Running From Injury | Sports Medicine May 2013

Spring was a little late in coming this year, and as it continues to warm up, we have an opportunity to watch our surroundings change day by day. Running is a perfect way to watch the snow melt on the sides of the roads, the ephemeral flowers bloom, and buds on the trees turn into flowers, harkening summer.

While running is a rather uncomplicated sport, it comes with its struggles and risks. If you are new to running, consider starting easy and gently coming to your comfort level within the sport. If you are returning for the season, remember to start low and go slow to condition your body for its new activity. If you have been active all winter, then you’ve got a leg up on the rest of us!
In any case, new or returning, running can cause injury. It could be a sudden incident (rolled ankle or a tweaked knee) or a condition developing over time (overuse injuries such as shin splints and tendonitis), which accounts for approximately 50 to 75 percent of running injuries.

The top running-related injuries include:

• Stress fractures, which are pain in the lower third of the shin or feet, can be caused by changing to a hard running surface too quickly and overloading stress from repeated pounding, especially when muscles are fatigued or weakened.
• Shin splints, which are achy, stabbing pain on the inner shin area, can be accompanied by redness (inflammation from the tissue around the bone) and tenderness. It generally comes on from a rapid spike in training as well as tight calves or other biomechanical imbalances.
• Achilles tendonitis is stiffness, pain, and tenderness in the strong tendon behind the ankle. It increases with activity and decreases with rest. Acute cases come on within days. Chronic cases are accompanied by a tender nodule and redness. Tight calves are the chief cause. Additionally, overuse from unsupportive shoes or increasing intensity and volume of running too quickly are predictors.
• Plantar fasciitis is stabbing pain and tenderness on the bottom of the foot, through the arch, toes to the heel. Over time, flexibility and strength suffer, and severe cases can cause bone spurs, classically described as “first step heel pain” when stepping out of bed. Though over-pronation (foot rolling in) is the first mechanical flaw, it is caused by tight calves, poor foot support, and overtraining.
• Iliotibilal band syndrome is sharp stabbing pain on the outside of the knee from friction when the tight band (named from starting point to end- ilio-tibial) rubs on the knee. It increases with high miles and subsides when running stops. It often comes from chronically running on one side of the road or downhill running, and also from weak or tight muscles in hip and leg.
• Ankle sprain is typically point tender to the stretched ligaments and causes feelings of instability. They can significantly vary in degree of injury and recovery. Unfortunately, most sprains are poorly reported and under treated then later cause trouble for runners. Chronic ankle instability is a long term condition. Most commonly an ankle roll is an inversion sprain, when the ankle rolls outward.
• Blisters tender to be caused by friction. Often, poorly fitting shoes or folded socks can cause hot-spots that turn to blisters if ignored.
• Temperature related injuries include heat exhaustion, sunburn, hypothermia and frostbite. All are preventable. Think sunscreen, hydration and appropriate clothes.

The good news: it is easiest to control the injuries with insidious onset—generally the ones that come on slowly and mount to big trouble if left unattended. Correct running form would do us all a lot of good, too.

Remember to

• Warm up and cool down with stretching and light activity.
• Increase activity no more than 10 percent per week.
• Dress appropriately for the weather and hydrate well.
• Cross-train to mix it up and benefit your strength, core, and cardio and avoid boredom. It can also prevent overuse injury from repetition while keeping you active.
• Wear comfortable shoes with a good fit. Correcting any subtle biomechanical faults is critical to safe running. Consider how many times your foot hits the ground with each run. If you’re considering barefoot running, check out the pros and cons before you toss your trusty running shoes.
• Most importantly, listen to your body. Overuse injuries can come on slowly, but generally they start with a notion that something is wrong, such as calf pain, hot spot from the shoe, sore knees or a slight limp. These can all lead to injury that could have been prevented by listening to your body early on.

Sudden onset injuries (often accidental) are more difficult to prevent, but just as important to treat quickly. Many injuries can be treated with “first aid” of PRICE: protect, rest, ice, compress and elevate. Add stretches, and you have a DIY start to recovery. If you have difficulty treating these conditions on your own, please consider seeing a specialist. It is important to manage inflammation medically appropriately. Or a physical therapist can set you on a course of modified activity and prescribe a specific stretching routine. It is unfortunate to have to stop doing something you enjoy because of pain. Up to 90 percent of injury causes decreased activity, and five percent results in work absences.

Sometimes, quick relief can get you back to running in short order. We’ll be able to watch the subtle changes of spring to summer if we are out there running, not sitting on the bench.