Chapter 6: Therapy Diagnosis & Management of Common Running Injuries 4 Contact Hours
Expiration Date : May 29, 2028 Learning outcomes After completing this course, the learner will be able to: Outline the components for analyzing running mechanics. List the relevant lower extremity biomechanical diagnoses that are included in evaluation and assessment of runners. Course overview Evaluating and treating running injuries can pose a challenge for therapists. Running is a highly repetitive activity, and even minor biomechanical differences and musculoskeletal imbalances can be relevant. This course will look at analysis of running mechanics and outline important
Describe the most common lower extremity running injuries and how to evaluate, differentiate and manage them.
biomechanical considerations when evaluating and diagnosing runners. In addition, common running injuries will be outlined including symptoms, examination, etiology, diagnosis, and treatment.
INTRODUCTION
of their running workouts (Willwacher et al., 2022). When stress application characteristics do not allow enough rest for tissue remodeling to occur, tissue degeneration occurs, leading to injury (Willwacher et al., 2022). This course will not cover how to develop and prescribe training programs or how to manage training volume. Our focus will be on evaluation of the biomechanical factors that contribute to running injuries as well as evidence-based interventions for treatment. Healthcare Consideration: It is often difficult for runners to take time off from running. Because they are driven to improve and compete, time off for an injury can be a time of emotional turmoil. Clinicians working with runners should be aware of this and acknowledge it with their running clients. As appropriate, cross training activities like swimming and cycling should be recommended (Hall, 2023).
Overuse injuries are common among runners. Each year, 50% of runners will experience an injury that causes them to have to stop running for a period of time (Kakouris et al., 2021). These injuries are the result of the application of small but highly repetitive loads to the body that result in tissue degeneration. An important factor related to onset of running injuries is stress application characteristics. This refers to the runners’ training program: the amplitude, frequency, and duration Evaluating runners Evaluating and treating runners can be rewarding as they are typically highly motivated clients. It is also challenging because running is a highly repetitive activity. As such, seemingly minor musculoskeletal imbalances or biomechanical issues can become significant when repeated over and over again. A template for evaluating runners should include the following elements: 1. Review of training program (not covered here). 2. Evaluation of running biomechanics. 3. Biomechanical assessment. 4. Specific evaluation of painful structures.
RUNNING BIOMECHANICS
Greater muscle strength is needed to propel the body into double float phase elevation. Core stability is also relevant in supporting the head, arms, and trunk through the running cycle. Finally, initial contact during running demands that joints and muscles absorb increased amounts of energy. In fact, with running the ground reaction force increases to 250% of body weight (Running Biomechanics, 2023). The joints that experience the greatest increase in range of motion demands with running are the hip and the ankle. At terminal stance phase, 10 degrees of hip extension is needed right after toe-off. At the ankle, 10 degrees of dorsiflexion is needed at heel strike. This rapidly increases to 25 degrees of dorsiflexion as stance phase advances (Running Biomechanics, 2023).
The basic mechanics of running have many similarities with walking; however, running demands more muscle strength, more joint range of motion, and greater balance (Running Biomechanics, 2023). Compared to the walking gait cycle, the running gait cycle does not have a double support phase where both feet are on the ground. Instead, the beginning and end of the swing phase have a double float phase where both feet are off the ground. The amount of time spent in the double float phase increases as running speed increases (Running Biomechanics, 2023).
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