline and I was thinking about pursuing that. I travelled to London to get more experience there, mostly working in orthopedics and emergency medicine, but I was really more interested in non-operative management and rehabilitation.

There was a Sports Medicine Course in London, but it didn’t really live up to my expectations and then I heard about the ASMF certificate course in WA. The fact that WA was an excellent location for windsurfing may have also played a part in that decision.

Were you an athlete prior to commencing your career? If so what sport/sports did you play?

My major sport at university was sailing.

I captained the university sailing team for a few years, but I did also play rugby for the medical school team and rugby league for a different university.

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I began windsurfing when the sport was in its infancy as eventually hospital commitments made it impossible to continue keel boat racing.

I also began snow skiing while at Auckland as friends at uni were members of lodges and clubs. I became very interested in skiing and alpine medicine and spent two seasons in France where I also did lots of ski touring and climbing. I eventually worked on the ski patrol at Whakapapa in New Zealand. However, windsurfing became my major obsession and was certainly a reason to stay in WA. Of course, snow is the one thing WA lacks, so I worked at Mt Buller for several

years at the medical centre to keep up some of my skiing skills. The group of friends I windsurfed with used to ride mountain bikes in the winter to keep fit. When I stopped windsurfing due to family commitments, I started riding road bikes which eventually led to competing in road races and team time trials. After many years of cycling I eventually started sailing again as a friend and just bought a yacht and currently I am still sailing here in Perth in Division 1 Offshore Keel Boat Racing. The race to Bali has been cancelled due to COVID-19 so the focus this season is on a race to Exmouth which I am very excited about.

PEOPLE WHO SHAPED SMA

Can you describe your educational background?

Public high school in Napier, New Zealand.

Medical degree from Auckland University.

Master’s Degree in Sports Medicine from University of New South Wales. Fellowships in General Practice, Sports Doctor, and ASMF.

course had begun and many of the doctors in Perth who were interested in Sports Medicine enrolled.

This was distance education pre computers with video cassettes arriving in the mail.

We also had to go to the UNSW campus once a year.

How and when did you start working in sports medicine?

I really started working in Sports Medicine when I came to WA in the early 1990’s. I joined SMA and did a lot of volunteering at all the events they covered. I did the ASMF certificate and was fortunate enough to do some of my GP training with Ken Withers the Dockers Doctor. When Rob Moore the Eagles doctor started a clinic at the new Murdoch Hospital, I began working there with him. At that time the UNSW

How and when did you first join SMA? What was your initial role?

I joined SMA when I arrived in Perth and enrolled in the ASMF certificate. I did a lot of volunteering at events and eventually became the Medical Director for the City to Surf Fun Run and also the Rottnest Swim. I joined the WA board of SMA and was Treasurer and then President.

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PEOPLE WHO SHAPED SMA

After your initial period at SMA, what other positions did you hold?

I eventually became a Board Member and I was the Inaugural Chairman of the new One SMA Board.

How did being part of SMA help your career?

Being part of SMA was a fantastic way to meet other people in the Sports Medicine Community. I donâ&#x20AC;&#x2122;t think I would have had the opportunity to work with Rod Moore if I had not been an SMA member. Through SMA connections I was on the medical team for the Rugby World Cup in Perth and then became the Match day doctor for Super Rugby in WA. What has been your biggest contribution to SMA? I feel my biggest contribution has been contributing to the One SMA result whereby we now have a truly National Organisation.

What has been your career highlight?

Standing on the pitch at Subiaco Oval at the World Cup game between South Africa and England

was definitely a spine tingler but really my career highlight is being recognised by my peers with fellowship of ASMF. Do you have any career regrets?

I would have liked Sports Medicine to penetrate a bit more into medical education and especially General Practice.

I wish SMA had more GP members.

What do you believe is your most important contribution to your industry?

I feel my most important contribution has been promoting Sports Medicine as a valuable Medical Specialty and constantly embracing its Multi-Disciplinary strengths. My ongoing work in Orthopedics, General Practice, and Emergency Medicine compliments this.

What is your advice to those starting out on their career?

Join SMA and volunteer at events. Look to get work experience at a multi-disciplinary Sports Medicine Centre like the ones I have been fortunate enough to work in. Go to the SMA conference and attend local educational events.

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SPORTS TRAINER SPOTLIGHT

Sports Trainer Spotlight

Russel Henry

How did you get involved at SMA? During my playing days as an athlete in swimming, surf lifesaving and rugby I always had a keen interest in the treatment of injuries and the rehabilitation process to get back on the field. I found during my playing days, as I made the transition into master competition, I like so many others were spending more time on the physio’s table and heading to the doctors than actually playing on the field. This made me become aware of the lack of professional care being offered to athletes at events and made me look further into it. It was around the same time my children

started their own sporting careers and begun competing in gymnastics.

A conversation with my then physiotherapist, Victor Popov pointed me towards doing a level one Sports Trainer course with Sports Medicine Australia and after completing that you could say the rest is history.

How long have you been an SMA Sports Trainer?

It has been quite a while now; I completed my level one Sports Trainer course back in November 1999 and at that stage the course was run over four nights during the week as well as

two weekends with assignments to do on top of the practical and written test. It was little bit more involved back then, but we didn’t have the access to the technology and online resources available today through SMA. I then completed my level two Sports Trainer course in January 2002.

My involvement as a trainer saw me initially work as a volunteer with our local gymnastics club which led me to being part of the Queensland Trampoline Team at the Nationals for the past 20 years. During this time, I also sold my importing business in 2012 and moved into working as a Sports Trainer, working with SMA, First VOLUME 38 • ISSUE 1 2020

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SPORTS TRAINER SPOTLIGHT

Response Sports Trainers, Gymnastics Queensland and Gymnastics Australia.

In 2016, I completed my Certificate IV in Training and Assessment and have been delivering course for SMA to this day.

What do you love most about being a Sports Trainer?

It is hard pick what I love most about being a Sports Trainer as there are quite a few things I love about it, from the ability to help an athlete when they are at their lowest point after being injured and help them return to doing what they love and the variety of the work. I have had times where I have been covering grade five t-ball at the local school competition and then headed off to world championships with the Australian trampoline teams and pretty much every sport and level in between. I really enjoy working with and meeting with all the athletes from all over Australia and even internationally with the chance to work alongside some of Australia’s top physios, sports doctors, coaches, and of course my fellow Sports Trainers.

What has been the highlight of your journey as a Sports Trainer so far?

It would be hard to pick a single highlight as there have been so many memorable moments. It truly is hard to pick just one. One of my many highlights to this point was being part of the Australian trampoline team for over twelve years and traveling to places 54

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I wouldn’t have even imaged going to, such as, Russia, The Netherlands, Bulgaria, Japan, Canada, New Zealand and England. Working at the Commonwealth Games on the Gold Coast was a great experience, getting to be on the competition floor while our athletes were competing (and winning), attending Gymnastics nationals with the Queensland state team and being the only Sports Trainer there (all the other medical staff are either physios and doctors) and being treated as an equal by those people.

I suppose the best highlight would be dealing successfully with some of the worst injuries you can imagine in a sporting environment, I take

great pride out of being able to help an athlete in their toughest times.

What tips/advice do you have for any new Sports Trainers who are just starting out?

A big one that I still tell myself all the time is to never stop learning, try to take advantage of every opportunity you get to attend conferences, updating sessions, podcasts etc. Every time you are working with a physio, doctor or another trainer, watch what they are doing and ask questions, I have found over the years they are usually more than happy to impart their knowledge but above all enjoy what you’re doing and have fun.

Publisher Sports Medicine Australia Sports House 375 Albert Road, Albert Park 3206 ISSN No. 1032-5662 PP No. 226480/00028