Treating complex orthopedic injuries is often associated with lengthy rehabilitation. It often takes several months before a patient can resume training. The following case, including EMG-based training therapy for a foot fracture in a dedicated recreational marathon runner, shows how the patient was able to return to running after only four therapy sessions.
Downtime – Several weeks
Many people know the feeling when they’re told after an injury that they must completely refrain from sports and training for several weeks or even months. That’s it for all the hard-earned progress. Now, or in many weeks, it’s back to square one. This was also true in our example. After an accident, the patient was given an offloading boot in the emergency room and a blanket recommendation for strict rest over several weeks. But physiotherapist Simon Roth and his team were able to begin treatment just ten days after the injury to address muscular deficits early and help the patient get active again soon.
Session 1: Initial Assessment and Stabilisation
In the first session, the activation of the gluteus medius was examined using EMG mapping. This involves scanning resting activity, voluntary, and involuntary movement for abnormalities and potential imbalances. Using the myoact app, the recorded values were compared to standard reference metrics. A significant loss of muscular control on the affected side was identified, prompting the introduction of tailored exercises. With the help of biofeedback, the team selected exercises that avoided loading the foot while still activating the gluteus medius. Attention was also paid to the upper extremities, as using crutches can lead to muscular imbalances in the shoulder and neck area. Mapping helped identify these imbalances and initiate targeted corrective exercises.
Session 2: Progress Check and Adaptation
In the second session, held six weeks later, a retest was performed to assess the patient’s progress and adjust the program as needed. Muscular activation had improved. The patient had consistently performed exercises, such as the “Clamshell” drill. At the same time, strategies for overcoming fear of movement were implemented to gradually reintroduce weight-bearing on the foot. The peroneus muscle was also specifically activated to support forefoot pronation.
You can also view all the details of the case described here in the recording of the case study webinar.
Session 3: Return to Functional Loading
By the third session, at week 12, the patient was no longer using crutches and began progressive exercises such as unilateral squats. Special attention was given to ensuring proper loading and avoiding compensatory movements. A functional load test of the big toe joint still showed deficits, as this area had been offloaded longer. Using biofeedback, the most effective exercises were identified by measuring which exercises optimally activated the target muscles, maximizing training benefit for the patient.
Session 4: Integration and Running Analysis
During the fourth treatment (week 15), progress in gluteus medius activation under load was visible. The patient overcame fears by performing lateral load-bearing and jumping drills. A running analysis using pedobarography and EMG showed nearly symmetrical muscular activation, though contact time on the right foot was still elevated.
Results After 4 Sessions
The systematic training across the entire muscular chain led to a transition from voluntary to involuntary control. The combination of mapping, targeted biofeedback training, and proactive fear-management strategies enabled the patient to return to pain-free running much faster than expected and resume marathon training sooner than anticipated.
Conclusion
This example is intended to encourage a more individualised approach rather than relying on generalised treatment recommendations. The return to sport should be as active as possible and tailored to each patient.
Mapping and biofeedback training provide an opportunity to precisely address muscular deficits and select exercises based on the patient’s specific condition using real-time biofeedback.
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