Running Physio assessment template

Presenting Complaint: Primary area of pain or limitation: Left Achilles tendon Date of onset: 01/09/2024 Mechanism of onset: [ ] Gradual [x] Sudden [ ] Trauma [ ] Training change Pain at rest (0-10): 2 Pain with running (0-10): 7 Current symptoms during or after running: Sharp pain in the left Achilles, particularly during initial push-off and after runs. Running Background: Running experience: [ ] Beginner [x] Recreational [ ] Competitive [ ] Elite Years running: 5 Typical weekly frequency (pre-injury): 3 sessions per week Typical weekly distance (pre-injury): 20 km Longest regular run (pre-injury): 10 km Current Running Schedule: - Patient currently runs on Tuesdays (5km easy), Thursdays (5km tempo), and Saturdays (10km long run). Recent Training Changes (Last 6-8 Weeks): [x] Increased weekly distance [ ] Increased running frequency [x] Increased intensity/speed work [ ] Added hills or trail running [ ] Change in footwear [ ] Change in running surface [x] Reduced recovery days [ ] Return after time off Details: Increased weekly distance from 20km to 30km over 4 weeks, incorporating more high-intensity interval training, and reducing rest days from 2 to 1 per week. Cross-Training & Strength Training: Current cross-training: Cycling (30 minutes, 2x/week) Strength training: [ ] None [x] 1-2x/week [ ] 3+x/week Key exercises performed: Calf raises, squats, lunges Footwear & Equipment: Current running shoes: Brooks Glycerin 20 Shoe age / approx. km on shoes: 6 months / 600 km Orthotics: [x] No [ ] Yes - custom or off-the-shelf if mentioned Injury History: Previous running-related injuries: Right knee pain (patellofemoral pain syndrome) 2 years ago, resolved with physio. Previous stress injuries or fractures: None present. Other relevant musculoskeletal injuries: Occasional low back stiffness. Past medical history: No significant medical history. Load Tolerance & Recovery: Symptoms during run: [ ] None [ ] Mild [x] Moderate [ ] Severe Symptoms after run: [ ] None [x] Same day [ ] Next day [ ] >48 hrs What settles symptoms: Rest, ice, and stretching the calf. Sleep quality impacted by symptoms: [ ] Yes [x] No Goals & Expectations: Primary running goal: To run a pain-free 10km race. Upcoming races or events: Local 10km charity run on 15/12/2024 Short-term goals: Reduce Achilles pain to 3/10 or less during and after running. Long-term goals: Complete a half-marathon next year without injury. Red Flag Screening (Running-Specific): "The following screening questions are used to identify **bone stress injury, systemic risk factors, and training-related red flags**, consistent with best practice in running injury management." Bone Stress & Load-Related Risk: [x] Pain localised to one spot on bone [x] Pain worsens progressively with running [ ] Pain present at rest or at night [x] Pain persists or worsens despite reduced training [ ] Swelling, warmth, or focal tenderness over bone Training & Load Red Flags: [x] Rapid increase in distance, intensity, or frequency [x] Introduction of speed work, hills, or trails recently [x] Running through increasing pain [x] Minimal recovery days between sessions Health & Energy Availability: [ ] History of stress fracture [ ] Low energy availability / inadequate fueling [ ] Significant recent weight loss [ ] Menstrual irregularity, if applicable [ ] Low bone density / osteoporosis diagnosis "If multiple red flags are identified, running may need to be **paused or modified**, and further investigation (e.g. imaging or GP referral) may be required prior to progression." Objective Running Assessment (Clinician Use): Observation: Fascial hernia: No Atrophy: No Discolouration/bruising: No Foot, Ankle & Toe Assessment: "Normative Guidelines (Running): 1st MTP extension ~60-65 degrees (functional running range). FHL strength: able to tolerate single-leg heel raise with hallux load without pain. Foot intrinsics: ability to dissociate toes / maintain short foot during single-leg tasks." 1st MTP (toe) extension ROM (WB or NWB): Right: 65 degrees Left: 60 degrees Adequate functional toe extension for running (approximately 60-65 degrees): [x] Yes [ ] No FHL (Flexor Hallucis Longus) strength: Resisted hallux flexion: [ ] Strong [x] Reduced [ ] Painful - left Single-leg heel raise biasing hallux load: [ ] Tolerated [x] Limited - left Foot intrinsic control (toe dissociation / short foot): [x] Adequate [ ] Reduced BKTW Screening (Ankle Dorsiflexion): "Normative Guidelines: knee-to-wall distance approximately 8-12 cm. Side-to-side difference under 2-3 cm. Quality: heel down, controlled midfoot." Knee-to-wall distance: Right: 10 cm Left: 8 cm Side-to-side difference greater than 2-3 cm: [x] Yes [ ] No Movement quality: [x] Heel stays down [x] Neutral foot control [ ] Excessive pronation / collapse noted Strength & Control: Single-leg squat: [ ] Pass [x] Needs work - left Step-down control: [x] Pass [ ] Needs work Trunk control during single-leg tasks: [x] Adequate [ ] Reduced Isometric Maximum Strength Testing: "Normative Guidelines: side-to-side difference under 10-15%." Hamstring 90 degree flexion prone: Right: 180 Newtons [x] Strong [ ] Reduced Left: 170 Newtons [x] Strong [ ] Reduced Side-to-side difference: 5.8% Side-lying hip abduction: Right: 150 Newtons [x] Strong [ ] Reduced Left: 130 Newtons [ ] Strong [x] Reduced Side-to-side difference: 13.3% Seated knee extension at 90 degrees: Right: 200 Newtons [x] Strong [ ] Reduced Left: 195 Newtons [x] Strong [ ] Reduced Side-to-side difference: 2.5% Calf & Lower Limb Capacity: "Normative Guidelines (Running): single-leg capacity 25 or more repetitions with good control. Side-to-side difference under 10-15%. Symptom response: no increase beyond 24 hours." Single-leg calf raises (target 25 or more): Right: 30 repetitions Left: 18 repetitions Symptom response to calf loading: [ ] Nil [x] Mild [ ] Significant 90/90 elevated capacity fatigue test (target 25 or more): Right: 28 repetitions Left: 15 repetitions Impact & Plyometric Testing: Double-leg hopping: [x] Tolerated [ ] Symptomatic Single-leg hopping: [ ] Tolerated [x] Symptomatic - left 24-hour symptom response to impact: [x] Settled [ ] Increased Running Observation: Cadence: 165 steps per minute Overstriding: [ ] No [x] Yes Foot contact: Rearfoot Trunk lean: [x] Adequate [ ] Excessive Pelvic control: [ ] Adequate [x] Reduced