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Runner Injury

INTRODUCTION:

For preventive strategies to lessen running injuries is needed as these occur in 40%-50% of runners on an annual basis. Many factors influence running injuries, but strong evidence for prevention only exists for training modification primarily by reducing weekly mileage. Two anatomical factors – cavus feet and leg length inequality – demonstrate a link to injury. Weak evidence suggests that orthotics may lessen the risk of a stress fracture, but no clear evidence proves they will reduce the risk of those athletes with leg length inequality or cavus feet. It is needed to determine whether interventions to address any of these will help prevent running injury.

The overall proportion of injury by specific pathology was reported from 11 studies. The knee (28%), ankle-foot (26%) and shank (16%) accounted for the highest proportion of injury in male and female runners, although the proportion of knee injury was greater in women (40% vs. 31%). Relative to women, men had a greater proportion of ankle-foot (26% vs. 19%) and shank (21% vs. 16%) injuries. Patellofemoral pain syndrome (PFPS; 17%), Achilles tendinopathy (AT; 10%) and medial tibial stress syndrome (MTS; 8%) accounted for the highest proportion of specific pathologies recorded overall. There was insufficient data to sub-divide specific pathology between genders. The predominant injury in female runners is to the knee. Male runners have a more even distribution of injury between the knee, shank and ankle-foot complex.

When we are talking about running injuries, we should introspect why it happens or what are the factors/causes of injuries.

COMMON FACTORS CAUSING INJURIES :

  • Muscle weaknessSolution: Improve muscles strength through yoga.
  • Inadequate flexibilitySolution: Perform Cross Training and improve flexibility
  • Training errorsSolution: Learn from a trained and experienced trainer
  • Improper running shoesSolution: Wear Standard company’s running shoes
  • Abnormal biomechanicsSolution: Get body check up by orthopedic or spine specialist
  • Female athlete triad- Anorexia, Amenorrhea, Osteoporosis.

Above all lack of healthy diet, Lack of good sleep and irregular lifestyle will increase the risk of injuries.

Apart from above most common factors excess and fast running. When above-given reasons accumulate, at that time there are
chances of running injuries increases. Let us know about different types of running injuries and prevention of it.


TYPES AND PREVENTION OF RUNNING INJURIES :

1. STRESS FRACTURES :

It occurs to mainly distance runners like marathon runners. A stress fracture happens at the site- upper and lower thirds of the tibia, fibula, navicular, 2nd/3rd metatarsal and it is common in male and female both. Mainly it happens due to microtrauma and overuse of macules.It is often bilateral and recurrent.

In this treatment generally involves complete rest for 4 to 6 weeks, splinting and physical therapy, and rarely surgery. (No NSAIDS) or Newer modality-bone stimulator.

As far as prevention is concerned runner needs cross-training, proper footwear and proper diet which contains enough calcium.

2. PLANTAR FASCITIS :

This is the most common cause of heel pain. It is inflammation of the plantar fascia of the heel. Commonly seen in athletes with prolonged standing or running, flat feet and shortened tendoachilles. A symptom of Plantar Fascitis is sharp stabbing pain at the medial aspect ofthe heel, more in the morning. Treatment includes activity modification, soft well-cushioned footwear, night splints, toe stretching and curls,heel rolling, ice therapy and in some cases local steroid injection.

For prevention one has to AVOID BAREFOOT WALKING.

3. ANKLE SPRAINS :

In general case, it occurs due to twisting or traditional injuries. Uneven surface, improper footwear or an unfortunate landing is mainly responsible for this. There is a different kind of ankle sprain and none of them should be avoided by runners.

  • Grade 1- partial tear with no functional impairment
  • Grade 2- partial tear with moderate functional impairment and mild instability
  • Grade 3- complete tear with loss of function and motion

How to manage in these conditions is also one of the very important aspects. Let us understand as per grade manner.

  • Grade 1- RICE+ ankle support with crepe bandage/light brace for 2 weeks
  • Grade 2- Same treatment for 3-4 weeks
  • Grade 3- Stiff ankle brace/casting is necessary. Crutches are required to avoid weight bearing. In severe cases-surgery is rarely required.

In Ankle Sprain, Prolonged immobilization is common treatment error. For this one has to start Functional rehabilitation should start as soon as possible. The rehabilitation process includes:

  • ROM Rehabilitation-Achilles tendon stretching
  • Progressive muscle strengthening-toe raises, toe walks, heel walks, resistance exercises
  • Proprioceptive training-wobble board training
  • Activity-specific training-jogging, running, pattern-running

4. ACHILLES TENDINITIS/RUPTURE :

Achilles tendon takes the highest weight in the body(8* the body weight). It occurs 2-6 cm above the calcaneal insertionat the site of low vascularity. Rapid increases in distance, tight calf muscles, sudden eccentric contraction, flat footor improper footwear, etc.are main factors for this.

Main treatment includes rice, anti-inflammatory medications, orthotics(heel lift) and stretching. (No steroid injections-may cause ruptures).And in some cases, if no relief than one has to go for conservative treatment.

5. MEDIAL TIBIAL STRESS SYNDROME/SHIN SPLINTS :

This is the most common injury in runners. It occurs when the muscles and tendons covering the tibia become inflamed-soleus insertion periostitis. It has specific symptoms like pain in medial and posterior tibia diffusely, pain while running on hard surfaces, tiptoes and in sports involving a lot of jumping. When a runner is struggling with certain symptoms he/she has to take treatment for some time and that includes includes-Rest for 5-7 days, ice application, limb elevation at night, soft well-cushioned shoes.

Now prevention is an uttermost important aspect. For this runners can go for shock-absorbing and correct-fitting footwear, running on softer grounds whenever possible, Achilles stretching.

6. MEDIAL TIBIAL STRESS SYNDROME/SHIN SPLINTS :

This issue occurs commonly in a jumper and long-distance runners. Due to overuse or too much-inclined training, repetitive microtrauma occurs. For this, one can go for treatment like quadriceps and hamstring strengthening, ice application and physical therapy.

7. PATELLOFEMORAL PAIN SYNDROME/RUNNER’S KNEE :

This is more common due to repetitive downhill running, muscle imbalance and weak hips. Along with that it causes include patellar laxity, quadriceps weakness or chondromalacia.

Here we need to keep eye on that it happens more in females than males. As far as symptoms are a concern it includes anterior knee pain, crepitus and ‘movie theatre’ sign. For treatment one can go for Knee taping/bracing, anti-inflammatory medications, activity modification, running on flat/uphill terrains, Hamstring stretching and VMO strengthening.

8. ILIOTIBIAL BAND SYNDROME :

Again this is more common in distance runners. It includes a sudden increase in mileage(half-marathon runners), downhill running or weak hips. Inflammation of the iliotibial band-tendon which origins from the pelvis and runs down the lateral aspect of the thigh to the outside of the upper half of tibia.

It has typical symptoms like lateral knee pain during flexion. In this condition runners can do ice application, specific stretches, foam rolling.

9. PULLED MUSCLES :

It happens when one does overstretch of a group of muscles or acute muscle pull frequently occurs during sprinting. Apart fromthis inflexibility, improper warm-up and eccentric contraction are the common causes and that can be acute or chronic in some cases.

In this situation Pre-workout like Dynamic stretching and conditioning is essential.

10. SIDE STITCHES/EXERCISE-RELATED TRANSIENT ABDOMINAL PAIN :

Due to poor running posture and excess fast running this condition occurs. Surprisingly 70% of runners are affected because of this. Pain is caused by the diaphragm beginning to spasm from being overworked. In this situation bending forward and core muscle training, breathing training do help.

Last but not the least in above all conditions proper diet and fluid intake will help. Take adequate protein intake with a balanced diet,have around 3-liter fluids daily and have a proper meal after workout sessions.


ABOUT THE AUTHOR:

DR. NILESH SHAH

Orthopedic sports medicine and arthroscopic surgery specialist, in practice since 1992..Hon asst prof @ dept of orthopedics for
Arthroscopic Surgery at BJMC and Civil hospital, Ahmedabad.