the muscle belly. Resisted motion will be painful and pain is not typically referred4. Skeletal induced pain is localized. It will have inconsistent and overlapping segmental referral patterns and should be unilateral 4. Soft tissue dysfunction (trigger points) can produce pain in both and distal structures 8. When soft tissue structures are injured the sequele to the injury is one of altered biomechanics. It is impossible for a muscle to perform normally once adhesions are formed. Both function and movement on a macroscopic scale are altered 8. Trigger points are defined as extremely tender spots in a tight band of muscle which produces symptoms. Trigger points can be caused by: 4 Constant muscular contraction Overuse Emotional stress Localized trauma Sub-optimal local environment such as heat, cold, damp Prolonged muscle inactivity Hormonal imbalances Nutritional imbalances Compensation with antagonist for agonist Visceral disease There are two main classifications of soft tissue injury types, acute injury and repetitive motion injury. An acute injury refers to the muscle and fascial tearing from an acute trauma immediately resulting in inflammation to the area. The white blood cell, fibrinogen, adhesion process easily sets in forming palpable nodules within the structure of the muscle. Repetitive motion injury is related to specific physical factors related to overuse. These factors will decrease circulation and compromise cell recovery due to many factors. Cellular retention of calcium, poor repair, and altered function create a chronically inflamed tissue making proper function impossible 8. Many factors are potentially associated with hip injuries in running (table I). These predisposing factors may be divided into extrinsic and intrinsic categories (table II), but injuries most likely result from complex interactions among the various factors 2. Factors potentially associated with hip injuries in running 2 Significantly associated Previous injury Inexperience Competitive running Running distance (>64km [40 miles] a week) Excessive hip external rotation Narrow tibial width Regional muscle strength Incomplete rehabilitation of prior injury Running Related, but unclear or contradicting based on limited data Inadequate warm-up or stretching routines Taller body
height Lower extremity alignment Poor flexibility Running frequency Recreational running Running routine consistency Shoes used for >400km of running The use of orthoses Foot hyperpronation More aggressive or motivated running Not significantly associated Age Sex Body mass Hill or running Running on hard surfaces Time of the year or weather Running in the morning vs. times of the day Abnormal Pelvic obliquity Femoral anteversion Hip injuries in running are related to extrinsic factors including improper technique, poor shoes or running surfaces, abrupt changes in running routines, inadequate nutrition or hydration, excessive mileage (>64km [40 miles] a week) or rapid intensity advancement. If these and similar factors are not addressed, hip injuries may reoccur when runners resume their previous training regimens 3. Table II. Predisposing factors to overuse running injuries 2 Extrinsic Training errors (excessive volume, excessive intensity, rapid increase, sudden change, excessive fatigue, inadequate recovery, faulty technique) Surfaces (hard, soft, cambered) Shoes (inappropriate, worn out) Equipment (inappropriate) Environmental conditions (hot, cold, humid) Psychological factors Inadequate nutrition Intrinsic Malalignment (pes planus, pes cavus, rearfoot varus, tibia vara, genu valgum, genu varum, patella alta, femoral neck anteversion,