1/15/14 Therapeutic exercise for the treatment
of the injured runner
What needs work? Strength: Commonly addressed: Quads, hamstrings, glutes, hip abductors Commonly overlooked: foot intrinsics, core, hip rotators Flexibility: Commonly addressed: hip flexors, hamstrings, calves, ITBs Commonly overlooked: toe flexors and extensors, hip rotators What to focus on? FuncIonal, weight-­‐bearing acIviIes Performing ex. Barefoot IdenIfying compensaIons IsolaIng weak areas when necessary Emphasizing when exercises should be performed in relaIon to running Anterior Pelvic Tilt Common findings: Weak, long abdominal musculature Restricted hip flexors Endyourbackpainnow.com Core StabilizaIon Front Plank Progression Core StabilizaIon Abdominal Scissors Regression Strengthens abdominals Decrease lever lengths by altering hip and knee posiIon Stretches toe flexors Deechanges.blogspot.com ThesciaIcafix.com Wellsphere.com Ameliaburton.com.au MamiofmulIples.com 1 1/15/14 Core StabilizaIon Side Plank Progression Strengthens hip abductors, obliques, and ankle everters Oprah.com Core StabilizaIon Back Plank Progression Strengthens hip and trunk extensors Tinajuanfitness.info Iposture.com Femoral AdducIon and Internal RotaIon Phase I: Non weight bearing exercises
Goal: Improve neuromuscular control of gluteal musculature
Common findings: Weak hip external rotators Weak hip abductors Glute Ladders: 100-75-50-25-50-75-100% Max isometrics
Hold for 5 seconds at each position
Restricted hip external rotaIon Excessive foot pronaIon Runnersworld.com SLR with hip extension
Gluteus maximus extension
Thomas stretch
Phase I: cont’d
Phase II: Weight bearing exercises
Front and side plank progression
Goal: Improve endurance -and- neuromuscular control of mechanics
Lateral t-band walks
Uniplanar hip hikes
Multiplanar hip hikes
2 1/15/14 Phase II: Single Leg Squat Progression
Phase II: cont’d
Front Wall Squats
SLS with external support
SLS without external support
SLS while resisting
adducting directed
force
(Perform Better, Cranston, RI)
Skaters
All performed with mirror feedback
Foot and Ankle Exercises
Functional Activities
Arch raises/doming
Benefits: strengthen natural arch of foot
Doming and hopping
2 feet, then 1 foot
Integrate barefoot doming in all weight bearing exercises
Box Jumps Functional Activities
2 3 1 4 Single Leg
Square Jumps Plyometric program
Week 1 Bilateral jumps: Uniplanar, 2 sets of 20 seconds each Week 2 Bilateral jumps: MulIplanar, 2 sets of 20 seconds each Single leg jumps: Uniplanar, 2 sets of 10 seconds each Week 3 Bilateral jumps: MulIplanar, 4 sets of 20 seconds each Single leg jumps: Uniplanar, 2 sets of 20 seconds each Week 4 Single leg jumps: Uniplanar, 4 sets of 20 seconds each Single leg jumps: MulIplanar, 2 sets of 20 seconds each Box Jumps
2 legs then 1 leg 2 3 1 4 AcIve.com All performed with mirror feedback
3 1/15/14 Barefoot strengthening exercises:
Phase I
Foot and Ankle Exercises:
Toe abduction and adduction and flexion
Resisted adduction: →
Increases abduction mobility
Strengthens foot intrinsics
←Resisted
abduction:
Footcareny.com
Bilateral calf raises Increases toe spreading functional mobility
Strengthens foot intrinsics
Towel pick up:
Footcareny.com
→
Improves ability to “grip” ground
Maintain doming for all exercises
Strengthens foot intrinsics, esp.
arch
Footcareny.com
Barefoot strengthening exercises:
Phase II
Achilles tendinopathy:
Pain monitoring model Silbernagel, 2010
Pain for up to 24 hours not exceeding 5/10 Unilateral calf raises Ball toss Phase Goal Treatment Phase 1: Wk 1-­‐2 Start exercise, understand pain monitoring CirculaIon exercise, Two-­‐legged heel raises (3x15),One-­‐legged heel raises (3x10) Si]ng heel raises (3x10), Eccentric heel lowering (3x10) Phase 2: Wk 3-­‐5 Start strengthening Two-­‐legged heel raises on step (3x15), One-­‐legged heel raise on step (3x10), Si]ng toe raises (3x15), Eccentric heel lowering off edge of step (3x10) Quick rebounding (3x20) Phase 3: Wk 6-­‐12 Heavier strength training, return to sport One-­‐legged heel raise on step with added weight (3x15), Si]ng toe raises (3x15) Eccentric heel-­‐lowering on step with weight (3x15), Quick rebounding (3x20) Plyometrics training Phase 4: 3-­‐6 mo’s Maintenance. No symptoms One-­‐legged heel raises on step with weight (3x15), Eccentric heel raises with weight (3x15),Quick rebounding (3x20) Maintain doming for all exercises
Patellar tendinopathy:
Eccentric training
Appropriate hamstring strengthening
Emphasize hip extension and knee flexion
Eccentric single leg squats effective
Purdam 2004, Young 2005
Therapy ball
hamstring
bridges
Level I evidence: as effective as surgery
Bahr 2006
Eccentric loading on 25° incline
Return to standing performed bilaterally
2x Daily, 3x15 reps, 12 weeks
Progress to weight backpack
Supplement with superior patellar mobs,
thomas stretching
Single leg RDL
Brotzman 2012, Young 2005 4 1/15/14 Dynamic stretching warm-up
Dynamic stretching warm-up
Leg Swings: Stand up tall and swing your leg forward and then pull it back up underneath you. Keep stomach Ight. 20 swings/leg. Standing Hamstring: Stand tall, point your thumbs behind you, and Ighten your bueocks. Drive your right heel towards the ceiling, pivoIng on your lef hip. 10 reps each leg. Dynamic stretching warm-up
Lunge Stretch: Lunge backwards while keeping your stomach Ight. Reach the same side arm overhead and towards the opposite direcIon 10 reps/side Calf Stretch: Rock forward (to stretch toes) then rock onto your heel while pulling your toes up. Pause, 10 reps Foam roller
Walking Knee Hugs: While keeping a Ight core and standing up tall, walk forward while hugging alternaIng knees. Rise up on your toes, if you can. 10 reps each side. 5