Brian Schiff’s Blog
Injury Prevention, Sports Rehab & Performance Training Expert
3
Let me start off by saying I have the privilege to assess and treat many avid runners on a weekly basis. Some of them are triathletes and others just dedicated runners. While the age and experience level varies, I see more female runners in all.
Recently, a woman in her mid thirties came in for PT after being referred by a physician’s assistant (PA) with a working diagnosis of hip flexor tendinitis. She had developed pain running in the past few weeks. It was now at a level preventing her from running despite using NSAIDS to reduce inflammation.
Specifically, she complained of increased pain with figure 4 sitting, difficulty and pain getting up from a chair, and increased pain with running. Her pain level at the eval was 2/10 but went as high as 9/10 with running. Lots of things can cause pain in the hip joint.
Summary of clinical findings:
- Poor single leg stance on the involved hip with mild pain
- No leg length discrepancy
- Subtle antalgic gait
- AROM for hip and L-spine are within normal limits
- No pain with quad or hip flexor stretching
- Manual muscle testing reveals 5/5 strength for hip flexion (SLR and seated), abduction and adduction
- Pain with FABER testing
- Positive hip impingement sign
- Pain with deep squat
So, a very common issue I see in runners is iliotibial band (ITB) syndrome. In a nutshell, it involves excessive rubbing or friction of the ITB along the greater trochanter or lateral femoral epicondyle. It is more common along the lower leg just above the knee and typically worsens with increasing mileage or stairs.
The ITB is essential for stabilizing the knee during running. Several factors may contribute to increased risk for this problem:
- Muscle imbalances (weak gluteus medius and deep hip external rotators)
- Uneven leg length
- High and low arches
- Increased pronation leading to excessive tibial rotation = friction of the band
- Improper training progression
- Faulty footwear
- Poor running mechanics
- Limited ankle mobility (specifically dorsiflexion)
- Tightness in the tensor fascia latae (TFL) and glute max
Related information on this topic include a 2010 study published in JOSPT on competitive female runners with ITB syndrome:
Click here to see the abstract of the study
Click here to read an earlier blog post analysis of the above research article
Common signs and symptoms include stinging or nagging lateral knee pain that worsens with continued running. Hills and stairs may further aggravate symptoms. Some runners even note a “locking up” sensation that forces them to stop running altogether. How do I treat this?
It is clear that our society loves shoes and fashion. The problem is that fashion often does not equate to good function. Keep in mind your feet set the tone for the rest of your body’s biomechanics so it stands to reason that one would want to pay close attention to their foot structure and use the RIGHT shoes more often than not.
I treat and evaluate lots of runners on a weekly basis. I use the FMS, selective testing and gait analysis to help them resolve mechanical issues, overuse problems and improve running efficiency. However, when it comes to making footwear choices, I can only counsel them on what is best.
Recently, I wrote a column for Endurance Magazine on the impact of high heels and flip flops as it relates to injury risk. At the end of the piece, I give some exercises to address shortened muscles and soft tissue. I think all women who enjoy running (symptomatic or not) should give this a read. Click here to read the article.
One of the most common PT clients I see is an injured runner. There can be a umber of different reasons or factors involved leading up to a running injury, but I wanted to focus on this idea of gait retraining that is taking place today. With the advent of Born to Run and minimalist footwear, people have begun to question and debate what the best way to run is.
Is this suited for everyone?
Let me just say right away that I do not believe there is a simple answer here. Human beings are all unique and have different genetic and biomechanical makeups. What this means in effect is that they have their own set of “issues” if you will that I classify into common categories such as:
- Static alignment problems (arch, knee, hip, etc)
- Static and dynamic balance deficits
- Inefficient gait mechanics
- Muscle imbalances
- Soft tissue tightness
- Recurring pain patterns
The list could go on and on, but you get the point. The idea of “re-teaching” someone how to run differently than their natural motor pattern dictates in not easy and is a decision that should be well thought out and based on sound decision making. We are pre-programmed at birth with certain native motor patterns and running is one of those patterns. Generally, your brain finds the most efficient way for you to run in your own body.
Now granted, some run much better than others. Perhaps we can say athleticism plays a role in this, but as we grow and reach skeletal maturity our body type, training experience, strength and environment are also major factors . With that said, I know that runners with recurrent and/or chronic pain are looking for a finite solution to their problem. They grow frustrated when they are unable to log all their miles or finish a race.
If traditional PT or relative rest fails to alleviate the pain, we must delve deeper and look more closely at their gait. I think video analysis is a great tool for doing this. We use Dartfish at my clinic, and this is very useful for breaking down gait mechanics and detecting things like heel versus forefoot striking, overpronation, asymmetry side-to-side, trunk inclination, etc. Once we find things on video we must also correlate these findings to our clinical screening to uncover a cause and effect relationship.
In my practice, I take care of many athletes ranging in age from 10 and up. Many of the injuries I see are related to over training and overuse. Common things I see in the clinic on a daily basis include but are not limited to:
- Tendonitis
- Shin splints
- IT Band Syndrome
- Patellofemoral pain
- AC joint pain/arthritis
The list can go on and on. There are many factors (inherent and training related) that contribute to such problems. I personally believe many problems can be prevented with better education, smarter training, coaching predicated on individuality and physical response, and of course adding in more recovery. Cross training is also a must – just look at what sport specialization at an early age has done to current injury rates.
You need not look any further than the declining age of patients walking through the door with what I term “repetitive microtrauma” injuries. I saw a 14 year old cross country female runner a few weeks ago who had her second stress reaction injury inside of 12 months. In addition, the rise in the number of Tommy John surgeries performed in the past decade with respect to those having them at an earlier age may serve as a harsh warning sign about doing too much too soon or doing too much of the same thing year round.
I say all this simply to say we must not be oblivious to the rise in these types of mechanical injuries. Throwing, swimming, and running are all activities that become dangerous if done in excess, and they also produce predictable injury patterns. So, if you are curious about some risk factors and how to better balance your training and manage these types of injuries, then check out a webinar I just did for Raleigh Orthopaedic Clinic last week (click on the screen shot below to view the webinar)
This presentation is ideal for athletes, parents, weekend warriors and sports coaches looking for practical, straightforward information on this topic with some foundational guidelines that can be applied objectively and immediately to injury management and recovery. If this information helps just one person avoid an injury or accelerate their recovery then I will be thrilled! Please feel free to forward this post to friends, share it on FB or tweet it!
Back to top