Well the month of March is here and the running season is back in full force. Many of you have been training for and running in marathons and half marathons already! And I’m willing to bet that many of you have experienced pain or injury at some point during your training. Sometimes it’s nothing serious but other times it can threaten to derail your training and possibly keep you out of your race. So what can you do to minimize those issues and maximize your performance?
According to the American College of Sports Medicine these are the top 5 running injuries. Here are some strategies on what you can do to prevent and treat these problems and stay on track. Not surprisingly, 75% of running injuries occur from the knee down and the knee itself is the most common area injured.
Runner’s Knee:
This is also known as patellofemoral pain syndrome. It is caused by excessive stress to the undersurface of the kneecap and often causes irritation of the cartilage. Usually more common in women, it is often predisposed in individuals with too much rolling out of the feet (overpronation), too much outward angling of the limb at the knee (knock knee or genu valgum), a hypermobile patella, tight hamstrings, or weak hips, quads and glutes.
Treatment of this nagging problem usually involves a good stretching and strengthening program along with anti-inflammatory medication. Sometimes a supportive knee brace can help and a shoe orthotic may be indicated. Reducing your mileage and intensity for a time will help it resolve quicker. Cross training during this time can help you maintain your cardio fitness while giving your knees a break.
Stress Fractures:
A stress fracture can be catastrophic if you are in training for a particular upcoming event! A stress fracture is not like a fracture that occurs suddenly secondary to trauma to a particular bone. It occurs with cumulative strain to a bone and in runners it will usually involve the tibia (shin bone), calcaneus (heel bone) or the foot (metatarsals). It will require a visit to your doctor and an x-ray or maybe an MRI to make this diagnosis.
The problem is that it takes complete rest from impact activity of 6-8 weeks minimum for the fracture to heal. Often immobilization in a cast or removable walking boot is necessary. On rare occasions use of a bone growth stimulator or even surgery is required.
Hamstring injuries:
These injuries occur in the group of muscles on the back of your thigh which include the semitendinosis, semimembranosis, and biceps femoris. They are responsible for knee flexion and to a lesser extent hip extension. Injuries can range from a “pull” or a strain to a complete tear and usually occur with acceleration or sudden deceleration and in runners while sprinting. Pain, tightness and difficulty walking and running will follow and last from a few days to several weeks, depending on the severity. Swelling or bruising may indicate a more serious degree of injury.
Initial treatment consists of rest, ice, and stretching. Deep massage and the use of a roller can help with pain and swelling.
Once the pain and swelling have subsided a gradual return to activity should begin. Typically, I recommend cycling on a stationary bike or an elliptical followed by light jogging on a treadmill. By slowly increasing your activity 10-20 % a week you should be running again in a few weeks!
Iliotibial Band Syndrome:
If you are experiencing pain on the outside part of your knee this may be the problem. The iliotibial or IT band is a tight band of tissue extending from the hip down the outer thigh and attaching just past the knee joint. Repetitive movement over the lateral femoral condyle (prominent thigh bone at the knee) with constant flexion and extension while running can cause painful irritation and sometimes a popping sensation. A long stride, excessive bowlegged (genu valgum) alignment and hill training are risk factors for this injury.
While running cessation isn’t required, you may have to change your training routine or adjust your technique. Use of anti-inflammatory medication and ice may help resolve this issue and strengthening of the hip abductors may prevent this problem.
Ankle Sprains:
Ankle sprains are possibly the most common injury in all of sports. These will occur if the ankle “rolls” usually inward causing a stretch injury to the outer or lateral ankle ligaments most commonly. An ankle sprain can range from a mild stretching injury all the way to a severe ligament tear. More severe injuries will involve more pain swelling and often bruising or discoloration. One of these more severe cases may require a physician evaluation and an x-ray to rule out a fracture. Protected weight bearing on crutches and some form of immobilization may be required early on in treatment and later on bracing or taping can provide support on return to running.
This will definitely require rest and a hiatus from training. Ice for swelling, compression with a wrap, elevation and anti-inflammatory medication will help. Plan on not running for 4-6 weeks. If your ankle isn’t improving within a few weeks you may need treatment with a therapist or trainer. Evaluation by an orthopedic surgeon may be warranted also to rule out more severe injuries like occult fractures, high ankle sprains, or associated injuries to the cartilage or tendons which may inhibit normal progress.
Remember to listen to your body! Most injuries while running can be avoided by good shoe wear, avoidance of over training, and a good stretching and strength program that accompanies your training. If you experience any of these problems, a little time off or reduction in intensity can pay off in the long run. And if any of these persist or seem severe, don’t wait too long to have it evaluated by an experienced orthopedic surgeon or trained medical provider.