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Running Injury/Prevention Part II

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Thursday, September 9, 2010

Running Injury/Prevention Part II

More running injuries, prevention, and treatment…also I want to reiterate for those who didn’t read Part I, that I want you know what could be going on, so try treatments, but if the pain/discomfort persists, please go to a HCP and get diagnoses properly and treated.  Taking ibuprofen before every run can mask and injury and make it worse over time, unless that is the appropriate treatment!!
Stress Fractures
Stress fractures are common amongst runners, in the femur (thigh), tibia (shin) and feet. A stress fracture is a break in a bone caused by repetitive impact and contraction of the muscles. Stress fractures do no go completely through a bone as other fractures sometimes do. Since they are associated with heavy training, stress fractures can be mimicked by injuries to the muscles, tendons, ligaments and other fractures. 

How a stress fracture forms
Resorption and new formation of bone occurs in response to mechanical stresses. This is called bone remodeling. During periods of intense exercise, bone formation lags behind resorption. Without adequate rest, bones become susceptible to micro-fractures. With continued stress, micro-fractures may combine into stress fractures.

Risk factors for developing a stress fracture
A sudden or substantial increase in duration and/or intensity of training is the most significant risk factor for developing a stress fracture. Inadequate muscle strength, inflexible joints and low bone density may play a role when in the formation of stress fractures. In general, females are at greater risk to develop stress fractures. Although the reasons for this discrepancy remain unclear, possible causes include eating disorders, pre-activity conditioning levels, endocrine (hormone) factors, skeletal alignment and lower bone density. Lower bone mineral density is associated with the following, as discussed in earlier blogs: regular intake of carbonated drinks, white race, alcohol and/or tobacco use, low for weight/height ratio, steroid use (prednisone-type for asthma, e.g. not anabolic steroids) and use of depo-provera injectable contraceptive.
Pain that increases with activity and decreases with rest
Pain that occurs earlier in your workout in each successive workout
Pain that increases over time
Pain that persists even at rest
A specific spot on the involved bone that feels tender or painful to the touch
At first, stress fractures may be barely noticeable. But pay attention to the pain. Proper self-care and treatment can keep the stress fracture from worsening.
When to see a doctor

Stress fractures aren't always obvious. They develop over time, so it's difficult to tell exactly when they start to require a doctor's care. Go to your doctor if running or playing hurts your foot or leg even after you've stopped the provoking activity and given yourself time to rest.

The treatment for a stress fracture is rest from the offending activity. Four to six weeks of rest is usually sufficient, followed by a gradual increase to full activity. Immobilization in a brace or cast is done for situations in which there is pain with walking or at rest. Non-stress/non-impact training such as swimming or bicycling is generally safe and helps maintain fitness. For certain fractures, orthopedic referral is necessary if there is a risk that the fracture will not heal properly. 

Pain control is important. Regular ice application to the affected area can reduce both pain and inflammation. Some advocate very little pain medication as it may slow healing. Gentle massage can relieve pain and help increase blood flow. Dietary supplementation with Calcium (1200 to 1500 mg) and Vitamin D (400-800 IU) should be encouraged during the acute phase.

Preventing stress fractures is very important. Avoiding significant changes in frequency or intensity of training will help avoid multiple types of injuries, including stress fractures. Good footwear with limited wear and shoe inserts that absorb shock are helpful. A diet with substantial vitamin D and calcium can help improve bone density for individuals with this risk factor. Eating disorders rob the body of essential nutrients and hormones needed to maintain good bone health. If any problem exists with eating behavior or if a woman is having no periods, these issues should be addressed immediately. Avoiding carbonated beverages, alcohol and tobacco helps to reduce the risk of low bone mineral density.

Snapping Hip
Snapping hip syndrome is a condition that is characterized by a snapping sensation, and often an audible 'popping' noise, when the hip is flexed and extended. There are several causes for snapping hip syndrome, most commonly due to tendons catching on bony prominences and "snapping" when the hip is moved.
Iliotibial Band Snap
The iliotibial band is a thick, wide tendon over the outside of the hip joint. The most common cause of snapping hip syndrome is when the Iliotibial band (or "IT band") snaps over the greater trochanter (the bony prominence over the outside of the hip joint). If this is the cause of snapping hip syndrome, patients may develop trochanteric bursitis from the irritation of the bursa in this region.
Iliopsoas Tendon Snap
The iliopsoas tendon is the primary hip flexor muscle, and the tendon of this muscle passes just in front of the hip joint. The iliopsoas tendon can catch on a bony prominence of the pelvis and cause a snap when the hip is flexed. Usually when the iliopsoas tendon is the cause of snapping hip syndrome, patients have no problems, but may find the snapping annoying.
Hip Labral Tear
The least common cause of snapping hip syndrome is a tear of the cartilage within the hip joint. If there is a loose flap of cartilage catching within the joint, this may cause a snapping sensation when the hip is moved. This cause of snapping hip syndrome typically causes a snapping sensation, but rarely an audible "pop." This cause of snapping hip syndrome may also cause an unsteady feeling, and patients may grab for support when the hip snaps.
Most people do not bother seeing a doctor for snapping hip unless they experience some pain. Your doctor will first determine the exact cause of the snapping. You may be asked where it hurts, what kinds of activities bring on the snapping, whether you can demonstrate the snapping, or whether you have experienced any trauma to the hip area.
You may also be asked to stand and move your hip in various directions to reproduce the snapping. The doctor may even be able to feel the tendon moving as you bend or extend your hip.
X-rays of people with snapping hip are typically normal, but they may be requested along with other tests so that the doctor can rule out any problems with the bones or joint.
If your snapping hip is painless, no treatment is needed.
If the snapping hip bothers you, but not to the point of seeing a doctor, try the following conservative home treatment options:
Reduce your activity levels and apply ice.
Use nonsteroidal anti-inflammatory drugs, such as aspirin or ibuprofen, to reduce discomfort.
Modify your sport or exercise activities to avoid repetitive movement of the hip. For example, reduce time spent on a bicycle, and swim using your arms only.
If you are still experiencing discomfort after trying these conservative methods, consult your physician for professional treatment.
Stretching exercises prescribed by your physician or a physical therapist can help reduce discomfort.
If you have hip bursitis, your physician may recommend an injection of a corticosteroid to reduce inflammation.
In the rare instances that snapping hip does not respond to conservative treatment, surgery may be recommended. The type of surgery will depend on the cause of the snapping hip; arthroscopy of the hip may be indicated.
The key to preventing snapping hip syndrome is a balanced stretching routine. Stretch both the abductors and adductors evenly. The abductors are the hip muscles that move the
leg away from the midline of the body. The adductors are the hip muscles that bring the leg back to the midline of the body. It is recommended that athletes include an iliotibial-band stretch as part of their warm-up and stretching routines.

Also, I wanted to include a diagram so you can understand what muscles and bones I am referring to, for those of you who are visual learners like me!!

Yours In Good Health!


At September 9, 2010 at 10:45 AM , Anonymous Anonymous said...

ummm i knew running with you was the root of my problems... I'm just kidding it was just lyme disease... also another bad thing to go running with

At September 9, 2010 at 11:15 AM , Blogger Nurse Bridgid said...

Whilst you are being silly, Romeo, that is an excellent point you bring up of any to go see and HCP! You may have pain and swelling, and treat it with home remedies to get through runs, and then really damage yourself in the long run OR find out that the swelling/pain etc is from something unrelated like Arthritis, Lyme Disease, etc. :)


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