What needs work? What to focus on? 10/22/15. Common Malalignments. Lower Abdominals. Therapeutic exercise for the treatment of the injured runner

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1 Therapeutic exercise for the treatment of the injured runner What needs work? Typically Weak: Hip Abductors, Extensors, External Rotators Lower Abdominals Ankle Plantarflexors Foot Extrinsics Foot Intrinsics Typically Tight Hip Flexors ITB Hip Rotators (typically External) Ankle Plantarflexors What to focus on? Common Malalignments FuncNonal, weight- bearing acnvines Performing ex. Barefoot IdenNfying compensanons IsolaNng weak areas when necessary Emphasizing when exercises should be performed in relanon to running Non weight bearing exercises Goal: Improve neuromuscular control of gluteal musculature Lower Abdominals Glute Ladders: % Max isometrics Hold for 5 seconds at each position SLR with hip extension Gluteus maximus extension Thomas stretch 1

2 Abdominal Scissors Regression Decrease lever lengths by altering hip and knee posinon Front Plank Progression Strengthens abdominals ThesciaNcafix.com Side Plank Progression Strengthens hip abductors, obliques, and ankle everters Back Plank Progression Strengthens hip and trunk extensors Weight bearing exercises Goal: Improve endurance -and- neuromuscular control of mechanics Single Leg Squat Progression Lateral t-band walks Uniplanar hip hikes SLS with external support SLS without external support SLS while resisting adducting directed force Multiplanar hip hikes All performed with mirror feedback 2

3 Chair Squats Lunges Foot and Ankle Exercises Arch raises/doming Functional Activities Benefits: strengthen natural arch of foot Doming and hopping 2 feet, then 1 foot Integrate barefoot doming in all weight bearing exercises Box Jumps Functional Activities Plyometric program Single Leg Square Jumps Single legged box jumps Week 1 Bilateral jumps: Uniplanar, 2 sets of 20 seconds each Week 2 Bilateral jumps: MulNplanar, 2 sets of 20 seconds each Single leg jumps: Uniplanar, 2 sets of 10 seconds each Week 3 Bilateral jumps: MulNplanar, 4 sets of 20 seconds each Single leg jumps: Uniplanar, 2 sets of 20 seconds each Week 4 Single leg jumps: Uniplanar, 4 sets of 20 seconds each Single leg jumps: MulNplanar, 2 sets of 20 seconds each All performed with mirror feedback AcNve.com 3

4 Foot and Ankle Exercises: Toe abduction and adduction and flexion Barefoot strengthening exercises Resisted adduction: Increases abduction mobility Strengthens foot intrinsics Resisted abduction: Increases toe spreading functional mobility Strengthens foot intrinsics Towel pick up: Improves ability to grip ground Strengthens foot intrinsics, esp. arch Bilateral calf raises Maintain doming for all exercises Barefoot strengthening exercises: Hip Stretching Unilateral calf raises Ball toss Maintain doming for all exercises Achilles tendinopathy: Pain monitoring model Silbernagel, 2010 Phase Goal Treatment Phase 1: Wk 1-2 Phase 2: Wk 3-5 Phase 3: Wk 6-12 Phase 4: 3-6 mo s Pain for up to 24 hours not exceeding 5/10 Start exercise, understand pain monitoring Start strengthening Heavier strength training, return to sport Maintenance. No symptoms CirculaNon exercise, Two- legged heel raises (3x15),One- legged heel raises (3x10) Si^ng heel raises (3x10), Eccentric heel lowering (3x10) Two- legged heel raises on step (3x15), One- legged heel raise on step (3x10), Si^ng toe raises (3x15), Eccentric heel lowering off edge of step (3x10) Quick rebounding (3x20) One- legged heel raise on step with added weight (3x15), Si^ng toe raises (3x15) Eccentric heel- lowering on step with weight (3x15), Quick rebounding (3x20) Plyometrics training One- legged heel raises on step with weight (3x15), Eccentric heel raises with weight (3x15),Quick rebounding (3x20) Patellar tendinopathy: Eccentric training Eccentric single leg squats effective Purdam 2004, Young 2005 Level I evidence: as effective as surgery Bahr 2006 Eccentric loading on 25 incline Return to standing performed bilaterally 2x Daily, 3x15 reps, 12 weeks Progress to weight backpack Supplement with superior patellar mobs, thomas stretching Brotzman 2012, Young

5 Appropriate hamstring strengthening Emphasize hip extension and knee flexion Foam roller Therapy ball hamstring bridges Single leg RDL 5