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Return to Sport: Running Injuries in Student-Athletes: Summary
For strength testing, manual muscle testing may not be sufficient in the lower body as the therapist’s strength is typically the limiting factor. It can be more beneficial to utilize tools such as a handheld dynamometer or a 1-rep max testing for a greater comparison of differences between sides, as well as comparing to age related norms. The athlete’s footwear should be examined, looking for uneven wear patterns. It can also be important to note the drop of the shoe, use of inserts, and age of shoes. Functional Testing After strength testing, functional testing should be examined. Some functional tests should replicate running mechanics without impact. These include single leg balance (eyes open/eyes closed), single leg heel raises, lateral/forward step downs, single leg squats, and lunges. Next, plyometric strength should be examined if able. This might include a broad jump for distance or hop testing. It is important to note not only the distance with hop testing but also the body control.
The running readiness scale was created to help determine risk of injury in athletes, looking at a combination of five movements that mimic the demands of running. (See Table 4). Although results did not correlate with injury in collegiate cross-country runners, it can be a good tool to utilize in an exam to assess mechanics with functional movements. Table 4. Running Readiness Scale • Vertical jump (160 beats/minute) • Prone forearm plank • 6 inch step up (switch legs halfway, 80 beats/minute) • Single leg squat (to 45 degrees knee flexion; switch legs halfway) • Wall sit (90-90 position) Instructions : 1 minute per test, 30 second rest between Scoring : 1 point for each test completed correctly. </=3 higher risk of injury
Running Analysis Posterior View
Lateral View
• Base of support • Foot position (neutral, inverted, everted) • Knee angle (valgus/varus) • Knee window (space between knees) • Pelvic alignment • Trunk motion in frontal plane • Arm swing (cross over vs. in line with body)
• Foot strike at initial contact • Stride length/distance foot is in front of torso at initial contact • Knee angles throughout gait cycle • Trunk position • Vertical displacement
Common Running-Related Injuries Anatomy Incidence/Symptoms
Risk Factors
Intervention
Return to Sport
Patellofemoral Pain Syndrome (PFPS)
• ~40% of RRI • Vague anterior knee pain • Worse with sitting, running, after running • Due to overuse, weakness, motor control deficits, or mobility impairments
• Lack of forward trunk lean • Knee valgus • Contralateral pelvic drop • Tightness in gastrocnemius, quadriceps, hamstrings, or IT band
• Hip and knee strengthening* • Neuromuscular education/gait retraining • Improve flexibility/ mobility • Address training errors
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