The Runner, An Issue of Clinics in Sports Medicine , livre ebook

The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/S0278-5919(10)00033-5

Contributors
Clinics in Sports Medicine
The Runner
GUEST EDITOR: Robert P. Wilder
Department of Physical Medicine and Rehabiliation, University of Virginia, 545 Ray C. Hunt Drive #240, Charlottesville, VA 22901, USA
CONSULTING EDITOR: Mark D. Miller, MD
ISSN  0278-5919
Volume 29 • Number 3 • July 2010

The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/S0278-5919(10)00034-7

Contents
Cover
Contributors
Forthcoming Issues
Foreword
Preface
Evaluation of the Injured Runner
Kinematics and Kinetics of Gait: From Lab to Clinic
Flexibility for Runners
Patellofemoral Pain Syndrome
Stress Fractures in Runners
Running and Osteoarthritis
Exertional Compartment Syndrome
Neuropathies in Runners
Exertional Collapse in the Runner: Evaluation and Management in Fieldside and Office-Based Settings
The Female Runner: Gender Specifics
Pediatric Running Injuries
Index
The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/S0278-5919(10)00035-9

Forthcoming Issues
The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/j.csm.2010.03.011

Foreword
The Runner

Mark D. Miller, MD ,
Department of Orthopaedic Surgery, University of Virginia, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22908-0159, USA
E-mail address: mdm3p@virginia.edu

Mark D. Miller, MD Consulting Editor
I am happy to introduce another great edition of Clinics in Sports Medicine . This issue focuses on the runner. Runners come in all shapes and sizes and all levels of competition, but they all seem to share the same intensity for their sport. If you are like me, you simply cannot get by with telling your patients that if it hurts, quit running. That is why I am so happy that Dr Wilder heads a premier Runner’s Clinic at our institution. I have asked him to share his expertise with our readership as a guest editor for this edition; needless to say, he has done a remarkable job!
This issue begins with the basics—epidemiology, biomechanics, evaluation, and so forth; includes all of the sometimes difficult clinical entities (osteoarthritis, patellofemoral syndrome, stress fractures, and neuropathies); addresses some important considerations (collapse and flexibility); and also considers special populations (female and pediatric runners). Put it all together and you have the prefect treatise for evaluating and treating the running athlete. But do not let me run on with this Foreword any more…let us get started!
The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/j.csm.2010.03.010

Preface
The Runner

Robert P. Wilder, MD ,
Department of Physical Medicine and Rehabilitation, University of Virginia, 545 Ray C. Hunt Drive #240, Charlottesville, VA 22901, USA
E-mail address: rpw4n@virginia.edu

Robert P. Wilder, MD Guest Editor
An estimated 37 million Americans run for exercise. This represents a significant increase from the 30 million Americans running at the end of the running boom of the 1980s. Some of this increase has been attributed to a greater awareness of the health benefits of exercise and, importantly, a greater number of women runners. In 1980, women accounted for 10% of participants in marathons. In 2005, 40% of all marathoners were women. Although many of these participants do so primarily for recreation and fitness, data support a resurgence of competitive participants as well. As of the writing of this preface, a total of 26 US runners have eclipsed the 4-minute mile barrier during this indoor track season alone!
Clinicians are called on to meet the increasing demands to keep runners running (and running safely) from childhood through the senior years. This issue of Clinics in Sports Medicine will help health care practitioners meet the specific needs of the running athlete. A comprehensive running-specific history and physical examination, and when indicated, detailed kinetic and kinematic analysis will assist the clinician in making the most specific diagnosis as well as identifying contributing factors throughout the kinetic chain. Detail is provided regarding the management of common running injuries, including patellofemoral syndrome, stress fractures, compartment syndrome, and neuropathies in runners. Special topics including management of exercise-associated collapse and the runner with osteoarthritis are developed. Special considerations for pediatric and female runners are presented. Finally, a comprehensive review of flexibility will assist the clinician in counseling runners regarding this important adjunct to cardiovascular fitness.
I would like to thank Mark Miller, MD for his vote of confidence in me to assist with this issue and for the clinical expertise he has extended to so many of my patients. I thank also the authors, all experts in running medicine, for contributing to this issue.
See you on the roads!
The Runner , Vol. 29, No. 3, July 2010
ISSN: 0278-5919
doi: 10.1016/j.csm.2010.03.009

Evaluation of the Injured Runner

Eric Magrum, PT a , Robert P. Wilder, MD b , *
a UVa Health South Physical Therapy, 545 Ray C. Hunt #240, Charlottesville, VA, USA
b Department of PM&R, University of Virginia, 545 Ray C. Hunt #240, Charlottesville, VA 22901, USA
* Corresponding author.
E-mail address: rpw4n@virginia.edu

Abstract
The evaluation of the injured runner emphasizes the identification of intrinsic and extrinsic risk factors in addition to establishing injury-specific diagnosis. The history emphasizes identification of contributory changes in training regimen or technique. The physical examination includes a biomechanical and functional screening to identify related imbalances in posture, alignment, strength, flexibility, and lower quarter stability. Each runner is also observed walking and running because running is a dynamic activity, and subtle abnormalities not evident during static or open chain examination may become evident upon functional and dynamic evaluation. This comprehensive, running-specific approach to diagnosis assists the clinician in developing optimum rehabilitation programs.

Keywords
• Pronation • Supination • Flexibility • Patella

Examination of the runner
Two guiding principles assist in identifying risk factors for the injured runner. 1 - 4 Leadbetter’s principle of transition seeks to identify extrinsic risk factors 5 and states that injury is most likely to occur when the athlete experiences a change in mode or use of the involved part. Most running injuries occur when the athlete has a specific change in training, such as a change in running volume, intensity, or equipment. Accordingly, the history carefully searches to identify the change or transition.
Macintyre’s principle of “victim and culprits” underscores the importance of the biomechanical and functional examination. 6 The presenting injury represents the “victim,” which has occurred as a result of an inability to compensate for a primary dysfunction at another site, the “culprit.” The entire kinetic chain must be examined to rule out asymptomatic injury or dysfunction. For example, the “malicious malalignment syndrome” (femoral anteversion, knee valgus with increased Q angle, external tibia torsion, heel valgus, and pronation) can, with faulty training techniques, contribute to injury. 7

History
In addition to the standard medical history, a detailed analysis must be made of premorbid and current running history. Useful information includes weekly mileage, length of long run, pace, the number of pairs and types of running shoes worn, frequency of hill work and interval training, running surfaces, and review of flexibility, strength, warm-up exercises, and amount of cross-training activities.
Because overuse injuries are often asymptomatic in their origin, the history well before the symptoms first appeared must be inquired after. Were there antecedent changes in training routines, running shoes, or surfaces? When during running does the pain occur? Does the pain only occur with up or down hill, after a certain distance, or only when running on a particular surface? Does the pain occur during and after running? Is there any initial improvement with a period of warm-up? Self-treatments, prior medical treatments, and previous diagnostic tests should be reviewed. Finally, the health care provider should always ask the runner what he or she believes the problem to be.

Examination
Examination of the injured runner includes a sequential biomechanical screening, site-specific examination, functional screening, gait analysis, shoe wear assessment, and appropriate ancillary tests. 4, 7 - 9

Biomechanical Assessment

Standing
The examination of the runner begins in the standing position on an uncarpeted surface. The athlete should be in running shorts, without shirt, shoes, or socks on. The female athlete should be in an appropriate sports bra or gown. The examiner should have adequate space to step back to assess the athlete’s posture. Posture is assessed by having the athlete face the examiner, face sideways, and stand with the back to the examiner. The physician should start by observing the general contour of the spine, noting abnormal curvature, shoulder or pelvic