Common Lower Limb Pathology Related to Running

Shin Splints• Decreased flexibility in posterior musculature• Increased Tibial Varum• Excessive compensatory pronation• Training errors/start of spring sports• Hard running surfaces• Large angle of inclination at foot contact

Treatment for Shin Splints• Change running form: Increase cadence, bring foot under themfor contact• Incline running to decrease the angle of inclination and promotea mid or forefoot contact• Decreased center of mass displacement/increased knee flexion• Soft landing• Stretch posterior muscles, esp. soleus• Supinate for the stretch/support the arch• Anterior Tibialis stretch

Anterior Tibialis Stretch

Posterior Tibialis Tendonitis• Poor eccentric control of Posterior Tibialis• Accessory navicular/pronated foot• Pain with Single limb heel raise• Tender along pathway of PTT, esp. posterior to Medialmalleolus• More severe will have pain into the medial arch• Poor dynamic single limb squat• Pain increases with activity

Treatment for PTT• Taping• Orthotic• Change current shoe (light or mid stability)• Eccentric Control for PTT• Soleus/Gastroc flexibility (stretch with STN to avoidstressing the tendon medially)

Single Leg Stance with Trunk Rotation

Single Leg Stance with D2

Calf Stretch with STN

Achilles Pathology• Training Errors: Hills/mileage• Improper Shoewear• Decreased extensibility of posterior leg muscles• Excessive Pronation• Ballas et al. 1998, Am Family Physician• Pronation late in stance produces a proximal and distal stress tothe Achilles tendon and is a primary cause of Achilles tendonitis

Achilles Tendonopathy• Tendonitis/Tendonosis/Severs• If chronic in nature, tendonosis (tendon changes) vs tendonitis(sheath injury)• 2‐6 cm proximal to insertion• Pain worse in am and after exercise• Palpate for nodule• Positive squeeze test• Measure width of tendon

Insertional Achilles Tendonitis/Severs• Severs: 10‐14 years of age; growth plate issue• Worse with any shoes pressing against the surface• Tends to be chronic and constant in nature• Very sensitive to touch• 17‐18 year old runners: Check for Haglunds that is formedfrom the abrasion of the tendon on the bone

Treatment• Running Mechanics: Increase cadence to get more knee flexion,• Eccentric heel raises 3 X 15, twelve weeks• Gentle CFM/Gentle stretching• Taping to off load medial tissue• Orthotic to control excessive pronation and stress on medial tendon• Joint mobilizations to the TC and STJ if limited DF• Heel lift for tendonitis/heel cup for severs• CAM boot to decrease the stress on the insertion

Plantar Fasciitis• Does not usually occur in the under 25 population• Is a connective tissue dysfunction, not just heel pain• Symptoms: 1 st step versus continued walking• Most likely Severs Disease• Cannot strengthen the fascia• Growth Plate

Growth Plate

Patellofemoral Pain• Faulty running mechanics: Foot contact out in front ofCOM; landing in knee extension• Tight Posterior Musculature• Tight ITB• Excessive foot pronation at Mid‐stance• Poor Eccentric control of LE during dynamic activities

Treatment• Stretching• Patellofemoral Tape• Increase cadence: Foot contact under them, decreasebraking impulse and impact• Softer landing

Stress FracturesDeath sentence for a runnerOver trainingHave to get them to restChange cadence when they return to running/incline runningto get decrease load through the LEOrthotics

Exercises for Dynamic control• Clams• Eccentric Abduction• Single leg squat• AR/AMR/ALR (can use arms or legs for reach)• Medius band walks• Storks• Anterior step down (dips)

Stork, Hip Abduction Eccentric

Sidelying Clams

Medius Band Walk

Single Leg Squat/ Anterior Step Dips

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