Dear All
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I have a young male sprinter 17yrs old who complains that his right arm goes numb and feels disconnected when sprinting, this occurs after a couple of 60meter sprints. He also experiences a similar feeling in the right upper lateral leg but this is after a lot of training. He also reports mild lateral right knee and hip pain when sprint training. He was referred by his GP to physio who didn't know what it was and referred to me thinking it may be due to poor shock attenuation due to his 'flat feet'. However this seems unlikely to me since when sprinting he is a forefoot striker and uses a lot of knee flexion extension in propulsion. At low medium speeds and walking he changes to heel strike. On the treadmill video pics he is running fast enough to get onto toes. Watching him run outside his vertical CoM displacement becomes less the faster he runs and greatest at medium speeds with heel strike.
My feeling was this was a neurological problem perhaps down to two possibilities:
1) Nerve in the brachial plexus being compressed by muscle tension because of high arm / hunched shoulder posture during sprinting. (doesn't explain leg neuropathy)
2) Problem of restriction of blood supply to CNS possibly at the brain and through the Circles of Willis. (This might also explain leg problem)
Speaking to the physio I usually ref to he thought the most likely cause was tightness in the trapezium due to arm and shoulder posture. I referred to Him and wrote to GP outlining my concerns.
Any thought on that would be appreciated.
I am still making him orthoses to help with running in terms of the lateral knee pain and hip pain, which may be from lateral knee compartment compression since it is likely from his assessment that there are high abduction moments at the knee from GRF and CoP on the lateral foot. The large pronation RoM through the forefoot is tending to internally rotate the knee and this results in high tension in the ITB as it resists this. I was thinking of a high arched flexible orthosis with forefoot medial posting, EVA neutral post in the rearfoot and 4mm heel lift.
You can see from the attached pics that the CoP on the right foot is mostly lateral and the velocity increase significantly in midstance.
From the Video pics - At forefoot strike the foot and STJ is extremely inverted and at late midstance the rearfoot is still inverted but the forefoot goes through a large range of pronation and the medial ankle ligaments and retinaculum are under high tension ( shown by red arrow). The medial arch is almost completely flattened at this point. The left foot is similar and fromthe pressure mat data appears to bend at the midfoot during midstance i.e. the pressure increases on the lateral midfoot as the heel pressure reduces.
My question would be this: If I were to use the orthotic prescription described, would this reduce tension in the medial ankle ligaments (and probably the spring ligament) and so reduce the amount of stored energy available for propulsion? Or would this be compensated somewhat by the energy stored in the orthosis medial arch during its deflection.
By reducing the functional RoM of the forefoot and allowing the heel to contact the ground for longer and with possibly with more force, would this be reducing the potential of stored elastic energy and so reduce sprinting maximum speed?
The paradox may be that, I would imagine, this person would like to stop injury occurring and injury potential but at the same time maintain maximum effort potential (in terms of muscle and ligament forces) in order to gain maximum sprint speeds.
This pic shows vertical CoM excursion
What would you say here please?
Cheers and Regards Dave
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