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Running Injury/Prevention Part I

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Wednesday, September 8, 2010

Running Injury/Prevention Part I

OK, So I started this blog and realized that it is a LOT longer than intended, so I am going to make it a two-part blog :)

Enjoy, read up, and I want you to be aware of these injuries and how to prevent them.  And, while these are mostly due to running, you can get them from walking, and sometimes get these issues from other form of exercise, so please take note if you have any of these pains and see an HCP to get diagnosed and DON’T just take ibuprofen and run through it; you can cause serious injuries!!

IT Band Syndrome:
Runners Knee (Iliotibial band syndrome)
The IT band is a thick, fibrous band of fascia which runs down the outside of the thigh and inserts just below the knee. If this band becomes tight it can rub against the outside of the knee causing pain and inflammation. It attaches at the top to both the iliac crest (hip bone) and the Tensor fascia latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). Its purpose is to extend the knee joint (straighten it) as well as to abduct the hip (move it out sideways). 
As the ITB passes over the lateral epicondyle of the femur (bony part on the outside of the knee) it is prone to friction. At an angle of approximately 20-30 degrees the IT band flicks across the lateral epicondyle. When the knee is being straightened it flicks in front of the epicondyle and when it is bent, it flicks back behind.
Signs and Symptoms of ITB Syndrome:
Pain on the outside of the knee
Tightness in the IT band
Pain normally aggravated by running, particularly downhill.
Pain during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
Weakness in hip abduction (widening the hip)
Tender trigger points in the gluteal (upper and lower butt muscles) area may also be present.
What can the athlete do to prevent Runners knee?
RICE- Rest Ice Compress and Elevate
Avoid downhill running.
Stretch the IT band after training.
Massage techniques can also be very helpful in correcting excessive ITB tightness.
 An HCP may get you into Physical Therapy (PT) to work on ways to stretch and strengthen the surrounding muscles, and may even administer a cortisone injection to the area to decrease swelling in extreme cases.

Shin splints is a common name for pain at the front of the lower leg, usually to the inside of the protruding Tibia (shin bone). The most common cause is inflammation of the periostium of the tibia (sheath surrounding the bone). Traction forces on the periosteum from the muscles of the lower leg cause shin pain and inflammation. This has lead to the use of terms such as Medial Tibial Traction Periostitis.
Symptoms of shin splints:
Pain over the inside lower half of the shin.
Pain at the start of exercise which often eases as the session continues
Pain often returns after activity and may be at its worse the next morning.
Sometimes some swelling.
Lumps and bumps may be felt when feeling the inside of the shin bone.
Pain when the toes or foot are bent downwards.
A redness over the inside of the shin (not always present).
Shin Splints Treatment
Treatment for shin splints is as simple as reducing pain and inflammation, identifying training and biomechanical problems which may have helped cause the injury initially, restoring muscles to their original condition and gradually returning to training.
What can the athlete do about shin splints?
Rest to allow the injury to heal.
Apply ice in the early stages, particularly when it is very painful. Cold therapy reduces pain and inflammation.
Stretch the muscles of the lower leg. In particular the calf muscles associated with shin splints.
Wear shock absorbing insoles in shoes- this is for heel runners and is the common suggestion by HCP’s, not as much of an issue for forefoot runners.
Maintain fitness with other non-weight bearing exercises such as swimming, cycling or running in water, to rest the muscles
Apply heat and use a heat retainer or shin and calf support after the initial acute stage and particularly before training; it causes blood vessels to dilate and increases the flow of blood to the tissues to aid healing.
Overpronation of the feet
Oversupination of the feet
Inadequate footwear (debatable….as mentioned before!!)
Increasing training too quickly
Running on hard surfaces
Decreased flexibility at the ankle joint

In order to properly treat shin splints and prevent them recurring, the cause must be taken into consideration. No matter how much rest, anti-inflammatory medications and massage are used, without correcting the cause of the injury, the symptoms will continue to return.
Biomechanical problems such as overpronation and supination can be corrected using running shoes or insoles (or orthotics). As a basic rule of training, distances should not increase by more than 10% per week. This helps to ensure the muscles are not overworked.
For runners, try to avoid always running on hard pavements as they provide no shock absorption. Try running some of the time on tarmac, grass, or sand to reduce the shock passed through the legs.
Shin splints can be caused by overly tight muscles in the lower leg, including the calf muscles (gastrocnemius and soleus) and the shin muscles. Stretching on a daily basis and even receiving sports massage can help improve flexibility.

Anterior compartment syndromes arise when a muscle becomes too big for the sheath that surrounds it causing pain. The big muscle on the outside of the shin is called the tibialis anterior and is surrounded by a sheath. This is called the anterior compartment of the lower leg. Compartment syndromes can be acute or chronic.
 Acute anterior compartment syndrome can occur as a result of:

An impact which causes bleeding within the compartment that causes swelling.
A muscle tear which also causes bleeding/swelling
Over use injury, which also causes swelling.
Symptoms of anterior compartment syndrome include:
A sharp pain in the muscle on the outside of the lower leg, usually the result of a direct blow.
Weakness when trying to pull the foot upwards against resistance.
Swelling and tenderness over the tibialis anterior muscle. (upper calf)
Pain when the foot and toes are bent downwards.
What can the athlete do?
Rest, but try to exercise your upper body or cycle if it is not painful (swim, bike, Physical Therapy)
RICE in 20 minute cycles
What can an HCP do?
Prescribe anti-inflammatory medication (ibuprofen)
Fit for orthotic devices.
Refer to an Orthopedic Surgeon to operate; a small cut or two in the muscle sheath  will allow the muscle to expand out.
Chronic anterior compartment syndrome can occur as a result of:
Over use and over developing the muscle through training.
At rest the blood vessels are not at capacity. During exercise these blood vessels fill up much more and expand putting pressure on the sheath (can be painful due to varicose veins)
Symptoms include:
Pain which increases during exercise which eventually makes running impossible.
Pain goes after a short rest but comes back again during exercise.
Difficulty in lifting the toes and foot up.
Pain when pulling the toes and foot downwards.
What can the athlete do?
Rest until there is no pain- RICE when possible
Apply sports massage techniques to increase the elasticity of the muscle sheath.
Apply heat before exercise.
See a sports injury specialist/Physical Therapist
What can a sports injury specialist or doctor do?
Prescribe diuretics and anti-inflammatory medication.
Analyze your training methods, running gait and types of shoe to determine any contributory factors.
Use sports massage techniques to stretch the muscle sheath.
Prevention of Running Injuries
Running injuries are very specific due to the repetitive nature of the sport. Injuries are caused either by the bodies own intrinsic factors or by extrinsic factors.
The body works on a closed chain system when running i.e. when the foot is in contact with the ground, the forces and mechanics are transmitted along the leg to the spine. This is repeated every step and means if anywhere along this chain is out of line then potential injuries can happen.
Intrinsic factors
Intrinsic factors relate to the body itself. They are factors from inside the body rather than outside injury risk factors. Everybody has their own individual mechanics, some better than others. Some break down more than others. Everyone has their own unique threshold of injury.
What can go wrong?
If there is a biomechanical abnormality anywhere along the chain from the feet up, then injuries can occur. The most common problem is feet that collapse and overpronate causing the leg to turn in and pressure on the achilles, shin, knee, hip and spine. If you over pronate then you need stability trainers or running shoes to support the foot. In extreme cases where the runner is injury prone, orthotics may be prescribed.
Most specialist running shops will be able to look at your feet and tell you what foot type you are. Squinting patella and hips and knees that turn in are also common problems especially in women. Again, this means these areas and those above and below are placed under extra strain, leading to injuries.
A lot of biomechanical problems can be corrected using Physical Therapy (PT) For example, knees that fall in (giving a knock-kneed appearance) are usually the result of weak hip abductor muscles which would usually act to pull the thigh and so knee outwards. Tight hip flexors are also a very common problem with runners as the hip flexors are repeatedly contracted and shortened. I would advise all runners to include a simple hip flexor stretch in their warm up:
Hip flexor stretch
On one knee, other foot rested in front, tighten the stomach muscles and lean forwards.
If this is painful on the knee then try standing , pull one heel to the bum and pull knee backwards, keeping the spine still.
Hold both stretches for 30 seconds.
Tightness in the calf muscles can lead to over pronation due to lack of range and then shin pain. It is important to stretch the 3 layers of calf muscles.
Calf stretch
Standing on a step initially let the heels drop and stretch the large superficial muscles. Then repeat this stretch with the knee slightly bent to stretch the Soleus muscles which runs deep to the larger Gastrocnemius. This muscle is often forgotten!
Tightness in the spine is a very common cause of all running injuries treated. It is good to do some basic spinal mobility exercises to try and get the spinal joints moving before running. These can include pulling the knees to the chest, then lying on your front pushing up on the arms, and then you can rotate the spine lying on your back with the knees bent.

Extrinsic factors
Before training for any running event and even throughout your training you should be asking yourself the following questions

Running shoes
Have they worn out?
Are they the correct type?
Are you wearing racing shoes for slow mileage?
Do you pronate and have appropriate shoes? Go to a running store, and they can help to assess your feet, and your running style and find the best pair of shoes for you!!
Do you perform a warm-up prior to training? (The answer should be yes!)
Have you been increasing your training too quickly? A basic rule is a 10% increase in mileage per week. 
Are you running on a different surface to usual? Concrete pavements and roads offer very little shock absorption 
Are you doing a more hilly route than usual? Running up and down hills alters your body mechanics.
It’s a good idea to keep a training diary so you can look back and see what may have changed in your training; I use my Nike + for this so it is all online and I can keep track of my times, distances, and I usually note what kind of run it was.
Core strength
If the central part of the body is not strong then you will be more susceptible to injuries especially when you become tired at the end of a run.
 Make sure you do some abdominal exercises and gluteal strengthening. Try and get your club to organize a circuit session, include all the basic exercises like squats, lunges and calf raises.  Also, A good idea is to go to the gym and do a lot of muscle strength training in the legs on your days off from running; when running you repeatedly use the same muscles, so at the gym, strengthen the ones that aren’t used as much!!
Try to eat a balanced diet with lots of fresh fruit and vegetables and plenty of carbohydrates following training and protein to repair muscle damage. It is also vitally important to stay hydrated before and after training. 
There are some videos on Here


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