Running After Post-Op ACL - The Calf

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!...

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Why That Dorsiflexion Restriction You Missed May Be Your Runner's Problem

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...

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The Solution to Runners with Lateral Hip Pain

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:

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

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

2....

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The Solution to Proximal Hamstring Tendinopathy

 

Tendinopathy issues are often one of the most misunderstood conditions.  Historically, the rehab world has focused on stretching these, partially because patients often describe feeling tight.  On the surface, that seems like one of the best approaches, but as you understand tendinopathies further, you start to realize that this may be one of the worst approaches for a long-term resolution.

I have previously written about this with insertional achilles pain and the troubles I found in my career as I tried to help individuals suffering from it.  We can take the same approach with proximal hamstring tendinopathies as well.

The underlying principle to heal a tendinopathy is that you must progressively load it.  If you load it too much too soon or in an overly aggressive position, the patient will likely digress instead of progress.  If you load it too little or do not progress positioning, the resolution will be slow or potentially not occur at all.

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Fixing Knee Pain In Running...Don't Just Strengthen

cadence collapser Dec 24, 2019

Collapsing

In our last post, we discussed the idea of a collapsing runner. This is someone who either shows a Trendelenberg in the stance phase of gait, or collapses inward at the knee through hip internal rotation and adduction. This is common with runners experiencing knee pain.

Many times we find the typical initial prescription is hip strengthening. It makes perfect sense. The hip abductors and external rotators do not possess enough strength to control the collapse. Many runners will see improved pain levels with this plan, but it is also important to realize that many runners may have a reoccurrence of the pain at a later time. Is it possible that one of the reasons your runner improved is partially due to the time they likely spent reducing their running volume while in rehab?

Here’s the thing. Just because you improve a runner’s hip strength does not mean his/her running gait will change.²  If running brought on the pain and we’re not fixing the...

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Running Issues? Maybe You’re A Collapser

collapser it band knee pain Dec 22, 2019

Running seems simple.  All kids do it, so we should all do it well, right?  Unfortunately, many of us develop compensations that can correlate with issues.  One of these common
compensations, we like to call, “The Collapser”.

The Collapser is exactly what it sounds like.  Someone who conforms to the ground way too much.  They absorb force in an alternative plane to the sagittal, leading to abnormal forces.  How important is this?

Let’s look at what a Collapser looks like first.  You’ll notice the 2 hallmark signs of a Collapser (Picture to the Right):  Pelvic drop and an adducted/internally rotated hip. 

Typically, a runner will have one or the other, but you’ll note that this runner has both.  This can correlate with anterior knee pain3, lateral hip pain1, and a host of other issues.

So back to why it is so important.  When we walk, 3x our body weight goes through our knee.  When we run, this...

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Orthotics and Lateral Knee Compartment: A Response to a Reader's Question

Recently, one of our readers reached out with a great question: 

Reader's Question

"I have a 36 year old female marathon runner who has a pronated forefoot on the left.  She has had ACL reconstruction surgery on the left 15 years ago.  She recently had a lateral meniscal tear and arthroscopic surgery for debridement.  In the surgery the doctor found significant lateral femoral cartilage changes.  She wants to continue to run.  I feel an orthotic will help control her pronation and decrease her knee stress.  The podiatrist  wants to post the lateral side of the orthotic to help offload the lateral compartment of the knee.  Is this correct thinking or should she just have the arch supported to correct the forefoot?  Thanks for your help with my questions."

 

Our Response

Thanks for reaching out and great questions!  First off... a lateral wedge will offload the medial knee and is counter productive if you are issuing...
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Shin Splints: A Runner's Worst Nightmare

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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Runners with Achilles and Calf Issues...What do we do? A response to a reader's question

Recently, one of our readers reached out with a great question: 

Readers Question

"I currently have a few marathoners who seem to be having recurrent Achilles tendinitis and gastro/soleus strains.  I have tried stretching, Graston tech, eccentrics, and other traditional exercises / treatments.  Any suggestions on what to look or suggestions for training modifications would be greatly appreciated. "
 
 

Our Response

You're doing a lot of great things already.  Keep up the great work! This can be a population that is often really easy to help....or really difficult and challenging.  Here's a few things you can look into and see if any of them may apply to your runners.
  • Here's a blog we wrote that summarizes some of the literature and give ideas on plans for insertional achilles issues:  https://www.certifiedrunninggaitanalyst.com/blog
  • Types of runs: One really big thing for this group is to limit their hill running initially and then slowly...
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Treating Runners (and others) with Insertional Achilles Pain: Why We’ve Been Doing It All Wrong

The Struggle

For years, I despised treating the insertional Achilles tendon pain patient.  I tried everything I was told by different gurus.  One well-established ankle and foot orthopedist swore by heel lifts and prolonged stretching off a step: 3 minutes, 3x/day and you would get better.  The next told me to place patients in a walking boot to unload the insertion.  Another podiatrist requested I ultrasound and ice massage them.  My PT Mentors told me to exercise them.

At this point, my head was spinning and I begged not to see these patients anymore.  Finally, I began to see the light.  For some reason, this condition is poorly understood, causing it to not be treated properly.  To effectively treat it, we really need to understand why it is happening.

Understanding the MOI

It is not that the Achilles or calf is too tight as many had suggested to me.  It’s certainly not that we only need a modality-based treatment plan.  A...

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Top Running Rehab Professionals Know These 5 Things...

Read them in our guide for running rehab professionals here.  Just let us know where to send it!