1 / 17

Running Injuries: The Latest and Greatest

phil
Download Presentation

Running Injuries: The Latest and Greatest

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Running Injuries: The Latest and Greatest CPT Matt Fandre USAFP 2007

    2. Agenda Running Shoes Myth of flat feet ITB RPPS Stretching Cross Training Stress Fractures Endurance Events Exercise Hyponatremia Conclusion

    3. Running Shoes Running shoes are best matched to running style (foot strike, loading rate, etc.) It is safe to empirically follow this guide: Low arch/pronator: Motion control shoes High arch: Cushioned shoes Neutral: Stability shoes

    4. Flat Feet Myth High arched runners are more likely than flat feet runners to suffer overuse injuries

    5. ITB Common source of knee pain (lateral) in runners Evidence that this is more an overuse injury than a mechanical predisposition Pain worse running down hills or increasing stride length Treatment RICE, NSAIDs, Injection (consideration) Stretching of hip flexors and plantar flexors Strengthening needs to focus on gluteus medius muscles

    6. ITB Treatment

    7. RPPS Five-year prospective, randomized trial investigated long-term effects of open kinetic chain and closed kinetic chain exercises in the treatment of RPPS. Only 20% of patients reported being pain-free at five years Open kinetic chain group had less pain on the visual analog scale at night, less swelling of the joint, and less pain descending stairs as compared with the closed kinetic chain group Open kinetic chain exercises do not need to be avoided and should augment traditional closed kinetic chain exercises

    8. Open vs. Closed Chain OPEN CHAIN (Distal part not fixed) quadriceps exercises (i.e., maximum isometric quadriceps contraction in full extension) straight-leg raises leg adduction exercises in a side-lying position CLOSED CHAIN (Distal part fixed) seated leg presses-one-third knee bends on one leg or both stationary bicycling rowing machine exercises step-up and step-down exercises

    9. Stretching Pre-exercise stretching does not decrease lower extremity running injuries Stretching does reduce soreness after exercise (2%) A summary of 23 articles on stretching revealed an improvement in speed, but not running economy

    10. Rehab/Cross Training Study compared 2 mile times Water training Cycling Running No change in run times between the groups Cross training is effective in maintaining conditioning

    11. Stress Fractures Occur in 13% to 37% of runners Most heal in 6 to 8 weeks if compliance with protected weight bearing is followed In 2/3 of symptomatic patients, radiographs are initially negative Only half develop positive radiograph findings Most common sign in early stress fracture is a region of focal periosteal bone formation Bone scintigraphy is highly sensitive but lacks specificity in small joints such as the ankle and foot MRI is also useful in the diagnosis of stress reaction and stress fracture High degree of sensitivity and a higher degree of specificity relative to bone scintigraphy

    12. Stress Fracture Images

    13. Stress Fracture Images

    14. Stress Fractures Leg length inequality may be a risk factor Higher incidence of tibial, metatarsal, and femoral fractures in the longer leg Higher incidence of fibular stress fractures in the shorter leg Anterior tibial, medial malleolus, talus, navicular, fifth metatarsal, and sesamoids have a higher rate of nonunion Treatment of recalcitrant stress fractures with intramedullary nailing has enabled patients to return to sports at an average of four months. This is an option for the treatment of chronic tibial stress fractures

    15. Endurance Events 2-8% of marathon runners seek medical care Four hours post marathon average CK rise of 540% Risk of sudden death Running: 1:396,000 man-hours Marathon: 1:215,000 man hours

    16. Exercise Induced Hyponatremia Severe hyponatremia may occur during events lasting longer than one hour 3 mechanisms: Loss of electrolytes without enough replacement Fluid overload (water) Inappropriate fluid retention (aldosterone/ADH) Risk factors BMI < 20, female, temperature, longer race time, > 3L of fluid during the race Treatment Alternate between water and sports drinks No more than 1liter of water/hour Treatment does not involve rapid infusion of IVF.

    17. Summary Wear good shoes: namely, shoes that work for you Strengthen medial glutes for ITB Proper conditioning is more likely to reduce injuries than stretching Pay special attention to anterior tibial, medial malleolus, talus, navicular, fifth metatarsal and sesamoid stress fractures Don’t overconsume water before/during endurance events If you treat these patients, be aware of hyponatremia Use the knowledge of the smart folks

    18. Resources & Thanks Sports Medicine Fellows PT department Textbook of Running Injuries Clinical Journal of Sports Medicine American Journal of Sports Medicine Medicine & Science in Sports & Exercise Thank you to Dr. Kane, Dr. Brennan, and Dr. O’Connor

More Related