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“Where does it hurt?”; “On the outside part of your knee?”; “Oh, you must have ITB syndrome!” This is a classic example of the “point-to-it” diagnosis.
How many times have you been to a health care professional, told to point where it hurts, and immediately you’re given a diagnosis without so much as a simple physical examination? It seems so clear cut, right? Well, actually it isn’t that simple. All too often patients are quickly “diagnosed” without ever being properly examined, which can actually result in a misdiagnosis. We can’t just point to where we perceive pain and make a proper diagnosis. The pain needs to be put into context with the rest of the runner’s symptoms. The dysfunctional running must be linked to actual physical impairments in order to fully understand and treat the true culprit of the problem being presented. All of this must be accompanied by actually examining the runner and taking a good history.
In musculoskeletal injuries, the area where we perceive pain is often similar for different types of running injuries, so we cannot make a diagnosis based on pain alone. For example, a common area in which runners experience pain is along the outside of their knee. This knee pain is most often diagnosed as iliotibial band (ITB) syndrome, but in fact, the symptoms could actually be emanating from the calf or hamstring muscle.
ITB syndrome, calf strains, and hamstring strains (HS) can produce similar symptoms. And while the perceived area of pain may be similar for ITB, HS, and the calf, the actual source of the impairment and the rehab process itself are essentially very different.
So with so many running injuries being cursorily examined and potentially misdiagnosed, what do we do? In the following section, I’ve provided you with some basic tests to help you identify your problem area and begin to get control of your running injury as soon as possible. To better assess your specific area of tenderness, stiffness/inflexibility, weakness, and gait dysfunction try each test on both legs and note any differences between your injured leg and your non-injured leg.
ITB-
Tenderness: Use your hands to find specific points of tenderness and pain along the band on the outside of your leg anywhere from your hip to just below the knee. Note any specific areas of significant pain.
Stiffness: Lie on your back with your leg straight. Use a belt or a rope wrapped around the foot to pull your leg across your body, over the opposite leg. Be sure to keep your hips and pelvis down on the floor. Repeat on the opposite leg. Notice if you feel a greater restriction in movement or inability to pull one leg over compared to the other.
Weakness: Lie on your side, with the affected leg towards the ceiling and in line with the rest of your body. With a straightened leg, lift your top leg up towards the ceiling. Repeat 10 times. Now repeat with the other leg. Do you notice greater difficulty lifting one leg in comparison to the other?
Gait dysfunction: Try this: Hold onto your hips with both hands and run. Feel for any wobble or excessive movement in one hip compared to the other.
Calf-
Tenderness: Press into your calf muscle. Assess the entire muscle from behind the knee all the way down to the back of your ankle. Take note of any localized pain or specific stiffness.
Stiffness: Lay on your back. Hold your leg behind the knee with both hands. With your leg straight up in the air and knee straightened, flex your ankle (toes toward your nose). Note if one side is more limited or painful than the other.
Weakness: Stand and balance on one leg. Do a “calf raise” by pushing up through your toes and lifting your heel off the ground 20 times. Did you experience pain or weakness in the affected leg?
Gait dysfunction: Emphasize pushing off through your 1st toe (the big toe) when you run. Do you have more difficulty pushing off with one leg versus the other?
Hamstring-
Tenderness: Tenderness can be either on the outside or inside part of the back of your thigh, anywhere from behind your knee to your buttocks.
Stiffness: Lying on your back, pull your leg up towards your nose and straighten the leg (knee locked out). Do you feel more tightness or pain in one leg than the other?
Weakness: Lie on your stomach, bend your knee and kick toward your butt 20 times. Is there a difference in how far you can kick your leg? Is it more difficult to kick the injured leg back versus the unaffected leg?
Gait dysfunction: Try running and see if you feel a difference or difficulty with kicking back, a shorter kick back on one side than the other or a kick back that is not in line with the rest of your leg (i.e. is not straight).
In reality, running injuries don’t manifest as a particular diagnosis but instead as an injured body part(s).Most running injuries are a result of repetitive wear and tear that results from a problem within our running technique, form or training habits. The factors disposing us to running injuries are both intrinsic and extrinsic and can certainly be more complex than a simple muscle strain, which is why it is important to properly examine the injured area. The first step to overcoming any running injury is properly identifying what is injured. Once you are able to identify the specific problem, then you are ready to move on to recovery.
