COHF 001: 42 y/o Ultra-marathon runner presenting with abnormal gait, Low Back & Hip Pain after running the Grand Canyon rim-to-rim.
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In todays episode we discuss a case with an ultra marathon runner suffering from gait abnormalities along with low back, and hip pain. Let’s take a look at the specifics and see what the council has to say.
Case Presentation: 42 y/o ultra-marathon runner presenting with abnormal gait walking post running the Grand Canyon rim-to-rim.
- Patient presents with abnormal gait pattern i.e. abrupt pelvic shift up on Right while trunk tilts down and back to Right. upon returning from running rim-to-rim 6 months ago. As gone to see PT, chiro, ortho.
- Due to this movement pattern she is experiencing Left side hip pain and Right side low back and knee pain. States she has been mostly pain free throughout her training.
- Upon reaching a speed of about 6mph the abnormality disappears almost instantly and then reappears almost instantly once the speed lowers to more of a walking speed. States pain goes way in back and still in L hip while running
- 3d gait mechanics show significant drop in pelvic obliquity to the Right and external pelvic with internal hip rotation on Right
- 3d Mechanics are more normal during running.
- Decent hamstring Range Of Motion, limited hip extension glute activation on Right
- Little glute activation on right
Let’s Hear From The Council!
I would think they most likely have a reflex motor pattern issue concerning gait which is going to be a threshold issue during the strike pattern. Looking at things from a central to a peripheral basis. Want to check cerebellum, proximal joints, vestibular system and why it isn’t coordinating correctly with the muscular system. Will be prescribing movements such as rolling patterns, crawling exercises, all trying to fire up the intrinsic patterns, constantly monitoring the pain levels through out. Movements based on the central nervous system findings are going to be important to rehabing this.
Jeff talks about how abnormal breathing patterns can affect the core. Check for muscle imbalances that would be affecting breathing. 3D Gait mechanics would be beneficial to check. Gives access to the Transverse plane analysis. Is the client compensating from a previous injury? Shoe patterns & wear patterns can tell a full story. The EMG analysis would tell us about the muscle function during the eccentric loading phase of the gait. Based on the firing patterns, determining an appropriate exercise prescription to improve those imbalances.
Stephen would want to check the history of injuries as well as the foot wear pattern to get a quick indication on the basic mechanics. 99% of the time the place that sore is not the primary problem. Check the muscle strength bilaterally. Check the fundamental movements as well as going through regression of movements. Is there hip rotations during squat and gait. Use a stretch cage to repeat those movements from her daily activities. Begin with some bio feed back and force plates to have the patient to improve their technique.
Dr. Brandon Brock
Dr. Brandon starts from a top down approach with a postural analysis. Checks the vestibular pathways, checking their limits of stability to determine which systems are involved. This will allow us to see what muscles are compensating due to where the body inappropriately thinks it is. Would check the ocular system, can they fixate or not? Eyes, paraspinals and vestibular systems to ensure they are all responding in sync. Would incorporate brain exercises along with whole body rotational exercises to get these systems firing in the same pattern. Would also validate there is no inflammatory diseases adding to this problem.
Dr. Emily Splichal
The strike pattern would be indicated with the information that the pain is increased during slower speeds. Pelvic floor testing would be good to see if it is engaging. If it is not activating appropriately then glute function is greatly compromised. This could indicate why the hip has pain. Would start the reprogramming with deep core stability, then build on that glute function. After that core to foot sequencing would be a progression before moving back into full running. Check the symmetry of the feet for navicular drop or calcaneal eversion.
What other activities is she performing. Many athletes change sports during different seasons. Also past injuries that may have inflamed this issue. In many runners the glutes are going to be a major issue, and something that needs to be checked. The IT Bands are going to be an area to check for asymmetric dysfunction that would be effecting the gait and biomechanics. The suprior tib-fibula need to be moving properly. If there is any IT Band dysfunction or restriction in the Tibula/fibula it is going to alter gait and cause these types of problems. Working through the hypertonicity and adhesions with some soft tissue work, thus restoring the function back to where it needs to be. Obviously depends how soon it is after the race, as to what we can do at that moment.
Let’s Here The COHF Summary from the President of the Council.
Dr. Mark Wade
Checking compensation from previous issues, looking at temperatures during training. 3D motion capture would be great for a transverse plane view. Strike patterns, gait movement, symmetry. Checking breathing for proper function and muscular compensation affecting this. Check the entire kinetic chain with muscle strength tests, and looking at functional movements. Top down approaches are good using posture analysis. Are there any limits in stability and how does it connect to the ocular system. Reactivate the core structure, using some glute activation as the primary focus. Bring the patient slowly back into activity. Can incorporate stretching and specific movements incorporating the spine and full body. Myofascial work can be utilized as needed as long as we aren’t inflaming the musculature. Want to reset peripherally where possibly, but continue to re-assessing. Clam exercises focus primary attention into the glute.
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Dr. Mark Wade: Council President, Posture Expert, & Global Health Leader, bringing insight together with the council on health, wellness, physical rehabilitation, neurology and exercise fitness strategies for health care professionals.
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