Getting The Injured Runner Back On The Road
Tampa--Lower-extremity injuries are quite common among the nearly 30 million American runners. In a talk today at PT 2012 entitled, "Getting The Injured Runner Back on the Road, " David Nolan, PT, DPT, MS, OCS, CSCS, and Eric Berkson, MD explained how motion analysis can help clinicians better diagnose and treat running injuries.
The session began with an overview of common running injuries and risk factors. In numerous studies, the knee was the top site of muscoskeletal injury. Risk factors can be divided into extrinsic or environmental and intrinsic or physical. "As clinicians, we see intrinsic factors most of the time," said Dr. Nolan. Drs. Berkson and Nolan are colleagues at the Massachusetts General Orthopedics Sports Performance Center. Physicians and physical therapists work together to address bio-mechanical issues in runners. When a patient comes to the center, they are clinically evaluated by an MD. The patient is then bio-mechanically evaluated by a PT. The clinicians share their findings and come up with a treatment plan.
The center uses 3-D motion analysis, which uses body markers and an infrared camera to capture movement. Dr. Berskson remarked that a 2-D approach using a regular camera also works and is also more cost-effective. Bio-mechanical motion analysis using the 3-D imaging, however, gives clinicians a better picture of the kinetic chain. "As I've gotten away from searching for the silver bullet and looked at the entire chain, I've had better results for my patients," observed Dr. Nolan. Motion analysis helps clinicians find asymmetry in motion; it can be performed over long periods of time; and it is a good feedback tool for patients.
In a case study presented to the audience, the speakers showed videos from the lab of a 24-year-old male long distance runner with a history of anterior medial knee pain. He had stopped running because of the pain. Diagnostic tests found femoral and proximal tibial stress fractures. The motion analysis allows clinicians to break down the runner's stride into its component parts and analyze what, bio-mechanically speaking, is going on in each part. In both the initial contact--the moment when the foot hits the ground in stride--and the mid-stance--the moment when the foot is on the ground and the opposite leg is mid-swing--this runner had less flexibility in his injured knee. The ankle on the injured leg also showed higher pronation than its counterpart. While the runner was in the terminal stance--the moment when the toe clears the ground prior to swinging into the aerial phase--the femur on the injured leg showed no internal rotation.
This particular patient had limited shock-absorbing capabilities and had developed compensatory mechanisms, like forefoot eversions and irregular hip positions. Drs. Nolan and Berkson recommended limiting shock-absorbing activities in the short-term; and working on strength, flexibility and mobility exercises, as well as modifying his shoe.