Physical Therapy of Marathon Runners’ Injuries -- Assessment, Judgment, and Consultation

1. Physical Therapy ofMarathon Runners’ Injuries-- Assessment, Judgment, and Consultation 2006年ING國際超級馬拉松行前訓練 柴惠敏 台灣大學物理治療學系 951216 2006年ING國際超級馬拉松行前訓練

2. Epidemiology of Marathon Runners • in US, 2002 • 375 marathons & ~ 450,000 completed one • 30,000 in the largest marathon with 43% > 40 y/o USA Track and Field Road Running Information Center, 2003 • ING Taipei International Marathon, 2005: 60,000 • finished time (median) • male: 4 hours and 20 minutes • female: 4 hours 56 minutes • to seek medical attention during or immediately after completing the race: 2% to 8% • 17% of them MS problems • muscle cramps, blisters, and acute ankle and knee injuries 2006年ING國際超級馬拉松行前訓練

3. PT of Marathon Runners’ Injuries-- Assessment and Treatment • Biomechanical concerns of running injuries • Physical therapy assessment • Skills required for a PT on race day 2006年ING國際超級馬拉松行前訓練

4. foot strike mid-support take-off follow-through forward swing foot descent Running Cycle • stance phase • swing phase 2006年ING國際超級馬拉松行前訓練

5. gel heel pad Shock Absorption at Foot Strike • ground reaction force at FS = 2.5～3BW • biomechanical requirements at FS • LE motions • knee flexion, tibia internal rotation, and subtalar pronation • cartilage or fat pad • heel pad, metatarsal pad, meniscus, IVD • extrinsic factors • running shoes with large heel flare or cushion shoes • taping, shoe insole, or FFO • running surface 2006年ING國際超級馬拉松行前訓練

6. frontal plane section of heel pad metatarsalgia of central rays Patterns of Foot Strike • heel-strike • for long-distance runners • midfoot- or total-sole strike • forefoot- strike • for sprinter only • long-distance runnner  metatarsalgia or stress fracture of central rays 2006年ING國際超級馬拉松行前訓練

7. heel flare posterior view of shoe Lateral Heel Flare • lateral heel flare   moment arm  rapid pronation  prevention of ankle sprain 2006年ING國際超級馬拉松行前訓練

8. Heel Cup use of heel cup heel pad atrophy 2006年ING國際超級馬拉松行前訓練

9. Foot Motion during Mid-Support • foot pronation at mid-support in order to make the foot more mobile for further shock absorption • foot pronation  medial and inferior glide of talus and internal rotation of tibia  COG shifting medially   energy consumption and time to re-supinaiton • strategy: hard counter for controlling COG motions counter 2006年ING國際超級馬拉松行前訓練

10. Re-supination at Take-off • re-supination at take-off in order to make the foot rigid and support the body weight • LE motions：subtalar joint supinaiton、midtarsal joint locked, first ray plantarflexion, and MP joint full extension • windlass effect of plantar fascia •  ground reaction force   momentum (= mv) •  running speed •  impact force (= Ft) accumulated at metatarsal heads  metatarsalgia 2006年ING國際超級馬拉松行前訓練

11. plantar fascia plantar fascia Windlass Mechanism (Truss Model) Toe neutral PF of 1st ray Toe extension 2006年ING國際超級馬拉松行前訓練

12. plantar fascia arch support Arch Support in Pronated Foot • pronated foot  lower arch  plantar fascia stretched • A arch support would further stretch plantar fascia 2006年ING國際超級馬拉松行前訓練

13. Lower Extremity: High-risk in Injuries • pronated foot: functional low-arch • supinated foot: functional high-arch • tight Achilles tendon • tibial varum • bow-leg pronated foot 2006年ING國際超級馬拉松行前訓練

14. Functional Foot Orthosis • to maintain subtalar neutral position • to dissipate foot pressure 2006年ING國際超級馬拉松行前訓練

15. supinated foot neutral foot pronated foot Foot Types 2006年ING國際超級馬拉松行前訓練

16. Characteristics of Pronated Foot  arch height WB STJ neutral callus beneath 2nd and 3rd MTHs 2006年ING國際超級馬拉松行前訓練

17. PT of Marathon Runners’ Injuries-- Assessment and Treatment • Biomechanical concerns of running injuries • Physical therapy assessment • Skills required for a PT on race day 2006年ING國際超級馬拉松行前訓練

18. Common Musculoskeletal Problemsin Marathon Runners • etiology •  intensity or time • mal-alignment of WB joints • Insufficient or lax flexibility • muscle weakness or imbalance • poor posture • poor running surface • improper shoe fit LBP Achilles tendinitis iliotibial band friction syndrome stress fracture patellofemoral pain shin splint heel pain metatarsalgia plantar fasciitis 2006年ING國際超級馬拉松行前訓練

19. Achilles Tendinitis • etiology: Archilles tendon tightness • predisposing factors • sudden change in intensity • uphill running • S/S • Achilles tendon pain or stiffness • unable to raise on the heel, deep squatting, or stretch Achilles tendon • enlargement of Achilles tendon 2006年ING國際超級馬拉松行前訓練

20. resting resisted test stretch tendon muscle fiber tendon Distinguish Tendinitis from Sprain • pain on stretching in both conditions • different anatomical location • pain on isometric resisted test • tendinitis: positive • ligament sprain: negative 2006年ING國際超級馬拉松行前訓練

21. Rupture of Achilles Tendon • S/S • sharp pain, like be “kicked” • tenderness, swelling, or ecchymosis • dump at the rupture site • unable to one leg stance • positive Tompson test 2006年ING國際超級馬拉松行前訓練

22. Plantar Fasciitis neutral foot pronated foot plantar fascia 2006年ING國際超級馬拉松行前訓練

23. Anterior Compartment Syndrome • shin splint • muscles within anterior compartment: • tibialis anterior • extensor hallucis longus • extensor digitorum longus • pathology •  intramuscular pressure compression of muscle or vessels 2006年ING國際超級馬拉松行前訓練

24. Q angle Patellofemoral Pain Syndrome • chondromalacia • etiology • lateral tilt of patella • genu valgus • tibia torsion • pronated foot • excessive Q-angle 2006年ING國際超級馬拉松行前訓練

25. Iliotibial Band Friction Syndrome • lateral knee pain at 15-30 of knee flexion 2006年ING國際超級馬拉松行前訓練

26. popliteus Poplitus Tendinitis • etiology • downhill running • S/S • pain at resisted tibia rotation at 90 of knee flexion posterior view 2006年ING國際超級馬拉松行前訓練

27. Stress Fracture of Pars Interarticularis Superior facet transverse process Inferior facet 2006年ING國際超級馬拉松行前訓練

28. Rotator Cuff Tendinitis • S/S • shoulder stiffness, pain, or weakness • unable to raise the arm or put the hand on sacrum • drop arm test • differentiation • supraspinatus • infraspinatus • teres minor • subscapularis • long head of the biceps brachialis 2006年ING國際超級馬拉松行前訓練

29. Rhabdomyolysis • 肌纖維溶解症 • occurrence: downhill running • S/S: • muscle pain, low-grade fever, and dark urine after racing • muscle swelling, tenderness, and weakness are rare • laboratory examinaiton • serum CK with a level > 5X of normal value • 2 ~ 12 hr after injury and peak in 1 ~ 3 day • Rx • close monitoring for renal, cardiac, and metabolic complications coupled with early and aggressive hydration 2006年ING國際超級馬拉松行前訓練

30. PT of Marathon Runners’ Injuries-- Assessment and Treatment • Biomechanical concerns of running injuries • Physical therapy assessment • Skills required for a PT on race day 2006年ING國際超級馬拉松行前訓練

31. 向心 離心 Eccentric Exercises 離心運動訓練效果快 但易造成肌肉痠痛 向心運動動作與重力反向，收縮肌肉縮短 離心運動動作與重力同向，收縮肌肉拉長 2006年ING國際超級馬拉松行前訓練

32. 2006年ING國際超級馬拉松行前訓練

33. Embedded Padding in Shoe Insert lateral wedge medial wedge heel pad metatarsal pad 2006年ING國際超級馬拉松行前訓練