Runner “Must Knows” for Injury Prevention and Rehabilitation – Summit Physical Therapy

frontru1Injury Prevention

Since 1990 the sport of running has seen tremendous growth. Over the last two years though the sport is starting to plateau in this growth. Some websites show that there are over 30 million active runners in this country, this is fueled by the ever-growing participation in marathons and half-marathons. Runners will at some point in time experience an injury severe enough to cause them to miss a week or more in running. For the novice running they have a 2.5-3 time more likely chance of being injured and a study in 2008 showed that this novice runner is more likely to quit running altogether following that injury.

The majority of running injuries are related to overuse. We do too much, too fast, too soon. Most injuries occur during a transition period-a period where our training is undergoing some type of change. Common examples include:

  • Increasing mileage too quickly.
  • Changing intensity of training, such as moving from a base/distance phase to a strength or speed phase.
  • Changing the surface one trains on.
  • Even changing the type of running shoes.

Rarely do I see injuries in people who train very consistently, unless they are in the middle of a transition phase. The transition, rather than the absolute amount of training, seems to be linked closely to injury.

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A number of predisposing factors to overuse injuries have been identified.

Intrinsic risk factors are anatomic/physiologic factors inherent to the runner. Depending on the particular injury, potential factors may include muscle weakness or imbalance, inflexibility, a leg length inequality, or feet that are excessively high arched or flat.

Extrinsic factors are non-anatomic. Included here are primarily training errors and equipment. For the runner this is the too much, too soon, too fast part. Since most running shoes are meant to last about 400 miles, I see a lot of runners in the office who are ready for a new pair!

Addressing these intrinsic and extrinsic risk factors in addition to treating the specific injury itself will help ensure that one keeps running long after the presenting injury has resolved.

Certain principles form the core of running injury rehabilitation:

Know what you are treating. Plantar fasciitis and calcaneal stress fractures both present with heel pain. The treatment plans and the amount of training one may do, however, varies greatly. Runner’s Knee refers to a specific condition related to abnormal motion of the patella (knee cap). Runner’s knee, however, is only one of many causes of knee pain in runners, each requiring different approaches to treatment. Having a specific treatment plan directed at correcting the specific problem will guarantee best success.
Although inflammation is usually only one component of a running injury, its presence often leads to pain and prevents progress in rehabilitation. Common measures include:

  • Ice: 10-15 minutes 3 times a day. I’m often asked which is best, ice or heat? In any injury in which there is active swelling or early on, the first few days after the onset of pain, ice is best. In the absence of swelling, after a few days either ice or heat can be helpful, whichever seems to help most.
  • Medications: Aspirin or anti-inflammatories can be helpful for a short period of time. As a physical therapist I can not give pharmacological advice so you must consult your primary care physician regarding your medical history and any co-morbidities.
  • Modalities: Athletic Trainers and Physical Therapists can apply certain modalities, which are helpful in controlling pain and inflammation. Examples include electric stim, ultrasound, iontophoresis (using an electric stimulator to deliver anti-inflammatory medication) and phonophoresis (using ultrasound to deliver anti-inflammatory medication), cold low level laser.
  • Compress/elevate: If a joint is visually swollen (such as following a twisted ankle), wear a compressive wrap or sleeve. Elevate the limb above the heart.
This is where rehabilitative exercises come in. Flexibility, strength, proprioception/balance and functional drills are all important. More than anything else the athletic trainer or physical therapist does for us, these are the key. Rehabilitative exercises should not be thought of as just reinforcing strength and flexibility. The focal exercise also enhances blood flow and stimulates tissue remodeling.
So, even the strongest and most limber of us will benefit from rehabilitative exercises. And remember-they only work if we do them! When injured, plan to spend 30 minutes a day on rehabilitative exercise in addition to any other training we are doing.
This means correcting the factors that lead to the injury in the first place. Look over your training and see if there is any factor that has recently changed, such as an increase in mileage, or the addition of strength or speed work. Talk to your coach to see if perhaps this transition can be made more gradually. Have your started running different courses? The addition of hills or trail running has been linked to various running injuries. Braces, straps, and orthotic devices, when properly used, will minimize overload to affected structures. And be sure that your shoes aren’t overdone. 400 miles max-then they become kick around shoes.
General fitness enhances local blood flow which aids in tissue healing. It also helps prevent deconditioning including areas that aren’t even injured. Certain injuries (ie sciatica or stress fractures) require rest from running. For most running injuries, one can usually continue at least some level of running. Supplement what you miss from running by adding time cross training. Cross training may also be an option for those who can’t run at all, but be sure to clear this with your doctor. Good options include deep water running, the elliptical machine or the bike. Try to simulate what you would normally be doing on land, whether it be short repeat intervals, tempo sessions or long aerobic distance training.
With most running injuries, runners can usually maintain at least a modified schedule of running with symptoms dictating rate progression back to full training. When in doubt, be sure to discuss your running plan with your physical therapist, physician and trainer. Certain injuries (ie stress fractures) require a certain amount of time to heal even after we no longer have symptoms. Plan to continue the rehabilitative exercises for several weeks after return to training to ensure correction of the risk factors that may have led to injury.

Some additional practical guidelines:

  • When returning to running after more than a month off, start with a walking, then walk-jog (walk a minute, jog a minute repeats), then run program. There are specific return to running programs that can be implemented.
  • As I mentioned throughout this article, change shoes every 400 miles and be fitted by someone familiar with running shoes and gait styles. The shoe your training partner loves may not be ideal for you.
  • The 10% rule: Increase mileage by no more than 10% per week. The longest run should not increase more than 2 miles in any given week. One’s long run should usually not exceed 30% of one’s total weekly mileage. One exception: First time marathoners participating in a lower mileage program. Remember, however, that this amounts to a big progression, so avoid temptation to exceed one’s program in other areas.

When running with an injury be sure not to exceed the “Relative Activity Modification Guidelines”:

  1.  You may run with mild pain (0-3/10). If you have moderate pain (4-6/10), back things down until the pain is no more than mild. If you have severe pain (7-10/10), stop running!
  2. Discomfort that is present at the beginning of a run, but resolves after easing into the run is usually associated with mild injury. If you know that symptoms will worsen beyond a certain point (mileage or pace), you have defined your limit. Do not go beyond this point.
  3. No limping allowed! Sounds like a no brainer, but folks violate this all the time. One should not run with an injury that forces a change in normal gait. The flip side is that if you are able to run with a normal gait and the discomfort is no more than mild, the likelihood that healing is prolonged is minimal.

If you have any questions about a specific injury or would like a free 10 minute injury screen to see if physical therapy can help you get back on the road running pain free click the link https://www.summit-therapy.com/appointment/

Or call 423-777-4974 and mention you read this blog.
See you on the roads!

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