Lateral knee pain with cross over gait

SarahStephenson

Mentorship Member
Joined
Mar 12, 2021
Messages
7
Hi there, I am looking some help with a young runner.
Feb 2022 - developed right lateral knee pain, sudden onset when running, no injury but had increased mileage over previous 3 months from 60km a week to 80km a week. Run x6 days a week. Competes on track.
Nov 2021 - Reported tib post/ant injury, did not see him for this so unsure of presentation at the time but did resolve.


Assessment - ROM ok. Some soreness EOR knee flexion on initial assessment but this resolved in subsequent sessions
Co-ordination tests - weak ant fibres gluts both sides, medial bias, post bias with peroneal bias
I cleared up bed tests during each session and managed to restore ant gluts bias on bed, however in standing the lateral bias was found to be most vulnerable so I progressed him through the standing reaches, lunges, leaps in the lateral frontal plane.
The medial bias was initially restored with tib post and medial hamstring release but to complicate things he reported some minor back ache with sitting studying for exams and then there some subsequent internal oblique, medial hamstring and medial bias weakness on prone test that became apparent on 3-4th session.

His internal obliques were released and restored during the sessions and I gave him some obliques reaches supine and added transverse step but they returned weak the next session as did medial bias and medial hamstring prone test. This then threw me a little about what tissues were the ones that needing strengthening.
Also on a video running assessment he was found to have a slight pelvic hitch on landing on right leg more than left, and had cross over gait more right than left causing him to land on outside of foot in more supination.

We progressed through frontal lateral leaps, hops and running drills ok and I added transverse plane medial reaches in sagittal plane and transverse plane leaps/hops etc to address medial hamstring/obliques weakness and at time it seemed to cope ok with exercises and progressions to hops and running drills as re-test was strong at end of session. However the pain resurfaced when trying to returning to running training after a few weeks so I am back to drawing board and feeling like I need some help as to where to go from here.

My questions in my mind are

- Can the weakness in his obliques be the cause the medial bias test weakness or would you suspect I need to go back and check more distal structures eg hamstring, tib post. I recall from videos that weakness on his ant gluts on lateral bias can be from obliques/pelvic floor but wasn't sure if medial bias can be so affected by core area? Looking back I haven't used medial bias test as a KPI post int obliques release so will do this next session as this may give clues to this answer but just wondering whether to first target obliques or distal structures such as adductors/hamstring/tib post first.
- He was weak without pain when testing both frontal planes. Have you found incidences where you need to work on strengthening both medial and lateral frontal planes or is it always a case that one is weak and causing overload and then weakness in the other and so its a case of working this out and focusing on one of these planes.
- Does a cross over gait causing him to land in supination suggest that the lateral plane is still the priority to address needs work or should I consider anything else? Landing on the outside of his foot will put a lot of pressure through his peroneal eccentrically so will go back and check this but I am thinking this is a secondary factor that gluts are not doing good enough job to counteract adductors/medial hamstring bringing his leg inwards when landing.
- He runs on the track where they always train and run anti-clockwise so I wonder if this is a factor in the injury developing - have you found this as an issue when treating track runners and if so do you factor any extra strategies into their end rehab for this?

Many thanks in advance for you help,


Sarah
 

SarahStephenson

Mentorship Member
Joined
Mar 12, 2021
Messages
7
Dear Team,

Just to update you, I saw this patient again yesterday and think I have isolated his problem to peroneals. The lat bias was weak but much better when tested above ankle, the medial bias the same (so tib post overload/weakness)so think the back and oblique weakness was less of a factor.
I would still be interested to hear of thoughts to questions especially relating to cross over gait correction and also how to load peroneals for higher rehab exs eg leaps, hops. I have emphasised pushing through big toe for slouches and slouch to box.
Would you continue work through frontal plane to work peroneals more eccentrically so that it mimics his running style or look at working peroneals in concentric position?
Many Thanks,

Sarah
 

SarahStephenson

Mentorship Member
Joined
Mar 12, 2021
Messages
7
Hi Shane, thanks very much for the input all really useful questions for me to consider.
I think I do have the right access I just posted it into wrong area so will make sure I use difficult patients section next time.
Thanks again,

Sarah
 
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