Overuse Injuries

Overuse Injuries

Article by John Miller

What is an Overuse Injury?

Overuse injuries refer to injuries sustained from a repeated action (such as repetitive strain injury) instead of acute injuries, which occur in an instant (such as a sprained ankle).

Overuse Injuries Can Occur to the Following Structures:

Exercise applies stress to the body. Your body adapts by thickening and strengthening the various tissues involved.  Hence, muscles get stronger, firmer and sometimes larger, tendons get stronger and bone density increases.

However, if exercise is applied so that adaptation cannot occur, the excessive overload can cause microscopic injuries, leading to inflammation, which is the body’s response to injury.

Signs of Overuse or Inflammation include:

  • Swelling (which may be unnoticeable)
  • Warmth to the touch
  • Redness
  • Impaired function of the part.

All of these signs may be present but not noticeable in the beginning stages.  Often the first sign may be stiffness or soreness (especially in the morning), which may disappear with a warm-up. Continued use may cause continued damage, and the pain will last through, and past warm-up and maybe even worse after an activity is finished.

The Four Stages of an Overuse Injury:

  1. The discomfort disappears during warm-up.
  2. The discomfort may disappear during warm-up but reappears at the end of an activity.
  3. Discomfort that gets worse during the activity
  4. Pain or discomfort all the time.

In stage one, injury identification and treatment allow continuing activity as long as the injury does not worsen.

A stage 2, the activity may continue at a modified pain-free level while being treated.  Treatment must continue until completely healed.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity.

If the injury progresses to stage 3, the activity must immediately cease. The supervising physiotherapist will allow a return to action after identifying the cause, and you are completely symptom-free. Competitive athletes, depending on the individual circumstances, may return to activity with stage 1 symptoms.

What Causes Overuse Injuries?

  • Lack of appropriate muscle strength or endurance
  • Poor core stability
  • Muscle imbalance (strong, tight muscles versus weak stretched muscles)
  • Inflexibility
  • Malalignment or Biomechanical issues (e.g. flat foot, squinting patellae)
  • Training errors
  • Faulty technique
  • Incorrect equipment.

By far, the most common cause of overuse injury is training errors.  Moreover, the most common error is “too much, too soon”.

How to Prevent an Overuse Injury

We can prevent overuse syndromes.  Some of the ways to prevent this injury include:

  • Warm-up (including stretching) and warm-down (including stretching) before and after all exercise.
  • Use proper equipment (e.g. jogging shoes for jogging, a racquet that is the right size with the proper grip size and strings strung to your level of play).
  • Increase at a faster rate than 10% increase per week (distance, speed, weight, etc.).
  • Practice and concentrate on the correct technique.
  • Condition yourself for 2-3 weeks before starting – strength and flexibility.
  • Listen to your body – pain is a warning that something is wrong.  Early identification and treatment will allow you to continue your activity.
  • Identify and correct the cause of pain or discomfort.
  • Ensure full injury rehabilitation, e.g. a sore right leg can cause an overuse injury in the left through compensation.

Common Treatments for Overuse Injuries

The two most important steps in the management of overuse (inflammation) injury are:

  • Remove cause
  • Reduce inflammation
  • Carefully return to activity as the symptoms dictate.

Professional assessment and guidance are highly recommended for overuse injuries. Not only are you repairing acute symptoms you are also aiming to avoid its recurrence once your training resumes.

Tendinopathy (tendon injuries) can develop in any tendon of the body. You may have heard of tendinopathies referred to as its aliases: tendonitis, tendinitis, tenosynovitis and tendinosis. In simple terms, they are all tendon injury pathologies, so the medical community now refers to them as tendinopathies.

Typically, tendon injuries occur in three areas:

  • tendon insertion (where the tendon attaches to the bone)
  • mid-tendon (non-insertional tendinopathy)
  • musculotendinous junction (where the tendon attaches to the muscle)

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to occur suddenly, but usually, it is the result of repetitive tendon overloading. As mentioned earlier, health care professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This means "inflammation of the tendon".

Mild inflammation is actually a normal tendon healing response to exercise or activity loading, but it can become excessive, where the rate of injury exceeds your healing capacity.

Tendinopathy Phases

The inability of your tendon to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent.
  • Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good.
  • The tendon tissue is attempting to heal.
  • You must prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Prognosis: Poor!
  • Tendon cells are dying!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

What is Your Tendinopathy Phase?

It is crucial to have your tendinopathy professionally assessed to identify its current injury phase. Identifying your tendinopathy phase is vital to direct your most effective treatment since certain treatment modalities or exercises should only be applied or undertaken in specific tendon healing phases.

Systemic Risk Factors

The evidence is growing that it is more than just the tendon and overload that causes tendinopathy. People with diabetes, post-menopausal women and men with high central adiposity (body fat) seem to be predisposed to tendinopathies and will need to observe their training loads.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be similar or combined with bursitis.

How is a Tendon Injury Diagnosed?

To diagnose a tendon injury, your physiotherapist or doctor will ask questions about your past health, symptoms, and recent exercise regime. They'll undertake a thorough physical examination to confirm the diagnosis. They will then discuss your condition and devise an individualised treatment plan.

They may refer you for specific diagnostic tests, such as an ultrasound scan or MRI.

Tendinopathy Treatment

Tendinopathies can normally be quickly and effectively rehabilitated. However, there is a percentage of tendinopathies that can take months to treat effectively.

As mentioned earlier in this article, it is important to know what phase your tendinopathy currently is. Your physiotherapist can assist not only in your diagnosis but also guide your treatment to fast-track your recovery.

Before you seek the advice of your physiotherapist or doctor, you can start treating an acute tendon injury at home. To achieve the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as 2 times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.

When to Return to Sport

Every tendinopathy is different, so please be guided by your physiotherapist assessment. Be patient, and stick with the treatment exercises and load doses prescribed by your physiotherapist. If you start using the injured tendon too soon, it can lead to more damage and set you back weeks! It may take weeks or months for some tendon injury to heal and safely cope with a return to sporting loads.

Tendinopathy Prevention

To minimise reinjuring your tendon, you may require some long-term changes to your exercise activities. These should be discussed with your physiotherapist. Some factors that could influence your tendinopathy risk include:

  • Altering your sport/activities or your technique
  • Regular prevention exercises.
  • Closely monitoring and record your exercise loads. Discuss your loading with your physiotherapist and coach. They will have some excellent tips.
  • Always take time to warm up before and cool down / stretch after you exercise.

Tendinopathy Prognosis

While most acute tendinopathies can resolve quickly, persisting tendon injuries may take many months to resolve. Long-term or repeat tendinopathies usually have multifactorial causes that will require a thorough assessment and individualised rehabilitation plan.  Researchers have found that tendon injuries respond differently to muscle injuries and can take months to solve or potentially render you vulnerable to tendon ruptures, which can require surgery.

For specific advice regarding your tendinopathy, please seek the advice of your trusted healthcare professional with a special interest in tendinopathies.

Article by John Miller

sports injury

Sports Injury Management

You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving, or other problems will develop.

Ice or Heat?

We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, muscle tears or bruising, ice should help reduce your pain and swelling.

Once the "heat" has come out of your injury, you can use heat packs. We recommend 20-minute applications a few times a day to increase the blood flow and hasten your healing rate. The heat will also help your muscles relax and ease your pain. If you're not sure what to do, please call us to discuss your situation specifically.

Should You Use a Compressive Bandage?

Yes. A compressive bandage will help to control swelling and bleeding in the first few days.  In most cases, the compressive dressing will also help support the injury as you lay down the new scar tissue. This early healing should help to reduce your pain. Some injuries will benefit from more rigid support, such as a brace or strapping tape. Please ask us if you are uncertain about what to do next.

Elevation?

Gravity will encourage swelling to settle at the lowest point.  Elevation of an injury in the first few days is beneficial, especially for ankle or hand injuries.  Think where your damage is and where your heart is. Try to rest your injury above your heart.

What Medication Should You Use?

Your Doctor or Pharmacist may recommend pain killers or an anti-inflammatory drug. It is best to seek professional advice as certain medications can interfere with other health conditions, especially asthmatics.

When Should You Commence Physio?

In most cases, "the early bird gets the worm".  Researchers have found that the intervention of physiotherapy treatment within a few days has many benefits.  These include:

  • Relieving your pain quicker via joint mobility techniques, massage and electrotherapy
  • Improving your scar tissue using techniques to guide the direction it forms
  • Getting you back to sport or work quicker through faster healing rates
  • Loosening or strengthening of your injured region with individually prescribed exercises
  • Improving your performance when you return to sport - we'll detect and help you correct any biomechanical faults that may affect your technique or predispose you to injury.

What If You Do Nothing?

Research tells us that injuries left untreated take longer to heal and have lingering pain.  They are also more likely to recur and leave you with either joint stiffness or muscle weakness. It's important to remember that symptoms lasting longer than three months become habitual and are much harder to solve.  The sooner you get on top of your symptoms, the better your outcome.

What About Arthritis?

Previously injured joints can prematurely become arthritic through neglect. Generally, there are four main reasons why you develop arthritis:

  • An inappropriately treated previous injury (e.g. old joint or ligament sprains)
  • Poor joint positioning (biomechanical faults)
  • Stiff joints (lack of movement diminishes joint nutrition)
  • Loose joints (excessive sloppiness causes joint damage through poor control)

What About Your Return to Sport?

Your physiotherapist will guide you safely back to the level of sport at which you wish to participate.  If you need guidance, ask us.

What If You Need Surgery or X-rays?

Not only will your physio diagnose your sports injury and give you the "peace of mind" associated, but they'll also refer you elsewhere if that's what's best for you. Think about it. You could be suffering needlessly from a sports injury.  Please use our advice to guide you out of pain quicker. And for a lot longer.

If you have any questions regarding your sports injury (or any other condition), don't hesitate to get in touch with your physiotherapist to discuss. You'll find our friendly staff happy to point you in the right direction.

Acute Sports Injury Clinic

How to Best Care for Your Sports Injury?

There is never an excellent time for an injury. But we do know that most sports injuries occur over the weekend! That's why at PhysioWorks, we have established an Acute Sports Injury Clinic at a selection of our clinics on a Monday and Tuesday.

PhysioWorks has established an Acute Sports Injury Clinic at our Ashgrove, Clayfield and Sandgate practices to assist with the early assessment and management of acutely injured sports injuries.

The acute sports injury consultation fee is significantly lower than a routine assessment and treatment consultation. In most cases, your private health will cover the full cost of your full acute injury physio assessment fee.

Why Use an Acute Sports Injury Clinic?

Your Acute Sports Injury Assessment Consultation allows us to provide you with:

  • A quick and accurate diagnosis. One of our Sports Physiotherapist's or an experienced sports injury-focused Physiotherapist will confidently guide your new injury management.
  • Early acute sports injury care, professional advice and education. What to do this week?
  • Fast referral for X-rays, ultrasound or MRI scans to confirm your diagnosis.
  • Prompt referral to Sports Physicians, GPs or Surgeons with whom we work if required.
  • Immediate supply of walking boots, braces and rental crutches if needed.
  • Low-cost professional service.

More Information

For more friendly advice or guidance, please call your nearest clinic to discuss your specific needs.

Book Online Now! 24-Hours

Ashgrove Ph 3366 4221     Clayfield Ph 3862 4544     Sandgate Ph 3269 1122

sports physiotherapist brisbane

Who is a Sports Physiotherapist?

Sports Physiotherapy is the specialised branch of physiotherapy which deals with injuries and issues related to spokespeople. Practitioners with additional formal training within Australia are Sports & Exercise Physiotherapists.

What is Sports Physiotherapy?

Sports injuries do differ from common everyday injuries. Athletes usually require high-level performance and demand placed upon their body, which stresses their muscles, joints and bones to the limit.  Sports physiotherapists help athletes recover from sporting injuries, and provide education and resources to prevent problems.

Each sports physiotherapist usually has sport-specific knowledge that addresses acute, chronic and overuse injuries. Their services are generally available to sportsmen and women of all ages engaged in sports at any level of competition.

Members of Sports Physiotherapy Australia (SPA) have experience and knowledge of the latest evidence-based practice, skilled assessment and diagnosis of sports injuries, and use effective 'hands-on' management techniques and exercise protocols to assist recovery and prevent future damage. SPA members have access to the most recent advances in sports physiotherapy. You'll be pleased to know that most of PhysioWorks physiotherapists and massage therapists have a particular interest in sports injury management.

What is Physiotherapy Treatment?

Physiotherapists help people affected by illness, injury or disability through exercise, manual joint therapy, soft tissue techniques, education and advice.  Physiotherapists maintain physical health, allow patients to manage pain and prevent disease for people of all ages. Physiotherapists help encourage pain relief, injury recovery, enabling people to stay playing a sport, working or performing daily living activities while assisting them to remain functionally independent.

There is a multitude of different physiotherapy treatment approaches.

Acute & Sub-Acute Injury Management

Hands-On Physiotherapy Techniques

physiotherapy treatment

Your physiotherapist's training includes hands-on physiotherapy techniques such as:

Your physiotherapist has skilled training. Physiotherapy techniques have expanded over the past few decades. They have researched, upskilled and educated themselves in a spectrum of allied health skills. These skills include techniques shared with other healthcare practitioners. Professions include exercise physiologists, remedial massage therapists, osteopaths, acupuncturists, kinesiologists, chiropractors and occupational therapists, to name a few.

Physiotherapy Taping

Your physiotherapist is a highly skilled professional who utilises strapping and taping techniques to prevent and assist injuries or pain relief and function.

Alternatively, your physiotherapist may recommend a supportive brace.

Acupuncture and Dry Needling

Many physiotherapists have acquired additional training in acupuncture and dry needling to assist pain relief and muscle function.

Physiotherapy Exercises

Physiotherapists have been trained in the use of exercise therapy to strengthen your muscles and improve your function. Physiotherapy exercises use evidence-based protocols where possible as an effective way that you can solve or prevent pain and injury. Your physiotherapist is highly skilled in prescribing the "best exercises" for you and the most appropriate "exercise dose" for you, depending on your rehabilitation status. Your physiotherapist will incorporate essential pilates, yoga and exercise physiology components to provide you with the best result. They may even use Real-Time Ultrasound Physiotherapy so that you can watch your muscles contract on a screen as you correctly retrain them.

Biomechanical Analysis

Biomechanical assessment, observation and diagnostic skills are paramount to the best treatment. Your physiotherapist is a highly skilled health professional. They possess superb diagnostic skills to detect and ultimately avoid musculoskeletal and sports injuries. Poor technique or posture is one of the most common sources of a repeat injury.

Hydrotherapy

Aquatic water exercises are an effective method to provide low bodyweight exercises.

Sports Physiotherapy

Sports physio requires an extra level of knowledge and physiotherapy to assist injury recovery, prevent injury and improve performance. For the best advice, consult a Sports & Exercise Physiotherapist.

Vestibular Physiotherapy

Women's Health

Women's Health Physiotherapy is a particular interest group of therapies.

Workplace Physiotherapy

Not only can your physiotherapist assist you in sport, but they can also help you at work. Ergonomics looks at the best postures and workstations set up for your body at work or home. Whether it be lifting technique improvement, education programs or workstation setups, your physiotherapist can help you.

Electrotherapy

Plus Much More

Your physiotherapist is a highly skilled body mechanic. A physiotherapist has particular interests in certain injuries or specific conditions. For advice regarding your problem, please get in touch with your PhysioWorks team.

Post Running Muscle Soreness:

Is it an Injury or just DOMS?

Have you ever finished a big run and felt sore right after it? What about two days afterwards? Do you ignore it or have it checked out? The most common causes of post-run pain are either a legitimate muscle injury or delayed onset muscle soreness (DOMS).

Tips to Determine if it is a Muscle Injury or is it DOMS?

Differentiating between a muscular injury and DOMs is essential to ensure you are not overlooking a potentially sport-limiting injury and you are getting the injury managed appropriately. Early identification is key!

What is DOMS?

Delayed Onset Muscle Soreness or DOMs for short, is an exercise-related muscle condition that arises after intense, unaccustomed, physical exercise. The condition gets its ‘delayed’ name as symptoms are not usually felt until 24 to 72 hours after the exercise, normally peaking at the 48-hour mark after exercise. Research has demonstrated that DOMS is associated with tearing of myofibrils often at multitudinous junctions - best described as microtrauma. This process is followed by inflammation and a shift in intramuscular fluid and electrolytes. This process in combination with other local factors at the cellular and increased intramuscular pressure promote are what causes the soreness and stiffness experienced in DOMS. Tenderness is typically felt at the end of the muscle (at the tendon) where it attaches down along the affected limb and then as the condition progress. This can be felt throughout the muscle belly itself. The swelling, inflammation, tenderness and pain that arises can manifest as decreased joint range of motion, decreased strength and a decreased ability to absorb shock while exercising. This alteration is muscle function can last up to 10 days!

Muscle Injuries

Acute muscle injuries are quite different in how they present compared to DOMS. Typically, pain and stiffness is felt immediately in the affected tissue or shortly after. A ‘pop’, twinge, feeling of being kicked - without anyone actually kicking you - or an immediate collapse to the ground. As expected, the amount of damage to the tissue with a muscle injury exceeds that of DOMS. Any general movement of the muscle will reproduce your symptoms and if the injury is severe enough - bruising can begin to develop with some associated swelling. At the time of injury, following the RICE protocol (Relative Rest, Ice, Compression, and Elevation) is your best go-to treatment. You should also avoid HARM factors. No heat should be applied to the affected area. You should also avoid alcohol consumption, running or other painful movements.  Initially, it is a good idea to avoid massage until a professional has assessed the injury. All the HARM factors have the potential to increase bleeding, which may exacerbate your injury. Research suggests no anti-inflammatory drugs following a muscle strain is the best way to go. If you are seeking pain relief, it is best you consult your regular GP or a pharmacist for pain relief options that don't slow down your healing rates. More info: How to Treat an Acute Soft Tissue Injury

Benefits of DOMS?

Thankfully yes! The body adapts to the physical exercise that was undertaken once the DOMS resolves. So when you go and perform the same exercise again, the chance of DOMS onset decreases! However, adaptation to the causative exercise occurs rapidly after DOMS resolves. This adaptation with repeated exercise is called the “repeated-bout effect.” More info: Delayed Onset Muscle Soreness (DOMS).

How to Tell the Difference?

Your physiotherapist will be your best option for an efficient and accurate diagnosis between the two conditions, however, there are some simple factors to help piece together your injury when it comes to deciding whether or not to consult help. DOMS is more unpleasant when commencing a movement but eases as the muscle is warmed up, whereas a muscle injury will reproduce pain with any movement of the injured muscle. The most definitive factor is taking a detailed history of the injury. If pain was experienced during the event or immediately after, you are most likely looking at a muscle injury. If the pain is worst the day after and gets worse over the following days, you are most likely dealing with DOMS.

What to Do if You Have DOMS or a Muscle Injury?

If you suspect you have a muscle injury, it is best to consult your physiotherapist earlier rather than later. A thorough assessment is required to ascertain what exactly it is you have injured and start rehabilitation immediately to help minimise your time out of the sport! If you suspect you have DOMS, you need to avoid therapeutic interventions that increase muscle pain (e.g. excessive stretching, deep tissue massage) and vigorous physical activity should be postponed until resolution of pain and restoration of function due to:
  • Decreased shock absorption
  • Decreased coordination of muscle sequencing motion
  • Compensatory recruitment of uninjured muscle groups
  • Increased relative work intensity of the affected muscles at the same workload
  • Altered strength balance of agonist and antagonist groups
  • Inaccurate perception of functional deficits
There is evidence suggesting that compression garments, remedial massage and heat packs that all aim to increase blood flow will decrease your pain. If you’re unsure if it is a muscle injury or DOMS - we’re only a call away and our physiotherapists will happily answer your questions and establish the best plan of attack for you! At PhysioWorks, our physiotherapists are highly experienced in giving an accurate diagnosis and establishing an individualised rehabilitation program. We will look at what caused it, how bad the injury is, treat the root cause and implement a plan to prevent it from coming back! If you are in doubt or require more information, please don’t hesitate to contact your nearest PhysioWorks clinic.

Article by John Miller

Can You Reduce Knee Running Stress?

runners-knee Research shows that simply changing the way we run can have a significant bearing on how much stress goes through our knees... and who’s knees wouldn’t mind that? Heiderscheit et al. (2011) found that you can "offload" your knee joint stresses by simply increasing the step frequency while running.

Simple things that you can change:

  • Decreasing your step length to avoid overstriding.
  • Less up and down movement of your centre of mass.
  • Less "braking" force on your lower leg.
  • Less knee bend at foot strike.

What is an Efficient Cadence?

Most efficient marathon runners take roughly 180 steps per minute (90 each leg). If you take fewer steps than this, your knees, shins and heels have more impact stress per stride to disperse, plus you tend to overstride. The detrimental implications of overstriding are multifactorial. Primarily as you overstride, you require more hip flexion to pull your foot and knee further forward. This effectively inhibits the opposing gluteal muscle group. Your gluteals have a vital hip extension, external rotation and hip abductor control, which leads to hip control. Weak gluteals lead to hip “collapsing” issues. Overstriding also increases your heel impact rather than midfoot impact, leading to stress fractures in your heels or shins. Edwards et al. (2009) showed that reducing your stride length decreased the probability of stress fracture by 3% to 6%. And, who wouldn’t want to lower their risk of stress fractures? Overstriding also has an impact on the oscillation of your centre of mass. Essentially you’ll bounce up and down more. The effect is that the ground reaction force absorbed by the ankle, knee and hip at foot strike again increases. You’ve undoubtedly seen how some runners glide across the air with their feet touching the ground. Compare that to the struggling collapsing runner, who I'm sure you also encounter on running paths. This increases the braking force on the stance limb, increasing the ground reaction force imparted onto the knee. Finally, overstriding requires additional knee bend during your stance phase. This increases the likelihood of your kneecap compressing into the trochlear groove of your thigh bone. Do that enough, and you’ll have painful clicking kneecaps.

How Can You Increase Your Step Cadence to Improve Your Stride Length?

Step cadence can be easily measured and re-trained by running on a treadmill and either watching a step counter (e.g. Garmin) or listening to a metronome set at 180 to 190 steps per minute. Smartphone apps can be downloaded and played back as you run. Other research by Wily et al. (2105) has shown that you can effectively do this in a two-week block running four times per week. For more advice, please ask your running physiotherapist.

More info:

Running Injuries Running Analysis Knee Pain
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