Marathon runners often come to us with pain, but also they need to build up their mileage in preparation for one of the most challenging events in endurance sport. They're trying to do more when their body may be telling them they need to be doing less. 

How do we manage their symptoms, and guide them up to the marathon itself?

Find out in this podcast with Tom Goom (Running Physio).

150. Top tips for treating marathon runners. Physio Edge Track record: Running repairs podcast..

Apophyseal injury in children and adolescents are common and usually respond to simple unloading interventions. But what is the underlying pathology and why do some children succumb and others not? And why do some apophyses become painful and others fail completely with a complete avulsion? Despite these questions it is an area that is under-researched and few people have a specific interest in this area. 

Listen to the insights of Dr Matthieu Sailly, who is a French sports physician who has expertise and research interest in injuries in young athlete. He was the head of the Aspire Academy medical centre where he worked extensively with highly trained adolescent athletes and developed experience on growth related injuries and long term development strategies for immature athletes in various sports.

See also:

Physeal injuries in children’s and youth sports: reasons for concern?: http://bjsm.bmj.com/content/40/9/749.full

Sports-related acute and chronic avulsion injuries in children and adolescents with special emphasis on tennis: http://bjsm.bmj.com/content/41/11/827.full

“Goalkeeper’s hip”: acute haematogenous osteomyelitis secondary to apophyseal fractures: http://bjsm.bmj.com/content/40/9/808.full

Matthieu Sailly - Apophyseal injury in children and adolescents

When your patient has heel pain with their first few steps in the morning, after sitting for a while or at the start of a run, a diagnosis of plantar heel pain (PHP) or plantar fasciopathy might jump straight to the top of your list. How will you treat your patients with PHP? How long will it take? How can you explain PHP, the rehab and recovery to your patients?

In this podcast with Henrik Riel (Physiotherapist, researcher and PhD candidate at Aalborg University) we take a deep dive into PHP, and how you can treat it, including:
- How to describe plantar heel pain to your patients
- How to explain to your patient why they developed PHP, recovery timeframes and rehab
- Plantar fasciitis, plantar fasciopathy, plantar heel pain? What's the most appropriate terminology?
- Differential diagnosis for PHP including neuropathic pain, fat pad irritation, contusion or atrophy, calcaneal stress fracture and other diagnoses
- How to systematically perform an objective assessment and diagnose PHP
- Assessment tests to identify factors contributing to your patients pain
- Whether your patients require imaging
- How long PHP takes to recover
- What factors affect your patients prognosis and recovery times
- How to differentiate your treatment for active or sedentary patients
- Whether your patients can continue to run with PHP
- Factors that may hinder the recovery of your sedentary patients, and how to address these
- Whether your patients should include stretching in their rehab
- Types of strengthening to include in your rehab - isometric, isotonic or otherwise
- How many sets and reps should your patients perform of their strengthening exercises
- Whether orthotics are useful
- Corticosteroid injections - do they help or increase the risk of plantar fascia rupture?

Articles associated with this episode:
Alshami et al. 2008. A review of plantar heel pain of neural origin: differential diagnosis and management.
Chimutengwende-Gordon et al. 2010. Magnetic resonance imaging in plantar heel pain.
Dakin et al. 2018. Chronic inflammation is a feature of Achilles tendinopathy and rupture.
David et al. 2017. Injected corticosteroids for treating plantar heel pain in adults.
Digiovanni et al. 2006. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up.
Hansen et al. 2018. Long-Term Prognosis of Plantar Fasciitis: A 5- to 15-Year Follow-up Study of 174 Patients With Ultrasound Examination.
Lemont et al. 2003. Plantar fasciitis: a degenerative process (fasciosis) without inflammation.
Rathleff et al. 2015. High-load strength training improves outcome in patients with plantar fasciitis: A randomized controlled trial with 12-month follow-up.
Riel et al. 2017. Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on.
Riel et al. 2018. The effect of isometric exercise on pain in individuals with plantar fasciopathy: A randomized crossover trial.
Riel et al. 2019. Self-dosed and pre-determined progressive heavy-slow resistance training have similar effects in people with plantar fasciopathy: a randomised trial.

Other Episodes of Interest:
PE 062 - How to treat plantar fasciopathy in runners with Tom Goom
PE 061 - How to assess and diagnose plantar fasciopathy in runners with Tom Goom
PE 060 - Plantar fasciopathy in runners with Tom Goom
PE 038 - Plantar fasciopathy loading programs with Michael Rathleff
PE 012 - Plantar Fascia, Achilles Tendinopathy And Nerve Entrapments With Russell Wright

Physio Edge 092 Plantar heel pain - The latest research how to apply it with Henrik Riel

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