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Common Running InjurieS

Source: Runner’s World Online

Shin Splints

Definition: Inflammation of the tendons on the inside of the front of the lower leg. (Sports-medicine specialists don't like to use the term "shinsplints" because it commonly refers to several lower-leg injuries. We'll use it anyway but focus on the specific problem that is the most common: tendinitis of the lower leg.)

Symptoms: An aching, throbbing or tenderness along the inside of the shin (though it can radiate to the outside also) about halfway down, or all along the shin from the ankle to the knee. Pain when you press on the inflamed area. Pain is most severe at the start of a run, but can go away during a run once the muscles are loosened up (unlike a stress fracture of the shinbone, which hurts all the time). With tendinitis, pain resumes after the run.

Causes: Tired or inflexible calf muscles put too much stress on tendons, which become strained and torn. Overpronation aggravates this problem, as does running on hard surfaces, such as concrete sidewalks. Beginning runners are the most susceptible to shinsplints for a variety of reasons, but the most common is that they're using leg muscles that haven't been stressed in the same way before. Another common cause of shinsplints among beginners is poor choice of running shoes, or running in something other than running shoes. Runners who have started running after a long layoff are also susceptible to shinsplints because they often increase their mileage too quickly.

Self-Treatment: Many runners experience mild shin soreness, which usually can be tolerated. "If shinsplints hits you at the beginning of a season, a certain amount of running through it will help the body adapt," says David O'Brian, D.P.M., a podiatrist in Roselle, Illinois. "But if it's a persistent problem, you shouldn't run through it. "If it does persist, ice the inflamed area for 15 minutes three times a day and take aspirin or ibuprofen. Ice immediately after running. To hasten recovery, cut down on running or stop altogether. Recovery time: two to four weeks.

Medical Treatment: If the injury doesn't respond to self-treatment and rest in two to four weeks, see a podiatrist, who may prescribe custom-made orthotics to control

overpronation. Ultrasound and anti-inflammatories may also be prescribed. Surgery is rarely required.

Alternative Exercises: Nonimpact exercises such as swimming, pool running, walking, cycling in low gear.

Preventive Measures: To stretch and strengthen the tendons and muscles in the front of the leg, sit on a table or chair and loop an ankle weight around your foot. Without bending your knee, move your foot up and down from the ankle. Or have a partner grasp the foot to provide resistance. You can also strengthen the lower leg with band exercises. Anchor one end of an exercise band to a heavy object, such as the leg of a sofa. Stretch the band, then loop it around the end of the foot. Move foot up and down and side to side against the band's resistance to exercise different muscle groups. The band can be ordered from a doctor or bought at some sporting goods stores. Ask for "tension tubing. "Finally, make sure to wear motion-control shoes--and orthotics if your doctor says you need them. Don't run in worn-out shoes. Warm up well and run on soft surfaces. Avoid overstriding, which puts more stress on shins.

Iliotibial Band Syndrome

Definition: Inflammation and pain on the outside of the knee, where the iliotibial (IT) band (a ligament that runs along the outside of the thigh) is rubbing against the large leg bone, the femur.

Symptoms: A dull ache a mile or two into a run that lingers during the run but disappears soon after you stop. In severe cases, pain can be sharp, and the outside of the knee can be tender or swollen.

Causes: Anything that causes the leg to bend inward, stretching the IT band against the femur, such as bowlegs, overpronation, worn-out running shoes or workouts on downhill or indoor banked surfaces. A tight IT band can contribute to the injury. So can stepping up your training too quickly. Sometimes a single hard workout can cause IT band syndrome.

Self-Treatment: "You usually can't run through IT band pain," says Dr. Apple. "But if you do run, back off. Cut back on speed work, don't run downhill, and make sure to stretch the band a couple of times a day. The main thing you've got to do is restore the band's flexibility." IT band stretch: This is the most common and effective IT band stretch. Stand with your right leg crossed in back of your left, and extend your left arm against a wall, pole, chair or other stable object. Lean your weight against the object while pushing your right hip in the opposite direction. Keep your right foot anchored while allowing your left knee to flex. You should feel the stretch in the iliotibial muscle in your right hip and extending down the outside of your right leg. In addition to doing the IT band stretch, ice the knee for 15 to 20 minutes after running, try self-massage on the area and stretch hamstrings and other leg muscles. You should be back to easy running in two to four weeks.

Medical Treatment: If your IT band problem isn't responding to self-treatment after four weeks, see an orthopedic surgeon. Severe cases may call for a cortisone injection under the band to alleviate pain.

Alternative Exercises: Swimming, pool running, bicycling, rowing, but not stair climbing. "Anything that doesn't put pressure on the outside of the knee is fine," says Dr. Apple.

Preventive Measures: Stretch the IT band (after a workout is best). Stretch and strengthen quadriceps and hamstrings. Warm up well before a run. Avoid hard workouts on cambered roads, downhill surfaces or indoor tracks. Ease into any running program.

Achilles Tendinitis

Definition: Inflammation of the Achilles tendon. The Achilles is the large tendon connecting the two major calf muscles--the gastrocnemius and soleus--to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that's tendinitis), and, over time, can produce a covering of

scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Symptoms: Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. Limited ankle flexibility. Redness or heat over the painful area. A nodule (a lumpy buildup of scar tissue) that can be felt on the tendon. A cracking sound (scar tissue rubbing against the tendon) when the ankle moves.

Causes: Tight or fatigued calf muscles, which transfer too much of the burden of running to the Achilles. This can be brought on by not stretching the calves properly, increasing mileage too quickly or simply over-training. Excessive hill running or speed-work, both of which stress the Achilles more than other types of running, can also cause tendinitis. Inflexible running shoes, which force the Achilles to twist, cause some cases. Runners who overpronate (their feet rotate too far inward on impact) are most susceptible to Achilles tendinitis.

Self-Treatment: Stop running. Take aspirin or ibuprofen, and ice the area for 15 to 20 minutes several times a day until the inflammation subsides. Self-massage may also help. "I have every therapeutic machine available for the treatment of Achilles tendinitis, and the treatment of choice is massage with a heat-inducing cream or oil," says Marc Chasnov, a physical therapist in Rye Brook, New York. He suggests rubbing semicircles in all directions away from the knotted tissue three times a day. Once the nodule is gone, stretch the calf muscles. Don't start running again until you can do toe raises without pain. Next, move on to skipping rope, then jumping jacks, and then gradually begin running

again. You should be back to easy running in six to eight weeks. Medical Treatment: If injury doesn't respond to self-treatment in two weeks, see a physical therapist or orthopedic surgeon. Surgery to scrape scar tissue off the tendon is a last resort, but not very effective. "It usually just stimulates more scar tissue," says Chasnov.

Alternative Exercises: Swimming, pool running and bicycling (in low

gear). No weight-bearing exercises.

Preventive Measures: The best stretch for the Achilles is also the simplest. Stand on the balls of your feet on stairs, a curb or a low rung of a ladder, with your legs straight. Drop both heels down and hold for a count of 10. To increase the intensity of the stretch, keep one foot flat and lower the other heel. Then switch legs. Strengthen and stretch muscles in feet, calves and shins. A good way to do this: Sit on the floor with a weight taped or strapped to the front of one foot. Bend the knee at a 90-degree angle, with your heel resting on the floor; then lift the weight by pulling the toes toward you. Lower, and repeat. You can also do toe raises to help strengthen your calves. Wear motion-control shoes or orthotics to combat over-pronation. Don't run in worn-out shoes. Ease into any running program. Avoid hill work. Incorporate rest into your training schedule.

Plantar Fasciitis

Definition: An inflammation of the plantar fascia, a thick, fibrous band of tissue in the bottom of the foot, running from the heel to the base of the toes. When placed under too much stress, the fascia stretches too far and tears, causing inflammation of the fascia and surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and only aggravates the problem.

Symptoms: Pain at the base of the heel. "Most people describe it as feeling like a bone bruise or a stone bruise," says Joe Ellis, D.P.M., a sports podiatrist from La Jolla, California, and the author of Running Injury-Free (Rodale Press, 1994). "Plantar fasciitis is most severe in the morning when you get out of bed or at the beginning of a run, because the fascia is tighter at those times. The pain may fade as you walk or run. "Often, a runner will change stride to alleviate pain, but this only provides temporary relief. A bone spur may also develop at the heel, where the fascia has started to tear away.

Causes: Stress, tension and pulling on the plantar fascia. Runners with tight Achilles tendons (which put more stress on the fasciae), or high arches and rigid feet, or flat feet that over-pronate (twist too far inward on impact) are most susceptible. Worn-out shoes,

which allow feet to over-pronate, or shoes that are too stiff, which stretch the fasciae, can also make you more susceptible.

Self-Treatment: Reduce running. Take aspirin or ibuprofen daily. Ice the

area for 15 to 20 minutes several times a day. Ice-massage the fascia; to do this, fill a paper cup with water and freeze. Peel off the paper, place the ice under your foot, and roll the foot over it, from your heel to the ball of your foot and back again. A frozen-juice works equally well.

Medical Treatment: If the injury hasn't responded to self-treatment in four weeks, see a podiatrist, who may prescribe orthotics, ultrasound or friction massage. Surgery to detach the fascia from its insertion into the heel may be recommended if medical treatments don't help after a year. Success rate is 80 percent. Surgery to remove bone spurs usually doesn't work. "The spur isn't the problem," says Ellis. "It's a reaction to the problem."

Alternative Exercises: Swimming, pool running, cycling (in low gear). After surgery, only swimming is recommended during rehabilitation.

Preventive Measures: Stretch calf muscles. Strengthen muscles of the foot by picking up marbles or golf balls with your toes or pulling a towel toward you with your toes. (Grab some of the towel with your toes and pull, then release, grab, and pull some more.)To help stretch the fascia, you can perform a similar motion using a golf ball. Start with the golf ball under the base of your big toe and roll the foot forward over the ball, then back again; then move the golf ball to the base of the second toe and repeat. Do the same motion starting from each toe, always exerting enough pressure so that you feel a little tenderness. Plantar fascia stretch: Seated on the floor, with one knee bent and ankle flexed toward you, pull the toes back toward the ankle. Hold for a count of 10. Do 10 times.

Blisters

Blisters are common in running. However, they are easily prevented by keeping your feet dry and walking around in new shoes before running in them. Bring two extra pairs of socks the morning of a race. We often get our feet wet from the dew on the grass while walking the course. Wear socks that do not bunch up. The best socks to wear are boot socks for they do not bunch up and weigh less than tube socks. If you do get a blister, let me or the trainer know right away. Do not let it go, for it may get infected. Do not put a Band-Aid on a blister, it will only bunch up and cause more problems. The best remedy is to put some antibacterial ointment on the blister and tape over it before running. Sometimes it helps to put some Vaseline on top of the tape to reduce friction. Take the tape off when done running, wash thoroughly, and put more antibacterial ointment on it. Do not attempt to pop a blister. Popping a blister only invites infection. The trainer, or your mom or dad, may choose to pop the blister, but this should only be done under sterile conditions.