Common Lower Limb Pathology Related to Running. Catherine Irwin, PT, OCS January 10, 2012

Transcription

1 Common Lower Limb Pathology Related to Running Catherine Irwin, PT, OCS January 10, 2012

2 Objectives Pathology Treatment Shoe guidelines

3 Pathology Shin Splints Posterior Tibialis Tendonitis Achilles Tendonopathy/Sever s Plantar Fasciitis Patellofemoral Pain Stress Fracture

4 Shin Splints Decreased flexibility in posterior musculature Increased Tibial Varum Excessive compensatory pronation Training errors/start of spring sports Hard running surfaces Large angle of inclination at foot contact

5 Treatment for Shin Splints Change running form: Increase cadence, bring foot under them for contact Incline running to decrease the angle of inclination and promote a mid or forefoot contact Decreased center of mass displacement/increased knee flexion Soft landing Stretch posterior muscles, esp. soleus Supinate for the stretch/support the arch Anterior Tibialis stretch

6 Anterior Tibialis Stretch

7 Posterior Tibialis Tendonitis Poor eccentric control of Posterior Tibialis Accessory navicular/pronated foot Pain with Single limb heel raise Tender along pathway of PTT, esp. posterior to Medial malleolus More severe will have pain into the medial arch Poor dynamic single limb squat Pain increases with activity

8 Treatment for PTT Taping Orthotic Change current shoe (light or mid stability) Eccentric Control for PTT Soleus/Gastroc flexibility (stretch with STN to avoid stressing the tendon medially)

9 Single Leg Stance with Trunk Rotation

10 Single Leg Stance with D2

11 Calf Stretch with STN

12 Posterior Tibilialis Taping

13 Achilles Pathology Training Errors: Hills/mileage Improper Shoewear Decreased extensibility of posterior leg muscles Excessive Pronation Ballas et al. 1998, Am Family Physician Pronation late in stance produces a proximal and distal stress to the Achilles tendon and is a primary cause of Achilles tendonitis

14 Achilles Tendonopathy Tendonitis/Tendonosis/Severs If chronic in nature, tendonosis (tendon changes) vs tendonitis (sheath injury) 2 6 cm proximal to insertion Pain worse in am and after exercise Palpate for nodule Positive squeeze test Measure width of tendon

15 Insertional Achilles Tendonitis/Severs Severs: years of age; growth plate issue Worse with any shoes pressing against the surface Tends to be chronic and constant in nature Very sensitive to touch year old runners: Check for Haglunds that is formed from the abrasion of the tendon on the bone

16 Treatment Running Mechanics: Increase cadence to get more knee flexion, Eccentric heel raises 3 X 15, twelve weeks Gentle CFM/Gentle stretching Taping to off load medial tissue Orthotic to control excessive pronation and stress on medial tendon Joint mobilizations to the TC and STJ if limited DF Heel lift for tendonitis/heel cup for severs CAM boot to decrease the stress on the insertion

17 Plantar Fasciitis Does not usually occur in the under 25 population Is a connective tissue dysfunction, not just heel pain Symptoms: 1 st step versus continued walking Most likely Severs Disease Cannot strengthen the fascia Growth Plate

18 Growth Plate

19 Patellofemoral Pain Faulty running mechanics: Foot contact out in front of COM; landing in knee extension Tight Posterior Musculature Tight ITB Excessive foot pronation at Mid stance Poor Eccentric control of LE during dynamic activities

20 Treatment Stretching Patellofemoral Tape Increase cadence: Foot contact under them, decrease braking impulse and impact Softer landing

21 Stress Fractures Death sentence for a runner Over training Have to get them to rest Change cadence when they return to running/incline running to get decrease load through the LE Orthotics

22 Exercises for Dynamic control Clams Eccentric Abduction Single leg squat AR/AMR/ALR (can use arms or legs for reach) Medius band walks Storks Anterior step down (dips)

23 Stork, Hip Abduction Eccentric

24 Sidelying Clams

25 Medius Band Walk

26 Single Leg Squat/ Anterior Step Dips

27 Anterior, Medial, Lateral Reach

28 EVA shows structural damage after 121 miles. Loss of initial absorption: 25% at 50 miles, 33% at 150 miles, 45% at 500 miles Replace shoe: divided by weight 250# every 300 miles 150# every 500 miles 100# every 750 miles

29 THANK YOU!