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Standard text messaging rates apply Sports Injury Talks – TWO: Common running injuries


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Nicholas Costiff (Chartered Physiotherapist) …

Nicholas Costiff (Chartered Physiotherapist)

Published in: Health & Medicine

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  • 1. Running Injuries Nicholas Costiff Chartered Physiotherapist and Vanessa Kavanagh-Sharp Musculoskeletal Podiatrist
  • 2. Aims
    • Introduction to the gait cycle
    • Biomechanical abnormalities
    • Assessment of lower limb biomechanics
    • Iliotibial band syndrome
    • Calf pain
    • Introduction to Podiatry and foot wear
  • 3. The Gait Cycle
  • 4. The gait cycle during running
    • Stance phase
    • Swing phase
    • Flight phase – neither foot is in contact with the ground
    • In slower running – the stance phase is longer than flight phase
    • As speed increases, the stance phase and swing phase times approach each other until stance phase becomes shorter
  • 5. Angle of gait 10 ⁰ The angle of gait is approx. 10 degrees The base of gait (distance between the heels) is 2 – 3 cms)
  • 6. Angle of gait
    • Changes from normal angle of gait and base of gait may be secondary to structural abnormalities or compensatory.
    • E.G. wide base of gait mat be to inctease stability
    • AS speed increases, the base decreases, the angle approaches zero and foot strike is on the line of progression.
    • This limits deviation from the CoG increasing efficiency
  • 7. 3 main biomechanical abnormalities
  • 8. Abnormal pelvic biomechanics
    • Excessive anterior tilt – tightness of hip flexors and poor control of abdominal and gluteal/hamstring musculature
    • May lead to inability to dissociate hip extension from pelvic movement.
    • External Rotators at the hip become tight as they work hard to provide stability and also cause abducted angle of gait.
    • Increased lumbar curvature = strain on facet joints and sacro-iliac joint
    • Knee flexion is greater at heel strike increasing the load at the patella, compression.
  • 9.  
  • 10. Abnormal pelvic biomechanics
    • Anterior pelvic tilt may also result in lengthening and weakening of the gluteal muscles.
    • This may lead to lateral tilting of the pelvis
    • Poor control of the hip adductors and abductors
    • on the weight bearing limb
    • Allow opposite hip to drop
    • during swing phase.
    • Trendelenburg gait
  • 11. Assessment of lower limb biomechanics
    • Posture
    • Lower back mobility
    • Mobility of the ankle, knee and hip joints
    • Muscle lengths over the hip, knee and ankle
    • Muscle strength
    • Balance and proprioception
    • Functional tasks ie squatting and core stability
  • 12. Posture
  • 13. Ilio-Tibial-Band Syndrome Runner’s knee
  • 14. Clinical features of ITBS
    • Ache overt the lateral aspect of the knee worse when running
    • Down hill and cambered course is particularly aggravating
    • Tenderness over the lateral epicondyle of the femur (1-2cms above the joint line).
    • Crepitus may also be felt
    • Repeated flexion and extension of the knee may aggravate symptoms.
  • 15. /…continued
    • Muscle length tests highlight tightness in ITB and gluteal muscles
    • Hip abduction and flexion strength is assessed
    • Biomechanics are assessed. Abnormal foot postures (excessive-pronation) may lead to excessive strain on the knee. Lateral tilting of the pelvis may also place excessive strain on the lower limb.
  • 16. Treatment
    • Activity modification
    • Ice, electrotherapy and pain killers
    • Soft tissue therapy aimed at tight muscles
    • Acupuncture for trigger points
    • Self massage with foam roller
    • Stretching of tight muscles
    • Strengthening the lateral stabilizers of the hip
    • Correction of abnormal biomechanics
    • Steroid injection and surgery.
  • 17. Calf pain
  • 18. Anatomy from the knee down
  • 19. Achilles tendinopathy
    • Runners have x15 greater
    • risk of Achilles tendon rupture
    • and x30 tendinopathy
    • Pain in the mid portion
    • (2-3cms above insertion)
    • responds much better to treatment
    • Also be aware of Haglund’s symdrome and bursitis
  • 20. History - overuse
    • The athlete with overuse tendinopathy notices gradual development of symptoms
    • Complains of morning stiffness after increasing activity
    • Pain diminishes after walking about and applying heat
    • Pain usually diminishes after starting activity only to recur several hours later
  • 21. History – partial tear
    • Onset of pain is usually more sudden
    • More disabling in the short term
    • Similar histological abnormality to overuse therefore treatment very similar except time frames.
  • 22. Predisposing factors
    • Years of running
    • Increase in activity
    • Change in surface
    • Change of footwear
    • Excessive pronation
    • Calf weakness
    • Poor flexibility
    • Genetics
  • 23. Treatment
    • Relative rest
    • Examination of biomechanics
    • Muscle lengthening – soft tissue massage
    • Stretching
    • Strengthening Hip musculature and plantar-flexors
    • Electrotherapy and acupuncture
    • Cortisone injection
    • Surgery