Common Injuries in Running Erica Martin, MD Promedica Physicians Group, Family Medicine and Sports Medicine Team Physician, University of Toledo Women’s Soccer October 2nd, 2019 Goals and objectives
• Discuss demographics of those who run in U.S.
• Describe changing running related injury (RRI) patterns.
• Discuss rates of RRI in general and also specific RRI.
• Discuss common presentations, physical examination, diagnosis, and management of common RRI. Why is this topic important?
• America is on the run!
• Demographics of those who run is changing, leading to changing injury patterns
Source: google.com Why do people run?
• Benevolence
• Weight loss (?)
• Freedom!
• Problem solving Why do injuries occur in running?
• Walking fast in a straight line?
• Rates of injury are high!
• Predictors of running injury?
• Prospective study of athletes in supervised training program, Bovens et al. Changes in injury patterns
• Most injuries are overuse injuries
• Knee + shin problems younger athletes
• Calf + Achilles + hamstring problems older athletes Show me the numbers!
Source: AAFP Roadmap for Running Related Injuries (RRI)
Knee injuries Tibia Foot and ankle • Patellofemoral pain Hamstring • Medial tibial stress • Achilles tendinopathy • IT band syndrome tendinopathy syndrome • Plantar fasciitis • Patellar tendonitis • Bony stress injuries of the feet Knee: Patellofemoral pain syndrome
• Anterior knee pain conundrum
• Predisposing factors? Knee: Patellofemoral pain syndrome
• Diagnosis/presentation?
• Primarily clinicalstairs, squatting, running
• May have mechanical complaints
• Typically no need for imaging Knee: Patellofemoral pain syndrome
• Treatment?
• Orthotics?
google.com Knee: IT Band Syndrome
• Presentation?
• Lateral knee pain, though can consider other less common causes
• Pathophysiology?
• Friction versus impingement versus biomechanics Knee: IT Band Syndrome
• Diagnosis?
• Clinical
• Ober’s test, Noble compression testing Knee: IT Band Syndrome
• Treatment?
• Physical therapy
• Not much evidence for steroid injection or surgery Knee: Patellar tendonitis
• Presentation?
• Anterior knee pain strikes again!
• Should be more localized than patellofemoral pain
• Thought of more in sports involving jumping Knee: Patellar tendonitis
• Diagnosis?
• Clinical
• Single leg decline squatdx from patellofemoral pain
• Can consider US if unclear
Source: AAFP Knee: Patellar tendonitis
• Treatment?
• Eccentric exercises “decline squat program”
• 4 stage program also described Hamstring injury
• Multiple mechanisms of injury
• Slow speed stretching versus quick/explosive movements
• Running hamstrings active for entire gait cycle! Hamstring Injury
• Presentation/diagnosis?
• Cramping pain, posterior thigh/buttock with radiation to popliteal fossa. Can be exacerbated with running and sitting.
• Bruising/palpable defect
• TTP over insertion at ischial tuberosity.
• Modified bent knee test
• If dx unclear, US or MRI Hamstring Injury
• Treatment?
• Acute injury managed a bit differently than chronic
• Acute: activity limitation at first, then PT
• Chronic: data lacking, but eccentric exercises may help
Source: https://www.muscleandperformance.com/ Tibia: Medial tibial stress syndrome
• AKA “shin splints”
• Stress injury tibial periostitis and microfractures Tibia: Medial tibial stress syndrome
• Diagnosis?
• XR if suspected tibial fracture
• If needed, MR better than bone scan Tibia: Medial tibial stress syndrome
• Treatment?
• Relative rest, calf stretching (soleus tightness) Foot and ankle: Achilles tendinopathy
• Largest tendon of body, connects triceps surae to insertion on calcaneus
• Primary plantarflexor of foot and ankle
• 2nd most common MSK injury in runners
• Risk factors Source: https://www.phrases.org.uk/ima ges/achilles-heel.png Foot and ankle: Achilles tendinopathy
• Diagnosis?
• Clinical usually
• Ultrasound Foot and ankle: Achilles tendinopathy
• Treatment?
• Eccentric heel lowering exercises • If insertional, don’t lower heels below toes • If midsubstance, can lower heels below toes
• No great evidence for injections, surgery, topical nitroglycerin Foot and ankle: Plantar fasciitis
• Plantar fascia static and dynamic stabilizer for medial longitudinal arch
• Predisposing factors? • Intrinsic
• Extrinsic
Source: google.com Foot and ankle: Plantar fasciitis
• Diagnosis? • Mainly clinical
• Inferior medial heel pain
• Windlass test
• Heel squeeze test
• Can exclude heel spur or calcaneal fracture with XR Foot and ankle: Plantar fasciitis
• Treatment?
• Passive plantar flexor stretching program
• ?high load strength training Foot and ankle: Bony stress injuries (BSI)
• Stress injury bone fails to respond to submaximal forces
• Ask about: • History of BSI
• Recent ∆ training
• Female athlete triad
Source: google.com Foot and ankle: Bony stress injuries (BSI)
• Examination
• Foot architecture
• Pain with weight bearing
• Focal tenderness, bruising
Source: orthobullets.com Foot and ankle: Bony stress injuries (BSI)
• High risk locations • Navicular
• Base of the 5th metatarsal
• Talus
• Base of 2nd metatarsal
• Sesamoid bones
Source: https://differenttruths.com/wp- • Medial malleolus content/uploads/2019/02/Beware.png Source: Skeletal Radiology Sept.2017 Foot and ankle: Bony stress injuries (BSI)
• Diagnosis? • XR first
• If high risk location, get MR Foot and ankle: Bony stress injuries (BSI)
• Management?
• If high risk area immobilization and non-weight bearing x 6 weeks, consider surgical consultation
• Otherwise, weight bearing modifications to be pain free
• Calcium and vitamin D supplementation to aid in healing In summary…physical therapy for everyone (mostly)!
Source: google.com Works cited Aderem, J., & Louw, Q. (2015). Biomechanical risk factors associated with iliotibial band syndrome in runners: A systematic review. BMC Musculoskeletal Disorders, 16(356). doi:10.1186/s12891-015-0808-7
Arnold, M. J., MD, & Moody, A. L., MD. (2018). Common Running Injuries: Evaluation and Management. American Family Physician, 97(8), 510-516.
Bondi, M., Rossi, N., Magnan, B., & Brivio, L. R. (2015). The Achilles Tendinopathy: Pathogenesis Review. International Journal of Orthopaedics, 2(3), 289-299. doi:10.17554/j.issn.2311-5106.2015.02.52
Bovens, A., Janssen, G., Vermeer, H., Hoeberigs, J., Janssen, M., & Verstappen, F. (1989). Occurrence of Running Injuries in Adults Following a Supervised Training Program. International Journal of Sports Medicine, 10(S 3). doi:10.1055/s-2007- 1024970
Fields, K. B. (2011). Running Injuries - Changing Trends and Demographics. Current Sports Medicine Reports, 10(5), 299-303. doi:10.1249/jsr.0b013e31822d403f
Galloway, J. (2011, December 13). Why Are So Many People Running These Days? Retrieved from https://www.huffpost.com/entry/why-are-so-many-people-running-these-days_n_1008634 Works cited contd. Malliaras, P., Cook, J., Purdam, C., & Rio, E. (2015). Patellar Tendinopathy: Clinical Diagnosis, Load Management, and Advice for Challenging Case Presentations. Journal of Orthopaedic & Sports Physical Therapy, 45(11), 887-898. doi:10.2519/jospt.2015.5987
Opar, D. A., Williams, M. D., & Shield, A. J. (2012). Hamstring Strain Injuries. Sports Medicine, 42(3), 209-226. doi:10.2165/11594800-000000000-00000
Rajasekaran, S., & Finnoff, J. T. (2014). Plantar Fasciopathy: A Clinical Review. Current Physical Medicine and Rehabilitation Reports, 3(1), 67-76. doi:10.1007/s40141-014-0069-7
Scott, A., Huisman, E., & Khan, K. (2011). Conservative treatment of chronic Achilles tendinopathy. Canadian Medical Association Journal, 183(10), 1159-1165. doi:10.1503/cmaj.101680
Tenforde, A. S., Yin, A., & Hunt, K. J. (2016). Foot and Ankle Injuries in Runners. Physical Medicine and Rehabilitation Clinics of North America, 27(1), 121-137. doi:10.1016/j.pmr.2015.08.007 Thank you!