This week's case is a runner whose goal was to run 10-12 miles/day, 5 days/week.
The eval was as follows
Subjective: Pt reports episodic R lateral knee pain since high school 7 years ago. Latest episode started last October but worsened in December (2012). Since then unchanging overall. Sx are intermittent rated 1-7/10 and worse with running, better with rest. Normally runs 50-60 miles week, but currently can only run 1-2 miles before pain onset.
Objective:
key: F = functional (WNL), D = dysfunctional, N = non-painful, P = painful, PDM = pain during movement, ERP = end range pain, LRF = lat rotation and flexion, MRE = med rotation and extension
ROM
Cervical
flexion FN
extension DN
Rot Left DN mod Right DN sev
MSR Left FN Right DN
Hip IR Left FN Right FN
Hip ER Left DN Right DN
Tibial IR Left FN Right DN
ankle inv Left DN sev Right DN sev
ankle ev Left FN Right FN
MSF DN
MSE DN sev
Ankle df Left DN mod Right DN sev
hip ext Left DN, mod Right DN, sev
SLS EO Left FN Right DN, EC
SLS EC Left DN Right DN
rolling Left DN upper Right supine and prone
Myofascia: moderate restrictions in R lateral upper and lower LE patterns
Day 1
- IASTM to the upper and lower lateral LE patterns
- MWM tibial IR and talocrural posterior glide to improve ankle df in half kneel position
- hip IR MWM with a belt
- instruction on use of EDGE Mobility Band for dynamic hip flexor stretching and tibial IR
- pre and post test measure was ankle mobility in half kneel
Day 2
- the patient reported being able to run 4 miles instead of only 1.5-2, and was pleased with his progress
- ankle df on the right in half kneel was still DN, with moderate loss compared to the left which was DN, mild loss
- Tx as above
- added clams and single leg stance anti-rotation with a band
Day 3
- The patient reports only being able to run 2 miles, and having increased knee pain
- ankle df was DN, min-mod loss on right, closer to the left in motion
- tibial IR was still DN mod loss compared to left min
- SLS on left FN, on right DN (eyes open)
- after IASTM around lateral lower LE patterns and ankle patterns, we focused more on proprioceptive training
- single leg stance anti rotation for warmup, progressing to SL step downs with PNF cuing to the lateral thigh to prevent valgus collapse
- instruction on slight lean and increase cadence to between 150-180 BPM
Day 4
- the patient ran 7 miles after adjusting cadence and working on forward lean to minimize overstride
- ankle df was now DN, mild loss bilaterally, right tibial IR was still DN compared to left, but improved
- instructed on EDGE Mobility Band ankle wrap with repeated end range ankle plantarflexion to improve df, which made both sides FN
Day 5
- The patient reports running 8 miles, and running 8 days in a row.. I told him to take a break because a majority of running injuries are due to
stupidityimproper training. - He was just too excited to be able to run again after months of taking a break!
- added hurdle step for balance/symmetry and proprioception, step downs with hip abduction
- taped the lateral line of the right LE to give proprioception on hip adduction and valgus collapse as the only remaining DN was SLS on the right
- instructed on landing with the right LE slightly wider than he was as a treadmill assessment showed landing toward the midline on the right side
That's it so far! The IASTM, MWM, and HEP with the EDGE Bands helped quickly restore movement symmetry to the tibia, hip and ankles. Stability needed to be addressed over the next set of visits but the biggest change that was made was the lean and cadence suggestions.
By way, is anyone aware of research that shows hurdlers have common asymmetries of overstride on the right? This is the 3rd hurdler I've treated in 6 months with similar right sided LE complaint and the same asymmetries?
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