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Common Injuries in Running

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Common Injuries in Running 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? • Physical therapy • 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!.
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