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!.