Staying Injury Free - Part 2 by Sinead Moffatt MISCP

 
     The 5 Most common Running injuries

(1) Runners Knee

This refers to pain in or around the knee cap and is usually a direct cause of over training, poor biomechanics and poor footwear. The two most common forms of runner’s knee are patellofemoral syndrome and patellar tendinopathy. ‘Patellofemoral Syndrome’ involves softening or wearing away of the cartilage under the knee cap resulting in pain and inflammation. It occurs due to repetitive flexion/extension of the knee due to distance running/downhill running, steps/stairs and sustained sitting. Athletes complain of a diffuse ache underneath or beside the knee cap and crepitus (grinding noise) when the knee bends. It can be caused by mal-alignment of the knee cap due to altered biomechanics (e.g. over pronation/excessive rolling in of the feet), muscle imbalance, or articular cartilage abnormalities. Patellar tendinopathy involves thickening of the patellar tendon and pain at the inferior pole of the knee cap. It occurs due to overuse, overloading, reduced flexibility and calf muscle weakness.

(2) Iliotibial Band (ITB) Syndrome

This occurs due to friction between the tendon of the ITB (a muscle on the outside of the thigh) and the lateral femoral epicondyle of the femur (thigh bone). It results in pain and inflammation on the outside of the knee where the tendon rubs against the thigh bone at approximately 30º of knee flexion. Foot strike occurs at aprox 21º knee flexion. Athletes complain of a dull ache 1-2cm above the knee joint when running and also have local tenderness. ITB Syndrome may develop due to abnormal biomechanics, over training, tightness of the ITB, downhill running and poor footwear.

(3) ‘Shin Splints’

Refers to pain along the shin bone which may occur due to overtraining, poor biomechanics, poor footwear and training on hard ground. Three different types of injuries can exist in this area. Bone pain can occur due to a Tibial Stress Fracture. It is characterised by localised pain over the area of the fracture (break) which starts early in the run and continues after running. It is more common in females and those with osteoporosis. It can be diagnosed by a bone scan.

Medial Tibial Stress Syndrome refers to pain and inflammation along the medial aspect (inside) of the shin bone. Inflammation usually develops at the insertion of the tibialis posterior and soleus muscles. Pain usually decreases as the athlete warms up but returns after the run and the following morning.

Recurrent Exertional Compartment Syndrome can also occur in runners. Its exact cause is unknown but its onset is thought to be due to overtraining which results in inflammation and fibroses leading to reduced elasticity of the fascia surrounding the muscles in this area.

(4) Plantar Fasciitis

This is an overuse condition of the plantar fascia which is a thick fibrous band of tissue that runs from the heel to the base of the toes. When it is placed under too much stress the fascia tears and becomes inflamed. The pain is usually most severe in the mornings on getting out of bed and at the beginning of a run. Altered biomechanics such as over pronation (increased inward rolling of the foot on impact), poor or worn footwear, overtraining and tight calf muscles are the main causes of this injury.

(5) Achilles Tendinopathy

The Achilles tendon is a large tendon that connects the two major calf muscles, gastrocnemius and soleus, to the back of the heel. Pain and inflammation can result due to a tear of the Achilles tendon or tendinopathy can occur due to overuse and degeneration. Poor biomechanics, poor footwear, tight calf muscles, rapidly increasing speed or distance can cause Achilles pain.

   Good training habits for marathon runners  Follow a training programme that is suitable for a person of your age, weight, height and current fitness level.  In order to minimise the risk of injury and achieve your goal stick to the broad principles inherent in this schedule, i.e. the long/short day sequence should be maintained and the rest days included. Always perform a warm up and cool down. Perform foam rolling after running to release muscle tension and prevent injuries. Treat yourself to a massage this can help reduce muscle tension and prevent injuries especially as the mileage builds up. Ensure you get adequate sleep and recovery. Pace yourself in training and races; monitor your breathing and heart rate. Measure your sweat rate during training so you can devise your fluid replacement plan for race day. If you sustain an injury do not ignore it; always follow the P.R.I.C.E Protocol.
 

  What to do if you sustain an injury. If you suspect you have sustained an injury always follow the P.R.I.C.E. Protocol.

    Protect – the injured area e.g. use crutches, protective bracing if appropriate.

  Rest – the damaged area to avoid further injury.

  Ice - the injured area for 5-10 minutes regularly for 48-72 hours to minimise bleeding in the damaged tissue and reduce pain.

  Compress – the injured area to resolve swelling & aid recovery.

  Elevate – the injured area to prevent the accumulation of fluid in the damaged tissue. If you suspect a serious injury – for example a fracture (broken bone), large muscle/tendon tear seek immediate medical attention.  Avoid heat, alcohol, vigorous massage and moderate/intense activity for the first 72 hours. Depending on the severity, area and type of injury you sustain you may need to rest for a few days or longer. As a guideline any injury that continues to ‘niggle’/cause pain after 2-3 days of rest should be reviewed by a Chartered Physiotherapist. They will be able to perform an assessment of the injury and give you a diagnosis. Your Chartered Physiotherapist can perform a biomechanical assessment if required. They will also give you a rehabilitation programme and advice with regard to your training.
 

  Tips for race day Apply ‘second skin’ over vulnerable areas of the feet and toes. Rub vaseline on body areas that are repetitively rubbing against your running attire e.g. nipples. Keep as warm as possible before the start of the marathon; an old jumper, hat etc. that can be disregarded at the start of the race would be ideal. Ensure you perform an adequate warm up prior to the start. Pace yourself at the start; conserve your energy, remember it’s a marathon not a sprint! Encourage family/friends to be on route to support you as the marathon is both a physical  and mental challenge. After crossing the finishing line, ensure that your change out of your running top immediately, to prevent hypothermia; have a change of warm clothes in your race bag at the finish line, in case you can not locate your family/friends. As uncomfortable as it may be, keep moving after the finish line; this will help prevent joint stiffness and muscle tightness and therefore minimise the onset of pain. Once showered and changed spend 10-20 minutes performing static stretches to prevent the onset of muscle soreness the following day. Continue this routine over the next few days. Ice baths can help ease pain in the working leg muscles following the marathon; 5-10 minutes maximum duration.
 

This article was compiled by Sinéad Moffatt MISCP. Sinéad is a member of the Chartered Physiotherapists in Sport and Exercise Medicine. She currently works extensively in sport from

Bodyworks Physiotherapy & Sports Medicine Clinic, Baggot St, Dublin 2 (01) 6788947.

Chartered Physiotherapists are health professionals allied to the Medical Profession and carry a university qualification. The title “Chartered Physiotherapist” and the initials “M.I.S.C.P.” indicate that a physiotherapist is a member of the professional regulating body the Irish Society of Chartered Physiotherapists. You can directly contact a Chartered Physiotherapist or your G.P. can refer you for a consultation. More information can be found at www.iscp.ie, the Golden Pages or contact the ISCP directly at 01-4022148.