Running Injuries & Illness 01

BPFA, Run (1)History and Examination

In order to establish a diagnosis for any musculoskeletal injury, it is vital to understand the exact mechanism and circumstances of the injury process. By knowing the direction of forces acting upon a particular body part, it is possible to focus further history and examination towards developing a diagnosis (from an exerciser’s viewpoint, developing an understanding of how and why the injury occurred).

Running-related injury often results from adjustments in training and it is therefore important to elicit this in any consultation. The parties (medical professionals, physiotherapists, exercisers etc) should attempt to define changes in the volume of training including weekly running distances, frequency, intensity and type of training, i.e. hill, interval, sprint or endurance. New equipment such as training shoes or running kit may also result in an altered running pattern leading to injury. Certain injury patterns may develop when an individual switches from running on a soft surface, i.e. sand or grass, to concrete.

Diet and nutrition may also have an important role in injury development and prevention (see Female Athlete Triad within Running Illness, Post 07) and should also be considered in the history. It is important to ask about the level of competition and importance of running for an individual. An elderly patient who runs for independence and fitness may be equally affected by an injury as a young ‘elite’ athlete. It is always worth considering the possibility that pain or disability may be resulting from a non-musculoskeletal cause and ‘red flag’ symptoms should be elicited early in any consultation.

Examination of any musculoskeletal injury requires observation, palpation, movement assessment and further specialist testing. When examining an exerciser it is important observe for deformity, swelling, bruising and scars. Observation should include a focused assessment of the injured area as well as a more generalised evaluation of the exerciser during walking and standing.

Palpation attempts to elicit tenderness, crepitus and temperature differences. The range of motion (ROM) of a joint should be assessed actively, passively and against resistance, looking for restriction of range, stiffness or pain during movement in all directions. There are numerous special tests that can be used to assess each musculoskeletal structure. For qualified professionals it may be useful to incorporate a few well rehearsed tests into an examination routine in order to elicit subtle pathology and to build upon this as clinical experience develops.

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