Thursday, November 4, 2010

Managing Functional Running Injuries Using Orthopaedic Physical Therapy

Here is an article just published in the Orthopedic Practice Vol. 22; 4:10. I believe that understanding the stage of the injury can improve the functional outcome for the patient:


While many people think that running is simply for sports participants or the marathon runner, South Florida physical therapist Bruce Wilk acknowledges that many people run as part of their recreational activities, work requirements, educational standards, and achievement of developmental motor skills.

In his newly published article in the Orthopedic Practice, Wilk and associates Annmarie Muniz, and Sokunthea Nau define running as a functional activity of dailiy living, identify risk factors for common running injuries, and propose an evidenced-based model supporting the orthopaedic physical therapy rehabilitation of running injuries.

“What we have found is that when we properly identify the stages of a patient’s running injury, we can significantly improve their functional outcomes,” says Wilk.

Simply put, a patient’s injury has five stages:

Stage 1: Pain upon exertion
Stage 2: Pain at rest
Stage 3: Pain that interferes with ADLs
Stage 4: Pain that is managed with medication
Stage 5: Pain that is crippling

Wilk says that recognizing the stages of running injuries provides insight into the severity of a particular injury, general prognosis, and a more effective rehabilitation. “As injuries present in more advanced stages, the time spent in the early phases of rehabilitation is likely to be longer,” Wilk states. “Manual therapy, proprioceptive neuromuscular facilitation, and neurodevelopmental treatment should be incorporated appropriately depending on the individual’s learning style and current standing within the proposed phases of running rehabilitation.”

Wilk cites 4 phases of rehabilitation:

1) Self-management, rest, restore ROM
2) Fix muscle imbalance and work on body awareness
3) Functional strengthening
4) Efficient return to running (the functional goal is running)

“Running is a critical requirement for participation of many activities not only for competitive athletics,” states Wilk. “Therefore, it is the therapist’s responsibility to focus on the restoration of the ability to independently and efficiently perform this ADL. By properly staging his running injury and implementing associated stage-specific rehabilitation, we were able to help our patient pass the running portion of this test and return to his work duties.”

Bruce Wilk

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