Robert P. Wilder

Overuse injuries: tendinopathies, stress fractures, compartment syndrome, and shin splints.

Approximately 50% of all sports injuries are secondary to overuse and result from repetitive microtrauma that causes local tissue damage. Injuries are most likely with changes in mode, intensity, or duration of training and can accumulate before symptoms appear. Intrinsic factors contributing to injuries are individual bio-mechanical abnormalities such as malalignments, muscle imbalance, inflexibility, weakness, and instability. Contributing extrinsic (avoidable) factors include poor technique, improper equipment, and improper changes in duration or frequency of activity. Injuries are often related to biomechanical abnormalities removed from the specific injury site, requiring evaluation of the entire kinetic chain. This article discusses common overuse injuries of the lower leg, ankle, and foot: tendinopathies, stress fractures, chronic exertional compartment syndrome, and shin splints.

The Effect of Running Shoes on Lower Extremity Joint Torques

To determine the effect of modern‐day running shoes on lower extremity joint torques during running.

A standard measure for exercise prescription for aqua running

Aqua running has been promoted as a method for cardiovascular conditioning for the injured athlete as well as for others who desire a low impact aerobic workout. Recent studies have suggested the need for an environment-specific measure of exercise intensity. Twenty healthy subjects, 10 men and 10 women, underwent a graded exercise test of aqua running to investigate the relationship between cadence and heart rate. This was done to determine the utility of cadence as a measure for exercise prescription. The graded exercise test followed a standard protocol for exercise testing in aqua running. Results demonstrated a high correlation between cadence and heart rate, both as a group as well as individually. We conclude that cadence may be used as a measure for exercise prescription for aqua running.

Bioengineering principles of hydrotherapy.

Hydrotherapy is based on several important bioengineering principles that permit the design and development of aquatic exercise devices, techniques and programs. These principles involve several forces (buoyancy, drag, inertia), hydrostatic pressure and the specific heat of water. By acquiring a knowledge of these bioengineering principles, an individualized exercise program can be prescribed that will enhance physical fitness which is associated with desirable psychological changes.

The Influence of Arch Supports on Knee Torques Relevant to Knee Osteoarthritis

PURPOSE Changes in footwear and foot orthotic devices have been shown to significantly alter knee joint torques thought to be relevant to the progression if not the development of knee osteoarthritis (OA) in the medial tibiofemoral compartment. The purpose of this study was to determine if commonly prescribed arch support cushions promote a medial force bias during gait similar to medial-wedged orthotics, thereby increasing knee varus torque during both walking and running. METHODS Twenty-two healthy, physically active young adults (age, 29.2 +/- 5.1 yr) were analyzed at their self-selected walking and running speeds in control shoes with and without arch support cushions. Three-dimensional motion capture data were collected in synchrony with ground reaction force (GRF) data collected from an instrumented treadmill. Peak external knee varus torque during walking and running were calculated through a full inverse dynamic model and compared. RESULTS Peak knee varus torque was statistically significantly increased by 6% (0.01 +/- 0.02 N.m.(kg.m)(-1)) in late stance during walking and by 4% (0.03 +/- 0.03 N.m.(kg.m)(-1)) during running with the addition of arch support cushions. CONCLUSIONS The addition of material under the medial aspect of the foot by way of a flexible arch support promotes a medial force bias during walking and running, significantly increasing knee varus torque. These findings suggest that discretion be employed with regard to the prescription of commonly available orthotic insoles like arch support cushions.

Exertional compartment syndrome.

Chronic exertional compartment syndrome should be considered in any runner experiencing exertional leg pain. Runners typically describe a tight, cramping ache over the involved compartment that commences at a reproducible point in the run and resolves with rest. Diagnosis should include a careful history and physical examination as well as documentation with intramuscular compartment pressure monitoring. Milder cases will resolve with activity modification and conservative care. More severe cases or those failing conservative care are referred for fasciotomy.

Differences in Static and Dynamic Measures in Evaluation of Talonavicular Mobility in Gait

STUDY DESIGN Controlled laboratory study using a cross-sectional design. OBJECTIVES To compare the measurements of navicular drop during walking and running to those made clinically during a static position in a group of healthy young adults. BACKGROUND The navicular drop test is a common clinical measure of foot structure and, more specifically, of talonavicular joint function. Previous work has focused on static measurement to establish the relationship between navicular drop and various overuse injuries. However, loads on foot structure are dramatically increased during gait. Examining navicular drop dynamically is more reflective of the functional demands of the foot when walking and running. METHODS The navicular drop of 72 healthy runners was evaluated using 2 static methods. Results were used to classify individuals into groups and compared to dynamic measures of navicular drop made during walking and running. Three-dimensional motion capture and an instrumented treadmill were used to assess dynamic navicular mobility. A repeated-measures analysis of variance (ANOVA) was performed to examine differences between measurement conditions. Between-group differences were assessed with independent-samples t test (P<.05). RESULTS Static measures of navicular drop were not found to be uniformly predictive of dynamic function during walking or running. Functional navicular drop measurements underestimated the dynamic measures in all foot types, while subtalar neutral drop overestimated dynamic measures for individuals with neutral and hypermobile foot types. No differences in navicular drop were found between foot types during walking, and small differences were found in running only between the hypomobile and hypermobile foot types. Maximum foot deformation during gait occurs at the time of maximum ground reaction force. Significant differences in navicular drop between foot type groups measured statically become muted when looking at group differences while walking and running. CONCLUSIONS Differences in navicular mobility between foot type groups during walking and running indicate that factors other than static alignment affect dynamic foot mobility. Dynamic assessment of navicular mobility may be an effective tool to examine the interplay of how the extrinsic force demands of gait and intrinsic structure and neuromuscular control affect foot function in walking and running.

Lower limb joint kinetics during moderately sloped running.

CONTEXT Knowledge of the kinetic changes that occur during sloped running is important in understanding the adaptive gait-control mechanisms at work and can provide additional information about the poorly understood relationship between injury and changes in kinetic forces in the lower extremity. A study of these potential kinetic changes merits consideration, because training and return-to-activity programs are potentially modifiable factors for tissue stress and injury risk. OBJECTIVE To contribute further to the understanding of hill running by quantifying the 3-dimensional alterations in joint kinetics during moderately sloped decline, level, and incline running in a group of healthy runners. DESIGN Crossover study. SETTING Three-dimensional motion analysis laboratory. PATIENTS OR OTHER PARTICIPANTS Nineteen healthy young runners/joggers (age = 25.3 +/- 2.5 years). INTERVENTION(S) Participants ran at 3.13 m/s on a treadmill under the following 3 different running-surface slope conditions: 4 degrees decline, level, and 4 degrees incline. MAIN OUTCOME MEASURE(S) Lower extremity joint moments and powers and the 3 components of the ground reaction force. RESULTS Moderate changes in running-surface slope had a minimal effect on ankle, knee, and hip joint kinetics when velocity was held constant. Only changes in knee power absorption (increased with decline-slope running) and hip power (increased generation on incline-slope running and increased absorption on decline-slope running in early stance) were noted. We observed an increase only in the impact peak of the vertical ground reaction force component during decline-slope running, whereas the nonvertical components displayed no differences. CONCLUSIONS Running style modifications associated with running on moderate slopes did not manifest as changes in 3-dimensional joint moments or in the active peaks of the ground reaction force. Our data indicate that running on level and moderately inclined slopes appears to be a safe component of training regimens and return-to-run protocols after injury.

Overuse injuries of the elbow.

Overuse injuries result from repetitive microtrauma that can lead to inflammation and local tissue damage in the form of cellular and extracellular degeneration. The elbow, secondary to its central positioning, is predisposed to an array of injuries that are often companion to associated pathology of the spine, shoulder, and hand/wrist complex. An understanding of etiology and rehabilitative management will assist the clinician in the diagnosis and treatment of common overuse injuries involving the elbow.

Common injuries in athletes with obesity and diabetes.

Musculoskeletal injuries and diseases are common in persons with obesity and diabetes mellitus. High body mass index is associated with an increased risk for musculoskeletal injuries, diseases, and disability. There is a significant positive correlation between the level of obesity and musculoskeletal injuries, and disability and health-related costs. The prevalence of obesity and diabetes is inversely proportional to health-related quality of life.