The Basics Running is a versatile sport that can be done just about anywhere. Various settings and courses give runners a multitude of choices and challenges – from trails with steep inclines or uneven paths to the beach for those who love the sand under their feet. Some high school or collegiate athletes prefer running on a track, including short-distance sprinters, long-distance marathoners and runners attempting their first 5K. Whatever a runner’s goals or abilities, everything must start with basic core strength and stability, along with single-leg strength, stability and proprioception.
Running is essentially hopping from one lower extremity to the other repetitively. If one of the limbs is weak or injured, compensation may occur within the same or opposite limb leading to further injury from overloading and overworking. Most runner injuries are secondary to a weakness or insufficiency somewhere else in their gait mechanics. One small insufficiency with repeated impact can magnify quickly.
Assessments and Treatments
At Davis PTSR, many of the individuals we treat are runners or those running as a part of a sport on the field or court. They range from those at competition level or who simply use running as a mental or emotional outlet. They also vary in age, skill level and ability. Beyond the physical injury itself, there are psychological effects often overlooked. We understand the need for physical movement and activities and are committed to helping patients through the mental struggle when injury interferes with their sport or emotional outlet.
When treating runners, it is imperative to look at the whole patient, not solely the body part that is hurting. Ideally, it is recommended a healthy runner come in for baseline testing to prevent a potential injury, but that is not always the case. Often times we see a patient after the injury has already occurred. Assessments, such as the Athletic Movement Index (AMI), are an invaluable tool which allow us to look at each limb’s impact mechanics, flexibility and core strength and stability to determine any deficits.
The AMI assessment replaces guesswork with hard data to identify insufficiencies and develop a plan of care to rehabilitate, improve performance and decrease the risk of further injury. For example, if a runner complains of right knee pain but an AMI test shows deficits of increased speeds (lack of control and proprioception) and valgus with left lower extremity, the patient may be using the right lower extremity to compensate for the other’s weakness.
Balance and Symmetry
Maintaining good limb symmetry with runners prevents injuries and gait compensations. For those running on a trail or in a neighborhood, single-leg proprioception and balance are extremely important. A runner might stumble on a rock, step on rugged terrain, trip on a curb or have a toe may get caught on an uneven sidewalk. With any of these scenarios, strong, stable joints and good mobility to rebalance allow for a safer recovery.
A standard single-leg get-up test is a quick and useful tool that provides instant insight and easily identifies weakness between one limb versus the other.
At Davis, the AlterG® Anti-Gravity Treadmill™ is often used when treating runners - specifically for gait analysis in order to see if a patient is offloading and at what bodyweight he/she can run pain-free. Its use allows us to gradually increase the body weight as a patient’s strength improves and pain lessens. This steady, pain-free progression ultimately achieves a full weight-bearing return-to-run program. The AlterG® is also great when training for longer races and runs, decreasing the impact on joints while allowing a runner to continue doing what they love – RUN!
Most runners do not think of strengthening when they first come to rehab. However, strength is often the missing component if there is a weakness in any muscle or muscle group at increased speeds or mileage. The use of Blood Flow Restriction therapy is an intervention Team Davis regularly uses to add strength as an alternative method of building muscle when the joint may be in pain and cannot handle a load for strengthening.
Hindsight is 20/20, and prevention often comes second to an injury. All too often, runners do not have the necessary warm-up, stretching or strengthening program built into their routine. Even with the great advances in technology and physical therapy techniques, a comprehensive plan that addresses a runner’s deficits would not be complete without a home exercise program focused on core, hip and lower extremity strengthening along with stretching to improve flexibility. It is crucial to properly warm up and stretch daily, recognizing that four days without much stretching or strength training cannot be made up with one hour of physical therapy.
As PTs, Team Davis is responsible for educating patients about what their body needs and developing a mutually agreed upon program – both at our facility or home. Then it is in the patients’ hands to do the work with the PT’s guidance.