In the article Evaluation of an Injured Runner, Magrum and Wilder discuss several interesting points to consider when working with an injured runner. First, you must examine the entire kinetic chain. Running is truly a full body movement, which requires symmetry between the upper and lower extremities. Forces are transmitted from one area to the next, and excessive movement in one region can create dysfunction down the chain.
When working with this population, do not undermine the importance of a thorough history. Be sure to inquire about shoe type, weekly mileage, length of runs, running surface, and more. Because running is such a repetitive activity, the examiner needs to understand exactly when the pain occurs, where is occurs, and if symptoms persists or subside after exercise. Following a subjective history, they recommend beginning the evaluation in standing. Static posture is observed and any asymmetries are noted. Specifically look at patellar alignment, subtalar position, and sacroiliac joint motion.
As the evaluation moves from standing to sitting, ligament stress testing of the knee can be performed as well as reflexes, neural tensioning tests, and a vascular screening. Additionally, note how the patella tracks as the patient actively extends at the knee. Next, have the patient lie in supine. It is important to assess for a potential leg length discrepancy (clues from the standing and sitting evaluation can point toward a potential leg length issue). In supine, femoral torsion, tibial torsion, and the Q-angle can all be appropriately assessed.
The article continues on to discuss the sidelying evaluation and functional tests that should be performed when assessing a runner. Additionally, normal angles, pictures, and a review on how to perform different examination measures are outlined in the article. It is a great review for anyone, especially if you are expecting to evaluate a runner in the near future.
James Heafner PT, DPT, OCS:
Owner and lead physical therapist at Heafner Health, cash-based physical therapy in Boulder, CO. Areas of expertise include orthopedic and manual therapy, functional movement, pain science, and movement science.
In May 2013, I earned my Doctorate in Physical Therapy from Saint Louis University. After graduating from the Harris Health Systems Orthopedic Residency in October 2014, I moved to Boulder, CO. Since living in Boulder, I have started my own cash-based PT practice, earned my OCS certification, and teach for the OPTIM Fellowship and COMT program in Houston TX and Scottsdale, AZ.
Chris Fox PT, DPT, OCS: Physical therapist at Foothills Sports Medicine & Physical Therapy in Scottsdale, AZ and regularly lectures at the Phoenix Campus for NAU's DPT program and for Optim Manual Therapy's COMT program. Completed multiple advanced manual therapy courses implementing aspects of biomechanical analysis. He received his DPT from Saint Louis University in 2013. Completed Scottsdale Healthcare's Orthopaedic Residency (now Honor Health) in July 2014. He became a Board Certified Orthopaedic Specialist in 2015. Level I Expert in FMS and SFMA , Kinetacore FDN Level 1 certification, and IASTM Technique course completion. He would like to pursue further education in McKenzie Technique, Dry Needling, Strength & Conditioning, Orthopaedic and Manual Therapy.
Brian Schwabe PT, DPT, SCS, CSCS:
- Board Certified Sports Physical Therapist (SCS) at Elite OrthoSport in Santa Monica, CA which specializes in treating collegiate/professional athletes and clientele from the Beverly Hills, Hollywood, and Santa Monica areas.
- USC Sports Residency Trained Physical Therapist (<1% of all PT's residency trained)
- DPT from Saint Louis University
- Future plans/interest include:
1. USAW, SFMA & Catapult Systems technology for NBA teams
2. Pursuing a position as a sports physical therapist &/or Strength coach for a Division 1 athletic medicine department or professional sport team.
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