Chris our Sports therapist here at Back 2 Balance has written a blog discussing a common case that runners of all levels experience. He writes about how he approaches the assessment and treatment. He uses a case study to expalin further.
Now that we are a whole month into the new year. Almost everyone’s goal of being more physically active and being a more healthier version of themselves is in full swing. Now is around the time we start to feel the effects of this new found motivation and energy. As our bodies adapt to the demands we are putting it under we may start to find areas of soreness and problems may start to appear. Although these are often nothing too major or concerning it can be reassuring to come and get an assessment and even some advice.
This blog will discuss a common case that runners of all levels may experience and how I approach the assessment and treatment as a sports therapist.
A Runner’s Hip – Case Study
I recently had a client come in for an assessment, complaining of regular hip pain. The client was a beginner to intermediate level runner. They had been running for approx. 6 – 8 months. This pain was predominantly presenting at the front of the hip which travelled down the thigh. It felt like a constant dull ache which would worsen when that area was put on stretch. Along with worsening when driving with the knee upwards and general use of the leg. This client was also getting some outer thigh pain after periods of physical activity. As well as the felling of general stiffness after periods of being in the same position. For example sitting at a desk for work or standing in a long queue.
I started my assessment by gaining some more background information about the individual and their condition. Covering lifestyle and medical information/history. I then moved on to gain valuable information about when the client first experienced their symptoms and what could have possibly started it off. This client was unable to pin point an exact time in which they first noticed it. This suggested to me that there was no clear injury mechanism. They just noticed it after doing a longer run then usual. They got back home and they felt a dull sort of ache starting at the top of their hip just under that bony prominence at the front of your pelvis. This is known as your ASIS. With the pain travelling downwards towards the knee.
The client didn’t think anything of it. The next day they noticed that they were in a lot of discomfort and found most movements to either be restricted or painful with most activities being difficult to complete without pain.
After a couple of days the client felt good enough to venture out again. They noted there was a slight pain in the same place again but was able to push through and finish the run. Despite it getting worse throughout the run. It wasn’t till after, they started to feel the dull ache along with slight pinching feeling starting on the outer part of the thigh and up into the glutes. The client then found themselves falling into a pattern of going for a run when they are feeling good this then aggravating the problem areas and having to rest for a few days. This went on for a about a month or two. With symptoms getting worse and feeling of more intense pain.
Full Physical Assessment
I then conducted a full physical assessment of the client. During this assessment I looked for any dysfunctions in the area, possible muscle weaknesses, altered biomechanics, severity and sensitivity of the condition, and any other tests to help me with my differential diagnosis. Any findings I may have made is then noted down and will be address within the rehab and treatment I prescribe.
The main findings were a clear weakness of right side hip flexor muscles when compared to left. Right side hypertonic (tense) hip abductor muscles. As well as a few compensatory movements they had adopted to help them function in pain. They were also experiencing slight foot and knee pain when running due to the change in movement pattern. My clinical diagnosis was a slight grade one rectus femoris tear that is developing into a tendinopathy.
I prescribed a course of 6 sessions over the span of 6 weeks in order to treat the injured muscle, rebuild strength in relation to running and suggest more optimal movement patterns. As-well-as guide them back to running in a way that is best for them and their body.
The first session consisted of client education regarding their condition. I clearly explained my diagnosis and reasoning. Giving feedback on any standout symptoms or objective measures. I find this to be an important aspect as I feel it helps the client have more responsibility over their condition. I believe they feel more at ease once they have an understanding of what has happened and why ‘X,Y, Z’ causes pain, feels restricted etc. We also had a open discussion about the best way for this certain individual to manage their condition in a way that fits their lifestyle best. This involved planning/fitting their exercises into their busy home life. This also allowed me to tailor their rehab into several exercises spread throughout the day to make it more manageable to the client. The rest of the session consisted of some light soft tissue work to the quads and upper hip area. This is to help with the healing process through the removal of waste products and promotion of new blood flow. Along with helping the alinement of collagen fibres. I also gave the first part of ‘homework’ for the client to do in their own time. It helped speed up their recovery process. This consisted of low level isometric muscle contractions and the application of ice.
On sessions 2,3 we started with a recap of the client’s progress. I asked a few questions regarding how they have been feeling during daily life and then replicate some tests. The main focus of these two sessions were; to gain strength back into the hip flexors and start to off load the lateral hip muscles that were starting to become effected due to altered movement. To start we used muscle activation techniques such as isometrics and METs. This was to improve the mind muscle connection and tolerance of the muscle under load. This provided us with a good base to start hip strengthening exercises. This was the main aim of the take home exercises, which consisted of straight leg raises resisted knee drives and running specific drills. During the sessions we would focus on general hip and leg health. Working on strengthening and off loading certain muscles to improve running mechanics.
On week 4 we held a mini reassessment. This involved the same tests I had conducted in the first assessment. This was so that we were able to compare the results and monitor their improvement. The results were very positive for the client. We could both see there was an improvement on muscle strength, and movement patterns were becoming a lot more developed. It was at this point the client voiced their desire to try a run for the first time in about 2 months. We discussed the possibility and together came up with a way for the client to go for a relatively light run but enough for them to get their desired enjoyment out of it. Therefore the homework for this week was to try the run. Making sure they were still following the management strategies we had created in the first session.
On the 5th session the client came in with a big smile on their face and feeling really positive about the run we had planned. They said they were able to complete the whole run without any pain or discomfort. They did note a little bit of muscle soreness 48 hours post run but it was manageable and soon went away. So within this session we did a bit of soft tissue work on the whole right quad. This was to help with any recovery and muscle soreness. We also progressed the strengthening exercises to heavy eccentrics – strengthening through stretch. These were given as homework along with repeating the same run.
On the 6th and final session the client was still really positive about their progress. They had been doing all the exercises and was feeling really strong. They were even able to complete the same run as before but in a quicker time with little to no muscle soreness. The session was more of a summery as we went over the clients progress throughout their rehab. We also discussed what to do if they were to get a flare up again and how to manage any symptoms. We then recapped all the exercises we had done. I created a pre run stretch and strengthen session to do that is individualised and specific to this particular client. Finally, we discussed the best way for them to progress their running distance and intensity in a safe and effective manner.
This client was also advised to come back within a month as a way to check in on their progress and get any treatment they my need. In this case the client did just that and a month later. They came in still feeling really positive about their hip and their general running. During this session the client told me of a few minor niggles they were experiencing. This was because they were back to progressing the length of their runs. We then created a warmup and strengthen programme for the individual that takes 10 minutes to do before every run. The client found this very helpful and was keen to implement it straight away.
I now regularly see this client about once a month. This is to get a bit of treatment and we discuss any advice I may have about any issues they may have been experiencing. The client is very happy with their time under my care. They found the sessions to be personalised and targeted to the problems they were having. They would highly recommend anyone with any sort of issues or conditions that impacts them to book in with myself to get an assessment and see how I may help them.