Leg Pain in the Running Athlete, An Issue of Clinics in Sports Medicine

Alexander Meininger

Description

This issue of Clinics in Sports Medicine, Guest Edited by Alexander K. Meininger, MD, is devoted to Leg Pain in Athletes. Leg pain is a common manifestation of many ailments for which the athlete is vulnerable. In this issue, authors will discuss the most common causes of leg pain, including tibial stress syndrome, stress fractures, and exertional compartment syndrome. Attention will also be given to the evaluation of the injured runner, risk factors (such as the female athlete triad), and useful imaging adjuncts will be discussed.

Sujets

• Sports Medicine
• Medical
• Médecine

Informations

• Publié par: Saunders
• Date de parution: 28 avril 2012
• Nombre de lectures: 8
• EAN13: 9781455744381
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Clinics in Sports Medicine , Vol. 31, No. 2, April 2012
ISSN: 0278-5919
doi: 10.1016/S0278-5919(12)00008-7

Contributors
Clinics in Sports Medicine
Leg Pain in the Running Athlete
Dr., Alexander K. Meininger, MD
Orthopaedic Surgery and Sports Medicine, Moab Regional Specialty Clinic, 476 West Williams Way, Suite B, Moab, UT 84532, USA
ISSN  0278-5919
Volume 31 • Number 2 • April 2012

Table of Contents
Cover
Contributors
Forthcoming/Recent Issues
Foreword
Preface
The Anatomy and Biomechanics of Running
Evaluation of the Injured Runner
Diagnostic Imaging in the Evaluation of Leg Pain in Athletes
The Female Athlete Triad
Muscle Soreness and Delayed-Onset Muscle Soreness
Hamstring Strains and Tears in the Athlete
Medial Tibial Stress Syndrome
Stress Fractures in Runners
Chronic Exertional Compartment Syndrome
Popliteal Entrapment in Runners
Tendinopathy Treatment: Where is the Evidence?
Rehabilitation of Running Injuries
Index
Clinics in Sports Medicine , Vol. 31, No. 2, April 2012
ISSN: 0278-5919
doi: 10.1016/S0278-5919(12)00010-5

Forthcoming/Recent Issues
Clinics in Sports Medicine , Vol. 31, No. 2, April 2012
ISSN: 0278-5919
doi: 10.1016/j.csm.2012.01.001

Foreword

Mark D. Miller, MD
S. Ward Casscells Professor of Orthopaedic Surgery, University of Virginia, Team Physician, James Madison University, 400 Ray C. Hunt Drive, Suite 330, Charlottesville, VA 22908-0159, USA
E-mail address: [e-mail]


Mark D. Miller, MD, Consulting Editor
One could argue that the limping athlete is more difficult to diagnose and treat than the limping child. There are a variety of conditions that can cause leg pain in the athlete and these often coexist and represent a significant challenge. As we all know, runners want only one thing—to return to running. Unfortunately, many of these conditions require prolonged treatment and rehabilitation, so that goal is often not immediately achieved. Dr Alexander Meininger from the Moab Regional Specialty Clinic in Moab, Utah has put together an excellent treatise on leg pain in running athletes. This edition has a very organized format, beginning with anatomy and proceeding to evaluation and then treatment of each condition. The issue concludes with an excellent review of rehabilitation. The running athlete is a major challenge to us all, but hopefully this issue will provide some insight that will make our job just a little easier.
Clinics in Sports Medicine , Vol. 31, No. 2, April 2012
ISSN: 0278-5919
doi: 10.1016/j.csm.2012.01.002

Preface

Alexander K. Meininger, MD
Orthopaedic Surgery and Sports Medicine, Moab Regional Specialty Clinic, 476 West Williams Way, Suite B, Moab, UT 84532, USA
E-mail address: [e-mail]


Alexander K. Meininger, MD Guest Editor
Leg pain in the running athlete can be a complicated and frustrating experience for the athlete and physician alike. Myriad of clinical conditions is complicated by the diverse and disparate diagnoses captured under the wastebasket term “shin splints.” This issue is designed to provide the sports medicine clinician or surgeon our most current understanding of the pathophysiology behind leg pain in runners.
The first article is written by one of our foremost leaders in running medicine, researcher, and Sports Medicine Rehabilitation director Dr Terry Nicola. He eloquently summarizes the biomechanics of running as a basis for understanding pathology. I am thrilled to engage my mentor Dr Jason Koh in the next article, who describes our routine for evaluating running injuries clinically, while Dr Bresler and his team write a wonderful summary of the radiologic findings unique to leg pain.
Subsequent articles breaking down the differential diagnoses discuss muscle cramps, hamstring injuries, medial tibial stress syndrome, exertional compartment syndrome, and popliteal artery entrapment by Drs Bush-Joseph, Leland, Guelich, Hutchinson, and Turnipseed. Tendinopathy treatment is a hot topic in sports medicine today and I am honored to have Dr Sherwin Ho's expertise to examine the evidence for treatment. Obviously no discussion of leg pain would be complete without recognizing stress fractures and the role of the female athlete triad and I am indebted to Drs Provencher and Dunlap for their insights.
None of this would have been possible without the dedication, time, and effort of my contributing authors. I want to give special thanks to Dr Mark Miller for granting me the opportunity to participate in the Clinics in Sports Medicine , as well as Jessica McCool from Elsevier for keeping us on schedule. Last, to my beautiful wife, Angie—I couldn't have done it without your support and understanding, thank you.
It is my pleasure to share this work with you. I hope that you'll enjoy reading this issue as much as I enjoyed assembling it.
Clinics in Sports Medicine , Vol. 31, No. 2, April 2012
ISSN: 0278-5919
doi: 10.1016/j.csm.2011.10.001

The Anatomy and Biomechanics of Running

Terry L. Nicola, MD, MS a , b , c , * , David J. Jewison, MD d
a UIC Sports Medicine Center, 839 West Roosevelt Avenue, Suite #102, Chicago, IL 60608, USA
b Department of Orthopedic Surgery, University of Illinois at Chicago, Chicago, IL, USA
c Family Medicine Department, University of Illinois at Chicago, Chicago, IL, USA
d MacNeal Sports Medicine, 125 East 13th Street 615, Chicago, IL 60605, USA
* Corresponding author. UIC Sports Medicine Center, 839 West Roosevelt Avenue, Suite #102, Chicago, IL 60608
E-mail address: [e-mail]

Keywords
• Running • Biomechanics • Gait cycle • Running injuries
The study of the biomechanics of running refers to understanding the structure, function, and capability of the lower extremities and overall kinetic chain that allow a human to run. Although no two individuals share identical anatomy, strength, or proprioceptive qualities, there are many similarities to understand regarding the role of each individual's running cycle to diagnose and treat injuries that occur from running. This article discusses the anatomy of the lower extremity as it relates to the ability to run, the running gait cycle, and abnormal anatomy and biomechanics related to running injuries.

Running Gait Cycle
The running gait cycle is different from the walking gait cycle. The gait cycle can be described as the series of movements of the lower extremities between foot initial impact with the surface until it reconnects with the surface at the end of the cycle. 1 To better understand the gait cycle, we examine the walking gait cycle and its differences from the running gait cycle. There are 2 main phases of the gait cycle, the stance phase and the swing phase. 1 – 3 ,4 The stance phase occurs during the period of contact between the foot and the running or walking surface. These phases occur in both walking and running. When one lower extremity is in the stance phase, the other is in the swing phase ( Figs. 1 – 3 ).

Fig. 1 Swing and stance phases of running. Right leg in stance phase, left leg in swing phase.

Fig. 2 Swing and stance phases of running. Right leg footstrike, end of float phase, beginning of swing phase left leg.

Fig. 3 Swing and stance phases of running. Float phase of the running gait cycle.
Running is distinct from walking because of an additional float phase, which occurs twice during running. This float phase occurs between stance phase and the swing phase, where both lower extremities are not in contact with the ground. 1 Therefore, running at any speed can be defined as either 1 leg or no leg striking the ground throughout the gait cycle. During the walking cycle, there is a period of double stance phase during the walking gait cycle in which both lower extremities are in contact with the walking surface. 2 This occurs for walking at the very beginning and very end of the stance phase. This means that during walking, 1 or 2 legs are always in contact with the ground during stance phase. 1 For walking, stance phase occurs typically for about 60% of the gait cycle, and swing phase occurs for about 40% of the cycle. 1, 2 For walking, stance phase occurs in greater than 50% of the cycle, with swing phase consisting of the rest of the cycle. 3 The opposite is true for running, in which stance phase is less than 50% of the cycle. 2, 5 This swing phase for greater than 50% of the cycle causes an overlap of swing phases between lower extremities, generating the characteristic float phase. As velocity in running increases, stance phase becomes even less of a percentage of the cycle. 2 Therefore, sprinters spend a smaller percentage of the gait cycle in stance phase. Additionally, step length and cadence are increased during running compared to walking. 2, 5 Stride length is the distance from initial contact of 1 foot until the same foot makes contact with the running surface again. Step length is the distance between initial contact of one foot and the subsequent initial contact of the opposite foot. Cadence is the number of steps taken during a certain amount of time. As running cadence, stride, and step length increase, velocity and ground reaction forces increase. 2, 5 This has implications for increased stresses through the lower extremities and risk for injury. One other difference is that walking has a wider base between individual footstrikes. This is the distance betw