Running Injuries
Achilles Tendinitis > Iliotibial Band Syndrome > Chondromalacia > Plantar Fasciitis > Shinsplints
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
tendonitis), 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 overtraining.
Excessive hill running or speedwork, 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 over-pronate (their feet rotate too far inward on impact) are most
susceptible to Achnilles 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 sussides. 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 a 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 overpronation.
Don’t run in worn-out shoes. Ease into any running program. Avoid
hill work. Incorporate rest into your schedule.
Definiton:
Inflammation and pain on the outside of the knee, where the iliotibial
(IT) band (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 speedwork, 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.
Definition:
A softening or wearing away and cracking of the cartilage under the kneecap,
resulting in pain and inflammation. The cartilage becomes like sandpaper
because the kneecap is not riding smoothly over the knee.
Symptoms:
Pain beneath or on the sides of the kneecap. “It’s a soreness,
a nagging discomfort,” says Dave Apple, M.D., an orthopedic surgeon
at Atlanta’s Piedmont Hospital. Pain can worsen over a year or so
and is most severe after you run hills. Swelling is also present. In severe
cases, you can feel-and eventually hear-grinding as the rough cartilage
rubs against cartilage when the knee is flexed.
Causes:
Excessive pronation (when the arch collapses too much and the foot rotates
too far inward) can cause the kneecap to twist sideways. Fatigued or weak
quadriceps muscles, which aid in proper tracking of the kneecap, can prevent
the kneecap from tracking smoothly. A muscle imbalance between weak quads
and tighter hamstrings can also pull the kneecap out of its groove. Hill
running (especially downhills) can aggravate the condition, as can running
on the same side of a cambered road, or, in general, overtraining.
Self-Treatment:
Stop running. Ice the knee for 15 minutes two or three times a day. Use
a flexible, frozen gel pack that wraps around the knee (or, in a pinch,
try a bag of frozen vegetables). Take aspirin three times a day for 12
weeks. “Aspirin has been found to block further breakdown of cartilage,”
says Apple. Also try self-massage on the sore spots around the knee. Once
the pain and swelling are gone, strengthen quadriceps by doing “step-down.”
Stand on a step or box at least 4 inches high. Keep your right quadriceps
tight while you lower the left leg slowly toward the floor. Then raise
it back up to the box, and relax. Repeat 40 times with each leg. Continue
increasing repetitions in increments of five every two days, all the way
up to 60 reps. Don’t forget to stretch quadriceps and hamstrings.
When you start running again, you also might try wearing a rubber sleeve
with a hole that fits over the kneecap, which can help the knee track
better. You should be back to easy running in four to six weeks.
Medical Treatment:
If chondromalacia isn’t responding to self-treatment after four
weeks, see an orthopedic surgeon. He or she may prescribe custom-made
orthotics to control overpronation. Surgery to scrape away rough edges
of cartilage can alleviate some pain. Despite what you may have heard,
cortisone injections won’t work. “The problem is, you won’t
feel pain while you’re crunching your knee to bits,” says
Dr. Apple.
Alternative Exercises:
Swimming, pool running, rowing. Anything that doesn’t put pressure
on the knee.
Preventive Measures: Stretch and strengthen quadriceps, hamstrings and
calves. If you overpronate, consider switching to motion-control shoes
with firm midsoles. Don’t run in worn-out shoes. You may need orthotics.
Avoid downhill running, and stay off cambered roads. If you can’t,
try to run on the flattest part of the road. Incorporate rest into your
training schedule. Don’t overdo it.
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 fascuutis 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 overpronate (twist too far inward on
impact) are the most susceptible. Worn-out shoes, which allow feet to
overpronate, 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 can 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 with 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.
Wear orthotics if you overpronate or have flat feet. Ice area for 15 to
20 minutes after running. Run on soft surfaces. Don’t run in worn-out
shoes. Incorporate more rest into your training schedule.
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 persistant 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 overpornation. Ultrasound and anti-inflammatories may also
be prescribed. Surgery is rarely required.
Alternative Exercises:
Non-impact 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 over-striding, which puts more stress
on shins.
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