Abstract:

Background: Ultramarathons span distances over 50 kilometers through all types of terrains.(1)  The intensity of these races puts exorbitant amount of strain on the body leading to lower extremity injuries, including Patellofemoral Pain Syndrome and Iliotibial Band Syndrome.(2) (3) (4)  Related to musculoskeletal inequalities, incorrect biomechanical function in gait, and most importantly over  training.(2) (3)  These injuries are frequently treated with stretching, self myofascial release (SMF), and anti-inflammatories.

Objective: This study is to determine if manual therapy can be used to decrease a runners ailments, there by improving their running performance.

Case Presentation: 24 year old female ultrarunner with chronic pain of the left knee and hip following an undiagnosed injury to the knee.

Intervention: Patient was treated for 8 sessions ranging from 1-2 hours each, over the course of 5 weeks. Treatment performed by student therapist, taking full postural assessments at the beginning of each session.(5) Treatment with manual therapy techniques focused on releasing Tensor Fascia Latae, iliotibial band, and breaking up tension in patellar retinaculums. Patient was given exercises for activation of Gluteus Medius.  Progression was rated using Bournemouth Musculoskeletal Questionnaire for pain, Fitbit sleep tracker, as well as a goniometer to measure hip ROM.

Outcome:  Patient achieved clinically significant improvement on the Bournemouth Musculoskeletal Questionnaire, increase hip range of motion, and was no longer waking up from pain. Furthermore, the patient was able for the first time to complete a 50 mile race without stopping, the use of stretching, pain management treatments, or a knee brace.

Keywords: ultrarunning, ultramarathons, running, knee pain, Tensor Fascia Latae, Iliotibial band, Gluteus Medius, Manual Therapy, Patellar retinaculums, Patellofemoral Pain Syndrome, Iliotibial Band Syndrome, Musculoskeletal inequalities