Sunday, April 8, 2012

Common Running Injuries and How to Treat Them

Our calendars have been marked with numerous races over the past few months, and many of you have enjoyed participating in some of those races. But along with the increase in WOOT and WOOP members training for and running in these events, there has also been a marked increase in injuries. Fortunately, we have on our team several women who are qualified to offer advice on a variety of running-related topics, and who are willing to do so. WOOT and WOOP member Crystal Brooks recently obtained her degree in Sports Medicine, and was happy to provide some treatment tips on some of the more common running injuries. Thank you Crystal!

Post by Crystal Brooks

Before I get into the nitty gritty, here is my disclosure: I AM NOT A SPORTS DOCTOR. I did however, recently graduate from college with a degree in Sports Medicine, and my intent is to pursue a career in physical therapy upon my return to the States. Please do not take everything I say as gold, for I do not know it all, but I do hope to provide you all with some useful information relating to running injuries. Running injuries are not uncommon; in fact they are far too common. As runners, we often try to ignore the symptoms of an encroaching injury and attempt to train through them in the hopes that the injury will disappear, when in fact the symptoms are likely to get worse. Shin splints, plantar fasciitis, achilles tendonitis, and ITB are four of the most common overuse running injuries.

Shin splints are an overuse injury that affects many runners. Often times it is the way in which the athlete is running as well as the shoes they wear which can result in shin splints. Even though there is no definite cause as to why shin splints happen, it has been linked to inflammation along the tibia which activates the pain. In most cases the pain arises during activity. Some athlete’s have found that if they change their foot strike, they often develop pain around the shin. In general, it is good practice to focus on foot strike to help alleviate pain in your lower legs. When you are running, your heel should be the first to strike the deck, then the middle of the foot, followed by the ball of your foot. Shin splints can also lead to stress fractures on the tibia, which can set a runner back for a minimum of four weeks of no running. Common indicators for shin splints are mild swelling as well as tenderness located on the inside of the tibia (or shin bone).

If you notice discomfort in your lower legs after running, ice the area immediately. The ice will help minimize swelling and hopefully reduce the severity of the injury. It is also suggested that you do not run or do any impact fitness for about two weeks, or until the injury has healed. NSAID’s (Non steroidal anti-inflammatory drugs) will also help minimize the pain and swelling. Motrin may also be used, if necessary.

Once you decide to return to running, you need to ease back into it. Doing too much too soon will likely aggravate the previously injured area. There is a good stretching exercise which you can do prior to running, to help reduce pain in your shins. You can stand or sit (depending on how well your balance is), take your toes and flex them towards your body (or up if you are standing). Hold this flexion for about 10 seconds. I personally do this exercise two or three times depending on the length of my run.

Another very common injury for runners is plantar fasciitis. I have personally experienced this injury and know that the severity of it can get downright painful. The plantar fascia tendon originates at the heel and disperses among the toes. The tendon becomes strained through repetitive training and inflammation evetually occurs. Initial pain may start at the heel where the tendon originates. Generally a burning sensation or irritation will generate around the heel and progress up towards the arch of the foot. The pain in the foot also tends to be greater when you first wake up, and then it slowly disappears after moving the foot.

Runners tend to experience this injury a lot, due to the constant pounding on the pavement or trail. Uphill running may also aggravate the symptoms of plantar fasciitis. This is another injury that runners tend to IGNORE…which is not a good idea. If the injury is not treated, or given time to heal, it can eventually become difficult to not only run, but also just to walk. 

If you think you may have plantar fasciitis, then I highly recommend that you stop running and seek medical advice. Plantar fasciitis is an injury that may always continue to plague you. Of course NSAID’s are always recommended to help with inflammation and pain, but if you prefer non-medicinal options, here are a few home treatments which you can do to help alleviate some of the pain.

First, stretch as if you are doing a hamstring stretch. Lean your hands against a wall, and put one leg straight while the other leg is slightly bent. The farther back the leg is, the deeper the stretch will be. This stretch will also help your achilles tendon as well as the plantar fascia tendon. Another effective treatment is to take a water bottle, fill it with water and freeze it. Then take the frozen water bottle and roll it on the floor with the troubled foot. The cold will sting the foot, but it will soothe the area of injury as well. Lastly, when you wake up in the morning, before you put your feet on the floor, take two minutes and massage the foot. Massaging the tendon will help relieve the tightness which develops in your feet while you are sleeping. There are also feet straps available, which can be used to stretch the tendon while sleeping. Getting fitted for proper shoes, and possibly wearing heel pads, may also help to eliminate the symptoms of plantar fasciitis.

Once you have been either cleared by your doctor to start running or feel that you are well enough to start running, ease back into it. Like I stated before, you do not want to lose months of training due to the fact that your ignorance got the best of you.

Relating to plantar fasciitis is achilles tendonitis. While studying sports medicine, I found it interesting that achilles tendonitis accounts for 15% of all overuse injuries related to running! That truly is a large number. While you are running, your achilles withstands your body weight up to eight times the load!! Your achilles takes a lot of pounding while you are training for a race, no matter how fast, slow or how far you are running. Achilles tendonitis begins with inflammation in the tendon sheath. If the stress on the tendon continues, it causes the tendon sheath to become severely inflamed which in turn develops tendonitis.

Common reasons for this injury are essentially due to poor decision making and training errors. Proper training should provide adequate time for your muscles to recover in order to help absorb the shock from the constant impact. If you do not allow adequate time to heal, you put your legs at greater risk for injury. SHOES are also another factor contributing to this injury. If you pronate, whether it is over or under, chances are you probably should not be wearing stability shoes. Yes, your shoes should be comfortable for your feet as well as your body, because after all, eight times the weight is applied to your lower legs; HOWEVER, they need to be right for your body. With as many shoe clinics that are made available to us on the island, take the time find out what type of shoe is correct for you and begin training PROPERLY! Stretching properly during your warm-ups is very important as well.

If pain persists while running, STOP! Or if you experience pain while performing any type of jumping exercise, or if your muscles are overly tight when you wake up, take the time to go have your legs examined. If you delay in seeking medical advice you may eventually rupture your tendon. A friend of mine tore her achilles tendon and was unable to resume training for a full year. ONE YEAR of lost training is not worth ignoring an overuse injury such as this one.

Lastly, an injury which many current WOOT/WOOPers experience every day…ITB! Many of you are long distance runners, which means you are at a greater risk of injuring the iliotibial band (ITB). The reason is due to the constant flexion and extension of the knee in relation to the lateral femoral condyle. Yes, I know, what on earth is a lateral femoral condyle? Well…here is a great diagram to show you just exactly where your ITB is as well as the lateral femoral condyle.

I bet you didn’t realize you were going to get an anatomy lesson today! An inflamed bursa is what puts pressure on the ITB, causing exterior pain in the legs. This pain begins to become more noticeable after a certain mileage point but does not occur while a person is walking. Uphill and downhill walking or running may also aggravate the bursa and produce ITB symptoms. Surprisingly however, running through ITB pain will not set you back a great deal unless the pain becomes intolerable.

If it has been determined that you have ITB syndrome, it is highly recommended to cut back your training miles. It probably also wouldn’t hurt to change your shoes out more often than you usually do, to provide adequate support for your legs. Ice and NSAID’s are good ways to help minimize the pain. Of course, stretching the upper legs is also very important to help alleviate pain in your ITB. Below are several different exercises to help stretch your ITB, as well as ways to use a foam roller.

I will conclude by saying that the common factor in all of these injuries is improper stretching, poor training, and lack of attention to foot care. Pay attention to all of these and you will drastically reduce the odds of injuring yourself. Remember to also seek medical advice sooner rather than later; in doing so you may prevent longer setbacks in your training cycle.
Barry, N., Dillingham, M. F., & McGuire, J. L. (2002).
NonSurgical Sports Medicine. Baltimore , Maryland: The Johns Hopkins University Press.

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