Rehabilitation

Running is one of the most popular forms of cardiovascular exercise in the United States, particularly in the greater Portland area where the mild climate and miles of trails allow year-round outdoor training. Running is one of the most efficient modes of exercise, with minimal equipment and no gym membership required, and many people are able to fit a run into their lunch hour. Unfortunately, approximately 65% of runners will sustain a repetitive use (“overuse”) injury during a year's worth of training that will cause them to seek medical attention or stop running.

Chloe Murdock, PT, DPT, CSCS, specializes in working with runners. Drawing on both her personal and professional experiences, she is able to accurately diagnose and treat not only the specific injury, but also identify all contributing factors to ensure that the injury doesn’t return once the athlete resumes running. At The KOR we believe that running is a lifestyle, and if you take good care of your body you’ll be running happy and healthy for decades.

Reduced Disability and Mortality Among Aging Runners ; American Medical Association, 2008.

MR Imaging of the Knee in Marathon Runners Before and After Competition; International Skeletal Society, 2001.

Here are some of the things you can expect as part of your running assessment and treatment at The KOR Physical Therapy:

Assessment

• Video gait analysis:  Most running assessments will begin with a video gait analysis of the patient walking and running both barefoot and in sneakers. This gives the PT a chance to watch the runner in action and identify areas of weakness (such as asymmetrical trunk/spine mobility, hip weakness, or hamstring tightness) that are contributing to the injury. With our advanced motion analysis software we can slow down the video and easily spot such deficits, as well as monitor progress over time.

• Foot assessment:  Assessing foot structure in both weight bearing (standing) and non-weight bearing (lying down) positions helps to tell us how much support a foot needs. This support can come from a sneaker, custom or over-the-counter orthotic, or from your own foot muscles if you are a barefoot/minimalist runner. In conjunction with the video running assessment, we can determine how good a job your shoe/foot muscles are doing of supporting your unique foot structure.

• Strength measurements:  We use hand held dynamometers to accurately assess strength of specific muscle groups. This gives us much more reliable and objective data than a traditional manual muscle tests performed with the hands alone. Using this sensitive tool we can identify mild asymmetries that would otherwise go undetected, but are very important in endurance sports such as distance running. Our dynamometers also allow us to accurately track progress.

• Range of Motion measurements:  There is a minimum amount of range of motion (flexibility) that all joints involved in running need in order to significantly reduce the risk of injury. These joints include the thoracic and lumbar spine (mid and lower back), hips, knees, ankles, and certain joints in the feet (i.e. the big toe). These angles are measured with a goniometer. 

• Muscle Length:  Similar to joint range of motion, most muscles involved in running need a certain amount of flexibility, or length, to allow proper running form. These lengths are measured in specific test positions with a goniometer or tape measure.

• Dynamic balance assessment:  Distance runners are notorious for having poor balance and coordination. However, running is essentially a series of single leg hops strung together. Unlike walking where there is a period that both feet are in contact with the ground at once (adding increased stability), only one foot contacts the ground at a time during running. As a result, runners must have good balance in order to accommodate uneven surfaces and changes in terrain without spraining an ankle or falling. We assess dynamic balance through a series of functional tests such as the Single Leg Squat Test and the “Y” Test.

Treatment

• Manual techniques:  There are various methods for mobilizing – or stretching – joints and soft tissue (muscles, tendons, ligaments, and fascia). We use a variety of research-proven manual techniques (based on practitioners such as Kaltenborn, Maitland, and Mulligan) to efficiently and painlessly increase the flexibility of specific tissues. All of the therapists at The KOR Physical Therapy are also trained and highly skilled in performing high velocity manipulations of specific joints.

• Therapeutic Exercise:  Therapeutic – or rehabilitative – exercise is arguably the most important piece in the effective treatment of musculoskeletal injuries. Physical therapists are the MOST qualified practitioners in prescribing specific, appropriate, and effective exercises for maximizing function of a specific muscle, joint, or limb.

• Functional Exercise:  Functional exercise has become a buzzword in recent years in response to research showing the enormous benefits of exercise that mimic activities that we perform on a regular basis. For runners, functional exercise should include movements that involve not only one limb, but both legs, the core muscles, and arms. These movements are often performed with reciprocal movements of the arms and legs to mimic running mechanics, and can be performed at varying speeds and with emphasis on specific parts of the gait cycle.

• Proprioceptive training:  Proprioceptive training is another way to describe balance training, which we know most distance runners are in need of (see Dynamic Balance Assessment above). We use specialized equipment such as the Shuttle Balance, Balance Board, and BOSU Ball to improve proprioception in our runners with ever-changing exercises. Most of these exercises are performed barefoot in order to strengthen the small intrinsic muscles of the feet that become weak by years spent wearing shoes.

• Taping:  Taping of the knee and foot/ankle has long been used by physical therapists and athletic trainers to allow athletes to return to sport with less pain. Recent research (Classifying Patients with Patellofemoral Pain Syndrome Who Respond to Patellar Taping; Journal of Orthopaedic & Sports Physical Therapy, November 2006)  supports the use of short-term taping in conjunction with manual and exercise interventions for the effective and efficient treatment of common injuries such as “runners knee”, or patellofemoral pain syndrome.

Clinics to Help Runners Reduce Injuries

As a way of staying engaged and active in the community, The KOR offers informational running clinics throughout the year. These clinics are meant to bring together the running community and provide information on common injury prevention and proper training techniques. New research and trends (such as barefoot running) are discussed, and there is time for a question and answer session. In addition, free running screens and video analyses are offered by our highly trained staff of physical therapists. Our next running clinic and open house at The KOR is planned for September, 2010 – check back soon for details!

In addition to clinics offered at our facility, we are happy to offer free consultations to cross country and track and field teams as well as running clubs. We can come to your practice facility and provide information to your athletes and coaches on common injury prevention as well as how to determine when to seek medical advice. When injuries are detected early they are easier to treat and equate to less time away from practice and competition. Contact Chloe Murdock at chloe@thekorpt.com to request a free consultation for your team.

Performance Training for Runners

For runners who are not injured but wish to improve their overall performance, run a P.R. at a specific distance, or even finish their first 5k, The KOR offers one-on-one and small group performance training. This highly individualized program is one of the most comprehensive you’ll find in the area, and is run by The KOR’s PT’s running specialist, Chloe Murdock, PT, DPT, CSCS.

The foundation of this program is a comprehensive initial evaluation, which includes a video running analysis, foot assessment, strength, range of motion, and muscle length/flexibility measurements, and dynamic balance assessment. In addition, Chloe can help you design a training program that optimizes your hard training days while allowing for the proper rest and recovery your body needs to improve overall. These training programs are based on heart rate max field testing and training zones for the more advanced athletes, and rate of perceived exertion (RPE) for more novice runners. Chloe can show you how to safely and effectively integrate strength and power training into your routine, as well as improve your running technique through plyometric exercise, speed training, and form drills. This program offers its clients the benefits of both hands-on manual treatments to speed recovery and optimize performance as well as skilled exercise prescription and coaching to help you meet your goals.

Contact Chloe at chloe@thekorpt.com for pricing and Running Performance Training details.