River City Running Symposium Jenelle Deatherage, PT, OCS Rock Valley Physical Therapy

Transcription

1 River City Running Symposium 2015 Jenelle Deatherage, PT, OCS Rock Valley Physical Therapy

2 A Brief History of my Running Career Then and... Now

3 Common Running Injuries- Prevention and Treatment Jenelle Deatherage, PT, OCS Rock Valley Physical Therapy

4 A smart runner has yet to be born -Amby Burfoot

5 Do we know what causes injuries? Study out of Brazil, published in JOSPT Oct 2014 Interviewed 95 recreational runners of various ages and experience levels and asked What do you think can cause injuries in runners?...

6 What did the runners say? Not respecting the body s limitations Excessive training Not stretching Foot type (arch height) Wearing the wrong shoes #1 Most cited reason for injury- NOT STRETCHING

7 What did the runners say? Not respecting the body s limitations Excessive training Not stretching Foot type Wearing the wrong shoes #1 Most cited reason for injury- NOT STRETCHING

8 Does Stretching Prevent Injuries? Two separate systematic reviews found stretching provides no protective effect against running injuries warm-up to increase body temp vs. stretching

9 Why is this important? How will you spend your extra 15 min?

10 What did the runners say? Not respecting the body s limitations Excessive training Not stretching Foot type Wearing the wrong shoes #1 Most cited reason for injury- NOT STRETCHING

11 Traditional Footwear Recommendations Arch type- low, medium, high Shoe type- motion control, stability, cushion

12 Military Studies Air Force and Army Assigned shoes based on plantar shape Controls received stability shoe No significant difference in injury rate

13 So now what? Do not make radical changes Try on many different shoes Fit based on comfort

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15 Understanding Running Injuries Overuse= repetitive, cumulative, microtrauma Stress or trauma >> adaptation or repair Envelope of function - modifiable

16 Patellofemoral Pain Syndrome or Runner s Knee Plantar Fasciitis ITB Syndrome Stress Fracture Achilles Tendonitis Top 5 most Common Running Injuries

17 #1 most common running injury Shearing and/or compression between the kneecap and femur

18 Pain located underneath or around kneecap Generally achy but can become sharp Worse with squatting, descending stairs, impact activities Can be painful at rest with knees in bent Symptoms of PFPS

19 Structural Alignment Risk Factors Q angle Hip anteversion Tibial torsion Patellar hypermobility Shallow groove Over pronation at foot/ankle?

20 Current evidence points to a top down breakdown of dynamic control Dynamic Variables

21 Hip control in patellofemoral pain Gluteal muscles not strong enough or not firing properly to control rotation of the leg when the foot strikes Causes caving in of entire lower leg Track (leg) moving underneath train (kneecap)

22 IT Band Syndrome- basic anatomy Connective tissue which originates at the hip and travels along the outside of the thigh A projection of the tensor fasciae latae and glut max muscles Attaches to side of femur and to the tibia

23 What is ITB Syndrome? Source of pain is abnormal friction between the ITB and the femur Truly tightness or functional malalignment due to muscle imbalance/dynamic forces

24 Symptoms of ITB Syndrome Sharp stabbing and/or burning pain on outside of knee Worse when knee is moving through 30 degrees of bend Worse with running downhill, going down stairs Does not warm-up but progressively worsens if activity is continued Horrible and you kind of want to cry a little

25 What causes ITB syndrome? Literature more mixed than for PFPS Likely similar causesdynamic control issues Less likely true tightness and more imbalance between muscles which blend into ITB

26 How to we evaluate knee injuries in runners? Evaluate structural alignment Look at flexibility of hips/knees Assess strength with manual testing of patient on treatment table Evaluate dynamic control of leg, preferably with single leg activties Look for muscle recruitment patterns with single leg exercises

27 Squat Test Even contribution from hip and knee muscles Increased quadriceps, decreased gluteal activation

28 Step-down Test Look for... Trunk position Pelvic alignment Leg position

29 Single Leg Squat Test Looking for variables similar to Step Down Test

30 PFPS/ITB Treatment Starts with good evaluation into underlying causes Basic mat-based strengthening exercises Dynamic control exercises- single leg! Gait retraining...

31 PFPS/ITB Treatment Changing firing patterns/muscle recruitment patterns Ensure runner knows what it feels like to move incorrectly/correctly and to recruit muscles properly Use visual feedback from mirror or help from family member for feedback

32 PFPS/ITB Exercise Examples Mat based exercises clamshells side leg raise side plank bridging

33 Weight Bearing Exercises starting line exercise single leg squat with mirror

34 PFPS/ITB Prevention Gradual progression of mileage/intensity Incorporate gluteal exercises into strengthening program Incorporate single leg dynamic control exercises into program Do not ignore sore knee symptoms, think of threshold for tissue stress Consider gait evaluation

35 Achilles tendonitis/tendinopathy Acute vs chronicdifferent source of pain and different treatment approach

36 Who gets Achilles tendinopathy? Older runners at higher risk Changes in footwear Changes in running form Calf dominant runners

37 Achilles Rehab/Prevention Addressing any recent, self selected changes in footwear and/or gait mechanics Begin eccentric protocol if appropriate Address calf dominance with gait retraining and proximal hip strengthening If acute, consider temporary heel lift

38 Something hurts! Can I still run? yes if... Symptoms warm-up within 5-10 minutes and do not return No sharp pain No asymmetrical changes in running form due to pain (no limping) No localized pain following run for >2 hrs Consider where you are in your training cycle and is it worth the risk

39 How to be a smart runner Gradual training progression Complete rehab of injuries Regular strength exercises Common Sense Know when to seek help

40 When in doubt...use your best judgment

41 Thank You!

42 References 1. Fradkin AJ, Gabbe BJ, Cameron PA. Does warming up prevent injury in sport? The evidence from randomized controlled trials? J Sci Med Sport. 2006;9: Knapik JJ, Brosch LC, Venuto M, et al. Effect on injuries of assigning shoes based on foot shape in Air Force basic training. Am J Prev Med. 2010;38:S197-S Louw M, Deary C. The biomechanical variables involved in the aetiology of iliotibial band syndrome in distance runners- A systematic review of the literature. Phys Ther Sport Feb;15(1): Noehren B, Hamill J, Davis I. Prospective evidence for a hip etiology in patellofemoral pain. Med Sci Sports Exerc. 2013;45: Richards CE, Magin PJ, Callister R. Is your prescription of distance running shoes evidencebased? Br J Sports Med. 2009; Saragiotto BT, Yamato TP, Alexandre DL. What do recreational runners think about risk factors for running injuries? A descriptive study of their beliefs and opinions. J Orthop Sports Phys Ther. 2014;44: YeugSS. Weung EW, Gillespie LD, Interventions for preventing lower limb soft-tissue running injuries. Cochrane Database Syst Rev. 2011:CD1256.