Sports Medicine: Just the Facts

• During walking the hamstringsare active at the end of
  swing phase and into stance phase until the foot is in
  full contact with the ground. This occurs at about 10%
  of the walking gait cycle. During running, they are
  active during the last third of the swing phase during
  hip and knee extension. Here they are acting concen-
  trically across the hip joint but eccentrically across the
  knee joint. This action initiates hip extension and
  resists knee extension simultaneously (Birrer and
  Buzermanis, 2001).


• During walking, the anterior tibial musclegroup is
  active from late stance phase through the swing phase
  and then for the first 10 to 15% of the next stance
  phase. This produces dorsiflexion of the ankle during
  the swing phase through concentric contraction. It
  also helps to control plantar flexion by initial contact
  through eccentric contraction, thereby preventing foot
  slap. During running, they are active from late stance
  phase, through the swing phase and for the first 50 to
  60% of the next stance phase. For their duration of
  activity they are undergoing concentric contraction.
  During walking, they decelerate foot plantar flexion at
  IC; however, during running they appear to accelerate
  movement of the leg over the fixed foot. In heel strik-
  ers, a greater degree of activity is found in the anterior
  tibial muscle group than in midfoot strikers (Birrer
  and Buzermanis, 2001).


• Activity of the posterior leg musculature begins
  during terminal swing of gait. During walking, these
  muscles act to resist forward movement of the tibia
  over the fixed foot during the stance phase. They are
  active from 25 to 50% of the stance phase through
  mostly eccentric contraction. During their last 25% of
  activity, they undergo concentric contraction to initi-
  ate active plantar flexion. During running gait, initial
  contact is a period of rapid dorsiflexion. Here the tri-
  ceps undergo eccentric contraction, again to resist this
  motion. They are active for approximately 60% of the
  stance phase. Initially they serve to stabilize the ankle
  joint at initial contact, and then to provide for propul-
  sion (Birrer and Buzermanis, 2001).

COMMON RUNNING INJURIES

PATELLOFEMORAL SYNDROME

• Definition
  
  
  1. Pain associated with the articular surface of the
     patella and femoral condyles.
     2.Runners knee—No. 1 presenting complaint to
     runner’s clinics
  
  
  2. No. 1 cause lost time in basic training in military
     recruits
     
     
     • Diagnosis
       
       
       1. Anterior, peripatellar, and subpatellar pain
       
       
       2. Increased pain following prolonged sitting (theatre
          sign) as well as running downhill and walking
          downstairs.
       
       
       3. Apprehension (shrug) sign
       
       
       4. Abnormal patella tilt (tilt less than 5°in males and
          less than 10°in females)
       
       
       5. Abnormal patella glide (medial glide less than 2
          quadrants, lateral glide in excess of three quadrants)
       
       
       
       
     
     
     • Contributing factors
       
       
       1. Femoral dysplasia
       
       
       2. Patellar facet asymmetry
       
       
       3. Malalignments (especially those contributing to
          excessive pronation)
          a Femoral anteversion
          b.External tibial torsion
          c. Varus ankle, foot
          d. Patella alta, baja
          e. Weak VMO
          f. Tight lateral structures (ITB)
          g. Increased Q angle
          •Treatment
       
       
       4. Patellofemoral syndrome treatment
          a. Correct biomechanical factors which lead to
          compensatory subtalar pronation and obligatory
          internal tibial rotation: genu valgum, tibia vara,
          hind foot varus, and forefoot pronation
          b.Flexibility: ITB, HS, and gastrocnemius
          c. Manual therapy to stretch tight retinaculum:
          medial glide and tilt.
          d. Strengthening: Quadriceps, hip abductors and
          external rotators
          i. Multiangle isometrics
          ii. Short arc terminal extensions (last 30 deg.
          ROM extension)
          iii. Gluteal strength
          iv. Closed chain strengthening with cocontrac-
          tion of quads, HS, gastroc soleus
          e. McConnell taping
          f. Bracing (patellar straps and braces)
       
       
       
       
     
     
     • Consider with persistent symptoms
       
       
       1. Magnetic resonance imaging(MRI): Osteochondritis
          and cartilage injury
       
       
       2. Injections: Steroid and synvisc
       
       
       3. Surgery: Lateral release if tight retinaculum and
          realignment
       
       
       
       
     
     
     
     
  
  
  
  

ILIOTIBIAL BAND SYNDROME

• Definition
  
  
  1. An overuse tendonopathy of the iliotibial band
     most commonly as it passes over the lateral
     femoral condyle
  
  
  2. No. 1 cause lateral knee pain in runners
  
  
  
  

522 SECTION 6 • SPORTS-SPECIFIC CONSIDERATIONS