Case of the Week: Running and Loading Loss

Just a quick COTW write-up and I'm writing this on Father's Day, taught this weekend, and on top of that, not feeling well.

Normally I include the evaluation on these but here's the skinny:

Subjective: Mid 30s female, began running last year, had to stop after running a half marathongs due to left hip pain with running only. She stopped running for several months and the hip pain subsided. She recently started running again and noticed recurrence of left hip pain.

Objective:

• MSR, MSE, and MSF were all FN
• SL stance and swing were DN on the left and FN on the right
• SGIS in standing did not appear limited on the left compared to the right.... initially
• hip, trunk, ankle, and tibial ROM were all FN

The only thing that brings on her complaints is running > 5 miles or running at faster paces. However, SGIS against a wall to her true end range is what reproduced the left hip pain, indicating a loss of loading on the involved.side. This is what she looked like

That's a lotta side a glidin-a!

SGIS shift corrections to the left in standing had a mild to moderate pinch for the first 2 sets but this rapidly improved. However, to test, I wasn't about to send her on a 5 mile run. Instead we decided to go outside and have her run for 5-8 minutes at a faster pace after a quick warmup. She thought this may bring on her hip complaints. 

Watching a runner and their asymmetries is one of my favorite assessments, this is what we found

• right arm crossed to mid-line in front
• left arm crossed way past mid-line over rotating her trunk to the right, effectively causing unloading of her lumbar spine, and placing her hip flexors at a lengthened position prior to swing phase

When asked, "Why do you run like that?" The answer was, "I hold my phone in my right hand." So she does not move her right arm as much because of tracking her time, distance, etc. She was instructed on a mild forward lean, a smaller stride, and swinging her arms back with both elbows bent to 90, with minimal forward arm swing. This felt strange to her, but she was able to do it with moderate cuing and different speeds with no onset of pain. 

My wife ran with her over the weekend in a running club and she had her phone in an armband on her right arm. She did not complain of pain at all, but unfortunately, her iPhone went flying out of the band and landed on the road without case... D'OH!

I'm following up with her tomorrow to see how her other runs have gone.