Along with trick or treating and Thanksgiving, the fall brings with it a season of road races and people trying to milk as much as they can from the increasingly shorter days and changing weather. I’ve gotten emails, seen posters and flyers, and contemplated participating in a couple of events. All of this got me thinking about a type of athlete that seems to be plagued with more chronic injuries than any other sport, the distance runner. Whether it’s those dull knee aches, or the “tweak” one might feel in his or her knee, most of these injuries are not simply necessary evils of running, but rather are preventable and treatable conditions that all runner’s should be familiar with.
Although, we’ve discussed this before, Iliotibial Band Syndrome (ITBS) is a very common ailment, especially in those runners whom have increased their workload tremendously over a short period of time. Common examples of this would be what one might call a “weekend warrior” (a person who goes all out on the weekend by running a very long distance, but does not do any other runs during the work week), or an individual who is training for a race, and realizes a couple of weeks before the race that he/she is not nearly close enough to his/her running goals and significantly beefs up the intensity or distance in the training program to try to catch up.
ITBS is characterized by a diffuse pain just above the knee joint and lateral to it (projecting along the outside of the knee) that an individual usually has trouble finding a “pinpoint” spot to describe it by. It is caused by excessive friction associated with repetitive extension and flexion of the knee joint. The IT band is essentially a thickened band of connective tissue called fascia that starts at the hip joint and inserts on the patella, tibia, and biceps femoris tendon at the knee.
ITBS can be somewhat difficult to treat and does not usually get better over night. An athlete should ALWAYS be aware of the RICE technique which stands for: Rest, Ice, Compression, and Elevation. Furthermore, adequate stretching of the IT band should be completed before running to try to prevent this problem and can be done by crossing the legs and reaching upward and bending at the side. In fact, if one develops ITBS, RICE is applied and in some cases, foam roller stretching may be done, and cortisol injections may be indicated to bring down the swelling, but abductor strengthening is usually done once a patient can complete an IT stretch without feeling discomfort.
Another common problem seen in runners Patellofemoral Pain/Stress Syndrome (PPS), which is characterized by pain developing right in the front of the knee and typically getting gradually worse over time. The mechanism of this injury involves the patella (knee cap) bone moving in an inappropriate track when the knee is extended (straightened) due to an imbalance of pull typically as the result of overly tight lateral (outer) structures of the knee (the Vastus Lateralis, Iliotibial Band and Lateral Retinaculum) and weakened medial structures of the knee (inside of leg), such as the Vastus Medialis Oblique (VMO). This will pull the kneecap off to the outside a little too much and can cause pain an inappropriate friction on the soft tissue below the kneecap where the patella normally does not track.
Treatment of PPS involves the application of RICE, the use of taping methods to help stabilize the knee and the patella, strengthening the medial muscles of the knee to fix the tracking problem, massage to possibly loosen tight lateral structures, and sometimes most importantly orthotic shoe inserts because many times individual’s suffering from PPS have over pronation of their foot which exacerbates this knee instability.
One of the biggest complaints of runners, in fact, nearly 11% of all running injuries, involves the condition called Achilles Tendinopathy. Achilles Tendinopathy can either be acute or chronic, which means the onset can either be one that develops over a few days (acute), or one that gradually creeps up on you (chronic). This type of injury is characterized by soreness of the achilles tendon which is located just above the bony portion of your heel bone and connects the gastrocnemius and soleus muscle (calf muscles) to the calcaneus bone of the heel. These muscles are responsible for the power we get on our “push off” phase in walking or running.
Pain is usually constant throughout a workout in the chronic form and will usually be worse when a person is running up a hill because of the strain on the tendon from the angle at which the foot is at. In fact, wearing high heels can contribute immensely to achilles tendinopathy because the achilles tendon is shortened because of the angle of the foot, and when the individual puts on her flat running shoes, the tendon is greatly stretched in comparison to the former state. Pain in the achilles is usually palpable by touch, and in the acute form will seem to seem to subside with rest and after the individual has “warmed up.”
Achilles Tendinopathy is treated similarly to other lower extremity injuries by application of ice and rest. It is also suggested that an individual see a specialist to examine his or her gait to see if over pronation is a factor that may indicate the use of orthotics. Furthermore, some individuals can benefit from taping of the back of the leg and in severe cases a plaster cast for a period of time. Lastly, some competitive athletes are temporarily provided with a small heel pad to help alleviate pain during essential workouts/competitions because it will help alleviate stress on the tendon, but ideally rest is the best option for such an injury.
The list of running injuries could go on and on, but by adding these three injury mechanisms and symptoms to your list of running knowledge, you may help yourself avoid some of the more common ailments during your training routine. By avoiding these injuries or catching them before they worsen, you’ll not only feel better, but you’ll perform better and reach your maximum potential. For more running injury information, check out one of my previous articles: Spring Running: The most common running injuries and tips for prevention.
Please remember that it is always important for an athlete to consult with a sports medicine specialist for proper diagnosis and treatment plan to ensure that the injury is not something more serious.
Before this topic is brought to a close, it only seemed appropriate to quickly discuss an upcoming event that is being held on October 28th, 2011 in Randolph, MA. The event is being held by Kyleigh’s Cure which is a foundation that holds a number of road races throughout the year in which the proceeds go to fund research for Galactosemia. This upcomming event is a Halloween Costume Extravaganza, so get your tickets now because they’re not sold at the door! Kyleigh is a 6-year-old girl who was diagnosed with this debilitating disease that involves the inability of her body to metabolize the sugar, galactose. The most common form involves a deficient or missing enzyme (Galactose-1 phosphate uridyl transferase) which results in the build-up of metabolic products in the infant’s body that may lead up to development of convulsions, liver problems, kidney problems, delayed development, sepsis, and a plethora of other conditions if it is not caught early on in its course. Her parents, local police officers, have dedicated their lives to helping fund a cure for this disorder that typically does not get as much funding as other, more common congenital enzyme deficiencies because it only affects 1/60,000 Caucasian births. Please consider attending the “Spooktacular Halloween Gala” to help a great cause and stay tuned for the spring race. Racing is always fun, but running for a cause brings an extra sense of accomplishment and really makes a difference in the world. More information regarding this event and future races may be found at: http://www.kyleighscure.com/index.html
As you prepare for your fall races, remember to have fun. Exercise is not about killing yourself. It’s about maintaining your health, enjoying the marvel of the human body as it adapts to a stressor, and freeing your mind from the stressful daily tasks that we all endure. Whether you’re racing this fall, or simply just enjoying the last few days of decent Boston weather please try to: run well, be safe, and most importantly, have fun.
Please feel free to leave me any comments, feedback, concerns, or insight on this page or email me at [email protected] Also, if you like what you’ve read subscribe to the feed to get my articles sent directly to your inbox!
Khaund, R., Flynn, SH. Iliotibial Band Syndrome: A common source of knee pain. American Family Physician. 2005 Apr 15;71(8):1545-1550.