Runners’ pain is a very common problem and is complex in the treatment as well as assessment. Our main protocol at Dynamic Neuromuscular Rehabilitation is running Gait Analysis. What is Gait Analysis? It is the study and assessment of the biomechanics of human motion during walking or running. The patient is equipped with electronic markers on his lower extremities for the purpose of motion capture recognition. While the patient is walking and/or running on the specially equipped treadmill, real time data is generated from his joints and muscles and is recorded into a sophisticated software. Once the data is collected it would be analyzed by a clinician. Classical gait analysis evaluates; forces, joint angles, muscle activity and pressure. We believe there is more success in the treatment if we have a better assessment of the abnormalities of the muscles. We focus on the idea of finding the core problem and then change it. Let’s look at our overview of what’s behind the symptoms, what our main assessment is about, and what we should consider during treatment.
Our dynamic evaluation begins with the question, “What is the underlying cause?” Not all situations are perfectly clear right way so we need to assess the patients overall running behaviors. Using Observational Gait Analysis we determine what are the patients running patterns of motion and in which phases of running does the pain occur. Focusing on the big picture could mean catching the core problem in the tightness of the right hip when patient complains of pain in the left ankle. Due to the slight differences in the way all people move when being assessed by Gait Analysis for runners, we noticed that the abnormal patterns carry over into all other activities. This is a huge aspect to consider because the neuromuscular balance is off. This explains why the problem would be in the right hip when the pain occurs in the left ankle. Let’s look at a cross country runner for example, if during running we notice the trunk slightly leaning over, pelvic collapse, or if the leg alignment is off we know that the concept of tissue stress and strain is at play here. This concept is related to many abnormalities runners with injuries may experience. Due to these abnormalities they have a lessened capacity to handle loading cycles before their joints experience overload. All of these abnormalities are caught during evaluation of the patients’ movements such as off sets or dorsiflexion.
There are many different aspects to look at when assessing a runner. Along with evaluating the history, video of the physical activity, and the Observational Gait Analysis, we survey and ask the patient questions in order to better understand them. For example, what type of shoes do they wear, are they comfortable, do they have any kind of orthotics, what’s their flexibility like, their strength, and alignment. We also ask about the patients’ running behaviors, we assess the mechanic of that behavior, we consider what their training consists of, also, how often the patient does it. Knowing our patients history is critical. We take into consideration weather they might be a recreational, competitive, or novice runner. We want to understand their mindset, what their goals are, and what they want to get out of running. With this we can better determine what kind of treatment to give our patients. Asking where their symptoms are anatomically, what kind of pain is experienced, and if it is rapid or gradual can help us pinpoint the root problem. Along with that we want to know if the pain happens at the beginning of the run or towards the end, or even if it might only hurt after the run when the body is in a relaxed state and how long does this pain last. For example, if the pain subsides after a few minutes after running then we know it is most likely located in the MTJ.
The reasons for pain may be as simple as the runner not having enough experience in technique, the training volume and habits may be harmful, they may be too competitive, or even something as simple as the speed at which they run is too fast for their bodies’ mechanics. All of these could not only cause pain, but they are a red flag for a serious possible future injury. If it is alignment of the legs with the pelvis and lower back then it is a matter of changing the training or incorporating an at-home workout to satisfy the body in alignment for better performance on the track. Without our focus being solely on the treatment we take the time to get to know our patients. Talking to our patients is one of the most crucial aspects in aiding them. We value their devotion to running and want to help the best we can. If there were a specific race they were training for we would want to know how long have they been running and how many miles a week? With this information we have the knowledge of how they are using their body and how we can help make that process more progressive and healthy. By asking all these survey-like questions we get a better understanding of the drawbacks in the patients running techniques and can characterize where the physical impairments are located because they may be distal from where the initial symptoms are. Considering all this, our main goal is for the patient to understand the problem to get optimal results from treatment.
Poor running mechanics reduces the systems’ ability to tolerate strain and stress. This is when the patient seeks help due to overuse. With these poor running mechanics the patients makes themselves susceptible to error while running thus harming his or her body. The high load and frequency of running, which is the overuse, results in the pain. This tissue overload prevents from tissue homeostasis to avoid pain and injury. When starting treatment our goal is to reduce the excessive magnitude and frequency of loading by focusing on the patients training approaches. The number one step is figuring out how they train and where the error in their training lies. Once we figure that out we can adjust the routine with things such as, stretching, foot orthotics, hip strengthening, retraining, foot wear modifications, an increase in lower back flexibility, and techniques of training. With these modifications the runner should stop experiencing pain and prevent future injury. Our goal is the increase the patients functions, mechanics, and increase performance levels to the best of their abilities.
Apart from the adjustments to the training techniques, at our runners’ clinic we use an integrated method of Running Gait Analysis and conventional in-clinic exams like diagnostic ultrasounds. Ultrasound tests help us see the abnormalities in the muscles and tendons, but do not necessarily assist in finding the precise location of the problem from the pain. As we know, in the neuromuscular system it may come from a number of other locations. To find this precise problem we use Running Gait Analysis. This new technology helps us understand all the uses of forces exerted and dispensed during movement, just like running. However, there is a difference between walking and running. During walking you have a period of double or single leg support at all times, and during running you never have double leg support because you are in the air most of the time. Focusing only on masking the symptoms is not our intentions. The Gait Analysis for runners is what gets us to the root of the cause for the symptoms. For the ideal aid of people suffering from runners’ pain we have a long experience in the use of ESWT (Extracorporeal Shockwave Therapy) for the care of the foot, ankle, hip, knee, and leg. Our duty and intention lies in determining the error, aiding with treatment, and understanding our patients’ needs.
At our runners clinic we utilize the most advanced and latest technologies available. At our state of the art Gait Lab we combine analysis of biomechanics in runners and running injuries. In addition to our real time Gait Analysis what sets us above everyone else is that we combine our first privately owned CAREN technology to examine weight bearing for symmetry, which isn’t possible to do so just with a standard treadmill analysis itself. By determining where the muscle imbalances are we can pin point the abnormalities and create a patient specific treatment plan and running program. Dr. Kalika has studied with Dr. Christopher Powers who is referred to as the worlds authority on treatment and prevention of running injuries. Our protocols are based on studies that show that the root cause of overuse and runners injury is directly related to movement dysfunction. Therefore, by using multiple approaches we provide our patients with the most successful treatment and prevention of future injuries.