Running Athlete: Part C. Case Analysis Materials

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Mae Tiffany Gordon
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1 Running Athlete: Part C Case Analysis Materials

2 Case 1 Subjective Examination (performed offcamera) Runs very sporadically, but generally 2-3 x per week around 2-4 miles Play recreational soccer Denies any significant past or current history other than an old ankle fracture

3 Case 1 Objective Examination Posture varus, hyperext, fem IR, lateral WB ROM - Limited rom in lumbar flexion, and T/L jn flexion HIP- decreased ext and flexion, good rotation, mild increase in IR on left Limited pronation, Navicular drop 5/6mm = normal to slightly reduced Special tests *Assymetrical lunge test 4/7cm Plank level 1, lateral level 2, supine 2+

4 Case 1 Movement Analysis Dynamic warm up Loss of lumbar stability during hip flexion Loss of stability in lunge In frontal plane Out-toeing posture throughout

5 Running Gait Video Analysis Case 1 Movement Analysis Walking - increased lordosis Bouncy gait Loud strike on treadmill, increased muscle activity in right L2/3 Rear Out toe throughout Fem IR Wide base Pelvic control Side Ant tilt of pelvis, los of hip ext, loss of knee flexion in swing Early lift & excessive vertical, loss of knee flexion at initial contact Low cadence Upright posture no lean

6 Case Study 1 Home Exercise Program Dumbbell decline squat for better eccentric quad and loading control, Bridges for improved lumbo pelvic stability particularly in sagittal plane Mobilize ankle to reduce vertical displacement and increase sagittal plane mobility

7 Case Study 2 Subjective Examination Left Medial hamstring strain 43 yr old elite masters runner Doing workout yesterday, during the middle of a run felt a tightening in the hamstring and then a sudden zipper like pain in posterior thigh during mid stride that stopped her from running immediately. Moderately severe pain. This was a 7am run ( not usual training time ) on a week of increased training mileage as well as speed as she prepares for a national championship in the masters category where she is number 2 in the country. Of note -.this workout and injury occurred the day after travelling 6 hours in a car to check out a new family pet and was on top of a long history of hamstring and glut tightness that occurred consistently after prolonged sitting. This has worsened slightly in the past year and is only in the left hip Current Training base is 70 miles and recently there is more track work than usual & more speed.

8 Case Study 2 Objective Examination Standing posture symmetrical and unremarkable, mild increase in tone in extensors Lumbar - Standing forward flexion initially pain limited at tibial tuberosity Loss of rotation left > right, Lumbar Extension and quadrant pain free Loss of right side bend, relative excess on left side bend Right hip march at > 90deg = left pain hip pain Simple lateral weight shift collapse on the left hip into adduction Hamstring decreased strength on MMT and pain, local spasm in palpation of mm belly Good strength in a mid range supine bridge yet long lever supine bridge on left poor and painful L4-S1 articular provocation negative Thomas rectus length= left 30/90, right 90/90 - rectus tight, psoas = good length Reasoning of hamstring working against the tight rectus on the left Foot neutral with good rom, normal movmenmt, slight loss of eversion strength but not fatigable weakness Neuro within normal limits, including slump Obvious functional deficit of loss of pain free running speed ( Unable to run > 5.5 mph)

9 Case Study 2 Movement Analysis Not evaluated in great detail due to the pain and clear nature of the injury. Running evaluation would be appropriate in the later stages of recovery Things to think about..lumbar stability contribution, possible discogenic and hip pains in sitting that have pre-loaded this hamstring and training error has strained the tissue Think about cause Vs Victim!

10 Case Study 2 CR/ Treatment / Home Exercise Program Note during the interview the importance of getting inside the mental state of an elite athlete (her detailed prep, her attention to training details, the importance of a logical and rapid recovery as well as realistic advice regarding the likelihood of a miracle recovery Local modalities (icing, e-stim) Kinesio taping Cycling and elliptical for range and tissue health, reduce inflammatory congestion Bridging supine and lateral in the pain free range for tissue health and focus on postural endurance Avoid stretching for days- let the tissue consolidate and maintain its length through functional activities Start very gentle mid range eccentric control with Kick and catch B drill in standing

11 Case 3 Subjective Examination 1500m Olympic hopeful Works as a personal trainer Sports performance evaluation No current injury Past history of minor overtraining injuries in the ITB and a SIJ problem that resolved with improved focus on hip strength

12 Case 3 Objective Examination Left > right rigid dorsiflexed first ray ALT excellent Left pronated, loss of resupination General loss of lumbar flexion and rotation+ Good squat, quad control and ROM ITB on right very tight Excess internal rotation, loss of ER - anteverted hip Plank lateral level 2 excess side bending, front plank (sagittal plane) excellent but a little rigid/cocontracting

13 Pelvic drop, L > R L > R Femoral IR Case 3 Movement Analysis Low recovery in swing/loss of knee flexion (for elite runner) Dynamic warm up hamstrings limited, medially aligned lunges, excessive inverted heel rise, heel walk/dorsiflexion good, skipping is side bent

14 Mobilize 1 st ray Case 2 Home Treatment Program Supination general mobility throughout the day Lateral stability - strength (planks, resistance bands etc) and movement re-education (e.g. dynamic warm up control of lateral motions in lunge and skip) Glut activation

Evaluation of Gait Mechanics Using Computerized Plantar Surface Pressure Analysis and it s Relation to Common Musculoskeletal Problems

Evaluation of Gait Mechanics Using Computerized Plantar Surface Pressure Analysis and it s Relation to Common Musculoskeletal Problems Laws of Physics effecting gait Ground Reaction Forces Friction Stored