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Return to Sport: Running Injuries in Student-Athletes: Summary
Common Running-Related Injuries
Return to Sport
Anatomy Bone Stress Injury (BSI)
Incidence/Symptoms Risk Factors
Intervention
• 20% of collegiate track and field athletes • Mild diffuse ache after specific time of running, at specific time in gait cycle • Pain does not “warm up” • Progresses to localized pain at rest • Localized bony tenderness • Femur: + fulcrum test • “Shin splints” • Diffuse pain at posteromedial tibia with activity • Tenderness along posteromedial tibia • Weakness in tibialis • Progressive Achilles pain/stiffness • Swelling/thickening at Achilles • Excessive pronation • Reduced dorsiflexion • + arc sign or + Royal London Hospital test • Due to friction of the ITB shifting over lateral femoral condyle • Lateral knee pain • + Noble compression test • Poor flexibility in ITB and hip flexors posterior, soleus, flexor digitorum longus • Weak/painful plantarflexion
• Prior BSI* • Menstrual changes* • Training errors* • Excessive rear foot eversion • Excessive hip adduction • Excessive dorsiflexion at initial contact (> 5 degrees) • High vertical loading • Downhill running • Training errors • Contralateral pelvic drop • Increased ground contact time (slow cadence) • Prolonged rearfoot eversion • Hip abduction weakness/evertor dominance • Increased BMI • Training errors • Contralateral pelvic drop • Increased ground contact time (slow cadence) • Rapid or excessive pronation • Increased BMI • Crossover running • Contralateral pelvic drop • Reduced knee flexion at initial contact • Excessive eversion
• Improve nutrition • Activity modification • Address strength/ neuromuscular control deficits • Optimize cadence (150–180 steps/ minute) • Encourage midfoot strike High Risk BSI • Non weight bearing 6 weeks • More gradual return to running • Hip strengthening • Foot strengthening (control eversion) • Footwear • Stretching gastrocnemius • Gait retraining** (increase cadence) strengthening • Cross training • Footwear—heel lift (limited evidence, avoid minimalist shoes • Gait retraining** (reduce forefoot strike, increase cadence) • Relative rest—avoid stairs, cycling • Hip/core strengthening • Stretching ITB • Hip strengthening • Intrinsic foot
Low Risk BSI • 12–13 weeks High Risk BSI • Non WB x 6 weeks • 12–17 weeks Initiate running after can walk >30 minutes pain free x2 weeks
Medial Tibial Stress Syndrome
• 30% recover in 1 month
Achilles Tendinopathy
Iliotibial Band Syndrome (ITB)
• Gait retraining** reduce transverse plane movement
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