The Most
Common Running Overuse Injuries - As Featured in The Sun Newspaper
Blisters are far
and away the most common running injury. Often thought of as a small and
insignificant; often not even referred to as an “injury” they can cause
unimaginable discomfort. The knock on effect is that you adapt your running
gait and make yourself prone to other injuries. Blisters are caused by
excessive friction on an area of skin, make sure your shoes fit you correctly
and don’t wear cheap socks! Some people use Vaseline on the sock to prevent
friction between sock and shoe or two pairs of socks can have a similar effect.
If you do get a blister try and let it resolve naturally. If you need to run on
it, make a pin prick with a sterilised needle in the edge of it (NOT if it is a
blood blister – leave these well alone) and ease the clear fluid out. Wash with
antiseptic and cover with a Compede plaster. If you run on a fluid filled
blister, likelihood is it will pop and you will run on raw skin and make
yourself vulnerable to infection. When you have showered take extra care to dry
your feet and apply antiseptic to any open skin.
Achilles
tendonitis is characterised by pain from the lower calf down to the heel
bone. It used to be thought of as an inflammation of the tendon but now is
thought to be degeneration hence the new term “Achilles tendinopathy”, there is
generally a loss of strength in the tendon from a loss of normal fibre
structure. Achilles tendinopathy typically occurs from abnormal foot
stroke in push-off and too-tight calf muscles. Achilles injuries can be either acute, meaning occurring over a period of a
few days, following an increase in training, or chronic which occurs over a
longer period of time. In addition to being either chronic or acute, the
condition can also be either at the attachment point to the heel or in the
mid-portion of the tendon (typically around 4cm above the heel). Healing of the
Achilles tendon is often slow, due to its poor blood supply. You can prevent
Achilles tendinopathy but ensuring you have good running shoes, any history of
tendon problems and it may be worth getting a gait analysis and if required,
orthotics to keep your foot correctly aligned as you run. If you suspect a
tendinopathy, rest, ice – to ease the pain, anti-inflammatory drugs will not
help as there is no inflammatory response; and seek treatment early to reduce
your healing time. A sports injury specialist will be able to accurately
diagnose your pain, and then treat usually with a combination of massage,
acupuncture, ultrasound or electrotherapy. Rebuilding the strength in the
tendon and calf is an essential part of healing but should be gradual as to not
exacerbate the tendon.
Plantar
fasciitis is inflammation of the thick tissue on the bottom of
the foot. This tissue is called the plantar fascia. It connects the heel bone
to the toes and creates the arch of the foot. Plantar fasciitis occurs when the
thick band of tissue on the bottom of the foot is overstretched or overused.
This can be painful and make walking more difficult. The symptoms are pain and
stiffness in the bottom of the heel which may be dull or sharp, the bottom of
the foot may also ache or burn. The pain is usually worse in the morning when
you take your first steps; after standing or sitting for a while; when climbing
stairs or after intense activity. This can be an acute injury or build up over
a period of time. You can prevent the acute onset by regularly stretching the
foot and calf muscles. To prevent the more chronic overuse cases ensure you
have proper footwear that support the arch of your foot and cool down
effectively after each run. A sports injury specialist can treat with massage,
acupuncture, electrotherapy and often will use a supportive taping technique to
enable the fascia to rest. Home exercises will be prescribed to aid your
recovery.
Shin
splints or to give the medical term, medial tibial traction periostitis
is the inflammation of
the periosteum of the tibia (sheath surrounding the bone). Traction forces on
the periosteum from the muscles of the lower leg cause shin pain and
inflammation. Shin splints can be caused by a number of factors which are
mainly biomechanical faults and training errors. The most common causes are
over pronation or supination of the feet, inadequate footwear, increasing
training too quickly, running on hard surfaces and decreased flexibility at the
ankle joint. Symptoms include pain over the inside
lower half of the shin; pain at the start of exercise which often eases as the
session continues, pain often returns after activity and may be at its worse
the next morning, sometimes there is swelling, lumps and bumps may be felt when
feeling the inside of the shin bone and pain when the toes or foot are bent
downwards. To prevent shin splints, consider off road running for some of your
mileage and stretch your calves regularly. This is an injury prone to
reoccurrence so seek help at the first glimpse of symptoms; many runners have a
sports massage once a month as prevention to injuries such as this.
Illiotibial
band syndrome (ITBS) is the first injury commonly referred to as
runner’s knee. The illiotibial band
(ITB) is a long, thick tendon with similarities to fascia, which runs between
the tensor fascia latae muscle in your hip and attaches to the head of fibula
just below the outside of the knee. ITBS is the irritation of this insertion at
the knee often combined with tension throughout the ITB. You can help to
prevent a tight ITB and ITBS by stretching the quadriceps muscles and the
hamstrings but the most effective prevention is to regularly roll the outside
of your thigh along a foam roller with your body weight providing the stretch.
This can be painful, particularly if the ITB is already tight but is worth
persevering with to prevent more long term problems. There are biomechanical
factors to consider including the alignment of your foot, knee and pelvis so
any continual ITB problems are worth getting assessed by a sports injury
specialist. Treatment will consist of a rest period followed by massage,
acupuncture or electrotherapy and core stabilisation programmes are often
instigated.
Patellofemoral
Pain Syndrome is the second injury sometimes referred to as runner’s knee.
Patellofemoral pain syndrome (PFPS) is a generic term that describes pain at
the front of the knee from the patella (knee cap). The pain is usually caused
by a mal tracking of the patella, meaning it does not move in the correct
manner when the knee is bent and straightened. This in turn causes damage to
the surrounding tissues and structures. The symptoms include aching in the
joint particularly at the front and under the patella; tenderness on the inside
border of the patella; swelling after activity; clicking or cracking present
with bending of the knee; sitting for long periods can be uncomfortable and
there may be muscle wasting in longer term cases. You are more prone to this
injury if you have a small knee cap, if you have tight leg muscles, weak
quadriceps and those that do a lot of long distance or hill running. You can
prevent this injury by ensuring you have a good muscle balance in the thighs,
having a biomechanical assessment of your patella and keeping all leg muscles
flexible. If you are suffering with patella femoral pain, see a sports injuries
specialist as they can tape the knee into the correct position and teach you
corrective exercises. They will also be able to loosen the tight structures
around the knee and correct any muscle imbalance.
Stress fractures
can be caused by overtraining, a shortage of calcium, or by some basic
biomechanical flaw - either in your running style in or your body structure.
Common stress fractures in runners occur in the tibia (the inner and larger
bone of the leg below the knee), the femur (thigh bone) and in the sacrum
(triangular bone at the base of the spine) and the metatarsal (toe) bones in
the foot. More miles means greater
stress, this is one injury you should not ignore. Stress fractures are like a
hardboiled egg, the shell is cracked and next stop is a full fracture. Not all
stress fractures will show on an X-ray, a bone scan is sometimes required so
see a doctor who specialises in treating running injuries. To prevent stress
fractures make sure your mileage increase is steady, 10% increments per week is
seen as the safest rate. Seek help as soon as you suspect a stress fracture, the
longer you run on it the longer your healing time will be.
Anterior Compartment
Syndrome is when a muscle becomes too big for the sheath that surrounds it
causing pain. The big muscle on the outside of the shin is called the tibialis
anterior; this is surrounded by a sheath. The main purpose of this muscle is in moving the foot upwards and
outwards (dorsi flexion and eversion). A great deal of stress can be placed on
this muscle throughout the running gait cycle. Compartment syndromes can be acute or chronic. Symptoms of an
acute onset include a sharp pain in
the muscle on the outside of the lower leg, usually the result of a direct
blow, weakness when trying to pull the foot upwards against resistance which
may result in a slapping gait, swelling and tenderness over the tibialis
anterior muscle and pain when the foot and toes are bent downwards. Anterior
compartment syndrome may be caused by an impact which causes bleeding within
the compartment and therefore swelling, a muscle tear which also causes
bleeding or an over use injury which also causes swelling. Seek help
immediately if you suspect an acute onset. Symptoms of a chronic anterior compartment
syndrome include pain which increases during exercise which eventually makes
running impossible, pain goes after a short rest but comes back again during
exercise, difficulty in lifting the toes and foot up and pain when pulling the
toes and foot downwards. Prevent this by stretching regularly or having sports
massage on the lower legs. If treatment is required a sports injuries
specialist can increase the elasticity of the muscle sheath.
Hip Bursitis
causes pain on the side of the hip, which makes it uncomfortable to lie on the
affected side. Bursitis is inflammation of a 'bursa', which is a small sac of
fluid. The function of a bursa is to protect other tissues from compression and
friction, but too much stress, or a direct blow to a bursa can cause it to
become inflamed. The medical term for the hip bursa is the 'Trochanteric
Bursa', so called because it is located over the 'Greater Trochanter' of the
thigh bone (the bony lump on the top of the outside of the thigh bone). A
person suffering from hip bursitis will have hip pain over the area of the
bursa, but in severe cases this pain may radiate down the leg. The pain will
usually be brought on by hip movements such as walking, running, and climbing
stairs. Treatment for hip bursitis aims to settle the inflammation down.
Treatment will include ice, electrotherapy and stretching of the
illiotibial band, and may be successful in curing the condition. However, in a number
of cases of hip bursitis, particularly chronic (long-term) cases, a corticosteroid
injection is sometimes indicated. Hip bursitis will often try and
masquerade as a muscle strain but the large swelling often gives it away. Ice
and rest until the swelling and pain have gone. If it continues for more than
two weeks, seek help from a sports injuries specialist.
Snapping Hip Syndrome
in most cases is caused by the movement of a muscle or tendon over a bony
structure in the hip. The most common site is on the outside of the hip where a
band of connective tissue known as the illiotibial band passes over part of the
thigh bone that juts out called the greater trochanter. When you stand up
straight, the band is behind the trochanter. When you bend your hip however,
the band moves over and in front of the trochanter. This may cause the snapping
noise. The iliopsoas tendon, which connects to the inner part of the upper
thigh, can also snap with hip movement. Another site of snapping is where
the ball at the top of the thigh bone fits into the socket in the pelvis to
form the hip joint. The snapping occurs when the rectus femoris tendon, which
runs from inside the thighbone up through the pelvis, moves back and forth
across the ball when the hip is bent and straightened. Less commonly, a
cartilage tear or bits of broken cartilage or bone in the joint space can cause
snapping, or a loose piece of cartilage can cause the hip to lock up. This can cause pain and disability. Unless
snapping hip syndrome is painful or causes difficulty in sports or other
activities, many people do not see a doctor or have it treated. For minor
snapping syndrome pain, try home treatments such as reducing or modifying
activity, applying ice or using over-the-counter pain relievers. For more
severe pain or pain that does not improve with home treatment, see a sports
injuries specialist. They will treat with an emphasis on stretching,
strengthening, and alignment. Sometimes, treatment with a corticosteroid
injection to the area can relieve inflammation. In rare cases, doctors may
recommend surgery.
Plica Syndrome is
rare but should be considered if you have been diagnosed with either patella
tendonitis or meniscal tears and have not had improvements with treatment.
Often called "synovial plica syndrome," this is a condition that is
the result of a remnant of foetal tissue in the knee. The synovial plica are
membranes that separate the knee into compartments during foetal development.
These plica normally diminish in size during the second trimester of foetal
development. In adults, they exist as sleeves of tissue called "synovial
folds," or plica. In some individuals, the synovial plica is more
prominent and prone to irritation. Diagnosis is made by physical examination of
the knee or during arthroscopic surgery; MRI is not particularly useful in this
case. Symptomatic plica syndrome is best treated by resting the knee joint and
taking anti-inflammatory drugs, this is usually sufficient to allow the
inflammation to settle down. Occasionally, a corticosteroid injection in to the
knee will be helpful. If these measures do not alleviate the symptoms, then surgical
intervention may be necessary. This surgical procedure is performed using an
arthroscope, or a small camera, that is inserted into the knee along with instruments
to remove the inflamed tissue. The arthroscopic plica resection has good
results assuming the plica is the cause of the symptoms. Unless symptoms are
consistent with plica syndrome and the plica looks inflamed and irritated, the
plica is usually left alone. Plica resection during arthroscopy is only
performed if the plica is thought to be the cause of symptoms.
In summary, to give yourself the best chance of staying injury
free; always warm up and cool down, use a steady mileage increase rate, include
strength training, vary your training, eat a balanced diet, hydrate
appropriately, have a sports massage every four weeks, seek help as early as
possible if you suspect an injury and make sure you give yourself adequate rest
and recovery time. Running injuries are
nearly always overuse injuries which develop over a period of time until
continuing to run is no longer an option. Seeking early treatment is by far the
best option in order to get back to running as soon as possible. They key to injury prevention is if your pain
makes you change your running style; seek help at the first opportunity.
The best stretches for
runners are:
·
The calf stretch in a press up position
·
Anterior calf stretch by sitting on your feet
·
Seated hamstring/groin stretch combo
·
Standing quad stretch
·
Kneeling quad stretch with added hip flexor
·
Seated glute stretch
·
Lower back stretch – hugging knees.
Hold each stretch for 30 seconds in the cool down and repeat each
twice.
If you are seeking help from a sports injuries specialist make
sure they understand your goals, ie to return to training as soon as possible.
Always phone and ask to have a chat with the therapist before you book in, that
way you can ensure they are on the same page as you in managing your injury and
returning you to the level you were at before and not just declaring you fit
because you can walk pain free. Set realistic goals together with your therapist
and be clear about what you need your body to be able to do.
The Tennis Elbow Conundrum
Tennis elbow, or to give it
its medical term, lateral epicondylitis; is the bane of many people’s lives
regardless of their devotion to tennis. Almost as bothersome is the problematic
golfer’s elbow or medial epicondylitis. Both these injuries are inflammation or
degeneration of the tendons that attach to the medial (inside) or lateral
(outside) parts of the humerus in the elbow joint.
The symptoms of tennis elbow
are pain and tenderness on the outside of your elbow and sometimes in the
muscles on top of your forearm. Tennis elbow usually affects the arm of your
dominant hand because this is the arm you use the most. Symptoms usually
develop gradually. The pain may get worse when you move your wrist or if you
repeat the activity that triggered the pain. The pain may become constant. Your
affected arm may also be more painful when you grip or twist something, such as
turning a door handle or shaking hands.
Tennis elbow is caused by an imbalance
between wrist flexors and extensors, the muscles in your forearm that control
the main movements at the wrist. This imbalance can be brought to the forefront
by a repeated overuse of your arm. Playing tennis three times in a week when
you haven't played for some time is the sort of overuse that could cause tennis
elbow. However, most people who develop tennis elbow haven't been playing
tennis. A range of different activities that involve repeated hand, wrist and
forearm movements is more often the cause. This includes activities like using
a screwdriver, using vibratory work equipment (such as a drill), or even using
a keyboard – particularly relevant these days. Rarely, tendon damage can happen
after a single and often minor incident, such as lifting something heavy or
taking part in an activity which you don't do very often, such as painting and
decorating. These activities can cause a tear in your tendon.
The first step in establishing a treatment
programme is to determine whether the tendon is thickened or degenerating, this
is CRUCIAL in starting you on
the right programme. If your tendon is thickened it needs rest. The thickening
is often due to an influx of fluid to the tendon causing a compressive force
and inflammation, rest and ice are a must to reduce the pressure and thickening.
Often steroid or plasma injections are mentioned at this point but the most
recent research by the top elbow experts currently indicate no significant
benefit from such treatment. This thickened tendon is also known as reactive
tendinopathy.
If your tendon is degenerating and not
thickened, you must NOT rest and must begin rebuilding it. The tendon must be
overloaded in order to regain strength. This is achieved with high loads of
eccentric (lengthening) movements at a fast pace. There must be 48 hours of
rest in between loading sessions. Another treatment found to be successful in
some cases is stretching called proprioceptive neuromuscular facilitation (PNF)
which uses a maximal force to cause maximal relaxation; this is used in
conjunction with the loading exercises.
There are several other treatment options
that can be tried such as ultrasound, electrical stimulation, massage and
acupuncture. Often, more then one modality is used at once for the best
results. A new theory behind solving the tennis elbow conundrum is to consider
the whole kinetic chain. This means consider all the joints used in the
movement, not just the elbow. For example, the shoulder, the cervical and
thoracic spine. Research has shown those with elbow problems have benefitted
from addressing deficits with shoulder and spinal movement ranges. A “cervical
glide” (a mobilisation of the cervical vertebrae) has been shown to have a
positive effect on tennis elbow symptoms. We should remember the vast neural
structures that run through the elbow and these come through the spine. Central
sensitisation (a neural affliction) can cause a decreased pain threshold so
should be considered when treating tennis elbow.
Returning to thinking about the whole
kinetic chain, there may be a muscle recruitment problem within the arm or
further down the chain at the shoulder or in the back or the core. Addressing
these issues should they apply can have a good effect on tennis elbow symptoms.
To this...
Nathan Hauritz - Dislocated Shoulder
Nathan Hauritz’s place in the Australian World Cup squad has
been jeopardised by his seemingly innocuous fielding injury. Hauritz is
awaiting scan results to see the extent of the damage, but is facing a lengthy
recovery from a dislocated shoulder.
A dislocated shoulder
is when the head of the humerus is forced out of the glenohumeral socket (made
up of your clavicle and scapula). This is turn can tear or rupture ligaments
and the labrum, which is a cartilage based substance that adds depth to the
shoulder socket. As long as there is no fracture, once the shoulder is
relocated the damage to the bone is over. However, it is the ligaments, labrum
and often also tendons that need time to heal. Shoulder dislocations are
heavily associated with re-injury and therefore an effective rehabilitation
programme is essential to the long term recovery of the joint. A partial
dislocation is known as a subluxation and causes similar damage, but usually
not as serious.
Medical attention should always be immediately sought even
if the shoulder appears to have relocated itself. There are several
complications that could occur if the joint is not further investigated. Once a
doctor has confirmed rehabilitation can begin (this usually follows a period of
rest) strengthening and stabilising exercises can be prescribed. Range of
motion and flexibility exercises are not included until the very end of the
programme and the focus is to re-stabilise the joint and prevent future
dislocation.
This injury is different from an acromio-clavicular joint
sprain which is sometimes also referred to as a shoulder dislocation. Shortened
to “AC” joint, this is where the clavicle (collar bone) meets the scapula on
top of the shoulder. This joint can often become sprung (subluxed) from a fall
and is particularly common in rugby. This causes ligament damage and sometimes
leaves a step deformity in the bones as they don’t always fully re align.
Both injuries require rehabilitation to prevent against
re-injury and complications later in life such as osteo arthritis. If you have
suffered such as injury and need a rehabilitation programme get in touch with
LD Sports Therapy today to discuss the best course for you.
Lee Westwood - Calf Muscle Tear
Lee Westwood has been all over the news this week due to his calf injury. The Ryder Cup victor is on the verge of becoming World Number One but will his injury hinder his current form?
There are several muscles running through the calf but the two most prone to strain injuries are the gastrocnemius and the soleus. The gastrocnemius begins
above the knee attached to the femur and attaches to the achilles tendon. This muscle is most prone to injury as it crosses two joints, the ankle and the knee. The soleus is a deeper muscle, it orginates below the knee and again attaches to the achilles tendon.
What causes a muscle tear?
A muscle tears when it is put under a force it cannot withstand. This can be
more likely to happen when the muscle has not been warmed up properly; when it is fatigued; when there is scar tissue present due to previous injury or when there are predisposing factors such as biomechanical problems. In Lee's case, it is a recurrence of a previous injury and likely to have been affected by fatigue. Muscle tears are graded in seriousness from 1 to 3. A grade 1 tear is a minor strain that can heal as quickly as 2 weeks, with the correct management of the injury. A grade 3 tear means a complete rupture of all fibres and can take up to 6 months to heal, sometimes longer. A grade 2 strain is a midpoint between a strain and a complete rupture when only some fibres are torn.
What are the symptoms of a muscle tear?
It may be possible to identify the specific point when the muscle tore, usually with a grade 3 tear. More often however, the pain is gradual and may not be noticed as soon as it happens. Pain with movement, swelling and loss of flexibility are all indicators there has been a tear in the fibres. Pain and difficulty completing movements are usually what leads to help being sought.
If you think you have suffered a muscle tear, get in touch with LD Sports Therapy today to begin your rehabilitation programme and regain full fitness.
Rafael Nadal - Patella Tendonitis
Rafael Nadal missed the chance to defend his Wimbledon
Champion title in 2009 due to a chronic knee injury. Here, his condition of
patella tendonitis is explained.
The patella tendon connects the kneecap (the patella) to the
shin bone. This is part of the 'extensor mechanism' of the knee, and together
with the quadriceps muscle and the quadriceps tendon, these structures allow
your knee to straighten out, and provide strength for this motion. The patella
tendon, like other tendons, is made of tough string-like bands. These bands are
surrounded by a vascular tissue lining that provides nutrition to the tendon.
What causes patella tendonitis?
Patella tendonitis is the condition that arises when the tendon and the tissues
that surround it, become inflamed and irritated. This is usually due to
overuse, especially from jumping activities. This is the reason patella
tendonitis is often called "jumper's knee." When overuse is the cause
of patella tendonitis, patients are usually active participants of
jumping-types of sports such as basketball or volleyball. Patella tendonitis
may also be seen with sports such as running and football. Also, some patients
develop patella tendonitis after sustaining an acute injury to the tendon, and
not allowing adequate healing. This type of traumatic patella tendonitis is
much less common than overuse syndromes.
What are the symptoms of patella tendonitis?
Patella tendonitis usually causes pain directly over the patella tendon. You
may be able to recreate your symptoms by placing pressure directly on the
inflamed tendon. The other common symptom of patella tendonitis is pain with
activities, especially jumping or kneeling. Less common, but not unusual, is
swelling around the tendon itself. It is more common now to use the term
“tendinopathy” for tendon problems but essentially it is the same condition as
described by the word “tendonitis”.
