Abnormal Running Gait

What are the most common injuries seen in runners?

1) Patellofemoral pain (PFP)
2) Iliotibial band syndrome (ITBS)
3) Tibial stress fracture (TSF)
4) Plantar fasciitis (PF)
5) Patellar tendonitis (PT)
6) Achilles tendonitis (AT)

What are some S/S of Petellofemoral pain (PFP)?

Retro or peripatellar pain

True or False? Proximal and distal factors are involved in patellofemoral pain

TRUE

What poor mechanics are said to be responsible for PFPS?

1) Poor foot mechanics
2) Poor hip control

PFPS occurs when there is poor __A__ and __B__ plane hip control

A) Frontal
B) Transverse

Poor frontal and transverse hip control results in what?

1) Excessive hip adduction
2) Excessive hip internal rotation

Why does poor frontal and transverse hip control result in excessive hip adduction and hip internal rotation?

1) Weakness of the hip abductors
2) Weakness of the hip external rotators

Previous studies have shown what treatments to be effective in treating PFPS when it is caused by proximal structures?

Treatment focusing on improved control in the absence of strengthening (No pain, improved function afterwards)

Recent studies have shown what treatments to be effective in treating PFPS when it is caused by proximal structures?

Hip strengthening alone

How do poor foot mechanics lead to PFPS?

1) Delayed or prolonged eversion
2) This leads to delayed or prolonged tibial internal rotation
3) Femur compensates by excessively internally rotating
4) Results in greater compression on the lateral aspect of the patella

Rehab studies have shown what treatment to be effective in treating PFPS when it is caused by distal structures?

Orthotics

True or False? Trunk control could be a factor in PFPS

TRUE

The iliotibial band acts as..

1) A lateral hip stabilizer
2) A lateral knee stabilizer

During knee flexion, the ITB moves..

Anterior/posterior

During knee flexion, the ITB moves anterior/posterior and creates..

Friction

What are some distal factors that could lead to Iliotibial band syndrome (ITBS)?

1) Rearfoot eversion
2) Coupling between rearfoot eversion and tibial IR
3) This could increase strain on the ITB

What are some proximal factors that could lead to Iliotibial band syndrome (ITBS)?

1) Weak hip abductors/adductors

True or False? There is an increase in hip adduction in runners who have had ITBS

TRUE

In the latest research, runners with ITBS ran with..

1) Less eversion
2) Greater IR at the knee
3) Greater hip adduction
****Proximal mechanism dominated

What are the two ways to have IR at the knee?

1) Tibia IR on fixed femur
2) ER femur causes the tibia to be IR

True or False? Knee internal rotation during gait analysis of runners with ITBS increased strain on the distal ITB

TRUE

There are three components that make up one movement that increases strain on the ITB. What are they?

1) Hip adduction
2) Relative femoral ER
3) Knee IR

Increased strain on the ITB could increase compression of the ITB with..

The lateral femoral condyle

Stress fractures require at least _________ rest from running

6 weeks

When looking at stress fractures, there is a _____ re-injury rate

36%

35-50% of all stress fractures occur in...

The tibia

Where can stress fractures r/t running occur?

1) Tibia
2) Navicular
3) Fibula
4) Metatarsal

Tibia stress fractures are associated with...

1) Increased GRF impact peak
2) Increased vertical GRF load rate
3) Increased tibial acceleration
4) Adduction free moment peak

True or False? It is presently unknown what strategies runners use to lower tibial shock

TRUE

What are some ways to reduce loading?

1) A midfoot/forefoot strike pattern
2) Landing with greater knee flexion

What are two potential mechanisms of patellar tendonitis r/t running?

1) Excessive DF, weak DFs
2) Excessive quad recruitment

How would excessive DF or weak DFs cause patellar tendonitis in runners?

Forward translation of the tibia is regulated by the quads instead of the DFs

How would excessive quad recruitment cause patellar tendonitis in runners?

1) Stiff gait
2) Attempting to compensate for hip or ankle weakness

Achilles tendonitis in runners is typically related to what?

1) Excessive or prolonged eversion
2) Tight tendon
3) Mid-foot pronation

What occurs during initial impact loading in runners with OA?

1) Subchondral bone thickening
2) Surface fissuring of cartilage

True or False? High impacts and loading rates are found in the OA population

TRUE

True or False? The body is not effective in absorbing the forces during running

TRUE

True or False? Loading rates are higher during walking and running after an ACL

TRUE

Higher loading rates are associated with what types of injuries?

1) Stress fractures
2) Plantar fasciitis
3) OA