For Every Injury A Cure
Pain, strain and breakdown are occupational hazards for every runner, and so it’s paramount to know when to back off and when to head for the treatment table
Running is the purest of athletics pursuits. It’s also a very personal journey: for some it’s chasing the feeling of invincibility that comes with winning races and breaking records; for others it’s a private Everest in the form of a marathon finish or faster time; for many it can be escape from mundane pressures, or simply the means to a better figure,
Whatever the runner’s goals or motivation, injury respects no demographic and can scupper the best-laid plans. If you are a runner you will inevitably have encountered some niggle or pain or worse. We hope to give you a basic understanding of most common running injuries what to look out for, how to treat injuries conservatively and most important, how to prevent them from happening in the first place. Running is a series of repetitive motion that leaves the body vulnerable to oversee injuries. Over time the cumulative load of this repetitive motion can find chinks in the armour and cause breakdown. Overuse injuries result from repetitive micro-trauma leading to local damage in the form of cellular and extracellular degeneration and are most likely to occur when we change the mode, intensity or duration of training. Often the area injured is not the prime instigator, it is merely the victim. The culprit may be an area of weakness, hypertonicty, imbalance, dysfunctional movement pattern, genetic or biomechanical. The goal of the therapist is to hunt down the culprits and change their ways.
Footnote: It is important to address flexibility, strength and stability deficits/imbalances by incorporating individualised flexibility, stability and strengthening programming in the treatment of running injuries.
Achilles Tendinopathy
The condition accounts for 11% of running injuries and can be career-ending if mismanaged early on. The Achilles tendon is the strongest tendon in the body and attaches the heel bone (calcaneus) into the two major calf muscles (gastrocnemius, attaching above the knee, and soleus attaching below the knee). The Achilles become injured when subjected to inordinate intrinsic and/or extrinsic loads. Aggravating factors can be speed training, age, bio mechanics and excessive weight. The precise site of Achilles injury will dictate severity and the course of treatment/rehabilitation. Soreness where the Achilles attaches to the heelbone is called insertional tendinopathy and is notoriously more difficult to treat
Signs And Symptoms
Weakness on the heel raises; morning pain that eases with activity (degeneration); pain that worsens with activity (inflammation) swelling
Treatment (specific to severity)
Modified running programme or rest; ice massage;cross friction;night splint; heel raise; orthotics
Flexibility (pain dependent)
Straight leg calf stretch Bent knee calf stretch Night splint/Strasbourg sock
Strengthening (pain dependant)
Isometric calf holds 2×1 minute
Eccentric heel drops, straight leg and bent leg 2×15 twice daily (single leg), not off step for insertional tendinopathy
Prevention
Build mileage slowly (10 percent rule); wear suitable shoes; develop strong, flexible calves; warm up before running
Proximal Hamstring Tendinopathy
This insidious injury manifests itself as a vague ache high up in the hamstring and deep into the buttock. The hamstring is made up of three muscles (semimembranosus, simitendinosis and biceps femoris). It originates from the seat bone (ischial tuberosity) and attaches around the back of the knee to several insertion including the tibia, fibula head and popliteus tendon. The hamstring flexes the knee, extends or hyperextends the hip and is responsible for forward propulsion and transferring power between the hip and knees joints required by running. Early, accurate diagnosis of this injury is vital, as a number of other conditions have similar symptoms, including piriformis syndrome, bursits, pelvic stress, sacral stress fracture and disc pathology, all of which have specific treatment protocols. Treat this one with respect; if mismanaged early it can linger for your entire career.
Signs and Symptoms
Pain high up in hamstring, buttock pain, pain when increasing pace, sprinting, loss of sprinting power
Treatment
Rest; ice massage; soft-tissue treatment
Flexibility
Avoid aggressive hamstring stretching for early-phase rehabilitation. Address flexibility imbalances, quads
Strengthening
Swiss ball hamstring curls 3×15 reps, slow and controlled full-range
Prevention
Appropriate functional range of hamstring flexibility; strengthen hamstrings and posterior chain; incorporate multi-directional drills
Stress Fractures
Stress fractures results from cumulative submaximal overload of a bone. Approximately six percent of you will have suffered one this year; ‘bend a hanger enough times and it will snap’ At a cellular level the regeneration of bone by osteoblasts is outpaced by the reabsorption of bone by osteoclasts, the bone gets no chance by recover and develops a stress fracture if not managed correctly. The accumulation of extrinsic factors (training load, terrain, duration, intensity) and intrinsic factors (nutrition, biomechanics, muscle fatigue and hormone levels) are ultimately responsible. Think of each factor as a ball, a juggler may have no problem juggling six balls, but add a seventh and there are balls everywhere. Common locations of stress fractures are the tibia, metersals, navicular and fibula bones. Less common sites include the femur, pelvis and sacrum.
Signs And Symptoms
Pain upon weight bearing activity that begins non-specifically but over days and weeks becomes more specific, sharp pain on single leg hop at point of pain (for lower limb); pain upon finger-point pressure (MRI is the gold standard diagnostic tool)
Treatment
Rest from running 6-12 weeks depending on bone stressed; Slow, controlled return to run programme over 4-6 weeks to normal training; address flexibility and/or strength imbalance
Prevention
Flexibility and strength programme; build mileage slowly; cross-training; wear appropriate shoes, allow sufficient recovery between sessions/races; eat healthy;take vitamin D and calcium supplements.
By David Campell