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On the Fast Track

How PT clinics across the country are helping patients run smarter, faster and better

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Many dedicated runners out there are certainly fans of other sports too. They'll go to ballgames, talk about the local teams, keep up with standings, and play in rec leagues. But running is different. While those other sports are more of a diversion, running feels like a calling, a reason for being, a physical and spiritual embodiment. Running isn't something they play -- it's something they are.

That calling has resonated in recent years across America. There are more runners than ever on trails nationwide and road races are setting participant records, with thousands of new events popping up every year to meet skyrocketing demand. Half-marathons and marathons have seemingly become the new 5Ks and 10Ks.

From a physical therapy standpoint, that certainly means injuries to treat. But it signifies something else as well. With the exploding popularity of running, an opportunity has been created for PT professionals to specialize in this area of sports medicine. In fact, one of the most notable trends in the field is a proliferation of clinics focusing on runners, with emphasis on proper gait, biomechanics and foot strike to both prevent injury and enhance performance. This niche enables promoting the brand of physical therapy and expanding its reach, all while creating a mutually beneficial relationship with an ever-growing population.

Shipping Up to Boston

The Spaulding National Running Center (SNRC) in Cambridge, Mass., is one such clinic. Irene Davis, PhD, PT, FAPTA, FACSM, FASB, serves as both the center's director and a professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She moved to Massachusetts in January 2011 specifically to launch the running center, after working for two decades at the University of Delaware in Newark.

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The Spaulding National Running Center (SNRC) in Cambridge, Mass., features force plates, motion-analysis tools, accelerometers, EMG equipment and a two-belt instrumented treadmill to capture real-time data and improve running mechanics. Opposite top photo, SNRC Coordinator Robert Morrison, DPT, studies the movement patterns of doctoral research fellow Erin Futrell. The training program at the center is performed barefoot, explained SNRC Director Irene Davis, PhD, PT, FAPTA (pictured on cover).

"While at Delaware, I had been researching running mechanics and their relationship to injury," she told ADVANCE. "I also started developing interventions for altering the mechanics I found to be related to injury. Once you establish a relationship between mechanics and injuries, you then have to alter them to reduce injury risk. That's really what led me down the gait retraining path, and developing interventions to change the way people run."

Davis had a vision to create a running center where these interventions could be implemented, and with the help of networking was able to make it happen.

"I met the chair of the Department of Physical Medicine and Rehabilitation at Harvard, who became excited about the idea of developing a clinical and research center focused on running in the Boston area. Personally, I felt very excited about taking my previous work to a new level where I could start a clinic, develop and mold it based on research and evidence-based practice for treating runners."

After arriving at the Spaulding Out­patient Center, Davis set about carving space within it.

"We spent the first year building out the clinic and research lab spaces," she explained. "Our grand opening was in April 2012, right before the Boston Marathon. Then we spent much of 2012 doing hardware and software development and integration, as well as reliability and validity studies in the research lab."

To enable cutting-edge research, along with runner evaluation and treatment, the running center includes force plates, motion-analysis tools, accelerometers, EMG equipment, and a two-belt instrumented treadmill.

"Our focus is and always will be on everybody from casual runners to elites, teenagers to 90-year-olds," related Davis. "We believe the closer we are to using our bodies the way they were designed, the less risk for injury. So the entire training program at SNRC is done barefoot. We believe everyone who wants to should be able to run pain-free, that running is the most natural form of exercise and can change the way you live your life. We do this by providing evidence-based, state-of-the-art treatment approaches to ensure the best running mechanics possible."

Track Town USA

On the other side of the country in Oregon is a picturesque city called Eugene, where the Willamette River meanders beneath towering Cascade Mountains. Affectionately known as "Track Town USA," it was here that legendary University of Oregon distance runner Steve Prefontaine raced against history in the 1970s under the tutelage of iconic Coach Bill Bowerman, a co-founder of Nike. The city is also home to Eugene Physical Therapy, which operates a running clinic under the direction of co-owner Jeff Giulietti, MPT, ATC, OCS, CSCS, COMT, FAAOMPT.

"We started Eugene Physical Therapy 11 years ago and founded the Running Clinic four or five years ago as an outreach program for people who typically wouldn't consider themselves patients," he said. "We work with a lot of runners and find many of them actually choose not to go to physicians for different reasons. Sometimes it's because they're only given medication as a treatment, and typically they haven't received a recommendation to go to physical therapy. So we entered this project with the idea of promoting our expertise in working with runners."

The predominant diagnoses Giulietti encounters among his running clients relate to the ankle, hip or knee, including iliotibial band syndrome.

"In reality, if you go deeper into the clinical examination, that's often a lumbar spine or sacroiliac problem," he explained. "Diagnoses such as IT band syndrome are the tip of the iceberg, because the anatomical attachments of these muscle groups are the pelvis. So if you're just doing foam roller exercises, which have become very popular in the PT realm, it's not enough. That's where having training in manual therapy and musculoskeletal differential diagnosis really helps our clinical expertise and outcomes for these patients."

Giulietti also spoke about the running gait abnormalities he tends to see among patients.

"Excessive heel strike is very common. One of the reasons for that is running shoes over the past 25 years have developed such a large heel cushion. Prior to that, it would have been very painful to run with this type of abnormal gait pattern. But shoes today enable you to have great biomechanical errors and actually get away with it. I'd also say excessively short stride is a common error, as well as lack of trunk rotation and arm swing."

Gateway Gait

Meanwhile, in America's heartland, a third PT clinic is also specializing in treatment of runners. The Program in Physical Therapy at Washington University in St. Louis launched its running clinic about three years ago as part of a pre-existing full-service practice. Gregory Holtzman, PT, DPT, associate professor of physical therapy and associate director of the clinical practice, has overseen the running clinic's development with a simple focus in mind.

"Our goal is really to help all runners who come here understand the impact not only of their running mechanics, but also the way they move in general," he related. "And how those two aspects impact each other to potentially contribute to pain and injury. That way they can put it all together, learn how to move more appropriately, and manage their injury to achieve running or performance goals."

The running clinic's equipment is fairly simple, Holtzman continued.

"Basically we have a treadmill that allows flat, uphill and downhill running. The motor is underneath, so we can obtain video from the front, back and side without any obstruction. The key aspect to our camera is its slow-motion capabilities. So I can take 3 seconds of video and expand it to 12 seconds. That really helps me break things down for runners and lets them visualize what we're talking about. I think they're always impressed and fascinated by the video aspect."

At each of the running clinics in Cambridge, Eugene and St. Louis, clients receive an extensive initial evaluation followed by shorter appointments to reinforce target areas and gauge progress. The duration of treatment regimens can vary based on the patient, but typically range from a few weeks to a few months.

"I would say to the physical therapy community as a whole that running gait is a very specific skill set," concluded Giulietti. "And the ability to effectively treat runners isn't achieved simply by going through a PT curriculum. You need to start working with a lot of runners, become educated on treating them and have a very good understanding of lower-extremity kinematics. Sometimes runners can have a normal office exam, but still go out and feel pain within a half-mile. You don't need to be a runner to treat a runner, but it certainly helps. This is a wonderful group of athletes who are unique."

Brian W. Ferrie is on staff at ADVANCE. Contact: bferrie@advanceweb.com

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