Rehabilitation of Running Injuries

Return to Sport in Athletes with Midportion Achilles Tendinopathy: A Qualitative Systematic Review Regarding Definitions and Criteria

“…Diagnosis based on clinical examination and US Resumed their previous activity level (before injury) During the 12-week training regimen, jogging/walking activity was allowed if it could be performed with only mild discomfort and no pain Patients were instructed to start jogging or walking at a slow pace, on flat ground, and for a short distance. Thereafter, their activity could be gradually increased if there was no severe pain in the tendon RR not reported VAS mean 9–12/100 after resuming previous activity level McShane et al [ 34 ] (2007) Narrative review NA Non-insertional Achilles tendinopathy Pain-free return to activity Back to their pre-injury level training regimen Returned to pre-injury training levels Not reported Both not reported Nicola and El Shami [ 35 ] (2012) Clinical commentary NA Midportion Achilles tendinopathy Return to running without pain Daily activities should be pain-free before returning to training For soft tissue injuries, there should be minimal residual tenderness In general, a period of 1–2 weeks of pain-free daily activities should be present before any consideration of return to running No running until patient is able to walk comfortably at 4.0 mph for 10 miles per week Both not reported Paavola et al [ 24 ] (2000) Pre-post study 83 Patients; 22 F, 61 M; 32 ± 11 years Competitive and recreational level, running and orienteering A diagnosis of unilateral, non-chronic Achilles tendinopathy based on clinical examination (defined as exertional pain and palpable tenderness in the Achilles tendon of < 6 months’ duration) Returned to their pre-injury level of physical activity Fully recovered their physical activity level Not reported Both not reported Paavola et al [ 36 ] (2002) Review NA Combination of Achilles tendon pain, swelling, and impaired performance To return the patient to the desired level of physical activity without residual pain. In athletes, an additional demand is that the recovery time should be as short as possible Able to r...…”

“…When defining RTS, a few authors described ‘absence of pain’ as follows: ‘pain-free return to activity’ [ 34 ], ‘return to running without pain’ [ 35 ], or ‘return the patient to the desired level of activity without residual pain’ [ 36 ].…”

“…Some studies reported a complete absence of pain as a criterion for RTS, whereas other studies accepted a certain level of pain. One study reported that pain during sports activities should not exceed 30 mm on a 0–100 mm visual analog scale (VAS) [ 22 ], while other studies stated that daily activities should be pain-free [ 35 ] or with minimal pain (1–2 on a 0–10 numerical pain rating scale) [ 8 ] before RTS can be considered.…”

“…Within the included studies, multiple aspects of functional recovery were described as criteria for RTS after AT. Nicola and El Shami reported that return to running should not be considered until one is able to walk comfortably at 4.0 miles per hour (mph) for 10 miles per week [ 35 ], whereas Werd stated that “RTS decisions should be based on […] the ability of the athlete to perform the necessary skills of the sport without restriction” [ 38 ].…”

Common Running Overuse Injuries and Prevention

“…Peak adduction is achieved at the mid-stance, while peak abduction is the highest at the middle of the swing phase (Novacheck, 1998). Th e ankle is inversed (6 to 8°) at foot-strike, then it moves to 8° of eversion through the amortization phase (Nicola & El Shami, 2012). Th e eversion range of motion during stance phase is the main determinant of the foot pronation.…”