Immunity Boosting Measures for Self-Care during Covid 19

Article By : Dr.Rohit Bahuguna (PT) & Jyotsna Bahuguna(Dt), BFY Sports & Fitness.

GENERAL MEASURES :

  • Daily Practice of Yogasana, Pranayama ,home exercise and Meditation for at least 30 minute.
  • Spices like Turmeric (Haldi), Jeera (Cumin), Coriander (Dhaniya) and Garlic (Lasun) recommended in Cooking
  • Maintain cleanliness in and around the home for all individual and the family. Avoid unnecessary visits to crowded places.
  • Drink warm water throughout the day.
  •  Wear a disposable mask. Clean your hand properly. Avoid unnecessary  touching to eye, nose, and mouth.
  •  Stay away from patients having a cold and cough. Do not sleep especially during the day. Do not stay waking up late at night.

Ayurvedic  Tips :

  • Take Chyavanprash 10 gm (1 table spoon) in the morning. Diabetics should take sugar free Chyavanprash.
  • Drink Herbal Tea/Decoction (Khadha) made from Tulsi (Basil), Cinnamon (Dalchini), Black Pepper (Kali Mirch), Dry Ginger (Shunthi) and Raisin (Munakka) – once or twice a day.Add Natural Sugar (Jaggery) and/or fresh Lemon Juice to your taste, if needed.
  • Golden Milk – half tea spoon of Turmeric (Haldi) powder in 150 ml Hot Milk – once or twice a day.

Simple Ayurvedic Prcodures :

  • NASAL Application – Apply Sesame Oil / Cocunut oil or Ghee in both the nostrils in morning and evening.
  • Oil Pulling Therapy – Take one table spoon Sesame or Coconut Oil in mouth. Do not drink, swish in the mouth for 2 to 3 minutes and split it off followed by warm water rinse. This can be done once or twice a day.
  • Steam inhalation with fresh Mint leaves (Pudina) or Caraway Seeds (Ajwain) can be practiced once in a day. Clove (Lavang) powder mixed with Natural Sugar / Honey can be taken 2-3 times a day in case of cough or throat irritation.

Advisable diet :

  • Drink warm boiled water or take boiled water with ginger powder. Avoid eggs as well as meat.
  • Eat homemade, easily digestible, lite, and warm food. Do not consume stale foods, fermented items, items made of maida flour, curd, and dairy products, junk food, cold drinks, and fridge water.
  • Do not consume cross contamination food. Also do not eat anything stored in the fridge for too long.
  • Spices like Turmeric (Haldi), Jeera (Cumin), Coriander (Dhaniya) and Garlic (Lasun) recommended in Cooking
  • Drink hot soup with green lentil (moong), redlentils (masoor), chickpeas, and kale. Consumevegetables such as bitter gourd (karela), pointed ground (parval), raw radishes (mooli), bottle gourd (dudhi), pumpkin, drumsticks, ginger, turmeric, garlic, and mint.
  • Do not eat slow digestive or sticky vegetables. Take fruits such as papaya, pomegranate, and amla.

Notes: Above mentioned Measures is to Boost Immunity for Self-Care, it does not claim to be COVID-19 Treatment. . These measures generally treat normal dry cough and sore throat. However, it is best to consult doctors if these symptoms persist.

Healthy snack bars!

Article by – Dr. Satyashree Vernekar , Physiotherapist(BPT), Certified Dry needling practitioner, BFY Certified Diet & Nutrition therapist, Lifestyle & skincare blogger)

Healthy snacking is an important part of diet which involves a balanced and nutritious snacking options without excess calories or sugar. During weight management , there are a various types of mid time snacks.  They include different types of nuts such as walnuts, almonds, raisins, berries, seeds such as pumpkin seeds, sunflower seeds etc. Eating these nuts solely can sometimes be boring. Here these healthy snack bars come in handy. These are an easy and tasty way to have a nutritious and well-balanced diet.

I have recently started including these Sirimiri healthy snack bars in my regular diet plan. They have all natural and nutritious ingredients. No artificial sweeteners or sugars. Their ingredient list impressed me a lot and hence thought of trying them. This is the perfect example of healthy food can be tasty too.

They have a list of natural ingredients like rolled oats, honey, pumpkin seeds, chia seeds, butter, peanuts, jowar millet crisps, watermelon seeds, some real dried fruits and berries. The ingredients change according to the variants.

The other 8 flavors are –

  1. Pumpkin seeds and Cranberries.
  2. Ginger, mangoes and sesame seeds.
  3. Chocolate and peanuts .
  4. Goji berries and Blackcurrants.
  5. Fig n flax and pumpkin seeds
  6. Almonds and raisins.
  7. Dates and walnuts
  8. Cocoa, coconut and raisins.

I have tried all the variants and my favorite is the Dates and walnuts.

These snacks have an amazing texture. The sweetness is minimal with natural sweetener like honey and dried berries. The number of nuts and seeds is maximum to give a very healthy snack. Rolled oats and jowar millets are the base of this bar and the different seeds give an amazing crunch and taste. The fragrance is either of natural cinnamon, elaichi or clove for various flavours. I loved how balanced these bars are regarding their carbohydrates, proteins and fats. Also, each bar gives around 170 – 180 Kcal of energy. I have also tried other healthy snack bars, but these are my favorite as there are even so many flavors to choose from.

They can be carried and eaten just anywhere. A quick snack to reduce those hunger pangs.

5 incredible Drinks you need Right Now.

During this pandemic situation it is very necessary to keep our body healthy and also increase the immunity. As this rainy weather starts, there are a range of ailments which start bothering everyone. These diseases can be kept at bay which some quick and healthy Teas.

  1. Hibiscus tea
  2. Herbal decoction or Indian Kadha
  3. OolongTea
  4. Immunity booster Tea
  5. Tulsi tea
  6. Hibiscus tea

This tea is made by boiling hibiscus flower petals along with a few Indian spices. Hibiscus tea has various benefits.

  • It helps to lower blood pressure
  • Aids in weight loss
  • Packed with anti oxidants.
  • Helps to fight bacteria.
  • Helps to increase immunity.
  • Helps to decrease blood fat levels.

I drink  1 cup Hibiscus tea every twice a week. It is always necessary to regulate the intake as too much of anything is bad. Sharing my recipe of hibiscus tea.

1 hibiscus flower + 2-3 mint leaves + ¼ spoon caraway seeds + ¼ spoon jeera + ½ ginger . Give it a nice boil. Optional add jaggery and lemon for extra taste.

  • Indian kadha or herbal decoctionThis has become more popular due to thecurrent Covid19 situation. Indian kadha have been used from the ancient times due to it’s various benefits.
  • It’s helps to increase immunity.
  • Aids in lowering blood pressure.
  • Helps in fighting off common cold.
  • Improves the health of organs.
  • It is anti bacterial.
  • Aids in digestion.

My recipe of kadha – Tulsi leaves + caraway leaves + 2 cloves + 1 dalchini + 4-5 black peppers + 2-3ra raisins + dry ginger + a pinch of turmeric. Boil together and strain. Optional add jaggery/honey and lemon while serving.

Do not add honey if the drink is hot.

  • Oolong Tea – This is a type of tea which contains both properties of black tea and green tea. The benefits are
  • Aids in weight loss
  • High in Antioxidants, hence help to fight off diseases.
  • Prevents Diabetes.
  • Lowers blood pressure.
  • Reduces dental caries as it contains small amount of fluoride.
  • Improves sleep.
  • Reduces cholesterol levels.

Oolong teas are available online and offline markets.

  • Immunity boosting tea.

This tea is a mixture of various immunity boosting ingredients like licorice, tulsi, green tea, ginger, harade etc. A cup of this tea helps in

  • Boosting metabolism.
  • Increases immunity.
  • Increases concentration.
  • Eliminates free radicals.
  • Lowers blood cholesterol level.
  • Works as a stress buster.

There are various teas present which help in increasing the immunity. I am using the Navvayd Immunity Boosting tea.

  • Tulsi tea – Tulsi is the most important herb which is used since ages as a medicine. It has various health benefits and hence is a sacred plant.
  • Packed with anti oxidants.
  • Helps to cure respiratory ailments.
  • Boots metabolism.
  • Aids in digestion.
  • Helps to reduce stress.
  • Lowers blood pressure.
  • Relives arthritis.

My recipe of tulsi tea – Tulsi leaves + ginger + a pinch of turmeric. Boil it well and strain. Optional jaggery and lemon.

These 5 herbal teas will give the best immunity and has amazing health benefits. So, start drinking them right now.

Veggie Wash. A must need in every Household during this pandemic.

The COVID19 pandemic is rampant throughout the country and the best we can do during this situation is stay safe. Taking care of ourselves by the continuous use of mask is necessary to keep ourselves away from the harmful virus. Also getting clean and nutritious food is the need of the hour to boost our immunity and fight off the bacteria and viruses.

The fruits and vegetables in the market are handled by various people, they are transported to various places and are also grown in different soils and conditions. All these factors are present when these vegetables and fruits are brought into the house. Cleaning them thoroughly is the best way to keep the harmful bacteria and virus away.The best way to do this is by using the Qraa Veggie wash. I have been using this from some time now and I could see the way it cleaned the vegetables and fruits so effectively. Only a small quantity is necessary while washing.

Ingredients – water, cocamidopropyl betaine, kathon CG, apple cider vinegar, citric acid, sodium chloride.

No harmful chemicals are present in the ingredients list and it is completely safe to use. The veggie wash has a strong sweet scent which does not stay over the fruits and veggies. It is completely liquid in consistency and only a small amount is required at a time.

How to use- Mix 15ml or 3 teaspoon of veggie wash in 500ml of water. Or 3% ratio of vegetable/fruits in water. Soak the vegetables or fruits in the prepared solution for only 1 minute. Then rub individual pieces thoroughly with hand dipped within the solution. Transfer the soaked vegetables/fruits into a strainer and wash thoroughly under running tap or clean water. Vegetables/fruits are now squeaky clean and ready to be consumed. Used daily to wash vegetables and fruits before consuming and avoid unwanted diseases caused by surface contaminants.

My Opinion:

I have been using this daily to wash the fruits and vegetables and I am happy with the results. All the surface contaminants are washed off completely making the produce very clean and safe to consume. This is the most important product during this pandemic time as we have to keep ourselves healthy and safe.

Do let me know your opinion in the comments section below.

Article by – Dr. Satyashree Vernekar, Physiotherapist(BPT), Certified Dry needling practitioner,BFY Certified Diet & Nutrition therapist, Lifestyle & skincare blogger)

STANDING ABS PILATES

Article By Jyoti Kamaal

When I started my first Pilates session, it was not something that I could comprehend immediately. I try to see many ways of exercise, as I was ever introduced in what was the fundamental principle of this workout. Being an Indian, I have seen YOGA for many years, as one ELEMANTARY work out The others are running, walking, swimming, sports which was a very common phenomena worldwide. Then, we saw Aerobics come to India and I joined it. I can say, it was indeed very energizing. I could feel I could dance, my body stretch, raise my legs, spread my arms and it felt like a full exercise.

The feeling of independence and liberating

Going forward I also found, this is very interesting and not only did I see it as a full blown energy work out, but it was somewhere between a dance and an exercise. I did not have to depend on equipment and machines, the feeling of independence and liberating was phenomenal. What I found interesting is, that my body will start showing signs of stagnancy after every workout. It will start fitting in my system as everyone experiences. In the start I instantly found a great improvement, a drastic change, a very classic reduction of weight and fat and inches.

And then gradually again, I will see my system getting to me. I realized I was only trying to fit into the exercise and do what the exercises were meant to be done. This journey did not end here, I also went forward and learnt gym exercises which was never one of my favorites and as I did move into the gym comfortably with the help of some very supporting Instructors. Not only did they help me work out on these machines, but they also helped me patiently increase my endurance in the gym. While I would work out on my own, I heard from many people gym is very boring. Yes, it could be indeed, but then I started adding playlist, headsets and there was a line of equipment that kept coming along with my gym actions. I also added a gym in my own house which is where I had the liberty and admiration to my fitness schedule. I took the best use of the space and got some interesting machines. I could be regular. I was very fond of my evening one hour workout routine with my music, with my own space, with my privacy. Since, I was learning enough I need not rush to any fitness instructor anymore.

One mechanism

I’m now observing strange sort of changes in body immunity. Somewhere, I just became so prone to do the exercise in one way. I felt I was doing it at the best ability if my body, because you have something mastered but in the process of regular regime. So, you need to see that your body is now gauging, what do you do every day, so your system starts saying we have lost enough weight. I’ve toned your inches made you desirable, fit in all your dream clothes, feel comfortable with your physical self. Oops, they now say – I’ll just take it a little easy that’s when you realize that your body has got very comfortable with this one mechanism. What you are thinking and when you start feeling that I am at my best. No, the results are not the same way. I went through this as I had a weak point, I was not very enthusiastic about floor and exercises, it was earlier that I did do it. Now I need to change my workout. I believe innovations and work out worldwide starting from the original of yoga then we went into running athletics, sports. We are now going to try new things which are very attractive aerobic, Zumba. Gradually, I learnt about the PILATE. I was absolute curious! On what is this new exercise format? They were new techniques. I see I was learning stability, concentration, balancing, body posture correction, breathing techniques. They were new methods. I was trying to see in my body adaptation not so to say that they won’t have a weirdness, something to raise eyebrows. Because, I was exercising for over 20 years but there was something different.

What i really like about this new change of exercising was that I could do something called standing abs. I was always slightly nervous when I have to come down on the floor to do my abs, my back was not very good. Then, here I learnt about standing exercises, yes that was my super exciting level. I felt I had reached the internal force of exercising, which I was always hunting. This is what exercising is about, you have to learn your body while you are learning the exercise. If I say I Ever thought of PILATES as my expertise. In the standing abilities, I gradually started seeing myself in the mirror, at the capability of my body. I could see that I could be fitter, with the new breathing technique, absolutely perfect. I was happy and gave me a sense of boost, regaining to the lost excitement and increased stimulation from the stagnancy of my body. I got back, I got a drive in my videos for standing abs /core workouts. That you will see there is nothing shaky, it made my concentration better Eat healthy Balance my body and because they repeat small steps, I can keep increasing my level at my own pace. As my journey is pragmatic and simple to follow in travel, gym floors, living rooms, gardens, terraces, I can ask you to follow my videos and what more. I see if you have more to clarify, if you want to ask more questions from an ONLINE VIRTUAL LIVE FITNESS LIFE STYLIST. It is me who could do live classes, answer your questions, give you the modernistic engagement, through the digital class You can do your workout along with me. I have learnt that exercise can be done anytime, anywhere, with anyone. One thing, I will always say is, learn about your body before learning about the exercise. I will also correct the statement- do not learn only about what the body can’t do, you learn about what the body is now looking to do. Everybody, who are looking to change but they always have a start statement-“I cannot do this and that”, it is a bigger echo, than I have come to this workout session but I’m not ready for it. So don’t overpower the inner strength and distinguished fact that your body is ready first from your MIND. IF you have issues in starting your workout, correcting your workout, seeing easily how you can do it in short a time more impact. Let’s do it together and BE FITMONKZ

Virtual online interactive workout

Just give 30 minutes 4 times a week and live a fitness lifestyle. Workout with me and virtual online interactive online personal class is available This venture was pioneer by me so, I can share the workouts for you to keep up, even when you are on the move, need flexible timings and want to be corrected and upgraded for your fitness lifestyle.

1. Fit in your flexible timing
2. Workout live online
3. Teach you multiple exercise
4. Do and interact with you
5. Guide and mentor you
6. Change your lifestyle in simple steps

“Who can change your lifestyle and make you fit, so you can be independent to be fit, when you travel or have off hours of work This is a unique that you have dreamt of and here it is“

Educating wellness lifestyle

Article By Jyoti Kamaal

I’m full of thoughts, of my fitness journey
It’s natural to have a blend of thoughts both ways.
I remember crystal clear that Initially one thought was determining a fact and the other was a doubt. In our journey of fitness, we are driven to the former only when we choose to be sure of it. If we choose the latter, then the journey terminates here, it’s not acceptable the journey hasn’t even started
We are resilient to always toss the doubt from the soul and allow the confidence to supersede. If, we are steadfast and bestow consistent dedication, then who are we-
“WE ARE THE GAME CHANGERS.”This is not philosophy, this is an undisputable and pure outcome of thorough rituals. You cannot compromise and must be true to yourself. I don’t say YOU now I quote “I” .
I have no intent of giving (knowledge) gyan and expect you to prove the theory, I’m a proven paradigm.

It is wisdom

Lifestyle transformation is not a mission, it is wisdom. I realized that there were phases of my day, when I was conscience, only when I looked at myself in the mirror. Why should only ‘a fit look’ attract us?
We are all in the same boat, so you can relate with this. I changed one thing , instead of seeing my external appearance and parking my thoughts there, I started to see the reflection of my habits, lifestyle, weaknesses and strengths at that locus. Rest of the time, there is a challenge to remember that.

I was sure I’m heading for a revolution transformation. It was time to fulfill my obligatory duty to my in-depth performance of appearance, radiance, calmness of body, mind and soul. All this was only conceivable with my lifestyle conventions.
So, let me narrate to you how I avoided the “yo yo” or “reoccurrence” in this situation
In order to improvise, I did not declare an extremist attitude of going in for the following
 Crash diets
 Surrender carbs
 Quit sweets
 Exercise as a zealot
 Goals are once achieved, i.e. zero look or for a single grand appearing occasion, automatically promotes me to stage II.
 Pity and reward my sacrifices , leading to a declaration- now its retracting time. Justify to indulge in forfeited slices of abandoned habits and changeovers as a reward.
Instead, I made promising changes. I determined that I had it in me, I will find my remedy to achieve my goal- “my true love”.

Let me share this tips with you – If you are starting with exercises, your mission is to achieve the big goal, first draw a big line and write your goal in the end of it. e.g., 10 kgs or 4 ” on waistline, flat belly, backfat or thin thighs and shaped booty, etc
Second, I suggest draw 10 small lines ones parallel to this big line , name each small line like 1 kg, 2 kg, 3 kg, 4kg and write the days in (brackets)
Third, achieve the smaller ones and strike off the small ones and erase the big line till the small line is struck off.

This will help you be inspired to move forward as an achiever not as a impossible or over ambitious fitness freak It brings fulfilment, a newness and a grandeur’s in us, to titivate the possibility and belief that it’s not too impossible for us. But the tangible triumph, is when it is not brusque, it is infinitude.
The luxury is educating wellness lifestyle to its potential that regenerate its lifespan. It’s evident, only when you start to reconnoitre YOUR OWN body’s functions. Observe its metiers and catastrophe in each step of your workout action. While eating, traveling, sleeping, working, resting, watching, talking, listening and feeling. Fitness is a lifestyle where you encounter a lethal combo of physiological and soulful aspects, from no other than yourself.
An effective fitness training is an eye opener. Educative and apposite practice energises your body and mind, that successfully earns your love. Since the age of 24 years, I ensured to be true to my lifestyle. I joined classes randomly, however, I then fired up my inspiration, to try innovative formats in my daily regime.
I transformed my own traditions.
I did only thing, constantly- Read my body, its vices and virtues and encouraged or altered the lifestyle.
This is where I designed “LIVE ONLINE FITNESS LIFESTYLE COACHING.”
Come and join my online classes , talk to me on my website and reach to me for long term goals. Write to me and we can travel this journey together.
Jyoti Kamaal

Virtual online interactive workout

Just give 30 minutes 4 times a week and live a fitness lifestyle. Workout with me and virtual online interactive online personal class is available This venture was pioneer by me so, I can share the workouts for you to keep up, even when you are on the move, need flexible timings and want to be corrected and upgraded for your fitness lifestyle.

1. Fit in your flexible timing
2. Workout live online
3. Teach you multiple exercise
4. Do and interact with you
5. Guide and mentor you
6. Change your lifestyle in simple steps

“Who can change your lifestyle and make you fit, so you can be independent to be fit, when you travel or have off hours of work This is a unique that you have dreamt of and here it is“

Diagnosing running injuries using a runner’s training & medical history

Article By : Auptimo (Systems for Gait & motion analysis)

Running injuries

With the increase of running-related injuries, it’s important for clinicians to formulate running-specific assessment plans for their patients. In this article series, we will be discussing a standardized approach that you can use integrate as a part of your assessment process. A running assessment is a step by step process including 4 stages:

  • Comprehensive medical review & training history.
  • A Physician Examination.
  • A running gait analysis, if the runner is symptotic.
  • Physical therapy consultation to propose programs for correcting biomechanical aberrations of running motion.

Medical & training history

Medical & training history documentation is an excellent tool used by clinics for diagnosing running-related injuries in patients. 

Here’s an effective ‘Runner intake questionnaire’ you can provide your patients at their first visit for assessing their running pattern & potential triggers for injury.

Clinical usage of the ‘runner intake questionnaire’

Running Injury History

A. RUNNING SURFACE & ROUTE CHARACTERISTICS

Knowing about the running surface & route used by the patient can help you estimate the resulting joint and muscle loads, & identify aspects that may be associated with injury risk.

Surface                                Injury
Beveled Roads When the foot lands on the lateral side of the road, the lower extremity is subjected to strain.
SandSoft tissue injuries such as midportion Achilles tendinopathy
HillsEccentric loading to knee extensors

B. MILEAGE AND RUNS PER WEEK

Recreational runners with weekly volume <24 km/week or <3 years of training have a higher risk of developing leg pain. 

Additionally, training for >7d/week (or >1 sessions/day) is considered as excessive. Such high volumes don’t allow enough time for the soft and bony tissue recovery, increasing the chances of injury. Studies have shown that <2d/week of rest increases the risk of overuse injury by 5.2 fold!

C. SHOE MILEAGE & WEAR

Assessing the mileage and wear pattern of the patient’s shoes can be extremely valuable. An average running shoe begins to break down at 350-400 miles, leading to abnormal loading mechanics of the foot and lower extremity.

Any asymmetry in the wear pattern of the sole might indicate an asymmetric running motion. A runner with a worn-out lateral heel of the shoe is forced to land in excessive supination with each step, increasing soft tissue stress in the midfoot.

D. FOOT STRIKE PATTERN

Surprisingly, most patients are unable to determine their foot-strike pattern accurately. Hence, we recommend that you use a video-based tool to accurately assess this parameter in the clinic.

As per recent studies, Fore-Foot Striking seems favorable for patients with unstable knee joints in the AP axis. As opposed to this, a Rear-Foot Strike pattern may be recommended for runners with unstable ankle joints. Cushioned shoes encourage heel striking whereas shoes with minimal or no drop encourage mid to forefoot striking.


Although the documentation of medical & training history is very important, it is seldom used in isolation. Instead, it should act as a guiding criteria for subsequent examinations of the patient.

Once this step is complete, you can use this documentation for conducting a comprehensive physical and functional assessment of the patient. 

At auptimo, we help clinicians introduce running analysis at their centers through GaitON, our motion analysis system. Its inbuilt running protocol assesses important biomechanical faults in running form and summaries all results in organised reports with normal values.  

For more information on GaitON’s running protocol, click here.

We, at auptimo help clinicians introduce running gait analysis at their centers through GaitON, our motion analysis system. For more information on GaitON’s running protocol, click here.​

REFERENCES: 

1. Altman AR, Davis IS. Barefoot running: biomechanics and implications for running injuries. Curr Sports Med Rep. 2012;11:244–50. [PubMed] [Google Scholar]

2. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. 9. Lippincott Williams and Williams; Philadelphia: 2013. [Google Scholar]

3. Azevedo LB, Lambert MI, Vaughan CL, et al. Biomechanical variables associated with Achilles tendinopathy in runners. Br J Sports Med. 2009;43:288–92. [PubMed] [Google Scholar]

4. Ballas MT, Tytko J, Cookson D. Common overuse running injuries: diagnosis and management. Am Fam Physician. 1997;55:2473–84. [PubMed] [Google Scholar]

5. Bonacci J, Saunders PU, Hicks A, et al. Running in a minimalist and light-weight shoe is not the same as running barefoot: a biomechanical study. Br J Sports Med. 2013;47:387–92. [PubMed] [Google Scholar]

6. Bonacci J, Vicenzino B, Spratford W, Collins P. Take your shoes off to reduce patellofemoral joint stress during running. Br J Sports Med. 2013 doi: 10.1136/bjsports-2013-092160. [PubMed] [CrossRef] [Google Scholar]Br J Sports Med. 2014 Mar;48(6):425–8. [PubMed] [Google Scholar]

7. Cauthon DJ, Langer P, Coniglione TC. Minimalist shoe injuries: three case reports. Foot (Edinb) 2013;23:100–3. [PubMed] [Google Scholar]

8. Chang WL, Shih YF, Chen WY. Running injuries and associated factors in participants of ING Taipei Marathon. Phys Ther Sport. 2012;13:170–4. [PubMed] [Google Scholar]

9. Chumanov ES, Wille CM, Michalski MP, Heiderscheit BC. Changes in muscle activation patterns when running step rate is increased. Gait Posture. 2012;36:231–5. [PMC free article] [PubMed] [Google Scholar]

10. Ciacci S, Di Michele R, Merni F. Kinematic analysis of the braking and propulsion phases during the support time in sprint running. Gait Posture. 2010;31:209–12. [PubMed] [Google Scholar]

11. Daoud AI, Geissler GJ, Wang F, et al. Foot strike and injury rates in endurance runners: a retrospective study. Med Sci Sports Exerc. 2012;44:1325–34. [PubMed] [Google Scholar]

12. Fellin RE, Manal K, Davis IS. Comparison of lower extremity kinematic curves during overground and treadmill running. J Appl Biomech. 2010 Nov;26(4):407–14. [PMC free article] [PubMed] [Google Scholar]

13. Ferber R, Noehren B, Hamill J, Davis IS. Competitive female runners with a history of iliotibial band syndrome demonstrate atypical hip and knee kinematics. J Orthop Sports Phys Ther. 2010;40:52–8. [PubMed] [Google Scholar]

14. Fields KB. Running injuries — changing trends and demographics. Curr Sports Med Rep. 2011;10:299–303. [PubMed] [Google Scholar]

15. Ford KR, Taylor-Haas JA, Genthe K, Hugentobler J. Relationship between hip strength and trunk motion in college cross-country runners. Med Sci Sports Exerc. 2013;45:1125–30. [PubMed] [Google Scholar]

16. Fredericson M, Misra AK. Epidemiology and aetiology of marathon running injuries. Sports Med. 2007;37:437–9. [PubMed] [Google Scholar]

17. Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health. 2012;4:485–95. [PMC free article] [PubMed] [Google Scholar]

18. Giandolini M, Horvais N, Farges Y, et al. Impact reduction through long-term intervention in recreational runners: midfoot strike pattern versus low-drop/low-heel height footwear. Eur J Appl Physiol. 2013;113:2077–90. [PubMed] [Google Scholar]

19. Giuliani J, Masini B, Alitz C, Owens BD. Barefoot-simulating footwear associated with metatarsal stress injury in 2 runners. Orthopedics. 2011;34:e320–3. [PubMed] [Google Scholar]

20. Gruber AH, Umberger BR, Braun B, Hamill J. Economy and rate of carbohydrate oxidation during running with rearfoot and forefoot strike patterns. J Appl Physiol (1985) 2013;115:194–201. [PubMed] [Google Scholar]

21. Hammer SR, Delp SL. Muscle contributions to fore-aft and vertical body mass center accelerations over a range of running speeds. J Biomech. 2013;46:780–7. [PMC free article] [PubMed] [Google Scholar]

22. Hespanhol LC, Junior, Pena Costa LO, Lopes AD. Previous injuries and some training characteristics predict running-related injuries in recreational runners: a prospective cohort study. J Physiother. 2013;59:263–9. [PubMed] [Google Scholar]

23. Hockenbury RT. Forefoot problems in athletes. Med Sci Sports Exerc. 1999;31:S448–58. [PubMed] [Google Scholar]

24. Hubbard TJ, Carpenter EM, Cordova ML. Contributing factors to medial tibial stress syndrome: a prospective investigation. Med Sci Sports Exerc. 2009;41:490–6. [PubMed] [Google Scholar]

25. Kelsey JL, Bachrach LK, Procter-Gray E, et al. Risk factors for stress fracture among young female cross-country runners. Med Sci Sports Exerc. 2007;39:1457–63. [PubMed] [Google Scholar]

26. Kindred J, Trubey C, Simons SM. Foot injuries in runners. Curr Sports Med Rep. 2011;10:249–54. [PubMed] [Google Scholar]

27. Knobloch K, Yoon U, Vogt PM. Acute and overuse injuries correlated to hours of training in master running athletes. Foot Ankle Int. 2008;29:671–6. [PubMed] [Google Scholar]

28. Kong PW, Candelaria NG, Smith D. Comparison of longitudinal biomechanical adaptation to shoe degradation between the dominant and non-dominant legs during running. Hum Mov Sci. 2011;30:606–13. [PubMed] [Google Scholar]

29. Lilley K, Stiles V, Dixon S. The influence of motion control shoes on the running gait of mature and young females. Gait Posture. 2013;37:331–5. [PubMed] [Google Scholar]

30. Lisman P, O’Connor FG, Deuster PA, Knapik JJ. Functional movement screen and aerobic fitness predict injuries in military training. Med Sci Sports Exerc. 2013;45:636–43. [PubMed] [Google Scholar]

Running Assessment : Complete guide on physical assessment of runners

Article By : Auptimo (Systems for Gait & motion analysis)

Cover_Running Assessment

Our previous article on running assessment focused on a simple ‘Runner intake questionnaire’ you can use to assess the training characteristics & running pattern of your patients. Understanding the training & injury pattern makes it very easy for a clinician to identify potential injury triggers & formulate specific functional assessments required in the diagnosis process.

In this article, we will be discussing a variety of physical tests used by clinicians to assess the runner’s ability to control motion symmetrically. These are simple yet effective assessments you can use to measure the mobility & flexibility of lower extremities, core & spine. As a clinician, we are checking if the runner is able to perform these tests with a symmetric range of motion (ROM), strength & endurance, & limb segment alignment.

The aim behind these tests is to detect any physical limitations in the runner that may be altering running mechanics. Moreover, it also helps in formulating physical therapy plans to equalize right- and left-sided capability.

Typically, the tests performed during a running assessment can be divided into weight bearing and non-weight bearing categories.

Weight Bearing Tests_Running Assessment
Non weight bearing tests_Running Assessment

WEIGHT BEARING TESTS

Posture Assessment

Posture_Running Assessment

Posture analysis is an important element of a running assessment. It is a static exam which can be done using visual observation or a posture analysis software    (depending on the amount of information you require).

In a typical posture exam, you should assess the anterior, posterior & lateral views of the patient. Some common postural deviations that you should look for are:
1. Uneven shoulders and spinal curvature may lead to asymmetric loading during running.
2. Excessive Anterior pelvic tilt limits the hip extension and trunk rotation during gait.  
3. Alignment of the knees (valgus, neutral, or varus) and the ankle inversion and eversion during stance.

Refer to our article on Posture analysis for a detailed ‘posture checklist’ you can use in your clinic.

Single Leg Squat Test

The single-leg squat test is a commonly used functional test for the hip & lower extremity.
It is useful in evaluating the strength & balance of the lower body, particularly the quadriceps and gluteal muscle groups, and the hip stabilizers.

Here is a great instructional video you can use to assess single leg squats in your patients and identify any deviations.

Spine ROM

Spine_Running Assessment

The measurement of spine range of motion (ROM) is very important  for runners, especially with low back pain.

It consists of a number of tests to help a clinician evaluate the mobility of the spine, including Lumbar flexion – extension ROM, thoracic rotation ROM, etc.

Refer to this link to learn about the various ROM assessments you can perform on your patient.

Y Balance Test

The Y Balance Test (YBT) is a simple, yet reliable, test to measure dynamic balance. Developed to standardize the modified Star Excursion Balance Test (mSEBT), the YBT has become extremely popular due to its simplicity and reliability.

Refer to the adjacent video to learn how you can use the  Y balance test in your practice.

Functional Dorsiflexion Tests (Standing Lunge Test)

The Standing Lunge test helps in assessing the dorsiflexion range of movement (DROM) at the ankle joint. It is a simple assessment which you can carry out using a wall and a tape measure.

To know more about Standing Lunge Test, refer to the adjacent video.

Functional Movement Screen Tests

A functional movement screen(FMS) is a combination of various weight-bearing tests to determine any dysfunctional or performance-limiting movement patterns in a runner.

The FMS uses a simple scoring system. Each individual test listed under FMS has scoring criteria to predict injury risk in a patient. According to recent studies, a score of <=14 on the FMS can be linked with greater injury risks.

For a complete scoresheet of tests listed under FMS & their scoring criteria, click here.

NON-WEIGHT BEARING TESTS

Non-weight bearing tests serve as a complement to the weight bearing tests. Some commonly used assessments include foot alignment, first metatarsal mobility, joint ROM, flexibility and strength of lower extremity muscle groups.

Hip Mobility Test

Reduced hip extension is a common observation in recreational runners. Traditionally, it is believed that lack of hip extension may be associated with reduced flexibility of the iliopsoas muscle.

Additionally, recent studies suggest that reduced hip flexibility and anterior pelvic tilt are coordinated motions. Runners who display decreased hip extension ROM during running often show an increase in the anterior pelvic tilt.

The reverse lunge is an easy way to test hip mobility. Here is an instructional video.

Flexibility Test

The sit and reach test is the most common of all flexibility tests. It measures the flexibility of the patient’s lower back and hamstrings.
For the step by step procedure of the test & its normal values, refer to this guide.

Patellar Position and Tracking

Patella_Running Assessment

Patellar tracking helps in determining whether the pain symptoms are related to patellofemoral alignment. Lateral trajectory of patella during a squatting motion or gait(detected through running gait analysis) indicates poor vastus medialis strength and high iliotibial band tension.

While assessing the patellar postion, it is important to assess any right-left asymmetry.

Strength

Strength measurements are very useful in tracking the progress of rehabilitation. Evaluating the patient’s muscle strength prior to treatment serves as a solid baseline to determine if the rehab plan is improving the patient’s condition.

Manual muscle-testing is the most common methods to measure strength in a running assessment. The MRC scale is a handy tool to rate muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle.

For more information on how to use the MRC scale in clinical practice, refer to this video.

The observations during a physical examination are useful in determining the physical impairments present in the patient. Interestingly, the imbalances/deviations detected during a physical examination are the result of a weakness/dysfunction localized in any other region of the body. For instance, A runner with a limited hip extension will tend to increase his stride by overstriding, which is a leading cause of tibial stress fractures.

In such cases, gait analysis of the runner helps in identifying the possible root cause of the musculoskeletal problem and identify various compensations that the patient exhibits to make up for the abnormality. Analyzing the runner’s gait will help you understand the relationship between individual physical impairments and altered running mechanics. It will also help you assess how these alterations relate to the patient’s injury. Hence, it is important to follow a physical examination step with a comprehensive gait analysis to obtain a complete running assessment. Our next post will cover some important aspects of gait analysis and how you can perform it at your clinic.

Biomechanical assessments for runners with midportion Achilles Tendinopathy issues

Article By : Auptimo (Systems for Gait & motion analysis)

With an injury rate of 2.35 per 1000 in the adult population (de Jonge et all, 2011), the Achilles tendon is one of the most commonly injured tendons, especially in athletes involved in running and jumping sports/activities (Kvist, 1994) (Wilson, 2005)

As per studies, the loading on the Achilles tendon during running increases to 12 times the body weight. This is much higher as compared to walking (upto 3.5 times body weight), or cycling (close to body weight) (Komi, et al., 1992).  Such loading rates when combined with improper running biomechanics can be detrimental to Midportion Achilles Tendinopathy issues in runners.

A gait analysis, whether observational or through a video based system, is an excellent way to identify any biomechanical faults in the runner. A biomechanical fault can be as a result of either a physical limitation in the body or a technical error in the running form.  

In this blog, we will discuss various biomechanical faults that are associate with excessive loading on the Achilles tendon.

BIOMECHANICAL FAULTS ASSOCIATED WITH INCREASED ACHILLES LOADING

FOOT STRIKE PATTERN

Running with a rear footstrike pattern is considered to load the Achilles tendon less than running with a forefoot-strike pattern (Komi, et al., 1992). As per recent studies, running with a midfoot- or forefoot-strike pattern, as opposed to a rearfoot-strike pattern, added an additional load of 48 times body weight for each mile (1.6 km) run. (Almonroeder, et al., 2013)

ASSESSMENT OF FOOT STRIKE PATTERN

Achilles Tendinopathy_Foot Inclination Angle

Foot strike pattern can be determined by measuring the foot inclination angle. 

The foot inclination angle is the angle between the running surface and the sole of the runner’s shoe and allows for the determination of foot-strike pattern.

Heel StrikeRearfoot strike Midfoot strike Forefoot strike 
(Landing on the posterior aspect of their heel)(Landing on the anterior aspect of the heel, with FIA <10 degrees)(Rearfoot & forefoot making contact nearly simultaneously, with FIA near 0°)(Forefoot landing with FIA <0 degrees)

Within the context of return to sport, to control for overall loading, a runner who runs with a forefoot-strike pattern would not be allowed to run as far as a runner with a rearfoot-strike pattern. (SILBERNAGEL & CROSSLEY, 2015)

OVERSTRIDING

Overstriding is found in 60-70% of amateur runners and is associated with the runner extending the knee excessively at Initial Contact. Although this strategy increases performance by increasing stride length, it compromises shock absorption & increases braking forces on the body.

A systematic review found that a high breaking force during running may be a risk factor for Achilles tendinopathy. (Lorimer & Hume, 2014)

Typical overstriders hugely benefit from cadence retraining, a method that promotes shorter and faster steps instead of longer steps.

This ensures the same performance and reduces the excessive load on hamstring.

Refer to this link by Stanford Health for some drills. 

ASSESSMENT OF OVERSTRIDING

Overstriding

Overstriding can be picked up when reviewing the video taken in the sagittal plane. 

The term simply means that the runner is landing excessively ahead of the center of mass of the body (COM can be approximated at the center of the pelvis). Doing this often increases the stride length of the runner, hence the name ‘overstriding’. (Souza, 2016 )

OVERPRONATION

Recent studies have linked excessive subtalar eversion with excessive Midportion Achilles Tendinopathy. In a study comparing running mechanics of runners with Achilles Mid-Portion Tendinopathy with healthy runners, The Achilles Tendinopathy Group displayed significantly greater sub-talar joint eversion displacement during mid-stance of the running gait.  (Ryan M, 2009)

Exercise programs for arch strengthening etc along with foot orthotics can be helpful in reducing excessive calcaneal eversion and reducing the load on Achilles tendon loading.

ASSESSMENT OF SUBTALAR EVERSION

Rearfoot_Eversion

Subtalar eversion can be assessed by measuring the rearfoot angle in the posterior view. Rearfoot angle is defined by the midline of the heel relative to the midline of the lower leg.

Any running gait analysis software like GaitON can be used to do a comprehensive running analysis of the runner. All you need is the software and the slow motion video feature of your mobile phone to start.

EXERCISE AS A TREATMENT

Exercise therapy is consistently supported with the highest level of evidence, and eccentric exercise is the most investigated type of exercise therapy. (Kingma, et al., 2007) It is recommended to initially treat all patients with exercise therapy for at least 3 months prior to considering other treatment options.  (Alfredson, 2003). 

Mentioned below is a progressive Achilles tendon–loading strengthening program that promotes exercise once daily and uses concentric/eccentric exercises.

Excercise_ Midportion Achilles Tendinopathy

REFERENCES

  1. Komi, P., Fukashiro, S. & Järvinen, M., 1992. Biomechanical loading of Achilles tendon during normal locomotion. Clin Sports Med..

2. Alfredson, H., 2003. Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med.

3. Almonroeder, T., Willson, J. & Kernozek, T., 2013. The effect of foot strike pattern on Achilles tendon load during running. Ann Biomed Eng..

4. de Jonge, S., van den Berg, C. & de Vos, R., 2011. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med..

5. Kingma, J., de Knikker, R., Wittink, H. & Takken, T., 2007. Eccentric overload training in patients with chronic Achilles tendinopathy: a systematic review. Br J Sports Med.

6. Kvist, M., 1994. Achilles tendon injuries in athletes. Sports Med.

7. Lorimer, A. & Hume, P., 2014. Achilles tendon injury risk factors associated with running. Sports Med..

8. Ryan, M. et al., 2009. Kinematic analysis of runners with achilles mid-portion tendinopathy.. Foot Ankle Int..

9. SILBERNAGEL, K. G. & CROSSLEY, K. M., 2015. A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation. Journal of Orthopaedic & Sports Physical Therapy.

10. Silbernagel, K., Thomeé, R., Eriksson, B. & Karlsson, J., 2007. Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. Am J Sports Med..

11. Souza, R. . B., 2016 . An Evidence-Based Videotaped Running Biomechanics Analysis. Phys Med Rehabil Clin N Am, 27(1), p. 217–236.

12. Wilson, J., 2005. Common overuse tendon problems: a review and recommendations for treatment. Am Fam Physician.

Biomechanical Faults linked with Patellofemoral Pain in runners

Article By : Auptimo (Systems for Gait & motion analysis)

UNDERSTANDING PATELLOFEMORAL PAIN IN RUNNERS

To manage patellofemoral pain in runners its important to understand the correlation between running biomechanics and  its effect on the patellofemoral joint. 

Patellofemoral pain syndrome (PFPS), most commonly known as ‘Runner’s knee‘ or anterior knee pain syndrome, is defined as “pain occurring around or behind the patella that is aggravated by at least one activity that loads the patella during weight-bearing on a flexed knee.” 

INJURY RATES

  • With an incidence of approximately 22 per 1000 persons, patellofemoral pain accounts for about 48.8% of knee injuries in runners.​
  • The incidence of PFPS in is higher in women (62%) as compared to men (38%) (Petersen W et al, 2013).

This is due to altered dynamic knee valgus, in which the knee collapses medially from excessive valgus, internal rotation of tibia, or rearfoot eversion.

This increases the lateral force on the patella, contributing to patellar maltracking (Myer GD, et al 2010)

PATHOPHYSIOLOGY

The exact etiology of pain in PFPS is still unclear.

Hypothetically, the pain is generated at the insertions of the extensor muscles, retinacula, Hoffa’s fat pad and subchondral bone trauma (Gulati et al., 2018).

Overloading of the patellofemoral joint during high-intensity training activities may also be a possible trigger for PFPS.

The combination of overload with dynamic valgus & functional lateralization of the patella may lead to overuse of the structures of the patellofemoral joint and thus cause anterior knee pain (Petersen et al., 2014).

CLINICAL PRESENTATION (Gulati et al., 2018)

  1. Typically, an active young adult will present with gradual onset of anterior knee pain associated with a grinding sensation perceived on movement.
  2. The pain is often bilateral, usually more on one side, and is typically worsened by climbing or squatting activity, described by the patient “giving away or slipping”, which is due to quadriceps inhibition.
  3. It is difficult to localize and the patient may just place their hand on the knee or circumscribe the patella, referred to as the circle sign.
  4. A locking or catching sensation after prolonged flexion of the knee (rising from a seated posture) is observed, referred to as the “movie theatre sign”

POTENTIAL CAUSES OF PATELLOFEMORAL PAIN IN RUNNERS

Like any running injury, PFPS can be caused due to any musculoskeletal impairment, training errors, biomechanical faults & extrinsic factors like footwear etc. 

In this section, we will be discussing assessments we can conduct to investigate each of these 4 aspects.

As a clinician, if we are able to figure out the root cause behind the injury, we can provide effective rehab for shin splints. 

Causes of Running Injuries

PART 1 : TRAINING ERRORS

Running is known to produce a great amount of loading in lower limb joints.

Hence, training errors are considered to contribute around 60% of running-related injuries.

Overtraining is one of the most common ‘Training Error’. It is often characterized by runners doing “too much”, “too soon”, “too often”, “too fast”, or “with too little rest”.

Running Volume

A mileage greater than 40 miles/week (64km/week) has been linked with an increased risk of running-related injuries, including patellofemoral pain (Nielsen et al., 2013).

In addition to the mileage, the rate of increase in weekly mileage should not exceed 10% of the current mileage. Secondly, an increase in the running pace should also be restricted to less than 3% per week.

For a complete set of running specific training guidelines, refer to this ‘UW Health Sports medicine runners book’.

Running Surface

When it comes to running surfaces, there’s a popular belief that running on softer surfaces is easier on the joints.

On the contrary, recent studies suggest that the overall stiffness of the body remains the same, irrespective of the surface. (Louie, et al., 1998)

In other words, the leg becomes stiffer while running on a softer surface, and more compliant while running on a harder surface. 

This implies that the overall impact on the leg remains virtually the same whether running on grass, concrete or asphalt.

However, this finding should be treated with caution. According to Dr. Brian Heiderscheit, Director of the University of Wisconsin’s Runners’ Clinic, “We know how the body adjusts to different surfaces in the short term, but what we don’t know are the long term consequences of running on a particular surface” (MCMAHAN, 2020)

Hence, incorporating multiple running surfaces in training can be a good strategy to minimize the risk of injury.

As per Dr. Heiderscheit, “Just like a runner would try runs of different intensities—tempo and interval training for instance—my advice is to incorporate a little bit of all the different surfaces into training,” (MCMAHAN, 2020)

Uphill/Downhill Training

Downhill running tends to increase the Tibial loading and impact force at the knee. (Vernillo, et al., 2016) Hence, downhill training should not be recommended to runners with Patellofemoral Pain.

Training errors can be understood by taking a detailed injury & training history of the runner. Here’s a sample ‘Runner intake form‘ you can use to understand the patient better.

PART 2 : EXTRINSIC FACTORS (FOOTWEAR)

Footwear can hugely affect posture & biomechanics. An ‘incorrect’ pair of shoes can lead to several injuries, even if there is no physical limitation in the body. 

A Clinical Assessment of the runner’s feet & shoe helps assess if the footwear needs to be replaced or while prescribing a new shoe. 

Here’s a comprehensive guide you can refer to for a shoe assessment of runners. 

PART 3 : BIOMECHANICS LINKED WITH PATELLOFEMORAL PAIN IN RUNNERS

Overstriding

Overstriding

A small degree of knee flexion is required at the moment of foot strike (initial contact) to ensure good shock absorption.

Now, imagine a case of an amateur runner looking to increase his running performance through an increase in stride length. 

Such amateur runners tend to achieve this goal through increased knee extension at foot strike.

Although the strategy of knee extension is helpful from immediate performance point of view as it is increases the stride length.

However, this increases the ground reaction forces at the patellofemoral joint, leading to Runner’s knee problems.

CORRECTIONS: Typical overstriders hugely benefit from cadence retraining, a method that promotes shorter and faster steps instead of longer steps.

This ensures the same performance and better shock absorption at the knee joint.

Additionally, Refer to this link by Stanford Health for some drills. 

Excessive Knee Flexion At Mid Stance

Knee flexion_ Patellofemoral pain in runners

Knee flexion angle is highly predictive of peak patellofemoral joint force, such that peak force increases as knee flexion angle increases (Wille CM et al 2014). 

Running with excessive knee flexion at Mid Stance (a moment when both knees are adjacent to each other) increases the patellofemoral joint stress & may require intervention. 

Alternatively, some data exists suggesting that lower knee flexion (<40 degrees) may be associated with certain subgroups of patients with patellofemoral pain due to increased ground reaction forces (Dierks TA et al 2011). 

So ideally, this angle should revolve around 40 degrees at mid stance.

CORRECTIONS: Along with a rehab program, Runners with excessive knee flexion at mid stance benefit from cadence retraining, a method that promotes shorter and faster steps instead of longer steps. 

Moreover, Verbal cues to promote a softer landing are also helpful.

Excessive Contralateral Pelvic Drop

Pelvic Drop_Patellofemoral Pain in Runners

The event of mid stance (both knees are adjacent to each other) is accompanied by a small contralateral pelvic drop, generally greater in women as compared to men. 

An excessive contralateral pelvic drop, increased hip adduction & internal rotation increases lateral stress on the patellofemoral joint, resulting in maltracking of the patella. (Dierks TA et al 2008)

CORRECTIONS: In addition to a rehab program, visual feedback to ask the runner to maintain a level pelvis is very helpful to prevent excessive contralateral pelvic drop.

Subtalar Over Pronation

Rearfoot_Eversion

Excessive pronation of subtalar joint in the midstance phase of the gait cycle can be a contributing factor to anterior knee pain associated with PFPS.

CORRECTIONS: 

In addition to a rehab program, studies also recommend the use of orthotics (Kannus VP,1992) or higher level of support shoes to correct subtalar overpronation.

A running analysis is the most useful tool to detect biomechanical faults like overstriding or pelvic drop in a runner.  Any running gait analysis software like GaitON can be used to do a comprehensive running analysis of the runner. All you need is the software and the slow motion video feature of your mobile phone to start.

PART 4 : MUSCULOSKELETAL IMPAIRMENTS

A physical examination of the knee should be performed in all patients with a chief symptom of anterior knee pain.

This helps in understanding if the injury is due to a physical limitation in the body or due to any other factor mentioned above. 

 The table below includes some commonly performed physical examination tests and their value in diagnosing PFPS. (Gaitonde, Ericksen and Robbins, 2019)

Physical examinations for patellofemoral pain
  • Postural deviations like exaggerated lumbar lordosis, asymmetric hip height, foot overpronation, knee valgus, or atrophic (decreased muscle mass) quadriceps are generally visible in runners with PFPS.
  • Hamstring (knee flexor) extensibility should also be checked as tight hamstrings have been associated with patellofemoral pain, possibly because of co-contraction of the hamstrings and quadriceps causing increased forces on the joint during exercise.

MANAGEMENT OF PATELLOFEMORAL PAIN IN RUNNERS

Clinical recommendations suggest most effectiveness with exercise therapy interventions followed by pain relieving medications.

Since multiple factors can contribute to PFPS, an individualized exercise therapy program is effective for managing patellofemoral pain in runners.

  1. Active rest is the principle mode of physical therapy in the acute phase of the condition. Any exacerbating movements or activities loading the knee joint should be avoided in the initial 2-3 weeks. Exercise regimens should focus on the hip, trunk, and knee. 
  2. Secondly, some recommend active stretching exercises, squats, ergometer, static quadriceps exercises, active leg raises, leg press, raising and lowering climbing exercises.
  3. Thirdly, exercises to strengthen the hip abductors and trunk-stabilizing exercises, including the rectus abdominis, are also seen to benefit the patient. Exercises should be continued for 5-6 weeks. (Petersen W et al 2014)
mcconell_taping_Patellofemoral Pain in Runners
Mc Connel Taping for PFPS

3. Lastly, early therapies for PFPS include taping and foot orthotics can temporarily help improve patellar maltracking in athletes. Mc Connel taping is the most popular type of taping used in PFPS. The tape applies a medially directed force to counteract lateral patella maltracking (including tilt, rotation and shift). 

Since you’re here…
…we have a small favor to ask. More people are reading our blogs everyday, and each week we bring you compelling content to help you treat your patients better. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. — Team Auptimo

ABOUT THE AUTHOR

Dr Teena_Profile

DR TEENA ELSA JOSEPH

Dr. Teena is a Sports Physiotherapist who has completed her BPT from Amity University & her MPT (Sports) from Indraprastha University. Her field of clinical expertise in sports & musculoskeletal physiotherapy includes manual therapy, dry needling & myofascial release. Apart from her work at Auptimo, she is also active as clinical researcher in a various of health & sports science research work at India Spinal Injuries Center, Delhi. She has achieved several awards for academic excellence along with professional certifications such as Dry Needling (Basic & Advanced), AHA certified BLS provider, NAEMT certified PHTLS provider, IRCS certified Senior professional in first aid, & NIDA certified Good Clinical Practitioner.

REFERENCES:

A-M

  1. Dierks TA, Manal KT, Hamill J, et al. Lower extremity kinematics in runners with patellofemoral pain during a prolonged run. Med Sci Sports Exerc. 2011; 43(4):693–700. [PubMed: 20798656] 
  2. Dierks TA, Manal KT, Hamill J, Davis IS. Proximal and distal influences on hip and knee kinematics in runners with patellofemoral pain during and prolonged run. J Orthop Sports Phys Ther. 2008;38:448–456.
  3. Gaitonde DY, Ericksen A, Robbins RC. Patellofemoral Pain Syndrome. Am Fam Physician. 2019;99(2):88–94. 
  4. Gulati A, McElrath C, Wadhwa V, Shah JP, Chhabra A. Current clinical, radiological and treatment perspectives of patellofemoral pain syndrome. Br J Radiol. 2018;91(1086). 
  5. Kannus VP. Evaluation of abnormal biomechanics of the foot and ankle in athletes. Br J Sports Med. 1992; 26(2):83–9. [PubMed: 1352474]
  6. Louie, M., Farle, C. . T. & Ferris, D. P., 1998. Running in the real world: adjusting leg stiffness for different surfaces. Proc. R. Soc. Lond. B, pp. 989-994.
  7. MCMAHAN, I., 2020. How Running Surfaces and Speed Influence Your Risk of Injury. [Online] Available at: https://www.podiumrunner.com/training/how-running-surface-and-speed-influence-injury-risk/ [Accessed 05 May 2020].
  8. Myer GD, Ford KR, Barber Foss KD, et al. The incidence and potential pathomechanics of patellofemoral pain in female athletes. Clin Biomech (Bristol, Avon). 2010; 25(7): 700-707. 

N-Z

  1. Nielsen, R.O., Nohr, E.A., Rasmussen, S. and Sørensen, H., 2013. Classifying running-related injuries based upon etiology, with emphasis on volume and pace. International journal of sports physical therapy, [online] 8(2),
  2. Petersen W, Ellermann A, Gösele-Koppenburg A, et al. Patellofemoral pain syndrome. Knee Surg Sports Traumatol Arthrosc. 2014;22(10):2264–2274. 
  3. Powers CM. The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. J Orthop Sports Phys Ther. 2003;33(11):639–646. 
  4. Saltychev M, Dutton RA, Laimi K, Beaupré GS, Virolainen P, Fredericson M. Effectiveness of conservative treatment for patellofemoral pain syndrome: A systematic review and meta-analysis. J Rehabil Med. 2018;50(5):393–401.
  5. Vernillo, G. et al., 2016. Biomechanics and Physiology of Uphill and Downhill Running. Sports Med.
  6. Wille CM, Lenhart RL, Wang S, Thelen DG, Heiderscheit BC. Ability of sagittal kinematic variables to estimate ground reaction forces and joint kinetics in running. J Orthop Sports Phys Ther. 2014;44(10):825–30 

COVER PHOTO CREDITS: “People photo created by freepik – www.freepik.com”