I do a ton of consults.  All of our instructors do.  And part of doing consults is seeing trends and recognizing these more quickly to allow a rapid resolution.  I'd like to talk through a recent consult with some easy to take away points to help our ACL Reconstruction patients return to running.  

This consult was with a recreational runner who was just shy of 4 months post-op ACL Reconstruction.  She had been progressing well with no joint effusion and only minor deficits remaining.  Suddenly, she began to experience posterior knee pain when running and generally was just getting increasingly sore.  The treating therapist had to shut down the runner for a couple of weeks and then in conjunction with the surgeon decided to do a consult and get a second set of eyes. 

There are a ton of issues that can create the problem described here and fortunately, most of those looked good on her.  We found one glaring issue.  Her calf!...

Whether it is a foot, ankle, knee, hip, or back issue, a missed dorsiflexion restriction can be a source of many of your runner’s complaints.  How can such a little thing throw off so much?  Let’s start with the most common compensation for a lack of dorsiflexion. 

Our bodies are smart and figure out ways around our deficits.  We typically begin to collapse inward at our medial foot when we can't move forward in the sagittal plane.  Some of our runners will even externally rotate their foot to get just a little more translation of their tibia over their foot. 

Stop for a moment and try this.  Imagine yourself with limited dorsiflexion as you move into midstance?  How would you get around it?  Now, allow yourself to collapse inward at your ankle/midfoot and you can see it’s a way to get past the lack of ROM.  This is a prime contributor to many of our runners who over-pronate or remain pronated too long during their...

Lateral hip pain in runners, as well as the general population, is a common occurrence.  Most commonly it is thought of as greater trochanteric bursitis, but a more appropriate name would be greater trochanteric pain syndrome.  Literature has shown, the bursa is most often not the irritated structure.^1,2  More commonly, it is found that a tendinopathy exists of the lateral gluteal tendons.  Much like achilles and patella tendons, the tendon isn't able to tolerate the load and overtime experiences changes in it's ability to transmit force, eventually changing it's collagen makeup.  

The hallmark sign of this syndrome is tenderness along the greater trochanter, where the tendons insert.  We've wrote about similar conditions previously and you can find these here:

• Achilles Tendinopathy
• Hamstring Tendinopathy   

There are 3 key components of rehab for a gluteal tendinopathy:

1. Avoid prolonged positions in which the tendon is being compressed

2....

Shin splints are a runner’s worst nightmare.  It’s a catch-all term that most commonly refers to runners suffering from pain along the medial tibia.  It can also progress into stress reactions as well as afflict runners along the antero-lateral portion of the tibia.  Commonly, rehab focuses on modalities to calm the pain, strengthening exercises for the lower leg and hips, and stretching.  Many patient’s see symptom reduction, but many also see a return when they begin to increase their mileage again.  It’s frustrating for the therapist and even more so for the runner.

I want to focus on a small change you can make to runners that pays huge dividends when they are experiencing pain along the antero-lateral tibia.  To effectively treat this, you need to understand a basic premise, the tibialis anterior is typically working too hard during the gait cycle and we need to change that.

Let’s take a look at a runner and the exact...

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