Sports Injury Talks – TWO: Common running injuries


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Nicholas Costiff (Chartered Physiotherapist)

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No notes for slide Sports Injury Talks – TWO: Common running injuries

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