Medical Mondays: News Notes
Monday, April 16, 2012
TOPIC: Common Running Injuries: Prevention & Treatment
Jim Johnson, MD: Sports Medicine
news notes via www.webmd.com
Running is a great way to stay in shape. But it can take a toll on your muscles and joints. To avoid running injuries, it's important to take precautions before you set out.
WebMD takes a look at common running injuries and gives you tips to prevent and treat them.
10 Common Running Injuries
Most running injuries happen when you push yourself too hard. Adding distance or speed to your running routine, running up hills, and interval training are just some of the reasons running injuries occur. Body mechanics -- the way your body is designed -- also play a role.
Many injuries occur when you first start running or after recovering from an injury. The hips, knees, legs, and feet are the most vulnerable to injury.
Here are 10 common running injuries.
Runner's knee. This is a common overuse injury. Runner's knee has several different causes. But it's commonly due to the kneecap being out of alignment.
Over time, the cartilage on the kneecap can wear down. Vigorous activity leads to pain around the kneecap, particularly when:
Stress fracture. This is a small crack in a bone that causes pain and discomfort. It typically affects runners in the shin and feet. It is often due to going too hard before your body gets used to a new activity.
Pain gets worse with activity and improves with rest. Rest is important, as continued stress on the bone can lead to more serious injury.
Shin splint. A pain that occurs in the front or inside of the lower leg along the shin bone (tibia). Shin splints commonly occur after a change in activity, such as running longer distances or increasing the number of days you run too quickly.
People with flat feet are more likely to develop shin splints.
Achilles tendinitis. This is inflammation of the Achilles tendon. That's the large tendon that attaches the calf to the back of the heel.
Achilles tendinitis causes pain and stiffness in the area of the tendon, especially in the morning and with activity. It is usually caused by repetitive stress to the tendon, often due to increasing running distance too quickly. Tight calf muscles can also contribute.
Muscle pull. A small tear in your muscle, also called a muscle strain, often caused by overstretching of a muscle. If you suffer a pulled muscle, you may feel a popping sensation when the muscle tears.
Treatment includes RICE: rest, ice, compression, and elevation.
Muscle pull commonly affects these muscles:
Ankle sprain. This is the stretching or tearing of ligaments surrounding the ankle. It often occurs when the foot twists or rolls inward. Sprains typically get better with rest, ice, compression, and elevating the foot.
Plantar fasciitis. An inflammation of the plantar fascia. That's the thick band of tissue in the bottom of the foot that extends from the heel to the toes.
People with tight calf muscles and a high arch are more prone to plantar fasciitis. Although it may be linked to an increase in activity, plantar fasciitis may occur without any identifiable reason.
Iliotibial band syndrome (ITBS). This syndrome causes pain on the outside of the knee. The iliotibial band is a ligament that runs along the outside of the thigh, from the top of the hip to the outside of the knee.
ITBS occurs when this ligament thickens and rubs the knee bone, causing inflammation. Long-distance runners are more likely to develop ITBS.
Blisters. These are fluid-filled sacks on the surface of the skin. They are caused by friction between your shoes/socks and skin.
To help prevent blisters:
Temperature-related injuries. These include:
These can be prevented by dressing appropriately, staying hydrated, and using sunscreen.
Tips to Prevent Running Injuries
By taking a few precautions and planning, you can prevent many common running injuries. Here are some tips for preventing injuries.
Listen to your body: Don't ignore pain. A little soreness is OK. But if you notice consistent pain in a muscle or joint that doesn't get better with rest, see your health care provider.
Create a running plan: Before beginning a running routine, talk to a trainer. A trainer can help you create a running plan that is in line with your current fitness abilities and long-term goals.
Warm-up and stretch: Many injuries occur as a result of inadequate stretching. Before and after you run, stretch your muscles thoroughly -- especially your calf, hamstrings, groin, and quadriceps.
Also, warm up for five minutes -- by walking, for example -- before you start stretching. Stretching cold muscles may cause injuries.
Cross train: Mix up your fitness routine. Don't only run. Try swimming, biking, tennis, or some other activity. This helps prevent overuse injuries that more commonly occur when you do the same type of exercise over and over again.
Dress appropriately: Wear lightweight, breathable clothing that wicks moisture away from your skin. Dress in layers. Also wear a hat to protect against the sun and cold.
Be shoe smart: Wear proper-fitting socks and shoes with good support. If the soles of your running shoes have worn thin or are angled, it's time to get a new pair. If you have foot problems, such as flat feet or high arches, consider using orthotic shoe inserts.
Run wisely: Run on a flat, smooth surface and avoid steep hills until your body gets used to the activity.
Be safe: Run during the day, in well-lit areas, or use a light so that you can be seen. Keep a cell phone and identification on you. If running with headphones, set the volume low enough so that you can hear cars and other noises. Run with a partner when you can.
Weather matters: Monitor the weather conditions before you go for a run. Don't run outside if it is over 90 degrees Fahrenheit, below freezing, or the humidity is high.
Stay hydrated: Make sure you drink an extra 1 1/2 to 2 1/2 cups of water on the days you run. If you are running for more than an hour, drink a sports drink to replenish electrolytes lost in sweat.
Most running injuries can be relieved by following these treatment strategies. If pain and discomfort continues, see your health care provider. You may need more advanced treatment to resolve your running injury.
Rest: Take it easy. If you keep running, your injury may get worse. Choose alternative ways to exercise while you heal, such as swimming or cycling.
Ice and cold therapy: Apply ice packs to reduce pain, inflammation, and swelling.
Compression: Wrap the affected area with tape and use splints and supports to control swelling and stabilize the affected area.
Elevate: If you sprain your ankle or hurt your foot, elevate it to reduce swelling.
Stretch: To reduce pain and tension of the affected area, gently stretch and massage the injured area.
Pain relievers: Take over-the-counter pain relievers, such as acetaminophen (Tylenol) or anti-inflammatory medications, such as ibuprofen (Advil, Motrin) and naproxen (Aleve), as recommended by your health care provider to relieve pain and inflammation.
Don't try to push through pain. If you notice discomfort, take a break from running. If the pain continues, seek care from your health care provider.
Preventing and Treating Common Running Injuries
Every runner's guide to preventing and treating 10 common pains and sprains.
"Don't run and you'll heal," are the words that every diehard runner dreads hearing.
"Runners don't want to stop running, and the good news is that you can run through most pain without causing permanent damage," says Lewis G. Maharam, MD, medical director of the New York Road Runners Club, the New York City Marathon, NYC Triathlon, the Suzuki Rock 'n' Roll Marathon -- among others. "But," he cautions, "if pain changes your running style, stop and see a sports doctor."
Most common running injuries are due to overuse, overtraining, or a biomechanical flaw in body structure and motion.
Here's how to prevent and treat the 10 most common running injuries so you never get sidelined again:
1. Runner's knee
Runner's knee is a wearing away of the back of the kneecap, causing pain in the knee. This can occur because of decreased strength of middle quadricep muscles, or shoes that do not give proper support when you come off of your forefoot on the inside. What to do? Maharam says the condition is typically treated with a full-length sports orthotic and strengthening exercises directed at the middle quad muscle. Talk to a sports medicine doctor about getting into physical therapy and learning about the best stretches to heal runner's knee.
2. Stress fractures
Stress fractures can be caused by overtraining, a shortage of calcium, or by some basic biomechanical flaw -- either in your running style in or your body structure, says sports podiatrist Stephen Pribut, DPM, clinical assistant professor of surgery at the George Washington University Medical Center in Washington, D.C. Common stress fractures in runners occur in the tibia (the inner and larger bone of the leg below the knee), the femur (thigh bone) and in the sacrum (triangular bone at the base of the spine) and the metatarsal (toe) bones in the foot.
"The more the miles, the greater the stress," says Maharam. And this is one injury you should not ignore. "Stress fractures are like a hardboiled egg," he explains. "The shell is cracked and next stop is a full-fledged fracture." See a doctor who specializes in treating running injuries, Maharam advises. "We only tell runners to stop when they have a fracture or a stress fracture and then we put them in a pool for water-running because stopping exercise is unacceptable to (most) runners."
3. Iliotibial band syndrome, a.k.a. ITBS
Marked by a sharp, burning knee or hip pain, ITBS is a very common running injury among marathoners. Indeed, it's responsible for as many as 80% of all overuse pains on marathon day. The ITB is a ligament that runs along the outside of the thigh -- from the top of the hip to the outside of the knee. It stabilizes the knee and hip during running, but when it thickens and rubs over the bone, the area can become inflamed or the band itself may become irritated -- causing pain. "ITBS may be caused by running on a banked surface that causes the downhill leg to bend slightly inward and stretches the band, inadequate warm-up or cool-down, running excessive distances, increasing mileage too quickly or certain physical abnormalities," says Pribit.
The best stretch? Place the injured leg behind the good one. If the left side is sore, cross your left leg behind your right one. Then lean away from the injured side toward your right side. There should be a table or chair that you can hold onto for balance. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times, prescribes Pribut. Anti-inflammatory drugs such as ibuprofen (some brand names are Motrin and Aleve) can help get the swelling down, he says.
4. Shin splints
The most common type of shin splints happen on the inside of legs. These medial shin splints are a running injury that results from a biomechanical flaw in your foot (which can be made worse by a shoe that doesn't offer enough support) and/or overtraining.
"Your best bet is to switch to a motion control or thicker shoe and a make sure to stretch out your calf muscles" before and after running, says Michael Fredericson, MD, doctor for the Stanford Cross Country and Track Team and an assistant professor of orthopaedic surgery at Stanford University School of Medicine. Do this by standing with your rear foot approximately two to three feet away from the wall. Your rear leg should be straight, the front leg bent and your hands touching the wall. Your feet should point ahead with heels on the ground. Hold for 10 seconds and repeat 10 times on each leg. Now do the same thing with your rear leg (that was straight) slightly bent at the knee. You should feel this stretch lower down.
5. Plantar fasciitis
Also known as pain in the middle of arch of the foot, plantar fasciitis is a running injury most frequently caused by an abnormal motion of the foot or too-tight calf muscles. Normally, while walking or during long-distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch, Maharam explains. "Your arch should only dip slightly during this motion but if it lowers too much, you have what is known as excessive pronation." What to do? "It is usually corrected with an orthotic and calf stretches" before and after running, Maharam says.
6. Achilles tendonitis
Achilles tendonitis is a running injury that typically occurs from abnormal foot strokestroke in push-off and too-tight calf muscles. "If you are pronating to the side and pulling at an improper angle, it becomes stressed and inflamed. That's why getting an orthotic to correct the biomechanics of your foot stroke at push-off is key," Maharam says. Also, he suggests doing the same stretch recommended for shin splints.
7. Muscle Pulls
Whether hamstring, quads, or any other muscle, pulls come from not being flexible and/or overexerting specific muscles. "Basically, pulls occur because you haven't stretched or because you are trying to beat your 18-year-old son in a sprint and you are 45," Maharam says. Pulls are basically small muscle tears, and the best way to treat a pull is to do more stretching before and after a run. To prevent hamstring pulls, place one leg on a chair and get your knee straight and bend over. Hold for 15-20 seconds. For an acute injury, ice and anti-inflammatory medication is helpful.
8. Ankle sprains
Ankle sprains occur because runners don't always watch where they are going. "They can step off curb or into pothole," Maharam says. "Pay attention to where you are running or run on a really good, level track where there is less chance of finding a gopher hole." When and if an injury does occur, ibuprofen and ice can help reduce swelling and pain.
9. Dizziness and nausea
"Most runner's drink too much, not too little" water, Maharam says. This can cause overhydration -- also known as diluting -- which lowers sodium levels in the body and stresses the kidneys. Common symptoms of diluting are nausea, vomiting, and dizziness. To avoid these problems, Maharam suggests: "Drink about one-cup (8 oz.) of fluid every 20 minutes while running. This way you will avoid becoming diluted."
One of the most common sports injuries, blisters on the feet are usually caused by friction combined with excessive moisture. Avoid them by choosing synthetic socks -- such as those by Nike Dryfit -- that wick away moisture," Maharam says.
Remember, Pribut says, that "about 90% of running injuries are due to overtraining, so a very slow buildup is important, and so are rest days." You'll save yourself pain and reach your goals, Pribut says, if you "avoid the 'terrible toos' -- training too much too soon, too often, and too fast."