Journal of Orthopaedic & Sports Physical Therapy - Mark F. Reinking, PT, PhD, SCS, ATC

Exercise-Related Leg Pain in Collegiate Cross-Country Athletes: Extrinsic and Intrinsic Risk Factors

Thu, 12 Jul 2007 00:00:00 EST

Mark F. Reinking, Tricia M. Austin, Ann M. Hayes
STUDY DESIGN: Prospective cohort design. OBJECTIVES: To determine in a sample of collegiate cross-country athletes (1) the percentage of athletes with history of exercise-related leg pain (ERLP) associated with running, (2) the incidence of ERLP during 1 season, (3) if factors including years of collegiate running, training distance, and gender are associated with ERLP, and (4) if there is a relationship between foot type and ERLP. BACKGROUND: ERLP is a common overuse pain syndrome, but little evidence exists regarding the prevalence, incidence, and risk factors. METHODS AND MEASURES: Eighty-eight collegiate cross-country athletes (44 male, 44 female) from 5 Midwest universities consented to participate. Prior to the season, athletes completed a questionnaire and 3 measures of foot type were performed: navicular drop, medial longitudinal arch angle, and visual assessment of foot type. Athletes completed a postseason questionnaire regarding the season incidence of ERLP. Statistical analyses of differences (t test, proportion test) and relationships (chi-square, relative risk) were conducted. RESULTS: Prior to the season, 60 of the 88 athletes (68%) reported a history of ERLP with bilateral medial leg pain the most common ERLP presentation. Over 50% of the athletes with a history of ERLP reported the pain had interfered with cross-country participation. Of the 67 postseason respondents, 38.8% reported ERLP incidence during the season. Most athletes (80.8%) who reported season incidence of ERLP had a previous history of ERLP. There were no differences between athletes with and without a history of ERLP or season incidence of ERLP regarding years of collegiate running, training distance, gender, and foot measures. CONCLUSION: ERLP history and season incidence was common among these cross-country athletes. The only risk factor identified for season incidence of ERLP was a history of ERLP.

J Orthop Sports Phys Ther 2007;37(11):670-678, published online 12 July 2007. doi:10.2519/jospt.2007.2534

KEY WORDS: injury risk, overuse injury, running

Factors Contributing to the Development of Medial Tibial Stress Syndrome in High School Runners

Mon, 05 Feb 2007 09:45:00 EST

Jason E. Bennett, Mark F. Reinking, Bridget Pluemer, Adam Pentel, Marcus Seaton, Clyde Killian

Study Design: Predictive correlational study. Objectives: To identify the incidence of medial tibial stress syndrome (MTSS) in a group of high school cross-country runners and to determine if a relationship exists between lower extremity structural measures and the incidence of MTSS. Background: Medial tibial stress syndrome is an overuse injury that occurs in long-distance runners. Literature exists that implicates structural deformity as a contributor to MTSS, but no studies have developed a predictive model. Methods and Measures: We measured 125 high school cross-country runners for tibiofibular varum, resting calcaneal position during stance, and gastrocnemius length. Runners developing MTSS over an 8-week period were placed in the injured group (2 men, 13 women; age 15.3 years ± 1.0), and 21 randomly selected uninjured runners were placed in the uninjured group (13 men, 8 women; age 15.7 years ± 1.5). Navicular drop was measured for runners in both groups. Reliability of measures was determined using an intraclass correlation coefficient (ICC 3,1). Paired t tests were used to compare the injury and noninjury groups. A logistic regression analysis was used to establish if the descriptive data could accurately predict the development of MTSS. Results: Paired t tests showed a significant difference in navicular drop test measures between the injured (6.8 mm ± 3.7) and noninjured (3.6 mm ± 3.3) groups. Logistic regression analysis revealed navicular drop test measurements and sex correctly identified athletes who developed MTSS with 76% accuracy. Conclusion: Our study supported the hypothesis that a pronatory foot type is related to MTSS. The combination of sex and navicular drop test measures provides an accurate prediction for the development of MTSS. Clinical measures that identify biomechanical risk factors for MTSS may allow prevention or early intervention.

J Orthop Sports Phys Ther. 2001;31(9):504-510.

Key Words: navicular drop test, overuse injury, running

A Comparison of Closed Kinetic Chain and Isokinetic Joint Isolation Exercise in Patients With Patellofemoral Dysfunction

Mon, 05 Feb 2007 09:45:00 EST

Henry A. Stiene, Joseph A. Brosky, Mark F. Reinking, Mary Beth Mason, John A. Nyland

Recently, there has been attention to the clinical application of closed kinetic chain and joint isolation exercise. Our purpose was to compare the effect of joint isolation and closed kinetic chain exercise on quadriceps muscle performance and perceived function in patients with patellofemoral pain. Twenty-three patients participated in an 8-week training period and were assigned to either a closed kinetic chain or a joint isolation exercise training group. An 8-inch (20.3 cm) retro step-up test was performed at baseline, 8 weeks, and 1 year. Seated knee extension testing was measured at baseline and at 8 weeks using peak concentric torque on an isokinetic dynamometer at 90°/sec, 180°/sec, and 360°/sec. Perceived functional status was rated as excellent, good, fair, or poor based on questionnaire response. Statistical analysis showed that both groups had significant improvement in peak torque at all speeds, but only the closed kinetic chain group showed significant improvement in closed kinetic chain testing and perceived functional status. We concluded that closed kinetic chain training may be more effective than joint isolation exercise in restoring function in patients with patellofemoral dysfunction.

J Orthop Sports Phys Ther. 1996;24(3):136-141.

Key Words: muscle strength, patellofemoral pain, kinetic chain

Assessment of Quadriceps Muscle Performance by Hand-Held, Isometric, and Isokinetic Dynamometry in Patients With Knee Dysfunction

Mon, 05 Feb 2007 09:45:00 EST

Mark F. Reinking, Kelly Bockrath-Pugliese, Teddy W. Worrell, Randall L. Kegerreis, Kristine Miller-Sayers, Jack Farr

One component of patient evaluation is muscle performance assessment. The purposes of this study were: 1) to determine the difference and correlation between hand-held, isometric, and isokinetic dynamometry test results in patients with knee dysfunction and 2) to determine the effect of pain during such testing. Bilateral quadriceps strength in 23 subjects with unilateral knee dysfunction was tested using concentric and eccentric isokinetic dynamometry at 60°/sec, isometric dynamometry, and hand-held dynamometry, both at 60° of knee flexion. Pain ratings were obtained before, during, and after each test. Statistical analysis revealed a significant difference between involved and uninvolved limbs for eccentric isokinetic dynamometry (p = 0.002) and hand-held dynamometry (p = 0.005); no difference was found between limbs for the concentric isokinetic and isometric dynamometry (p > 0.05). Mean percent deficits in quadriceps strength ranged from 11% to 18%, with no significant difference found between testing modes. Pearson product moment correlations ranged from 0.34 to 0.76 when comparing testing modes. No significant difference existed in pain scores before, during, and after each mode of testing. It was concluded that large variation existed between different testing modes, which results in different conclusions regarding the strength of the quadriceps in patients with knee dysfunction.

J Orthop Sports Phys Ther. 1996;24(3):154-159.

Key Words: muscle strength, knee, methods