Running Injuries Prevention and Management

There are millions of joggers and runners in the United States and up to 75% of them at some point sustain a running related injury. Many of these injuries are minor sprains while some can be major and lead to long-standing problems. I would briefly like to discuss some common injuries and their causes. You can then be aware of problems and what to do if these problems do not resolve themselves quickly.

Running injuries are often related to the level of training someone runs. Injuries are most common when runners begin a program and progress too quickly. Beginning runners are often hurt when they run too much too soon or run wearing poorly made shoes. More experienced runners incur overuse or stress injuries when they increase their mileage too quickly or overload the musculoskeletal system when training. Training errors are the most frequently cause of running injuries. Excessive mileage, intensive workouts with interval training, alternating fast running and jogging, increasing training on hills or a rapid increase in mileage all can overrun the body's ability to adapt to new stress levels. An inadequate warm up can also cause stress injuries.

External issues can also cause injuries such as the running surface and inadequate equipment. The most ideal surface for running is a soft level dirt patch. Asphalt roads provide more cushioning than concrete. However; running surfaces are dictated by what is available, what is safe and where someone has access to a running surface. A well-made running shoe is one of the most important things to prevent running injuries. Although no one shoe is ideal for all runners there are numerous designs and materials, which improve shock absorption, foot stability, cushioning and flexibility. Any shoe, which shows wears on the undersurface, should not be used for a running program, as this will only lead to injuries. Shoe supports or lifts are often helpful as well for people with leg problems causing a biomechanical problem.

Some people are born with biomechanical problems where limbs are oriented in certain directions or alerted while during running that lead to overuse and stress injuries. These can often be corrected by shoe inserts or certain exercises for the muscles of the lower extremity. It is recommended that people that take up running after years of sedentary living should first have a physical examination looking both at their muscles, tendons, bones as well as their cardiovascular health to make sure they are not going to get into trouble by taking up a new exercise program.

Specific running problems can be discussed briefly. The knee is the most common site for injury in runners. This is followed by Achilles tendonitis, shin splints, foot and ankle problems and occasionally hip and back problems. Again, these are often times caused by faulty training techniques; some biomechanical abnormalities or problems runners are born with or acquired by running.

The single most common problem in runners is a tracking problem of the kneecap. This is often known as runner's knee or patellofemoral stress syndrome. Normally, the kneecap glides smoothly up and down the groove between the thighbone. When the kneecap is off center either from a muscle imbalance or injury this causes pain under the knee cap. This is common in a runner who is beginning or who is beginning to increase mileage. The first treatment for this is curtailing the running activity, icing, stretching the hamstrings, strengthening the thigh muscles and avoiding heel and bent knee activities. Sometimes knee wraps, straps and certain braces are helpful.

A second common running injury is iliotibial track friction syndrome which involves a thick part of a muscle on the outer part of the thigh that attaches on the outer side of the knee. The friction of this muscle rubbing over the end of the thighbone causes inflammation and pain. A shoe alteration, some inserts, stretching and some muscle balance treatments can often correct this. Less common knee problems include stress fractures or tendonitis about the kneecap.

Shin splints cause pain on the front of the shinbone. This is actually a tendonitis of a particular tendon, which attaches on the bone and can lead to an inflammation of the covering of the bone and possibly a stress fracture. Physical examination, x-rays and bone scans can be done. Again, the treatment for this is often rest, icing, stretching and participating in another activity while this heals.

A painful inflamed Achilles tendon is a common running injury. Running downhill puts additional stress on the Achilles tendon as does toeing off during uphill running. Often runners that begin to run hills develop this problem. Burning pain usually develops early in the run, which becomes less severe during the run and then worsens after the run. Ice, massage, stretching, and some medications often times resolves this and sometimes even an ankle or heel lift can be given to the person to prevent the pain. Again, making sure the shoe is not worn and does have quite a bit of cushioning is key to prevent an Achilles tendonitis or a bursitis.

The most common cause of heel pain in runners is plantar fasciitis or heel spur syndrome. It is a reaction to traction on the ligament on the bottom of the foot where it attaches to the heel bone. The pain begins at the beginning of the work out, gets better and then begins again when the work out is finished. Often times people feel pain in the first steps during the morning. Some particular stretching exercises, injections and cushions often help this.

Sometimes back pain can be seen in runners, which is often due to some degenerative arthritis, which was present before the running began. This is often seen in middle age runners who increase mileage or begin running on hills. Hip pain, which is complained about is actually from the back in a number of occasions and can be treated like other back problems.

Stress fractures occur often when an athlete tries to increase mileage or speed too rapidly, which overwhelms the ability of his bone to withstand the new stress. Stress fractures can occur in any of the bones of the leg or foot. Ongoing pain, even while walking and tenderness over the bone and a recent increase in mileage strongly suggest a possible stress fracture. With all stress fractures, generally running needs to stop an alternative training program needs to be done to allow healing time. The most significant of these stress fractures is one involving the hip, which sometimes requires surgery to prevent devastating complications from a displaced hip fracture.

In general, with most injuries ice initially and subsequently heat is sufficient to allow healing, Treatment for the first 24 hours is generally helpful then some moist heat several times a day will often times decrease pain and allow muscle function to do well. Depending on the severity of the symptoms, either complete rest or reducing the mileage is usually essential. If a training error is the cause of the problem, the shoes must be corrected, the mileage decreased in half and gradually increasing. An anti-inflammatory medication such as aspirin or Motrin is often helpful.

When the pain resolves, again it is important to return to running but at probably half the distance one was running before and gradually increase the distance not too fast or not too soon. For those who don't wish to run, walking can be one of the best exercises. As with running, any pain or injuries should be looked at to prevent them from becoming long term.

An injury that lasts for a period of time or if someone is running through pain generally indicates a more significant problem. The runner should seek help from a physician to determine the problem and to correct it. Most every problem runners encounter can be diagnosed and corrected so a person can get back to enjoyable running. While not running, other exercises such as swimming, weight training, or cycling could be done to maintain cardiovascular health as well as muscular fitness. Running through pain or injuries is only going to cause more problems and lengthen the time one can get back to running pain free.