Injuries
Although running sounds like such a non-dangerous sport compared with football or lacrosse, there are actually a fair amount of injuries. The basic cause is the repetitive nature of the sport when there is an imbalance caused by underdeveloped muscles or a lack of flexibility. The easiest way to deal with injuries is thru prevention. This means lots of stretching, eating well, doing some weight training and cross training and not ramping up your workload too fast.
We will review of the most common injuries that we see, as well as some common ways to deal with them. THIS IS NOT A REPLACEMENT FOR SEEING A QUALIFIED PROFESSIONAL!!! It is merely so that you can understand your body and catch potential issues early and help you understand some of the causes behind them. We have a professional trainer on staff at MHS, and use your own doctor or one of the very good orthopedic specialists in the area.
Two good recommendations for doctors to see:
Dr. Andrew Collier, Orthopaedic. His office is at 2410 S Broad St # 200
Philadelphia, PA. (215) 334-3350. Although he lives in Moorestown.
Dr. Collier is the father of one of our own cross country runners, Ryan Collier, and lives in Moorestown. He is the doctor who saw to Coach Bickel and his multiple foot fractures, and has also attended to various other team members. He knows sports injuries very well, and is a good person to see for things like suspected stress fractures, or ligament and muscle and knee issues (although sometimes these issues may be caused by foot placement and need orthotics to correct).
What to do when you feel pain?
When you start to develop some sort of either intense pain, or consistent pain – please let your Coaches know as soon as possible. Catching injuries early is the best way to deal with them quickly. We will quite often advise you to “Go see Jenn.” She is a trained (and very good) trainer that understands all of these common injuries and more. She will give you a good diagnosis and method for trying to recover as quickly as possible. She will also recommend if she feels you need to see a doctor – but always feel free to seek other advice.
What are the common causes and recommendations?
Well, it can usually be summed up that something is aggravated and inflamed – that means something is rubbing in the wrong way and swelled up inside. The inflammation will usually cause some pain. The usual way to deal with inflammation is Rest, Ice, Compression and Elevation (RICE).
What are the most common injuries?
The most common problems are:
- Shin Splints – usually from running too much too soon and bad shoes.
- Knees – usually from growing too fast, weak thigh muscles or lack of flexibility
How can I avoid injuries?
- Stretch
- Good shoes –
- Running Shoes designed for running
- Get them fitted at the Moorestown Running Company so that they are adjusted for pronation – how you foot lands. Some people land on the inside, some on the outside – different shoes and inserts can drastically reduce this effect and potential injury.
- Also – limit running in a pair of shoes to about 400 miles.
- Have a new pair and old pair of shoes so that you can rotate them. When your shoes reach say 300 miles – buy a new pair and use the old ones for another 100 miles by rotating which pair you wear every couple of days.
- Muscle development. There are two simple isometric exercises that every runner should do every day:
- Sitting down – stick your leg straight out and tighten your thigh muscle. This helps with Runner’s Knee by getting your thigh strong enough to absorb the shock of running.
- Point your toes up toward the sky. Or walk on your heels. You will feel the front of your shin tighten up – this will develop your shins and avoid Shin Splints.
 Shin Splints
Shin splints are very common to new runners. It will feel like a dull to sharp pain along your shin or front bone of your calf.
Anterolateral shin splints affect the muscles in the front (anterior) and outside (lateral) parts of the shin. The shin muscles pull the foot up, and the larger and much stronger calf muscles pull the foot down each time the heel touches the ground during walking or running. The calf muscles exert so much force that they can injure the shin muscles.
The main symptom of anterolateral shin splints is pain along the front and outside of the shin. At first, the pain is felt only immediately after the heel strikes the ground during running, walking, skiing, or other similar exercises. If the person continues to run, the pain occurs throughout each step, eventually becoming constant. Usually by the time the person sees a doctor, the shin hurts when touched.
Posteromedial shin splints affect the muscles in the back (posterior) and inner (medial) parts of the shin, which are responsible for lifting the heel just before the toes push off. This type of shin splint often results from running on banked tracks or crowned roads and can be worsened by rolling onto the outside of the feet (pronation) excessively or by wearing running shoes that do not adequately prevent such rolling.
The pain produced by this type of shin splint usually starts along the inside of the lower leg, about 1 to 8 inches above the ankle, and worsens when a runner rises up on the toes or rolls the ankle in. If the person continues to run, the pain moves forward, affecting the inner aspect of the ankle, and may extend up the shin to within 2 to 4 inches of the knee. The severity of the pain increases as the shin splint progresses. At first, only the muscle tendons are inflamed and painful, but if the person keeps running, the muscles themselves can be affected. Eventually, tension on the inflamed tendon can actually pull it from its attachment to bone, causing bleeding and further inflammation.
The primary treatment is to stop running and do other types of exercise until running is no longer painful. Running shoes with a rigid heel counter (the back part of the shoe) and special arch supports can keep the foot from rolling onto the outside excessively. Avoiding running on banked surfaces can help prevent shin splints from recurring. Exercises to strengthen the injured muscles are useful.
Strengthening the Shin Muscles
1. Point your toes up toward the sky. Or walk on your heals. You will feel the front of your shin tighten up – this will develop your shins and avoid Shin Splints.
2. Bucket-handle exercise - Wrap a towel around the handle of an empty water bucket. Sit on a table or other surface high enough to prevent the feet from touching the floor. Place the bucket handle over the front part of one shoe. Slowly raise the front of the foot by flexing the ankle, then slowly extend the foot by pointing the toe. Repeat 10 times, then rest for a few seconds. Do 2 more sets of 10. To increase resistance, add water to the bucket—but not so much that the exercise is painful.
3. Toe raises - Stand up. Slowly rise up on the toes, then slowly lower the heels to the floor. Repeat 10 times, then rest for 1 minute. Do 2 more sets of 10. When this exercise becomes easy, do it while holding progressively heavier weights.
4. Outward rolls - Stand up. Slowly roll the ankle out so that the inner part of the sole is raised off the floor. Slowly lower the sole back to the floor. Do 3 sets of 10.
(From http://www.merck.com/mmhe/sec05/ch075/ch075c.html )
Runner's Knee - (Chondromalacia of the patella)
Pain around and sometimes behind the kneecap. One of the most common injuries among runners, runner's knee most often strikes as runners approach forty miles per week for the first time. Even after taking a few days off, the pain seems to come right back, sometimes even intensifying, after the first few miles of the next run. The pain often feels worst when running downhill or walking down stairs, and the knee is often stiff and sore after sitting down for long periods. You might hear a crunching or clicking sound when you bend or extend your knee.
The sure-fire test for runner's knee: sit down and put your leg out on a chair so that it's stretched out straight. Have a friend squeeze your leg just above the knee while pushing on the kneecap. She should push from the outside of the leg toward the center. At the same time, tighten your thigh muscle. If this is painful, you're looking at runner's knee.
Likely causes:
It's actually not your knee's fault at all. Blame your feet and thighs; for one reason or another they aren't doing their jobs properly. Your knee moves up and down in a narrow little groove in your thigh bone. It's a nifty design: when your legs and feet are working efficiently, your knee moves smoothly and comfortably with every step. But trouble appears when your kneecap moves out of its track, or rubs up against its sides. That trouble becomes pain when you factor in nearly 1000 steps per cartilage-grinding mile. Over time the cushioning cartilage around the knee becomes worn. That smarts. And that's runner's knee.
How did your knee get off track? Probably because of relatively weak thigh muscles and a lack of foot support. It's your thigh muscles that hold your kneecap in place, preventing it from trying to jump its track. Running tends to develop the back thigh muscles (hamstrings) more than those in the front (the quadriceps), and the imbalance is sometimes enough to allow the kneecap to pull and twist to the side.
Your foot, meanwhile, may not be giving you the stability you need. It's likely that your feet are making a wrong movement every time they hit the ground, and you're feeling the constant pounding and repetition of this mistake in your knee. Maybe you're overpronating (rolling your foot in) or supinating (turning it out too much) when you run.
Runner's knee is further aggravated by simple overuse. If you have steeply increased your mileage recently, you might consider holding back a bit. Likewise, back off on new hill work or speed work. Runner's knee can also be brought on by running on banked surfaces or a curved track. Running on a road that is banked at the sides, for example, effectively gives you one short leg, causing it to pronate and put pressure on the knee. Try as much as possible to run on a level surface, or at the very least give each leg equal time as "the short leg."
 Remedy:
This is an easily treatable injury with a little patience. First, relieve the pain by icing your knees immediately after running. You can use commercially available cold packs or simply put a wet towel in the freezer before you run. Wrap the cold packs around each knee for about fifteen minutes to bring down the swelling. Take an anti-inflammatory like ibuprofen or aspirin after running, too, but only with food and never before running. Before bed, put heating pads or warm wet towels on your knees for half an hour.
Stabilize your feet. Make sure you have the right kind of shoes for your foot type (review our tips on shoe shopping). Consider buying a commercially made foot support in the footcare section of your drug store. If, in combination with thigh-strengthening exercises, the foot supports are not enough to get rid of the injury, see a podiatrist about whether you might need orthotics.
Some of our runners have been advised to wear a Patella strap such as this - http://www.knee.ortho-net.com/fl/knee-gel-band.htm
Iliotibial Band Syndrome (ITB)
Pain on the outside of your knee (not usually accompanied by swelling or locking). The pain may be sporadic and disappear with rest, only to reoccur suddenly, often at the same point in a run. Depending on the individual, this could happen at four miles, two miles or just 200 yards. The pain often goes away almost immediately after you stop running.
Likely causes:
This is an overuse injury. The iliotibial band is a band of tissue that begins at the outside of the pelvis and extends to the outside part of the knee. The band helps stabilize the knee. If it becomes too short, the band rubs too tightly on the bone of your leg and becomes irritated. The tightness is usually the result of too much strain from overtraining.
Remedy:
Patience. This one takes a while. Give yourself plenty of rest, reduce your miles and ice frequently. You can keep running, but cut your run short as soon as you begin to feel any pain. Cut way back on hill work, and be sure to run on even surfaces. Look into some deep friction massage with a physical therapist.
  
Try some leg-raise exercises to strengthen your hips and be conscientious about the iliotibial band stretch. You might supplement that stretch with this one, doing it gently but often:
To stretch the IT band of your right leg, stand with your left side facing the wall. Cross your right leg behind your left, while putting your left hand ag ainst the wall. Put your weight on the right leg and lean against the wall by pushing your right hip away from the wall. Be sure that your right foot is parallel to the wall during the stretch. You should be able to feel the stretch in your hip and down the IT band (in this case, along the right side of your right leg). Hold for five seconds and do this ten times. For the left leg, do as above, but stand with your right side facing the wall, and put your left leg behind your right.
The material above on knees was taken from http://www.coolrunning.com/engine/2/2_5/194.shtml.
Also – see the article from Running Times by Dr. Brian Fullem - http://www.runningtimes.com/04may/itb.htm
Osgood-Schlatter's disease
Another common overuse injury is Osgood-Schlatter's disease. Although this condition usually shows up in the pre-adolescent ages, its symptoms of pain and tenderness often become more severe during adolescence, a time when the athlete is larger and more active in sports. Though it has a big name, Osgood-Schlatter's disease is just a painful bump over the front of the knee where the primary tendon (band of tissue that connects muscle to bone) of the knee cap attaches to the front of the lower leg bone (tibia). This point is a fulcrum, a power point for running, kicking and jumping. All of the pull of the quadriceps muscle comes through this attachment.
Osgood-Schlatter's ends as the adolescent matures and the growth plates close. The most important point I can emphasize about this condition is that, despite its name, it is not a disease. It is not dangerous; it does not lead to fracture or arthritis; and it does not require excessively aggressive treatment; it should not be treated with a cast or any form of stiff bracing.
There is no reason to make a child stop playing sports because of Osgood-Schlatter's, and there is no reason to operate on Osgood-Schlatter's in an adolescent. Treatments are ice, nonsteroidal anti-inflammatories as tolerated, knee pads to protect the area from being bumped, quadriceps stretching exercises, and activities as tolerated.
This material on Osgood-Schlatter’s Disease is from http://www.clevelandclinic.org/health/health-info/docs/0400/0448.asp?index=3902&src=news
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