1. IT Band syndrome, Patellofemoral tracking dysfunction, runner’s knee
Cause: tight Quadriceps and IT band develop poor quality of myofascial connective tissues (muscle, tendon, fascia) resulting in adhesion between those 2 structures and creating trigger points. Once trigger points develop in the myofascial tissues, the patient begins to feel referring pain into the knee cap (patella bone) area and pulls the bone while moving. Trigger points can happen anywhere under the excessive stress while running such as ITB insertion area in fibula, ligament and tendons around knee cap.
Solution: manual therapy (trigger point therapy, Myofascial release), ITB, Quadriceps and hip muscle stretching, Education for Foam roller self-stretching using body weight, Shockwave therapy (ESWT) to break up adhesion
Clinical point: the pain comes from the TrP (trigger points). Thus, finding out and releasing the TrP are the key to success.
2. Hip pain
Cause: Poor quality of myofascial tissues (muscle, tendon, fascia) in Gluteus, piriformis, hip flexors, TFL
Solution: manual therapy (trigger point therapy, Myofascial release), stretching and strengthening program, Education for Foam roller self-stretching, Shockwave therapy (ESWT)
finding out the TrP causing pain and weakness in the main muscles while running
Tight myofascial connective tissues in Gluteus- Quadriceps and ITB complex can cause poor alignment of ankle – knee – hip joint in weight bearing phase in running. It can cause knee valgus damage if it is being repeated while running
3. Ankle and foot pain
Cause: tight, weak and inflexible ankle, foot, arch and toe muscles
Solution: release tight muscles and activate intrinsic and extrinsic foot, ankle and arch muscles, stretching and strengthening program, balance exercise program, Shockwave therapy (plantar fascial, achilles tendon).
Reactivate peroneus muscles and tibialis posterior muscles for ankle inversion and eversion
Strengthening arch muscles (activate intrinsic toe muscles, tibialis posterior, stretch plantar fascial connective tissue)
Importance of medial foot arch
Arch collapsing results in poor leg alignment while running in the weight bearing phase. Thus, by strengthening the arch muscles in the foot, knee and hip joints will be stabilized while running. The medical practitioner needs to check foot, ankle and arch strength and function in the first exam.
4. Shin splint
Cause: when the muscles in the foot and lower leg do not function well, the rebounding force from the ground while running goes directly to the bone and it can cause stress fracture
Solution: decrease the running intensity or take a break from running, improve muscle conditions and blood circulation in lower leg and foot (myofascial release, trigger point therapy, shockwave therapy, electrotherapy, infrared therapy), improve arch strength and flexibility (manual therapy)
Clinical point: Shin splint happens due to the fatigued muscles haven’t had enough recovery. The muscles also develop adhesions and trigger points. Thus, improving the muscle condition and improving flexibility and strength of foot, ankle, and arch muscles are the key to success.
5. Plantar fasciitis, heel pain, achilles tendinitis
Cause: poor blood circulation to the plantar fascial connective tissue, muscle tightness in calf muscles, toe muscles, tight hip flexor and piriformis muscles can also decrease circulation in the foot, poor myofascial tissues and trigger points in the heel and tendons
Solution: Shockwave therapy is very effective for plantar fasciitis, heel pain and achilles tendon dysfunction, stretch and strengthening program
If there is TrP in the heel and achilles tendon insertion area, it should be released
Find good shoes (some medial arch support, enough space for toe box and ball of the foot, the front part of the shoes need to be flexible for foot and toe movement)
The combination treatment with manual therapy, shockwave therapy and exercise program has significant effect. Normalizing the myofascial connective tissues and improving circulation are the main treatment. Selecting good shoes is very important.