When Should A Patient Stop Running Forever?Jun 08, 2023
One of the hardest things to do is to tell someone they can’t do something they love. We’ve all had numerous conversations telling patients they shouldn’t work, walk, run, play contact sports or even simply twist on their hip. Luckily, much of the time we are telling patients to avoid these activities temporarily, not permanently. However, periodically we advise patients to refrain from activities such as running, skiing or cycling permanently due to their physical health. Here’s how we come to that conclusion for runners.
Stick To The Facts
As healthcare practitioners it’s important to keep our advice to patients evidence based. But for some reason many clinicians make recommendations to runners based on personal experiences, common myths or unsubstantiated facts. Some misguided advice I’ve heard over the years includes:
- My doctor told me not to run because I don’t have a “runner’s body”
- I was told I could only run in Hoka shoes
- I can’t run in the winter because it’s too cold for my body
- I should only run on my toes and not let my heels touch the ground to avoid impact
- I’m too old to run, I ran too much when I was younger
Whether this advice was given to patients with good intentions or by someone trying to use the “fake it until you make it” mentality we as physical therapists can do better. It starts with sticking to the information and data you collect from the patient.
Build A Clinical Picture Of The Runner
Patients are more than just a diagnosis. In fact one of the worst pitfalls of a healthcare practitioner is to categorize patients based on their diagnosis alone. For example if a runner has Plantar Fasciitis, Disc Herniations or Patellofemoral Pain Syndrome it may seem reasonable to tell them not to run. However, it is important for us to assess the patient’s ENTIRE clinical presentation prior to restricting them from running or other physical activities. Taking the time to thoroughly complete both a subjective and objective exam can be challenging in a fast paced clinical setting. Nevertheless, this due diligence during evaluations provides patients more accurate advice specific to their clinical presentation and injury.
To build a clinical picture for your runner, first take a history and subjective report of their symptoms. While many practitioners are well versed in taking subjective data it is essential to ask additional probing questions for high functioning patients such as runners. Running experts advise to get as detailed as possible when asking runners about their running injuries and activity levels. Here are some of the questions running experts ask:
- Do you experience symptoms while running?
- If so, during your entire run or only after a specific mileage?
- Do you experience symptoms while running up or down hills?
- What is your typical running pace?
- How many miles do you run at one time?
- How many miles do you run in a week, month?
- What shoes do you run in?
- How often do you get new running shoes?
- Do you follow a routine of stretching or strengthening exercises?
- Do you use a running coach?
- What are your running goals in the next 3-6 months?
Objective Tests And Measures To Assess Runners
Many injured patients and runners will benefit from assessments of posture, ROM and muscle strength. While these assessments are useful in constructing a plan of care they don’t provide information on the patient’s biomechanics in everyday life. In addition to a running gait analysis, performing a battery of functional tests (listed below) is essential in building the clinical picture of a runner. This emerging emphasis on functional testing helps assess movement biomechanics and draws correlations to injury risk factors during activities. Here are several common functional tests for runners.
- Lower Quarter Y-Balance Test
- Lateral Step Down Test
- Single Leg Sit To Stand Test
- Single-Leg Triple Hop for Distance
- Lateral Single-Leg Triple Hop for Distance
- Medial Single-Leg Triple Hop for Distance
- Functional Movement Screen
Who Should Stop Running?
Integrating subjective and objective data into a broader clinical picture to advise runners is challenging. In particular, for patients that it is not clear if they are appropriate to continue running. Developing trends in the literature show evidence based clinical approaches for injured runners follow several steps. First, take baseline subjective and objective data and initiate a PT plan of care. This plan of care could potentially consist of gait retraining, running shoe changes, corrective exercises and/or follow up PT visits. Once the patient has completed a part or all of the plan of care a reassessment is taken to determine the runner’s progress and assess their risk for injury with future running. Then (if appropriate) starting a return to run program followed by another reassessment of subjective and objective data builds the patient’s clinical picture. By examining this data the practitioner can decide whether a patient is appropriate to run or participate in running activities. In the end it is up to each physical therapist's discretion who should run and who shouldn’t. Emerging evidence shows people can run longer into life than we previously thought.
How To Become More Confident In Your Running Gait Analysis
Performing a running gait analysis can be intimidating for many clinicians. If you are interested in learning more about providing a running gait analysis and starting your own running gait analysis clinic check out our continuing education course “The Essentials of Running Gait Analysis”. Lastly, if you have questions about this content or the course feel free to reach out to us to discuss and we will personally respond to your questions.
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