Common Running InjuriesBy: Dr. Richard Hansen, D.C.Below is a list of common injuries that can occur while running. This list was generated to provide general information on the following conditions as an educational tool for patients. It is not a complete description on the specific mechanisms or physiological changes that occur with each injury, nor do they include every treatment that can be used to help resolve the injury. If pain is severe enough to inhibit function or if you have questions concerning your current injury, please consult Dr. Richard Hansen at 303-829-1040 or any other experienced sports injury healthcare provider. Plantar Fasciitis· What is it? Plantar Fasciitis is an inflammatory condition of the tissue on the underside of the foot that causes heel and arch pain. Pain is characterized as being sharp and is often worse with the first few steps in the morning. · What causes it? The most common suspected cause of this injury is excessive pronation of the ankle and flat-feet which causes an over-stretching effect on the plantar fascia. · What are some common self-treatments? Most practitioners advocate stretching the calf muscles to help relieve some of the tension being placed on the plantar fascia. Research, however, does not show that this helps to reduce the symptoms of plantar fasciitis. The use of foot splints at night have been shown to be effective as they help maintain slight tension on the plantar fascia while sleeping. Icing the arch and heel of the foot for 15-20 minutes. can help in reducing inflammation that has built up in the tissue. Additionally, lightly rolling the arch of the foot over a tennis ball can help in keeping the plantar fascia stretched throughout the day. Finally, wearing shoes with more cushioning/shock absorption is key to limiting the muscular activity associated with excessive pronation. IT Band friction syndrome· What is it? IT Band friction syndrome is pain that is localized on the outside of the knee over the lateral aspect that is usually only present during exercise. Downhill running seems to aggravate the symptoms the most, but pain seems to subside almost immediately when the athlete stops running. · What causes it? IT Band friction syndrome can be caused by a number of bio-mechanical or training errors. People who have a high-rigid arch which does not allow for adequate pronation or have extremely bowed legs are at an increased risk of this injury. Additionally, runners with a short leg are also at a risk of developing this injury. Sudden increase in training mileage, racing too frequently, excessive downhill running, running on hard surfaces, and running consistently on the same-side of the road are all factors that can cause this type of injury. · What are some self-treatments? Stretching the IT band and quads can help keep the muscle relaxed. However, care should be taken that over-stretching does not occur. To stretch the IT band, all the weight should be carried on the injured side and the upper body is leaned away from the injured side while the chest faces forward. Stretches should be held lightly between 30 seconds and 1 minute without bouncing. Icing the lateral side of the knee between 15-20 min, 2-3 times daily, can give temporary pain relief. Side-lying leg lifts can help isolate the gluteus medius muscle to help reduce the overactivity of the IT band. Patients should build up to 3 sets of 20 repetitions. Calf Strain and Achilles Tendonitis· What is it? A calf strain is a generic term used to define microtears in the calf resulting from overstretching of those muscles either from a single traumatic event or from overuse. Achilles tendonitis is an irritation or inflammatory response that occurs in the Achilles tendon to the back of the heel. Typically, both of these injuries present as a dull aching pain that is made worse with running and jumping activities, but can get better as the run progresses. Achilles tendonitis can sometimes cause pain that makes even walking difficult. · What causes it? The causes for these two injuries are numerous. They may be due to biomechanical deficiencies (such as over-pronation issues), training errors (such as too many hilly runs, worn out shoes, or too much running on hard surfaces), muscular inefficiencies (such as improper foot intrinsic firing patterns), or genetic structural-related issues (such as flattened arches).· What are some self-treatments? The most commonly prescribed self-treatments for these injuries are rest, ice massage, and activity modification (such as reducing training load or changing training surfaces). Arch supports (such as orthotics) and athletic taping to help maintain the integrity of the arch can help reduce muscular inefficiency if over-pronation is an issue. Be careful not to over-stretch the calf muscles, especially if the injury is Achilles tendonitis because it may worsen the condition. Additionally, adjusting your foot position from resting on the ground to resting against an incline when in a sitting position can help distribute pressure evenly across the foot limiting the amount of strain placed on the achilles and calf muscles. When stretching the calf muscles, if the back knee is slightly bent, this can better isolate the achilles tendon and lower/deep calf muscle called the soleus. Stress Fractures· What is it? Stress fracture is a fracture of the bone due to repeated minor trauma that accumulates over a period of a few weeks or months. In runners, this usually occurs in the metatarsals of the foot and the tibia. This injury is typically very painful but can be bearable at rest or when walking. Running,however, drastically and rapidly increases the pain symptoms. · What causes it? This cause of this injury is not well-understood. It is a common belief that the site of the bone fracture is one in which an abnormal concentration of forces is focused. Thus, the abnormal concentration of forces must be present and the bone must be not be sufficiently strong enough to resist those forces. Shin Splints aka Tibial Bone Strain· What is it? Shin splints is a generic term given to either anterior (front) leg pain or posterior (inside or back) leg pain. Pain is typically a deep ache that gets worse with running or walking on hard surfaces. · What causes it? Shin splints is form of bone strain that typically results from excessive running/over-training without a gradual progression or consistently running on hard surfaces. Bone strains result from tight periosteum or muscular attachments to bone. With shin splints, this is usually due to excessive ankle pronation and inadequate shock-absorbing ability of the bones not use to the stresses of the involved activity. Factors that can lead to shin splints include: inadequate footwear, training errors, bio-mechanical inefficiencies, abnormal menstrual patterns, and a low-calcium diet. · What are some self-treatments? The type of treatment depends on the grade of the injury. For a description of the grading system, refer to the running injury article on the Wellness of Boulder Website. For grade I injuries, calf stretching and calf strengthening (particularly heel raises) help in relieving some of the tension being placed on the tibial bone my the surrounding musculature. Ice massage to the sore area for 10-15minutes, 2-3 times daily, can help in temporarily relieving inflammation and pain in the injured area. If the injury was caused by a low-calcium diet, such as those that limit dairy products, should consider taking calcium supplements. If the injury is a grade 2 or 3, and the above treatments have been tried with no success. Custom-made orthotics should be considered to help control any pronation issues that may be experienced. Patellar Femoral Pain Syndrome (PFPS)· What is it? PFPS is defined as pain that is localized around the knee joint that results from bio-mechanical, muscular, and/or overuse changes that occur on the joint. Pain is often noticed when going up and down stairs, running (especially on hills and uneven surfaces), and with prolonged sitting. · What bio-mechanical changes can cause it? There are four main bio-mechanical variants that can increase your risk of PFPS. These include flat feet, high-arched feet, limited ankle flexibility, and an increased Q angle (angle at the knee between the quads and the lower leg) greater than 168°. · What are some self-treatments for PFPS? If pain is not severe or inhibiting normal function, icing the area of pain twice daily for 15-20 minutes can be effective. Strength exercises for the vastus medialis muscle such as chair squats can be helpful as long as pain is not reproduced. Special taping techniques for patellar tracking are also very effective in reducing the over-activity of the lateral quadriceps muscles. Use caution when stretching because overstretching can make the injury worse and increase the amount of recovery time. Osgood-Schlatter Syndrome · What is it? Osgood-Schlatter Syndrome is a condition most specific to growing children that develop pain or discomfort over the tibial tubercle (the bony outgrowth on the tibia, below the patella) where the patellar tendon attaches. · What causes it? Osgood-Schlatter Syndrome is typically caused by repeated contractions of the quadriceps muscles, which can lead to a minor separation of the growth cartilage from the underlying bone. Sports that involve excessive jumping, long distance running, and plyometrics in adolescents can predispose one to this type of injury. · What are some self-treatments? Unfortunately, this condition doesn’t completely resolve until the child ages and becomes skeletally mature. There are treatments that can help manage the pain and discomfort experienced with this condition. Icing the injured area for 15 minutes following activity can help control pain and inflammation immediately after cessation of the activity. Stretching the quadriceps muscles following exercise will also help in relieving pressure placed on the tibial tubercle by the patellar tendon. TOP OF PAGEBACK TO "EDUCATIONAL MEDIA" PAGE
