I recently finished this great course available for streaming through Vimeo by Nxt Gen Institute of Physical Therapy. It was previously recorded in in April 2016 and is taught by 2 excellent physical therapists: Christopher Johnson and Francois Prizinski. It delves into the assessment and treatment of running athletes and includes a great deal of information in regards to the role of pain science. The following includes a few knowledge bombs, but this is a short list compared to all of the information covered so I highly recommend checking it out!
Physical therapists are load management experts. A lot of times physical therapists are referred to as “the movement experts” but I think that load managers may be a more appropriate way to classify us. As physical therapists, it is our duty to understand the effects of load on the body’s tissues and how to progress and regress load appropriately. It is also important to understand how to apply load to create the effect we are looking for! This is definitely easier said than done, and is something I strive to improve my knowledge on!
Wilk Classification System: This system, described in more detail in this article is a great way to give a patient advice on whether or not they should be running on their current injury. The 5 stages below describe the severity in running injuries. If the patient presents with one of the red flags, that would indicate that they should not run on their current injury.
Stage 1: pain upon exertion; RED FLAG = pain that alters running mechanics
Stage 2: pain at rest; RED FLAG = pain that prevents rest
Stage 3: pain w/ ADLs; RED FLAG = avoidance of ADLs
Stage 4: pain managed with medication; RED FLAG = being in stage 4
Stage 5: crippling pain; RED FLAG = being in stage 5
Performing a Treadmill Analysis: At some point during the course of physical therapy treatment, the patient should be analyzed while they run. Running gait analysis can get super complicated so Chris has done a superb job of making running analysis simple and feasible for the physical therapist. He talks about this in terms of the 4S’s:
- Sound: notice the sound of the feet hitting the treadmill, does it sound like they are pounding through the floor, does one foot sound like it’s hitting harder than the other?
- Strike: does the runner demonstrate a rearfoot strike (heel strike), forefoot strike, or a more midfoot strike pattern?
- Step Rate: how many steps/min? To calculate this: count the # of foot contacts of 1 foot in 30 seconds and multiply by 4. Example: right foot contacts 40 times in 30 seconds, 40×4=160 steps per min
- Speed: also known as running velocity, this is essentially how fast/slow the person is running in mph
*For more on the 4S’s and treadmill analysis, check out this article that Chris wrote on Mike Reinold’s website.
Orthopedic Assessment: Here are a list of things to assess with runners during the physical examination.
- toe dexterity
- standing forward flexion
- free standing squat
- lateral step down
- half-kneeling lunge
- prone ankle dorsiflexion at 90 deg
- seated hip flexion MMT
- single leg hopping
- Johnson Table Test: novel test created by Chris that assesses hip abduction and external rotation in hooklying with the midfoot stabilized on a surface
- RUNNING (treadmill analysis)
Pain Science: Common Misconceptions Regarding Pain (the following statements are all FALSE)
- pain is always bad and a damage indicator
- pain must be abolished before engaging in normal activity and movement/therapy
- 0/10 pain and feeling 100% is normal
- passive treatment is the answer
- pain is synonymous with nociception
Like I said, this is a very brief description of the information presented in the course so I highly recommend checking it out for yourself!
Lastly, I’ll leave you with some great quotes from the course:
“It is very human to run and to lift.”
“If running sucks so much, why do 35 million people do it?”