Body Weight Support Return to Running in a Patient with Musculoskeletal Hip Pathology: A Case Study

Abstract

Background and Purpose:  Tendonosis is a weakened tendon, as can occur after prolonged running injuries, making return to running difficult. Stressing the tendon enough to remodel to become stronger, but not create further damage is a delicate balance. The purpose of this case study is to demonstrate how a body weight support device commonly used for patient with neurological conditions could have benefits to an orthopedic population as well. Measures/Intervention: A 24 year old female with right hip illopsoas tendonosis and labral damage presented with return to running goals. The patient presented with groin and sacroiliac pain, poor right gluteus medius neuromuscular control and decreased strength, fear of pain associated with running of 6/10 and increase in pain within 30 seconds of running. The patient participated in 27 session of progressive body weight support running over 13 weeks. Outcomes:  The patient was able to run for 31 minutes 29 seconds prior to increase in symptoms, she returned to her running group 1x/week, fear of pain decreased to 1/10, right gluteus medius strength improved to 98% of that of the left and neuromuscular control improved. Midpoint to final Lower Extremity Functional Scale score improved by 7 points which is just shy of a clinically meaningful change. Gait analysis revealed decreased stride length. Conclusion and Clinical Relevance: This intervention may be beneficial to orthopedic populations for task specific progressive loading of soft tissue to withstand forces, task specific neuromuscular re-education, fear avoidance model exposure to tasks, and progressive training. This intervention would fit within standard physical therapy addressing impairment based exercises and manual interventions. More study is needed using body weight support devices in orthopedic rehabilitation goals.