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Introduction to Running Injuries: Part 1

PIRIFORMIS SYNDROME

Piriformis Syndrome is usually felt in the middle of the glutes. Research into the relationship between the sciatic nerve and the piriformis muscle varies (Prakash et al, 2010). In most individuals, the orientation of the sciatic nerve runs inferior to the piriformis muscle. There are two types of piriformis syndrome, primary and secondary. Primary refers to a split piriformis muscle or split sciatic nerve. Secondary refers to a macro or micro trauma to the glutes. According to the research, 15% of cases have been related to primary causes. 

Symptoms

Runners do not always feel discomfort when running, however pain may be felt with movements such as sitting down, squatting or training at an incline. Piriformis syndrome often causes hypersensitivity and applying pressure to the area can cause discomfort. 

Causes

A big contributor to this are weak glutes and hamstrings or pelvic misalignment. When running, sometimes the muscles are not able to fire efficiently and as a result of this, the muscles are unable to tolerate the repetitive stressors of running. An increase in intensity or duration may contribute to the injury, as well as functional movements such as leg length discrepancy, imbalances or bad posture. Additional contributors include lumbar spine pathology and running gait. 

Treatment: How can we help?

Correcting biomechanical deficiencies can reduce the likelihood of piriformis syndrome. Interventions include soft tissue mobilisation, piriformis stretching, hip and lumbar spine treatment. Hip strength and movement to control the femur during functional activities may assist in the treatment of piriformis syndrome. 

TESTS & MEASURES

·          Functional Movement Test

·          Biomechanical Evaluation through surface electrodes, S-EMG.

PHYSICAL THERAPY (Tanley et al, 2010)

·         Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

·         Stretches

Dynamic and Ballistic exercises

SPORTS MASSAGE

Specific sports massage techniques such as effleurage, petrissage, cross fibre techniques onto the gluteus max, neuromuscular techniques onto the piriformis and soft tissue release, all assist in releasing muscle spasms within the piriformis. 

FOAM ROLLING: SELF MYOFASCIAL RELEASE

McKenny et al 2013, described myofascial release as a variety of techniques in which pressure is applied to the muscle and fascia.

Static stretching is commonly known to increase flexibility acutely but associated with acute reductions in performance. However, research has been undertaken combining foam rolling and static stretches (Škarabot, Beardsley and Štirn, 2015). Results concluded that combining both foam rolling, and static stretches all lead to increases in flexibility and produced an additive effect.

In terms of athletic performance, self-myofascial release does increase joint range of motion and does not impede athletic performance. It additionally alleviates DOMS (delay onset muscle soreness) and many athletes now tend to use foam rolling as a tool for enhancing their recovery. There is some evidence to suggest that long term, foam rolling may lead to improved flexibility, however more research is being undertaken. 

Foam rolling specifically for Piriformis syndrome would focus on releasing tension in the piriformis. The foam roller is placed on the piriformis and moves over the roller slowly backwards and forwards along the length of the muscle, for 20 rolls. For a deeper target, a golf or hockey ball can be used. This would be followed by piriformis stretches. 

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur.

 

 

ILIOTIBIBIAL BAND SYNDROME (ITB)

Iliotibial band (ITB) syndrome is where the long tendon of the ITB rubs against the tensor fascia latae muscle (outside knee joint) causing inflammation to the outside of the knee. 

Causes

Intrinsic factors include weak or tight lateral tissues specifically in the tensor fascia latae (TFL) and glute max. Over pronation, and poor foot biomechanics may also contribute to this injury. If the foot rolls in, and lower leg rotates as well as the knee, this increases the chance of friction on the band. Extrinsic factors can contribute such as shoe type and increase in duration and intensity of training. Recent research has found that runners with weakened or fatigued glute medius muscles in the hip, are more likely to end up with ITB syndrome (Geraci and Brown, 2005).

Symptoms

Runners may feel pain on the outside of the knee, mainly on the bony prominence around, outside or above the knee. Bending and straightening the knee may cause discomfort and tightness may be felt in the iliotibial band which runs down the outside of the thigh. This will tend to degenerate after activity. 

Treatment: How can we help?

TESTS & MEASURES

·          Functional Movement Test

·          Ober Test will establish if tension is in lateral tissues

PHYSICAL THERAPY (Noehren et al, 2014)

·          Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

·         Stretches

Dynamic and Ballistic exercises

Stretching would be a suitable treatment, however, there is controversy whether this method is appropriate. The ITB band is a thick strip of connective tissue, which makes it difficult to fully stretch. Alternatively stretching associated muscles and tissue, will assist in stretching and strengthening the surrounding area. Additional treatment such as foam rolling and sports massage therapy is also suitable. 

SPORTS MASSAGE

Massaging on TFL and glute max including effleurage, petrissage, soft tissue massage, neuromuscular techniques, and myofascial release and muscle energy technique stretching. Longitudinal massage over IT band and mobilisation techniques on IT band. 

FOAM ROLLING: SELF MYOFASCIAL RELEASE

McKenny et al 2013, described myofascial release as a variety of techniques in which pressure is applied to the muscle and fascia.

Static stretching is commonly known to increase flexibility acutely but associated with acute reductions in performance. However, research has been undertaken combining foam rolling and static stretches (Škarabot, Beardsley and Štirn, 2015). Results concluded that combining both foam rolling, and static stretches all lead to increases in flexibility and produced an additive effect.

In terms of athletic performance, self-myofascial release does increase joint range of motion and does not impede athletic performance. It additionally alleviates DOMS (delay onset muscle soreness) and many athletes now tend to use foam rolling as a tool for enhancing their recovery. There is some evidence to suggest that long term, foam rolling may lead to improved flexibility, however more research is being undertaken. 

Foam rolling specifically for ITB band syndrome would focus on releasing tension on the IT band and glute muscles. The foam roller is placed on the ITB band and glutes and moves over the roller slowly backwards and forwards along the length of the tendon, for 20 rolls. This is followed by glute and ITB band stretches. 

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur. 

 

 

PATELLOFEMORAL SYNDROME

The most common site for injured runners is the knee. Patellofemoral syndrome is the degeneration of the posterior surface of the patella (kneecap). There may be slight swelling around the knee after exercise. 

Symptoms

Runners may feel an aching pain in the knee joint, specifically around the front and under the patella. Continuing to run or walk may cause pain to the area. 

Causes

The initial cause of patellofemoral syndrome is overuse. This may be due to increased intensity or longer duration of training. Impact from running on a variety of surfaces during training, may cause the likelihood of patella tracking. There may be a disparity between the lateral and medial quads. Additional causes may be tight quads and IT band, as well as weak abductors. 

Treatment: How can we help?

TESTS & MEASURES

·          Functional Movement Test

·          Thomas test

·          Clarke’s test

PHYSICAL THERAPY (Noehren et al, 2014)

·          Stabilisation - Focusing on isolating muscle recruitment.

Non weight bearing exercises

Resistance band exercises

·         Mobilisation and Strength - Focusing on strengthening and maintaining control when performing exercises.

Strengthen Vastus Medialis and Glute Medias

Lessen tension into the ITB band    

·         Stretches

Dynamic stretches, focusing on vastus medialis and vastus lateralis. 

SPORTS MASSAGE

Massaging on and around the quads, including effleurage, petrissage, soft tissue massage, neuromuscular techniques, and myofascial release and muscle energy technique stretching. Longitudinal massage over IT band and mobilisation techniques on IT band. 

RETURN TO RUNNING

After the rehabilitation process and the athlete has no pain, a training programme should be followed. The programme will depend on individual progress, severity of injury and original fitness. This will include a gradual progression incorporating running sessions as well as the stretch and strength exercises, to maintain overall fitness and ensure the injury does not reoccur.