Academy of Orthopaedic Physical Therapy

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23.1 ORTHOPAEDIC MANAGEMENT OF THE RUNNER,
CYCLIST, AND SWIMMER
Table of Contents

THE RUNNER: EVALAUATION OF COMMON INJURIES AND TREATMENT

Abstract:

CONTENT: The author lends his expertise to providing his research-based perspective on the evaluation and treatment of running injuries. Dr Heiderscheit identifies the clinical presentation and management of patients who present with various common running-related injuries. These injuries include low back pain, patellofemoral pain, stress fractures, iliotibial band syndrome, hamstring injury, Achilles tendinopathy, and plantar fasciosis, among others. An interesting section on when it is appropriate to modify running form and strategies to implement a retraining program follows the injury section. Dr Heiderscheit then discusses the selection of running footwear and presents the evidence regarding the use of foot orthoses and their role in injury prevention and treatment. A posttreatment return-to-running program is then detailed. CASE ANALYSES: Two case studies are presented. The first case describes the integration of gait retraining, home exercise, and footwear change recommendations for a 19-year-old male referred to physical therapy for examination and treatment of bilateral knee pain. The second case illustrates the management of a 40-year-old female with persistent bilateral insertional Achilles tendinosis.

Keywords:​

running, stress fractures, retraining

References:

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EVALUATION AND MANAGEMENT OF COMMON CYCLING INJURIES

Abstract:

CONTENT: Dr Carcia and his coauthors provide the reader with a comprehensive review of the components of a road and triathlon bicycle. They also discuss how to optimally adjust a road and triathlon bicycle to the unique and individual needs of the cyclist. Injuries are then discussed in regard to the incidence, etiology, and management of microtraumatic and macrotraumatic cycling injuries. A specific emphasis is placed on recognition of the signs and symptoms of compressive neuropathies associated with cyclists and proposed biomechanical solutions. This monograph assimilates well with the companion monograph in this series titled Biomechanics of Cycling. CASE ANALYSES: Two case studies follow the didactic presentation on injuries. The first case is a 27-year-old self-referred male recreational cyclist who complains of lateral knee pain. The second case involves a 31-year-old male bicycle rider referred to an outpatient orthopaedic physical therapy clinic by his primary care physician for complaints of low back pain. Each case presents the patient's history, tests and measures, diagnosis, prognosis and plan of care, intervention strategy, and outcomes measurement.

Keywords:​

compressive neuropathies, cyclists, biomechanical solutions

References:

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ORTHOPAEDIC MANAGEMENT OF THE SWIMMER

Abstract:

CONTENT: Injury patterns commonly seen with each swimming stroke and their potential contributions to injury are thoroughly covered in this work. Conditions and physical dysfunctions commonly found in swimmers using orthopaedic and functional movement examinations are then discussed. Indications, contraindications, and various techniques of manual therapy treatment for the swimming athlete are also explained. Throughout the monograph the authors identify best practices in sport rehabilitation for the acute and long-term management of common swimming injuries and associated prognoses. The uniqueness of treating swimming injuries is elucidated. The authors' backgrounds in working with high level athletes lends credibility to the information presented and results in an abundant amount of information pertaining to swimmer injuries. CASE ANALYSES: Three case studies are presented at the conclusion of the monograph. The first case describes a 26-year-old woman, participating as an elite Paralympic swimmer with International Paralympic classification S6 who complains of recurring anterior shoulder pain. The second case is a 27-year-old elite level breaststroke swimmer who presents with recurrence of left medial knee pain. Lastly, a third case describes a 38-year-old right-hand dominant recreational swimmer presenting with a 4-week history of numbness, weakness, and a cold sensation in the right medial forearm and hand. Each case is unique and briefly outlines the authors' clinical reasoning in evaluation, treatment, and outcome of each condition.

Keywords:​

injury, swimming stroke, orthopaedic

References:

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BIOMECHANICS OF RUNNING

Abstract:

CONTENT: The work represents a concise, research-based compilation that will help clinicians become grounded in the biomechanical theories that play a role in understanding the physical demands of running and its impact on injury. The author introduces the reader to the spatiotemporal characteristics and ground reaction forces common to the running gait. Joint kinematics and kinetics in reference to the running gait cycle are clearly delineated. Biomechanical changes with regard to initial contact and foot strike pattern during running are then discussed. Risk factors that may contribute to running injuries are highlighted and also how running biomechanics are influenced by age, gender, speed, and surface inclination and stiffness. Dr Heiderscheit then explains how to perform a systematic and comprehensive video analysis of a runner's mechanics. The appropriate equipment needed to conduct a clinical analysis of running biomechanics and identify factors that can influence its accuracy is also discussed. CASE ANALYSES: Two case studies conclude the monograph. The first case describes a 35-year-old male sub-elite runner and triathlete who seeks physical therapy for evaluation of ongoing left calf pain. The second case is a 33-year-old female examined without referral with a chief complaint of right anterior lateral thigh pain with associated low back pain. Both cases detail the diagnostic process through history, systems review, pertinent tests and measures, diagnosis, prognosis, rationale for plan of care, specific interventions, and measured outcomes.

Keywords:​

ground reaction forces, kinematics, kinetics

References:

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