McGovern Physical Therapy Associates - The Personal Care Professionals

ARE YOU A RUNNER?

Then you have probably had an injury at some time during your running career.

The five most common running injuries are: Achilles tendonitis, chondromalacia, iliotibial band (ITB) syndrome, plantar fasciitis and shin splints.

Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon. The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone, and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking. Achilles tendonitis is more common in athletes and overall incidence of the condition is unknown. It occurs in approximately 6-18% of all runners. A flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 8 weeks. If the injury responds to this treatment, the patient will then be advised to wear low-heeled shoes and begin physical therapy to gradually stretch the tendons and muscles before full activity is resumed.

Chondromalacia, also known as runner's knee, is a degenerative condition of the cartilage surface of the back of the knee cap, or patella. It produces discomfort or dull pain around or behind the patella. It is common in young adults, especially runners. The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which it passes during motion of the knee. It can be caused by trauma or by chronic trauma, such as by applying excessive force to the patella via exercise, such as running. Biomechanical abnormalities such as over pronation of the feet can also result in incongruity between the direction the patella is pulled by the quadriceps muscle and the shape of the patellofemoral groove through which it travels.

Iliotibial Band Syndrome is one of the leading causes of lateral knee pain in runners. The iliotibial band is a superficial thickening of tissue on the outside of the thigh, extending from the outside of the pelvis, over the hip and knee, and inserting just below the knee. The band is crucial to stabilizing the knee during running, moving from behind the femur to the front during the gait cycle. The continual rubbing of the band over the bone, combined with the repeated flexion and extension of the knee during running, may cause the area to become inflamed, or the band itself may suffer irritation. Iliotibial band syndrome symptoms range from a stinging sensation just above the knee joint to swelling or thickening of the tissue at the point where the band moves over the femur. The pain may not occur immediately during activity, but may intensify over time, especially as the foot strikes the ground. Pain may also be present below the knee, where the ITB actually attaches to the tibia. For successful rehabilitation, it is essential to restore the flexibility of the iliotibial band, and the strength and flexibility of the muscles which act upon it. Stretching the band is a complicated task; ask a physical therapist for techniques.

Plantar fasciitis, which may cause the heel to hurt, feel hot or swell, is inflammation of the plantar fascia, a thin layer of tough tissue supporting the arch of the foot. Repeated microscopic tears of the plantar fascia cause pain. Sometimes plantar fasciitis is called "heel spurs", but this is not always accurate, since bony growths on the heel may or may not be a factor. Typically with plantar fasciitis, the pain is worse when first getting out of bed, or is noticeable at the beginning of an activity and gets better as the body warms up. Prolonged standing may cause pain as well. In more severe cases, the pain may worsen toward the end of the day. There are a number of possible causes for plantar fasciitis and they often work in combination. Tightness of the foot and calf, improper athletic training, stress on the arch or weakness of the foot are potential causes. Shoes that don’t fit, running too fast, too far, or too soon may hurt the plantar fascia. People with low arches, flat feet or high arches are at increased risk of developing plantar fasciitis. Ask your physical therapist about custom-made orthotics and pain-relieving stretches.

The term shin splints refers to a painful condition that develops along the inside of the shin (tibia). The usual location is along the lower half of the tibia, anywhere from a few inches above the ankle to about half-way up the shin. The repeated running cycle of pounding and push off results in muscle fatigue, which may then lead to higher forces being applied to the fascia, the attachment of fascia to bone, and finally the bone itself. In the early stages of shin splints a runner will describe a pain that is present when the training run first begins, but then disappears as running continues. The pain will often return after exercise or the following morning. As the injury progresses, the athlete will experience more time with the pain, and less time without it. Eventually, if ignored and training is continued, the pain may become quite sharp and may focus on a very small area of the bone. If this happens, a stress fracture may occur. Depending upon severity it is often necessary to completely stop running for a period of time. Generally this is done until day-to-day activities are pain free. When running is resumed – and this is where many injured runners make a mistake – it must be significantly different from the routine that lead to the injury. There should be a graded and gradual increase in run training, keeping an eye out for the return of any shin splint symptoms. Stretching and strengthening the calf muscles can help prevent the injury from returning.

If you have recently experienced one of these injuries, ask yourself these questions:

Have you changed your training routine by increasing mileage, adding speed, or hill training? If so, you may have to back off for awhile. Gradual progression of training allows your body time to adapt to higher demands placed on it. Each time your foot hits the ground it absorbs about 2.5 times your body weight and you land on each foot around 800 times/mile. Tissues that are injured are less able to withstand these forces.

How are your shoes? Your sneakers may look fine, but the materials in most running shoes lose their shock absorbing and stabilizing properties after a few hundred miles. Change your shoes after five hundred miles regardless of how they look. Your selection of shoe type is also important. Talk to an expert who knows your running habits, mileage, terrain and competition level. Also, see a physical therapist about appropriate custom-made orthotics.

Has your training surface changed recently? Soft or hard surfaces, slanted roadways, and hills all affect the mechanics of running.

How are your body mechanics? Everyone has different strengths, weaknesses, flexibility patterns, muscle recruitment skills and body types. All of these factors impact the way any of us runs. Changing your running style is a very difficult thing to do, but you should try to keep a comfortable stride length, hit the ground on an area from the middle of the foot to the heel of the foot, and take off with the toes. If your head seems to move up and down a great deal, or from side-to-side, you are running inefficiently.

The Do’s and Don’ts:

DO: See a physical therapist that you trust.
DO: Rest, ice, and elevate the leg (if that's what you injured!)
DO: Reduce your mileage to a pain free amount, even though it may be a blow to your ego. 
DO: Cross-train to maintain your overall fitness level with exercise such as biking or swimming.
DO: Trust and listen to yourself. Irritability, fatigue, insomnia, severe muscle soreness and getting colds and flu easily may me signs that you are overtraining. 
DO: Progress at a naturally comfortable rate. 
DO: Warm up by walking or jogging slowly for at least five minutes. 
DO: Cool down slowly at the end of your run by walking at least five minutes.
DO: Stretch before and after every run, especially the Achilles tendon, hamstrings, and quadriceps. Remember the best time to stretch is after you run and the muscles are pliable.
DO: Get on a weight training program to strengthen muscles around the hip, knee, ankle and abdominal area. This may take some of the shock away from the knee.

DON'T: Run though the pain. Your body is trying to tell you something–listen to it.
DON'T: Think you have to give up running. There's help out there!
DON'T: Ignore the problem. If you do, it is more likely to come back or get worse.
DON'T: Think that you have to fix things on your own. Physical therapists can help you be pain free!

McGovern Physical Therapy Associates, the personal care professionals, is a multi-specialty provider of outpatient physical therapy care located in Revere, Malden and Beverly, MA. Voted “Best PT Practice 2004” by ADVANCE for Directors in Rehabilitation magazine, our clinicians offer personalized manual therapy and exercise expertise, including a variety of customized treatment options. Combining innovation, experience and excellence, our staff of clinicians, as well as dedicated office personnel, work as a team to provide caring, convenient and professional service for total patient recovery.

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