 So now we want the the last talk I want to introduce you to Dr. Garrett Coughlin. I know Garrett very well. He qualified from UCD with a physio degree in 2004. And then he did his PhD in lower limb injuries and rehab in UCD in 2007. Apparently he had a great supervisor then. Over the last 15 years he's gained a lot of clinical experience and research from private practice to elite sport. Currently working with Mayo senior football, but he's spent a long time working with Connacht Rugby and has also worked with the National Rugby and National Hockey squads. Garrett is kind of a bit of an outlier in that he's combined his clinical work with a very active teaching and research program. He's published over 30 articles, primarily in the area of athlete profiling, concussion, lower limb rehab and assessment, and as well as more recently medical team game communication and positioning in field sports. He previously competed as a middle and long distance athlete at national and international level and trained with Jerry and Merck for a period of time. And he's currently living in Westport right on the edge of Ireland with his long-suffering beautiful wife and three children. Thanks, Brian. Thanks very much for the introduction. And I hit the wall on many occasions, running marathons as well in my time. So I'm, as Brian explained there, probably a bit of a mixed background in terms of research and clinical work. And I think an awful lot of what's been presented today has obviously been very research-based, which is part of my presentation, but I'm also hopefully trying to leave you with some clinical pieces as well as part of that. And some of that as per the presentation from Professor Moran earlier on is opinion and anecdotally orientated a little bit as well, but probably when we don't necessarily always have that research piece to back it up. Hopefully it just gives a bit of an insight from some clinical experience as well that I've had. So just from my point of view, just I would have trained with Jerry and Merck when I was about 22 years old for two or three years. And these are probably the two sort of iconic pictures for me of Jerry. One was how I knew Jerry when I was growing up in terms of looking at Irish runner and looking at Jerry winning double marathons or baddie cottons or wherever it was and trying to wonder what he was like and how good that he, how did he get as good as he was? The second one was then obviously Jerry as the coach and as the mentor and the person that I probably got to or they get to know. It's probably surprising that I'm even here because the Jerry and I probably had a bit of a falling out when we were coaching. Me with immaturity Jerry with his stubbornness and we ended up whereby for a reasonable period of time we didn't converse with each other. And then probably about 10 years ago we had a connection again with each other. He ended up in hospital with my little brother in the same ward, in the same, the two of them beside each other in the bed. And my brother was the polar opposite of me in terms that he wasn't the runner or the studious one, he was the partier and the guy going out getting the girls. But what struck me always with that was just how I'm reflected on today. It was probably just Jerry's ability to connect with whoever he engaged with in his time and thankfully all of it sadly just in terms of my brother passed away but Jerry and I had a connection after that and the sort of agreement we left was that we catch up with each other at a later date and unfortunately we never did. So it's probably regrettable but massively honourable for me to be here today probably to honour Jerry as well. So sorry now, I'm getting a bit upset now shall we get upset? So just to thank Mark and Brian very much for the invitation that it does mean a lot to me to come back and be able to do something like this for them. So the session plan for today, a little bit of a mix of things. Just want to give a brief overview on common running injuries, the risk factors for injury. Again as Professor Moran has outlined earlier on probably the question mark after injury prevention just some technical considerations and then just some suggested exercises as well for people to maybe consider as part of what they do. So the common running injuries piece and again we've been fortunate with the research that's there to have some more up-to-date and recent information around this and this was a systematic review done by a group from Loughborough, it was just published last year and it looked at non-ultra marathon runners and ultra marathon runners through a range of looking through lots of different studies over the years and what they found in their research was obviously that we've heard some of this already was that the majority of injuries happened at the knee and below and if we look at the two groups where you have the non-ultra marathon runners and the ultra marathon runners we can see that the high percentage of these injuries are in those particular areas, so the knee ankle, the lower leg, the foot and the toes. Furthermore then in that study if we look at the type of injuries that are occurring we've got there are telofenderal pain syndrome, medial tibial stress syndrome, fasciitis, tendonitis all of these are really common overuse injuries that tend to happen in athletes and I suppose for the most part they are the most common injuries that we see across the spectrum in an athletic population. More recently there was another paper published which looked back at a range of European and world indoor and outdoor championships and again this group just looked at male and female athletes and trying to look at the comparison between the type of injuries that happened and the time loss resulting from those injuries and also what the events were that the people were competing in and again there's a wide spectrum of people here today but we can see that the ones with the combined events like the heptathalon and the heptathalon are probably the highest injured group because of obviously the sporting demands that they have and we've got our middle and long distances somewhere in the middle and then we've got our more field-based sports and walks are somewhere down the bottom and again there's been multiple studies looking into the differences in terms of gender injuries in terms of short distance and long distance injuries as well and again probably the biggest conclusion that I put together from looking through the research which in fairness to me is not something I've done recently but until I went to prepare for this lecture today there's such a dearth of information there in terms of the consistency between the studies and I think that's probably what the benefit of having something like the Insight Centre that's linking up the different universities to try and have a more cohesive approach towards actually trying to identify how these studies are structured and what they're trying to identify but we'll talk about risk factors in a second but just basically the inconsistency with the studies has probably given us very little security around defining what the most common injuries may be at times Another systematic review and again just recently published and again this was from a multinational group of people and again Professor Moran outlined a couple of these earlier on but this was looking at injuries in short distance runners and these were people who ran under 15 kilometres a week and then longer distance runners in terms of people running over 15 kilometres per week and again as he outlined earlier on the history of previous injury is the most common cause of injury and that spans all sports for the most part in the sense of if you've injured a structure before there's a pretty good chance you're probably going to hurt it again or injure another area on the back of that area been previously injured and this review as well indicated that in the shorter running distances group is that an awful lot of their injuries were actually attributed to injuries that had not happened in running before so a lot of these people may be coming from doing other sports or other activities and take up running and they've had a previous injury from that which possibly leads to them having an injury when they take up athletics or a new sport and both of these areas of the history of previous injury and the injuries not attributed to running have a reasonably good support base for been risk factors for injury and it's when we get on to I suppose the other areas here like we've got our BMI, our age, our weekly running volume our previous running experience there's definitely much more lower to moderate quality of evidence to support that in terms of the risk factors towards us and again going back to what I said earlier that inconsistency in terms of the research, the sample pools that they use again going back to what Ciaran said in terms of the follow-up the prospect of quality of the studies it's been very limited in terms of what we can actually truly take from that as to what the risk factors are the biomechanical pieces Ciaran has outlined some nice areas around that and again as a physiotherapist working with athletes and peoples of all ages and different types of sports this is probably what we from our end are probably trying to very broadly look at I suppose and then obviously look at in detail on specific injuries to try and figure out A what's causing them and B how we're going to try and fix them and again this was from this systematic review just published this year looking at again a large cohort of athletes and again we're seeing all these type of overuse type syndromes again and again the majority of these are again about that below knee type structures the ones that are getting injured and we're looking at the colour scheme here at the bottom in terms of strong evidence all the way down to conflicting evidence and there's not a whole lot of green on the screen in terms of what actually causes these injuries to occur so that provides a massive challenge for clinicians in terms of trying to figure out what's wrong how we're going to fix these people and quite often as again Professor Moran outlined earlier on it's down to that individual athlete and trying to identify what their deficits are and how we can start to try and address the deficits they may have so injury prevention is probably the holy grail and if it even exists as a whole other thing as again has been spoken about earlier and again from my end I suppose the most common things that I see in terms of errors that people are making or why people are getting injured comes down in the most part in this again not just from a running perspective but across sports is essentially the training error in terms of again the acceleration too fast in the intensity of training or the duration of training the conditioning of the people that are doing the sport so again the understanding that maybe not going out for a 30-minute run during the week as it's kind of a filler to get more of your miles and actually potentially spending that on some strength work or some core work instead if you're time short kind of a massive influence in terms of how strong people are conditioned to actually go and do the sport that's been required of them and again it's probably something I see again and again where people are trying to push push push in terms of their higher mileage and probably not addressing some of the deficits they have which would actually help them to improve in the mileage that they are running but probably again is probably one of the biggest issues for people again where majority of people here are indeed online or are in general not professional athletes and having that opportunity to recover and prepare for next training session and have that again has been spoken earlier that adaptation to the training stress and the stimulus and not have that repeated tissue loading again as a major factor and then probably the most common thing that I see across the board is actually acknowledging that you're injured and we've again had the presentation about the niggles and the twinges and all that and they just drag they just drag and drag and drag for people and not that I'm trying to report business for the medical profession but if I probably had a year off for every person that came in and said you have had this for the last three months and they're now presenting to me with the issue whereas I've probably had they got them within a week or so would have been a very different outcome in terms of the development of a chronic condition that they have so probably an early acknowledgement of of an injury or a problem that they have and actually trying to address that much sooner again for my personal experience there's also a far better outcome for people than again hanging on to that niggle for a much longer period and again hearing what I'm talking about the biomechanics and running technique and running form etc and I suppose I probably approach it from a slightly different spectrum albeit not too dissimilar but probably some of the most common things for me in terms of trying to support a correct running style or running form in somebody is having the strength capacity to actually go and do that or the running form to go and run fast and again I'll get into these in a little bit more detail in a second but broadly that involves the ability for something to have an appropriate arm drive when they're running it involves them having stability through their trunk primarily along their front section here and on their outside section here it involves their lateral hips being nice and strong them having what is called a nice hip extension pattern so that they're able to push off the ground behind and then again we spoke about that sort of ground interaction with the foot and what that sends up the chain in terms of having a co-contraction when we go into our landing position and the co-contraction is basically multiple muscles trying to contract and stabilize numerous joints throughout our body to then allow us to absorb force to therefore actually try and propel ourselves forward with force as well so broadly for me what I'm looking at from a clinical perspective and people when they're coming into me is with a running related issue is very much based around these type of areas and don't get me wrong this is probably generic and today it can be very different depending on the injury that the person has as well and the things you may need to address with them so these apologies for the model these were just again just probably very broad categorizations by me in terms of what I probably see is a clinician as well and I've got three sort of categories and there probably could possibly be four categories here in the sense I've got the runner, the bopper the rotator and the fourth which I didn't include but as possible there is the shuffler which Jerry was a good proponent of as well as Marty said giving plenty of abuse for back in the day the runner for me in terms of this is probably the better techniques that I would like to have in one of the athletes I'm looking at regardless of their sport will involve them having a nice trunk lean so they're again they're getting their center mass forward from their hips they've got a nice elbow drive in terms of their techniques which links into their hip extension on the other side and then when I look at them front on they've got nice pelvic stability so they're not basically getting a hip drop on one side and what we'll also see again and it was interesting Curian's presentation he spoke about the research they looked at in terms of having that little bit of rotation forward as well with their arm to actually allow a counterbalance of force with the opposite leg on landing too so these are just some slow down videos of me on a trot here trying to suppose to demonstrate as best I can in a non-laboratory setting of what that type of technique would look like if I move on to the bopper this is the kind of person who probably looks like they're running particularly fast but they're generating a lot of sort of vertical forces on their runs and they're literally bouncing along like this a lot of the time in terms of their run and what we see on this person is probably that little bit of a difference in terms of the angle of that trunk lean it reduces their capacity to get as much hip extension behind here as well because they're trying to apply forces up the way a lot of the time they tend to keep their hands a little bit higher and they're driving up here all the time in terms of this position and they don't end up with a huge amount of elbow drive as a result in a vertical direction when they're running so again just to clip through on these they've got sort of this long sort of hang time in the air when they're on their running stride because as I said they're generating all of that momentum vertically up as opposed to having that more horizontal lean and drive forward from front on it doesn't look hugely different and especially I'm probably on a too short a distance here to probably demonstrate this perfectly but you can probably see that the arm drive is not a huge counter rotation compared to what we see on the other picture and I've got these at the end just to summarize those together and then we have the rotator who is the guy who's probably got the bruised knees a lot of the time from, sorry cracking into himself on runs but this is the for some reason it's just playing over itself and yeah here we go so again these guys are probably from trying to get that counter balance from the opposite side and they've got a significant pelvic drop on their running technique and it's typically resulted in them not having again that appropriate arm drive through they're carrying their arms in a low carriage position and again from a hip and a pelvic stability point of view they're literally just collapsing side to side as they're in that running technique which almost goes into the sort of the category but again they leak huge amounts of energy in terms of having this side to side and counter balance all the time and again just to try and show those kind of still frames of the sort of the three different techniques I like to think it was quite ingibits and like on this one but you can see probably just that again that trunk lean the hip extension, the push off, the arm drive difference between the three different techniques on this and then again on the front arm view we've obviously got our runner and a bopper reasonably similar but then we get into our rotator who again is leaking a lot of that energy side to side on their pattern so this was going to get on to sort of the exercises piece here in terms of again completely opinion directed and anecdotal and I don't make any apologies for that in the sense of I probably tried to give some amount of research background and supporting what Kieran's already said but these are probably some of the basic exercises I would use with some athletes in terms of trying to help them prepare for getting some of those fundamental patterns in so challenges of doing these is when you've got your two year old with you for the day and this is little Luca who started school this week, sorry play school this week I should say and surprised us all and daddy was at home with him on Thursday and for love no money he was not letting me do these at all and the biggest problem why I probably had to include this video was that when I went back sort of trying to cut the videos after that night Luca was in videos that I didn't even know he was in and he makes a guest appearance on multiple episodes of this so my apologies in advance because I wasn't going to get the time to go back and repeat all of the videos again and he makes sporadic little engagements on it so that's Luca so Brian Carpenter was actually going to demo some of these for me but based on my experience of his athletic prowess down the years I thought it might be safer for everybody and my insurance if we didn't do them so here is we spoke about that lateral hip stability that we need and that trunk stability up in this section here of our trunk and again from a basic point of view the side plank pattern and the progression of a side plank pattern is a real simple way of trying to hopefully try to strengthen these areas I pretend to try to activate these areas pre-training so again we don't need to start at the top in terms of the difficulty levels of these we want a shorter lever position from our elbow through to our knee to make things nice and comfortable in that position for us we can hold in that position or we can raise up our top leg in that position we then could look to go into second version of this which is lengthening that lever again to put more stress through this lateral trunk and again different versions of leg raises and that almost kind of running type positions on these again to put more stress on this underside hip in this position that can then be progressed even further with a very simple band setup tied off a fence and post or a pole whatever it is which is also bringing in a little bit of our arm drive pattern but the row is also doing a challenge that bottom hip a little bit further and then probably a little bit more of a conditioning space for us adding in a light weight into that row pattern and again I'm trying to stabilize this hip in a bit more of a functional landing pattern there that I would have spoken about earlier on where we've got that kind of co-contraction piece going on so again it's just trying to take you through the spectrum of how you might just progress that through and regardless of your level of activity or your capacities you can basically start anywhere on this spectrum in terms of trying to strengthen some of those structures the other piece I spoke about again was that trunks ability along the front or the anterior core and also trying to link that in with our hip extension so again trying to minimize equipment use and stuff that people can use before they go into training two simple techniques here again one is a dead bug pattern and again I kind of work through a spectrum of lengthening levers here where I start off with my feet on the ground and then I go to extending out into that longer position on both sides I create a lot of tension with my arms pulling down towards my knees which is forcing this anterior trunk to be nice and strong and then I go into more leg lengths longer lever positions to put a greater demand on that area and as we look to try and strengthen people through this anterior trunk to try and teach to get into that forward lean and be stable in that forward lean again this is a nice way of training this and things like front planks or supermans any type of these exercises can all be used to try and start to train this area in people again trying to link in the hip extension piece here so this back leg again is trying to be focused on that big guy behind which gives us most of our power to drive us forward and we're trying to link it in with the band here just messing with the band in terms of different directions again to try and get us to engage this trunk at the front and keep us nice and stable as we're going through our pressing patterns and I have two more videos to do and I think this is where Luca definitely jumps in and makes it his own but the this is probably one of the abusive some of the guys will be over that if you fractured Tom that you could be doing this exercise with me and that it wasn't always for a lower limb injury but for me this is looking at how we interact with the ground and again as Professor Moran's presentation displayed earlier on it is that ground contact that rate of loading that we have on the ground and again how that's being controlled so for me a lot of people when we go into the infamous heel strike four foot categories if they're in a heel strike position a lot of times they're inability to control that deceleration into that position as they land and then to be able to stabilize that position before they go into their push off onto their next stride so this tall lunge reach drill that we use is sort of a 90% weight on the front leg about 10% weight on the back leg and essentially is trying to teach my hip my knee my ankle and my foot to interact with the ground and be stable in that position when it interacts with the ground and by means of trying to progress that on normally we do this by adding weight onto this and I only have an AKG kettlebell at home and I'm afraid but you can go up to any sort of weight with that in terms of like a lot of people who are doing this drill will be up around 16-20 kilos but again you can do this body weight at the start of a training session to try and sort of again get that co-contraction pattern working for you and then as some of them progresses through it we'll bring them into that stepping pattern teaching them to have that force absorption piece when they hit the ground to then which will lead them into the force production piece which is the next slide and again I've added in the dumbbells here to demonstrate you can do this with more load and the rationale for that is obviously when we hit the ground we're hitting it at multiple times our own body weight and we need to create stress through the system to actually reproduce those forces the dumbbells I'm using are probably not going to replicate that force but the speed of motion trying to get heavier weight on that as we get technically corrected the form will obviously try and help us in terms of how we're on that force absorption part of our running pattern the last piece of this is probably again I have a term lateral hips stability but it's also trying to focus on that hip extension piece and again I spoke about at the start there in terms of somebody going into that tall lunge position here that's their landing position this drill here is called the hip lock pattern and it's very much about trying to get something to drive into that next phase of their running action and again a lot of injuries lower limb we'd use this in terms of trying to work I suppose from the ground up in terms of the foot stability all the way up in terms of your control with your hip as well and this does link in your trunk in that top position in terms of having to stay in that slight bit of forward lean as opposed we might see on the bopper whereby they're in this type of position here with the back hanging out because they're not getting any trunk stability at the front so again on this just a simple body weight progression that was the one where I definitely was going to run behind me and a b just joined in on this one as well but the pattern of this again is trying to teach that hip to you can see I start off in like the tall lunge reach position I'll go side on here just so you can see that now and again I'm trying to propel myself up into that forward drive position here and again there's multiple versions of this that you can progress in terms of driving on to steps etc in front you to get that bit more for propulsion but as an initial way of trying to cue this and educate someone this pattern this is what we would use and again you can add this in in terms of the weighted part of this again this is this the mighty 8kg kettlebell I have at home again you may not use a whole lot more than that in terms of that overhead pattern because it just becomes diminishing returns if I've got a 20kg kettlebell over my head in this position a lot of people are going to struggle to actually support that just from an overhead press point of view so again not essential but like a 2.5kg or a 5kg plate or even a med ball can do a lot of the same things and create a little bit more demand on you to try and support yourself and then sort of the final progression this is just trying to make it into a little bit more of a dynamic pattern again and I'm just doing a little bit of a lateral version of this here but you can obviously do a forward version of it as well and again this is trying to just get me into that landing that propulsion for position to try and train that lateral stability that hip extension that trunk control so as I said what I presented to you there is anecdotal its opinion related I don't mind that's what I use a lot of the time in terms of basic starters for a lot of people and stuff that I find really effective what I'm trying to do we're trying to return people to running the idea being that A it hope it resolves the injury that they have and when we talk about that running form I hope you can see that there's some relationship there to some of the biomechanical considerations that we spoke about earlier on and also the areas that we're getting injured that if we're trying to strengthen these areas a little bit more it hopefully results in us being injured a little bit less as well and get to enjoy what we do and that's me thank you very much