Recent Running Case Update | Modern Manual Therapy Blog

Recent Running Case Update

I wanted to give everyone an update to a recent case that I asked for your thoughts on. The original post can be found here.

We had some insightful feedback on youtube and the blog, so that you for that. I coached him on a slight lean forward as well as flexion in his hips to make up for the lack of hip extension on the involved side. This has been shown to reduce overstride.

He has also been working on his dorsiflexion on the right side. One thing I neglected to mention regarding the case is that he saw a rheumatologist prior to our online consultation. Even as a DPT, hearing the thought virus that his condition is some sort of rheumatic inflammation in his SIJ, made him very weary and increased his fear avoidance of running, working out, etc.

Here is the patient's update in the past 2-3 weeks since our last consult and when I posted the running video.

"The form work has definitely helped me tolerate running more. I'm able to run farther then I could a few weeks ago, but still I'm only able to do about 2 miles before stopping. It feels more natural then it did a few weeks ago to. The forward lean and working on good symmetrical posterior arm swing helps the most. I had a follow up with the rheumatologist I had originally met with and I asked her what her confidence was this was a rheumatic issue and she told me almost 100%. She also only reads my labs and takes a subjective hx. I know there is an element of cognitive neural sensitivity/threat because sx always increase after talking to her. ADLs are much better and I don't have as much toe out as before. My coworkers have also commented that I look more natural walking now. Still haven't tried cycling or lifting yet."

I told him to be weary of anyone who gives you any diagnosis with 100% certainty, as I view that as either arrogance/ignorance and even a little of both is not helping this situation. I'd say he needs to stop following up with her as she tells him the same thing every time (it's rheumatic) but to keep exercising as it will resolve on it's own. That's not particularly helpful.

Current advice I have given

  • get a new pair of shoes (he reports they are at least 1.5 to 2 years old)
    • EVA foam wears out whether or not you have miles on it
    • plus, they're worn with his old motor patterns and foot strike
  • keep working on ankle df

Where would you progress him at this point, with less pain during ADLs (remember was intermittent and only occurred after running 2-3 times), but still unable to run greater than 2 miles?

Also, a new Therapy Insiders Podcast on running is now live! Perfect timing for this Running Patient's Update! Join myself, and Drs. Gene Shirokobrod and Joe Palmer as we discuss assessments, treatments, and exercises for runners!

Keeping it Eclectic....


  1. Curious what kind of work on postural alignment/awareness you have done with him to-date. Also, what are your thoughts on cueing increased lean via hip flexion versus via ankle dorsiflexion? I would think the former would place increased extension moment stress on his lumbar spine.

  2. I would like to see how he moves in other then running positions lets say.... in standing combined back pelvic motions such as full flexion without knee bending / fell extension without knee bending / sidebending with hips/pelvis fully shifted to opposite side of shoulders. Then passive or active i guess SLR on each side, and passive hip IR and ER in 90/90. I most often see runners with restrictions showing in this pattern: limited lumbopelvic flexion and sidebending (lets say right) with matching short SLR and 90/90 hip IR on right and often but not always hip extension and ER is lacking on the opposite side (left for sake of story) and of course weak lateral hips..

  3. Elliot, I did these assessments on him. His involved hip is limited in hip IR as well as extension. The extension is a stability/motor control issue, passive much greater than active. Initially SGIS in standing to the right was also limited.

  4. Actually, I did cue him to lean with a slight flexed hip to reduce that "running in the backseat" due to lack of hip extension.