Runner with Recurrent Achilles Tendon Pain 4/21/2017 Kulig, Meyer, Poppert, Reischl 1 Young Runner with Recurrent Achilles Pain In alphabetical order: Kornelia Kulig PT, PhD, FAPTA Los Angeles, CA Lisa Meyer PT, DPT, OCS iSports Physical Therapy Los Angeles, CA Liz Poppert MS, DPT, OCS Physical Therapy Clinic, Santa Monica, CA Stephen Reischl, PT, DPT, OCS Reischl Physical Therapy, Long Beach, CA Our runner Her story Her pain diagram A message from this mornings lecture “Not every tendon problem is the same” • This case presentation illustrates: – The need for an approach other than eccentric training – The need for and value of movement observation, assessment, and intervention • This talk will provide a framework assessment of the runner • Laboratory activity will include movement assessment specific to the runner and intervention to improve the running skill
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Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 1
Young Runner with Recurrent
Achilles Pain
In alphabetical order:
Kornelia Kulig PT, PhD, FAPTA Los Angeles, CA
Lisa Meyer PT, DPT, OCS iSports Physical Therapy Los Angeles, CA
Liz Poppert MS, DPT, OCS Physical Therapy Clinic, Santa Monica, CA
Stephen Reischl, PT, DPT, OCS Reischl Physical Therapy, Long Beach, CA
Our runner
Her story
Her pain diagram
A message from this mornings lecture
“Not every tendon problem is the same”
• This case presentation illustrates:
– The need for an approach other than eccentric training
– The need for and value of movement observation, assessment,
and intervention
• This talk will provide a framework assessment of the
runner
• Laboratory activity will include movement assessment
specific to the runner and intervention to improve the
running skill
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 2
RUN well
Capacity
Skill
Salford.ac.uk
Getty Images
Our aim
Perform Well
Nydailynews.com/Bostonmarathon 2015
Our strategy?
Intervention driven
by systematic
hypothesis based
assessment
1. History
─ Training and medical
2. Running mechanics
a) Observational gait analysis
b) Ground reaction forces
3. Phase specific movement testing
a) Motor control
b) ROM, power, endurance
4. Local orthopedic examination
a) Tissue integrity
b) ROM, MMT, accessory motion
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 3
Phases
LOADING
PROPULSION
Skill assessment
Abbigail L Fietzer, PT, DPT, PhD Candidate
Musculoskeletal
and
Biomechanics
Research
Laboratory
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 4
Excessive
vertical
displacement
Loading Phase
Predictors of vertical ground reaction force
Our runner
Forefoot
strike at
initial contact
Has excessive peak
vertical GRF of nearly
3-times body weight
Lacks impact peak
Our Runner:
Loading Phase
Braking/propulsive ground reaction force
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 5
Braking and
propulsive GRF
Our runner:
Typical pattern
Above average force
Predictors of ground reaction
forces:
Medial and lateral
Excessive foot excursion
in frontal plane
Pelvic drop
WNL
Foot placement
crossing midline
-0.4
-0.3
-0.2
-0.1
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0.2
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06
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11
0.2
15
Fo
rce
(x
BW
)
Time (s)
Medial-Lateral Ground Reaction Force - Right Foot
R2 R4 R5 R6 R7
Medial
Lateral
Atypical pattern
Excessive force
Medial and lateral ground
reaction forces
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 6
Propulsion
• Our runner supinates late
Work distributions and foot strike pattern
Rearfoot
Strikers
Streane SM etal Med Sci in Sports and Exerc 2014
Positive
Work
Negative
Work
Forefoot
Strikers
Summary of Running Gait Analysis
Loading Phase • Evidence of increased load on Achilles tendon and plantar
flexors
– Increased vertical displacement
– Forefoot striker
– Excessive excursion from inversion to eversion
– Narrow base of support
• Resulting in:
– Excessive vertical, braking and medial ground reaction forces
– Increased work and musculotendinous demand on posterior leg
and plantar foot
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Summary of Running Gait Analysis
Propulsion Phase • Evidence of increased load on Achilles tendon and plantar
flexors
– Narrow base of support
– Prolonged pronation following midstance
• Resulting in:
– Excessive vertical, propulsive and medial ground reaction forces
– Increased positive work and musculotendinous demand on
posterior leg and plantar foot
Movement Testing
Based upon skill assessment
Running phase specific
Directs the orthopedic examination
Guides therapeutic exercise selection
Lab Session
Objectives:
• Perform and manipulate movement tests
specific to running phases
• Apply test findings to determine patient
specific treatment modalities
Runner with Recurrent Achilles Tendon Pain 4/21/2017
Kulig, Meyer, Poppert, Reischl 8
Loading phase specific
movement tests
• Anterior lower extremity reach
• Step down test
• Single leg balance anterior ipsilateral UE reach
• Single leg balance frontal plane medial ipsilateral UE