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Running and walking problems

These are not a medical problem although we look to doctors and expect them to know everything. They attend to the fracture, laceration or abrasion caused by falling off your racing bike and that is a trauma which is their area. The impressive skills suitable for those trauma injuries does not transfer to dealing with walking problems or running injury. The aching shin or sore knee that you suffer just walking or running, no matter how painful it may get is still a problem caused by the way you move, it’s a function problem not solved by sutures or medication. It has to do with the science of biomechanics, the mechanics of the skeletal structure that is our framework, a totally separate and more recent area of study/science. You do not need the surgeon for knee or foot pain. Their skills are appropriate, in fact you desperately need their help for the treatment of trauma (accidents) when bones need to be screwed together to save your leg but it is overkill for the subtle problems related to walking or running.

Sports problems which do require medical intervention are when you collide with another player and go down suffering concussion, laceration or twisting your knee, tearing ligaments and meniscus cartilage. That is a trauma and you may need surgical repair. The gap is when it comes to rehabilitation. Muscle rehabilitation programs will not succeed because the forces involved in lower limb weight bearing require the skeletal structure to firstly be correctly aligned. It is not appreciated though, the degree to which inherited misalignments prevent the rehabilitation of these players. Once injured, misalignments that predispose injury need to be corrected if the player is to return to the game.

Traditional explanation for running and walking problems is to firstly label problems as overuse. I have seen many patients who had several years before been at an elite national level in athletics or team sports but had suffered constant foot or leg injury. The traditional approach had given them a diagnosis term but not solved the problem. The medical team appropriately treat the laceration or concussion but it is another area to identify the faulty function that causes running injury and have the technique to realign the limb and solve it. The injured player was eventually dropped from the squad with only a diagnosis term to help with their disappointment. There is too much jargon and vague generalizations without a solution. I routinely solve the cause of their injury and they resume their sport but say, 'if only I'd known about you before when I had an opportunity because they didn't know what to do'.

'Petersen and Renstrom' state:
"Significant deviations from the normal anatomical structure, for example excessive pronation, can cause injuries. Even minor variations can be sufficient to do so if subjected to prolong or repeated loading."

This is where the significance of our individual variations is so overlooked. Those with significant variations may even suffer in childhood while others with minor deviations in structure only become aware of problems with the cumulative effect of their old age or if at some time they become much more active like joining the gym or taking up running.

These authors (P&R) mention 'runners knee' (which to them is 'iliotibial band syndrome') and state "Runners with excessive pronation of their feet or those who run on cambered roads have an increased risk". They are of course talking about incorrect function.

Other sources cite:
"Anatomic or biomechanical factors..... Body alignment, like knock-knees, bow legs, unequal leg lengths and flat or high arched feet.. or.. incompletely rehabilitated injuries or other anatomic factors."

Another suggests:
"How your foot lands: overpronation, underpronation, severe heel striker, toe runner.
Structural imbalances: such as one leg shorter than the other or bowlegs.
An increased Q-angle (the angle that is formed from the outside of the hip to the inside of the knee) found mainly in women (because of wider pelvises for childbirth) which causes knock-knees"

This is not correct as 'knock knees' are turned and locked back excessively. This is actually caused by foot roll and leg/knee rotation. As the author seems to have observed, the affect is made worse, more obvious when combined with the angled thigh in those women who have a classic wide pelvis. Another contributing factor is that women's hip joints face more anterior (forward) rather than the way men's face laterally (outward).

 

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