Running Assessment: Complete physical examination of runners

Our previous article on running assessment focused on a simple ‘Runner intake questionnaire’ you can use to assess the training characteristics & running pattern of your patients. Understanding the training & injury pattern makes it very easy for a clinician to identify potential injury triggers & formulate specific functional assessments required in the diagnosis process. In this article, we will be discussing a variety of physical tests used by clinicians to assess the runner’s ability to control motion symmetrically. These are simple yet effective assessments you can use to measure the mobility & flexibility of lower extremities, core & spine. As a clinician, we are checking if the runner is able to perform these tests with a symmetric range of motion (ROM), strength & endurance, & limb segment alignment. The aim behind these tests is to detect any physical limitations in the runner that may be altering running mechanics. Moreover, it also helps in formulating physical therapy plans to equalize right- and left-sided capability. Typically, the tests performed during a running assessment can be divided into weight bearing and non-weight bearing categories.

WEIGHT BEARING TESTS

Posture Assessment

Posture analysis is an important element of a running assessment. It is a static exam which can be done using visual observation or a posture analysis software (depending on the amount of information you require).

In a typical posture exam, you should assess the anterior, posterior & lateral views of the patient. Some common postural deviations that you should look for are:
1. Uneven shoulders and spinal curvature may lead to asymmetric loading during running.
2. Excessive Anterior pelvic tilt limits the hip extension and trunk rotation during gait.
3. Alignment of the knees (valgus, neutral, or varus) and the ankle inversion and eversion during stance.

Refer to our article on Posture analysis for a detailed ‘posture checklist’ you can use in your clinic.

Single Leg Squat Test

The single-leg squat test is a commonly used functional test for the hip & lower extremity.
It is useful in evaluating the strength & balance of the lower body, particularly the quadriceps and gluteal muscle groups, and the hip stabilizers.

Here is a great instructional video you can use to assess single leg squats in your patients and identify any deviations.

Spine ROM

The measurement of spine range of motion (ROM) is very important for runners, especially with low back pain. It consists of a number of tests to help a clinician evaluate the mobility of the spine, including Lumbar flexion – extension ROM, thoracic rotation ROM, etc. Refer to this link to learn about the various ROM assessments you can perform on your patient.

Y Balance Test

The Y Balance Test (YBT) is a simple, yet reliable, test to measure dynamic balance. Developed to standardize the modified Star Excursion Balance Test (mSEBT), the YBT has become extremely popular due to its simplicity and reliability.

Refer to the adjacent video to learn how you can use the Y balance test in your practice.

Functional Dorsiflexion Tests (Standing Lunge Test)

The Standing Lunge test helps in assessing the dorsiflexion range of movement (DROM) at the ankle joint. It is a simple assessment which you can carry out using a wall and a tape measure.

To know more about Standing Lunge Test, refer to the adjacent video.

Functional Movement Screen Tests

A functional movement screen(FMS) is a combination of various weight-bearing tests to determine any dysfunctional or performance-limiting movement patterns in a runner. The FMS uses a simple scoring system. Each individual test listed under FMS has scoring criteria to predict injury risk in a patient. According to recent studies, a score of <=14 on the FMS can be linked with greater injury risks. For a complete scoresheet of tests listed under FMS & their scoring criteria, click here.

NON-WEIGHT BEARING TESTS

Non-weight bearing tests serve as a complement to the weight bearing tests. Some commonly used assessments include foot alignment, first metatarsal mobility, joint ROM, flexibility and strength of lower extremity muscle groups.

Hip Mobility Test

Reduced hip extension is a common observation in recreational runners. Traditionally, it is believed that lack of hip extension may be associated with reduced flexibility of the iliopsoas muscle.

Additionally, recent studies suggest that reduced hip flexibility and anterior pelvic tilt are coordinated motions. Runners who display decreased hip extension ROM during running often show an increase in the anterior pelvic tilt.

The reverse lunge is an easy way to test hip mobility. Here is an instructional video.

Flexibility Test

The sit and reach test is the most common of all flexibility tests. It measures the flexibility of the patient’s lower back and hamstrings. For the step by step procedure of the test & its normal values, refer to this guide.

Patellar Position and Tracking

Patellar tracking helps in determining whether the pain symptoms are related to patellofemoral alignment. Lateral trajectory of patella during a squatting motion or gait(detected through running gait analysis) indicates poor vastus medialis strength and high iliotibial band tension.

While assessing the patellar postion, it is important to assess any right-left asymmetry.

Strength

Strength measurements are very useful in tracking the progress of rehabilitation. Evaluating the patient’s muscle strength prior to treatment serves as a solid baseline to determine if the rehab plan is improving the patient’s condition.

Manual muscle-testing is the most common methods to measure strength in a running assessment. The MRC scale is a handy tool to rate muscle power on a scale of 0 to 5 in relation to the maximum expected for that muscle.

For more information on how to use the MRC scale in clinical practice, refer to this video.

The observations during a physical examination are useful in determining the physical impairments present in the patient. Interestingly, the imbalances/deviations detected during a physical examination are the result of a weakness/dysfunction localized in any other region of the body. For instance, A runner with a limited hip extension will tend to increase his stride by overstriding, which is a leading cause of tibial stress fractures.

In such cases, gait analysis of the runner helps in identifying the possible root cause of the musculoskeletal problem and identify various compensations that the patient exhibits to make up for the abnormality. Analyzing the runner’s gait will help you understand the relationship between individual physical impairments and altered running mechanics. It will also help you assess how these alterations relate to the patient’s injury.

Hence, it is important to follow a physical examination step with a comprehensive gait analysis to obtain a complete running assessment. Our next post will cover some important aspects of gait analysis and how you can perform it at your clinic.

We are always happy to hear your ideas and views about our posts. To have a discussion about the physical examination of a runner, feel free to comment below or reach out to us.