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The past few months around 75% of my runners have had MTSS. when asked what factors they thought contributed to their injury they told me:
•wrong shoes
•overpronation
•flat feet
•high arched feet
•not enough stretching
•running on concrete/asphalt
•LLD
•poor form
(1/n)
•wrong shoes
•overpronation
•flat feet
•high arched feet
•not enough stretching
•running on concrete/asphalt
•LLD
•poor form
(1/n)
When asked what they have tried to address their injury:
•new shoes
•iced after running
•new compression sleeves
•shoe orthoses (OTC)
•stretched more
•KT tape
•ibuprofen
•ran on grass
•took time off running (due to pain)
(2/n)
•new shoes
•iced after running
•new compression sleeves
•shoe orthoses (OTC)
•stretched more
•KT tape
•ibuprofen
•ran on grass
•took time off running (due to pain)
(2/n)
When asked what their goals were for PT I heard:
•fix my form
•tell me what stretches to do
•tell me what exercises to do
•dry needling
•teach me how to tape
•tell me what shoes are best
•tell me what orthoses are best
Overall goal: be able to run pain-free
(3/n)
•fix my form
•tell me what stretches to do
•tell me what exercises to do
•dry needling
•teach me how to tape
•tell me what shoes are best
•tell me what orthoses are best
Overall goal: be able to run pain-free
(3/n)
My experience is not unique. Other authors have found similar findings:
What runners believe about their injury: https://pubmed.ncbi.nlm.nih.gov/25155860/ and here: https://pubmed.ncbi.nlm.nih.gov/31591346/
What shoe salespersons and physios believe:
https://www.tandfonline.com/doi/full/10.1080/19424280.2020.1734869
(4/n)
What runners believe about their injury: https://pubmed.ncbi.nlm.nih.gov/25155860/ and here: https://pubmed.ncbi.nlm.nih.gov/31591346/
What shoe salespersons and physios believe:
https://www.tandfonline.com/doi/full/10.1080/19424280.2020.1734869
(4/n)
What I wish my patients knew:
• rarely do non-modifiable, structural risk factors such as foot morphology, LLD, or genu valgus/varum matter
-MTSS specific: https://pubmed.ncbi.nlm.nih.gov/27729482/ from @markptatc
-overuse RRI general from @ironmomPT https://pubmed.ncbi.nlm.nih.gov/30805204/
(5/n)
• rarely do non-modifiable, structural risk factors such as foot morphology, LLD, or genu valgus/varum matter
-MTSS specific: https://pubmed.ncbi.nlm.nih.gov/27729482/ from @markptatc
-overuse RRI general from @ironmomPT https://pubmed.ncbi.nlm.nih.gov/30805204/
(5/n)
I also wish my patients knew that this injury takes a LONG time to recover from:
https://pubmed.ncbi.nlm.nih.gov/30312310/
And while some biomechanical factors have been identified most have very low effect sizes: https://pubmed.ncbi.nlm.nih.gov/29787473/
(6/n)
https://pubmed.ncbi.nlm.nih.gov/30312310/
And while some biomechanical factors have been identified most have very low effect sizes: https://pubmed.ncbi.nlm.nih.gov/29787473/
(6/n)
I could go on and on about what I wish they knew.
But what we often discuss is not what they did wrong (I rarely can pinpoint it) but what we will do moving forward. I will:
•listen to them
•be empathetic
•be patient
•try to clearly communicate
(7/n)
But what we often discuss is not what they did wrong (I rarely can pinpoint it) but what we will do moving forward. I will:
•listen to them
•be empathetic
•be patient
•try to clearly communicate
(7/n)
And I ask that they:
•not blame themselves
•not blame their coaches or training programs
•give my interventions a try
•try to sleep more
•find constructive ways to address their emotions
AND tell me how things are going (the good and the bad)
(8/n)
•not blame themselves
•not blame their coaches or training programs
•give my interventions a try
•try to sleep more
•find constructive ways to address their emotions
AND tell me how things are going (the good and the bad)
(8/n)
Ultimately, many of them will improve. What works?
•patient-PT relationship is
•aligning their goals with their body’s capabilities
•reducing running (distance/speed/frequency, etc)
•usually sleeping more
•gradually rebuilding tolerance to load
(9/n)
•patient-PT relationship is
•aligning their goals with their body’s capabilities
•reducing running (distance/speed/frequency, etc)
•usually sleeping more
•gradually rebuilding tolerance to load
(9/n)
Final:
I still look at gait and we try to maximize form and strength. But I place less emphasis on this than I used to.
I rarely use passive interventions
I believe Education, listening, relationship building matter the most. And I believe I can always do better.
I still look at gait and we try to maximize form and strength. But I place less emphasis on this than I used to.
I rarely use passive interventions
I believe Education, listening, relationship building matter the most. And I believe I can always do better.
