Injury and prevention treatment guide

Preventing injuries…or not

They’re the bane of so many athletes; runners are no exception.  Injuries are annoying:  They take time for treatment….and they take time away from training, and they can effect your motivation to return to exercising.  Fortunately, many injuries are preventable.  And others, if detected early, respond beautifully to simple treatments such as an ice massage, a little rest, and a slightly modified training program.  Do your best to listen to your body and to communicate with your trainer any aches and pains you may feel.  I can’t know what is happening in your body unless you tell me.  If a shoe fits properly and has a flexible sole, sturdy heel counter, proper Achilles cushion, and adequate toe box and heel lift, it can help absorb the stresses of normal running.  If it doesn’t have those features, it can cause injury.

Shin splints

The term can refer to any of three types of pain in the lower leg; anterior shin splints, stress fractures of the tibia and posterior shin splints.  Anterior shin splints, characterized by pain on the outside of your lower leg, usually result from injury to your shin muscles.  A frequent cause is the extreme difference in strength between shin and calf muscles.  You can help prevent this injury by strengthening you shin muscles.  Use the “Hammer shin machine” located at any of the LVAC gyms to strengthen these muscles.  If you are injured and involved in a running program, stop running!  Switch temporarily to another activity.  When you return to running, build your mileage gradually.

A stress fracture of the tibia is the probable injury if touching the hard bone on the inside of your lower leg causes pain.  Usually these fractures occur when you suddenly place repeated jarring demands on you legs.  The treatment for a stress fracture is the same as that for anterior shin splints.  It will take from six weeks to several months to heal.  Posterior shin splints, damage to the muscles on the inside (medial) portion of the lower leg, cause pain in the soft tissue behind the bone.  Most come from over-pronating.  Should you feel this kind of pain while running, stop.  Resume running only when you can do so without pain.  Switch to bicycling or swimming and strengthen your muscles with exercises.   Consider using arch supports to keep from over-pronating.

Achilles injuries

The Achilles tendon is a tough, elastic cable through which the muscles of your calf transmit force to your foot.  Injuries to it come from sudden tearing or micro tearing (tendinitis).  Sudden tearing, which leads to partial or event or rupture, is triggered by an isolated incident, and it often requires surgical attention.  Micro tearing, signaled by gradually building pain, can progress to partial and even total rupture if there is no healing.  Symptoms of micro tearing include pain and stiffness that’s at its worse when you awaken.  The pain diminishes as you warm up, and it may even disappear when you run.  When you cool off, though, the pain returns.  The next day, you’re even stiffer.  Most injuries to the Achilles come from severe, uncorrected pronation, improper footwear, gout, or inadequate flexibility.  The key to recovery from micro tearing is modified exercise with gentle stretching.  Follow this procedure for a week to ten days.  When you resume running, build your mileage gradually, train on alternate days, avoid hill running, and wear the proper shoes.  If your injury has led to rupture, cease running and see your physician.  Follow his advice for recovery and rehabilitation.

Quadriceps muscle strain

The quadriceps muscles lie on the front of the thigh and are the principal stabilizers of the knee joint.  These four muscles are more powerful than the hamstrings and are less frequently strained, but may be torn by an explosive sprint.  The methods for preventing and treating this injury are the same as those for the hamstrings.  Be sure to include some quadriceps stretches.

Runner’s knee

Runner’s knee occurs when the kneecap becomes misaligned and rubs on an underlying surface of cartilage.  Usually the pain is described as soreness around the kneecap.  It is aggravated by running or climbing stairs.  In most cases, you can relieve runner’s knee with rest, proper shoes, and a good training regimen.  When the pain is gone, you can resume running, but intersperse it with walking.  Stay on level surfaces and avoid hills and stairs.  Don’t do deep knee bends.  To forestall further injury and strengthen your quadriceps muscles, which give muscular balance and support to your kneecap, add some progressive resistance exercises (leg extensions).  Remember to follow up with leg curls for your hamstrings to prevent muscle imbalance.  After exercising, ice your knee for eight to ten minutes.  In the evenings, apply moist heat.

Illiotibial band syndrome

Illiotibial band syndrome (ITBS) is a friction injury to the illiotibial band, a sheet of connective tissue that runs down the outside of your thigh from your hip to the side of our knee and acts as an important stabilizer for your knee.  ITBS can result from a number of causes – bowed legs, excessive pronation (turning of your foot), and limb – length differences.  Hard downhill running or excessive speed work can precipitate the condition… so can a single hard race of 10K or longer.  Running exclusively on the same side of the road can bring on ITBS in the curb – side knee.  Left untreated, ITBS is progressive.  The best course for recovery is to stop running immediately…rest for two weeks.  Meanwhile, reduce inflammation by icing three times a day.  Begin a stretching program to loosen the band.  Before you try running again, check your shoes to see if there’s excessive wear on the outside of the heels.  If there is, buy new shoes with ample heel support and rear foot cushioning.  If your knee hurts at any point in the run, stop immediately and stretch.  Ice the knee and try running again the next day after more illiotibial band stretches.

Planter fasciitis

The plantar fascia is a band of tough connective tissue that runs from the base of your toes to your heel bone and supports the bottom of your foot.  Injury to it, called plantar fasciitis, is most common in runners who over pronate or who have high arches or flat feet.  Pain from plantar fasciitis starts in your heel and then radiates into the midsection of your foot.  Usually the pain is severe in the morning and as you start to run, but becomes more tolerable as you walk or run.  However, an hour or so after you stop running, the pain returns.  Plantar Faciitis worsens gradually; so early recognition can prevent serious cases.  When you first suspect you have plantar fasciitis, check your running shoes.  Those not up to snuff should be discarded.

Hamstring strains

An acute strain of the hamstring muscle is a classic example of a muscle tear.  It is often dramatic -  a sudden, searing pain and tightness at the back of your thigh accompanied by the inability to bear full weight on the affected leg or to bring it through the normal range of motion.  The main cause of this injury is strong, inflexible hamstring muscles.  You’ll need to begin stretching the hamstrings and perform strength training for the quadriceps muscles that allow them to become 50 percent stronger than the hamstrings.  Again – quad strengthening and hamstring strengthening should be done together – both legs with a resistance ratio of 3:2, quads to hamstrings. If you do strain a hamstring, check with your doctor before running.  Once he gives the O.K., start with short jogs; then, very slowly and cautiously increase the number of jogs and the distances you cover each day.  Before doing high – speed running; be sure that the power, strength, and endurance of the injured leg are equal to that of the other leg.

Cramps

A cramp, a painful spasm of a voluntary muscle, can have several causes – too little (or too much) sodium, magnesium, calcium, or potassium; dehydration; excess muscular fatigue, slight muscular strain; or poor blood circulation.  To help keep cramps at bay drink plenty of fluids, eat a balanced diet that includes fresh vegetables and fruits, and maintain a level of conditioning that allows you to perform comfortably.  If a cramp does occur, gently but firmly stretch the muscle.  If you are plagued by recurring cramps, check with your doctor to determine why.

Sesamoid pain

The sesamoid bones are located under the large toe, where they serve as the fulcrum for the tendon that inserts into the toe.  They permit you to flex your toes.  Inflammation (sesamoiditis) or fracture of these bones can mean extreme pain when you try to rise on your toes and stride forward.  Treatment for injuries include; immediate casting of your foot and ankle plus keeping the weight off them for six weeks.  Follow this with intensive physical therapy for an additional six weeks; then start a limited walking/running program.  Periodic ice/heat applications should aid healing.  Either inflammation or a fracture usually causes pain in the sesamoid bones, two bones found under your big toe.  Healing can be slow but ice/heat applications can help speed recovery.

Sciatica

Sciatica is caused by a strain to the sciatic nerve, a long ropelike nerve that starts on each side of your lower back and winds its way down your buttock and the back of your leg to your foot.  Sciatica can be brought on by the constant jarring of running, combined with flat feet, high arches, knee problems, and limb – length discrepancies.  The initial pain is subtle – a dull ache in your lower back, buttock, or the back of your thigh.  It may subside for several hours but it returns with each run.  As training continues over a number of weeks, the pain becomes severe.  To help prevent sciatica, keep your spine flexible by stretching your lower back muscles as part of your warm up and cool down.  And strengthen your abdominal muscles because they lend support to your back.  If you feel you might be developing sciatica, stop running.  To speed recovery, apply moist heat to the tender area.  Return to running when the pain subsides.

Ankle sprains

Ordinary sprains – stretching or partial or complete tears of the ligaments surrounding the ankle – often occur in runners who run on soft or uneven surfaces.  The first thing to do if you sprain an ankle – however slightly – is to stop running.  If the pain disappears completely after several hundreds yards of walking, it’s usually safe to resume running.  If the pain does not subside, forget the rest of your workout.  Apply ice to the affected area as soon as possible and elevate your ankle.  Place ice packs on the swollen area for 20 to 30 minutes every four to six hours.  If the pain persists, continue the ice treatments for two to three days.  When the ankle is not wrapped in ice, use an elastic bandage to give the weakened ligaments some support.  A serious sprain may require the use of crutches or a can to aid in walking.  If swelling persists longer than two to three days, have an x ray taken to rule out the possibility of a fracture.

Stress fractures to the metatarsals

Stress fractures of the small bones of the foot usually occur from funning too far, too fast, too soon.  Discomfort from these tiny cracks is fairly mild at first.  Most likely you’ll have a slight pain in the front of your foot after running for several minutes.  Eventually, though, the pain will become severe.  A stress fracture rarely needs a cast, but to speed recovery, stop running for a time.  Tape your foot and place it in a firm shoe with lots of cushioning.  After three to four weeks, try running on a soft surface.  Stay with the soft surface for another three weeks; then, resume your regular workout.

Calf strain

A strain of the calf muscles can strike at any time, especially if you’re older than 35.  Occasionally, your calf will signal trouble by cramping a few times, but most often the strain will occur without warning.  The standard treatment for a calf strain is to apply ice and a compress, and elevate the injured leg.  Use crutches to rest the muscle.  Within the limits of comfort, very gently stretch your calf and point your toes.  For a first or mild second degree strain, start walking normally – no limping allowed - with heel lifts in both shoes.  A third degree tear will most likely require physical therapy.