Common Running Injuries

One of the most common of all injuries is Achilles tendonitis. The Achilles tendon attaches the large calf muscles to the knee. Acute tendonitis often leads to chronic tendonitis, so it's best to try to avoid this injury whenever possible. Achilles tendonitis is very slow to heal.

Some of the symptoms of Achilles tendonitis include a small bump on the back of the tendon, swelling and redness, and pain on the back of the ankle while running.

One of the best ways to avoid Achilles tendonitis is not to overdue it when starting out on a new training program. Some people simply start out too quickly putting undue stress on the tendon. Others have a personality type that leads them to think that more is always better. These are the people who have to run harder, longer, and farther than anyone else.

This is especially a problem in running where there is so much impact on the body. Another way to injure your Achilles tendon is to run to hard on hills. This is even more of a problem if you are a runner that overpronates. The rolling of the foot to the inside can overstress the tendon. Care should also be taken on excessively bumpy roads and roads that have a slant.

Should you be unfortunate enough to suffer from Achilles tendonitis, the number one self-treatment is R.I.C.E.--rest, ice, compression, and elevation. You will want to take an anti-inflammatory to help reduce the swelling and aid in pain relief. If the issue is not resolved in a week, it is time to see a medical professional. You may need an x-ray or an MRI, and the doctor may want you to try orthotic devices, boots, crutches, or a splint at night. Physical therapy is also usually prescribed. If the tendon has ruptured, you will most likely be referred to a surgeon for repair and you won't be running any time soon.

One precaution you can take to avoid Achilles tendonitis is to get proper running shoes for your feet and to start on any new training program very slowly. Endurance running is going to require patience and persistence so there is no reason to start out of the gate like a racehorse. Make sure to take plenty of rest days and work in some cross-training.

If you have sudden heel pain, stop running. If it doesn't go away, seek professional help. It is much better to miss a little training time than to be out of commission for an entire season of running.

Swimming and cycling can help take the stress off of your Achilles tendon, as can stretching your calf muscles before and after running. Try this simple stretch for flexibility:

Stand flat with both feet on the floor. Rise up on your toes. Hold this position for a moment before slowly dropping back down to a stand. Emphasize the slow return to the floor. Once you are able to do this stretch successfully you can begin to add hand weights.

Foot Care Basics

If you want to run an endurance event such as a 10K race, the number one rule of foot care is to buy good running shoes. There are different shoes for different foot types, and it is an absolute necessity to pick the right one. Don't try and save money by going to a department store, go to a running sports specialty store--tell the salesperson how you will be using the shoe, and keep trying them on until you are absolutely sure that you have the most stable and most comfortable shoe you can find. See chapter 1 for more on choosing running shoes.

Next, familiar yourself with the symptoms of common foot injuries for runners. These include stress fractures, Achilles tendonitis, and plantar fasciitis. Learn how to stretch and strengthen the muscles, ligaments and tendons involved, and to recognize when it is time to move from self-care to seeking medical assistance.

Now concern yourself with the little things that might seem insignificant, but can be very painful and left untreated might bring an abrupt end to your training program.

Blisters

Blisters are caused by rubbing and in most cases it's the result of shoes that fit poorly. Blisters come in all sizes and can appear in just about any spot on the foot, even between toes. If a blister is small and not painful--leave it alone to heal on its own. If the blister is larger than the size of a quarter, causing pain, or swollen, it needs treatment.

Sterilize an instrument (razor blade, small scissors, etc.) in boiling water. Wash the blister with an antiseptic to prevent infection. Then slit a corner of the blister. The skin is dead so it won't hurt. Press the liquid inside the blister out through the slit. Then wash again with antiseptic, let dry and apply a small bandage such as a Band-Aid.

Calluses and corns

These are caused by continual friction in shoes that are too tight in either length or width.. They can be treated with antiseptic and trimming off the dead skin. Check out the first aid section of your local drugstore and you can also find little pads will holes in the middle that you can place on a corn to give it some protection from the constant rubbing. The most important thing you should do is stop the cause by getting shoes that are made for running and fit properly. Don't lace too tight or too loose.

Toenail problems

Ingrown toenails can be painful and if not treated can lead to infection. They are usually treated by cutting off the corner of the affected nail with clippers that have been sterilized. In many cases it is best to visit a medical professional--ingrown toenails can sometimes get so out of hand that surgery is required. Black toenails are another problem that can be caused by footwear. A blood blister has formed under the toenail. It's best to leave it alone and let the nail die and fall off by itself. This is another case where if the pain persists it's best to see a medical professional. It is not a good idea to try and drain the toenail yourself.

Athlete's Foot

This condition is caused by fungus and can be nasty, with skin that cracks especially between the toes--it's itchy and there can also be blisters and inflammation. It can be prevented by washing your feet often and making sure that you dry between the toes. It helps to have two pairs of running shoes so that you can switch off to let them dry out. Replace your cotton socks with synthetic ones that wick away moisture. There are many over-the-counter ointments that can be used to treat the condition.

Iliotibial Band Syndrome

ITBS is one injury that is primary experienced by long-distance runners. It presents itself as sharp or burning pain on the outside of the knee. The pain usually stops when you stop running and resumes when you begin running again.

The iliotibial band is a long, flat band of fibrous tissue that originates on the ilium (upper portion of the lateral pelvis) and extends to the tibia, just below the knee joint. It serves as a tendon for two hip muscles, the tensor fasciae lata at the front of the upper thigh and the gluteus maximus of the buttock. It helps stabilize the knee joint when the foot lands on the ground. During this landing motion, the ITB rubs over the lower portion of the femur. If the rubbing is excessive or too forceful the soft tissues become inflamed. This is known as iliotibial band syndrome.

There can be a number of causes of ITBS: running on a sloped or banked surface, not warming up or cooling down properly, increasing miles too quickly, excessive running downhill, high or low arches of the foot, or overpronation.

This tendon needs no extra strengthening as it is used in every step we take. Stretching the muscular attachments is helpful.

Lie on your back with hands at your sides and your legs out straight. Rotate your right leg outward so that your toes are pointed to the right. Lift your right leg off the floor a few inches, and keeping the knee straight, cross it over the left leg, making sure to keep your toes pointed right. You should feel your groin muscles work to hold your right leg crossed over to the left, and a tightening on the outside of your right thigh. Hold and repeat 8-12 times for each leg. Be careful not to roll over onto your hip as your right leg crosses over the left. Lying on the floor will keep your pelvis stabilized while you use opposing muscles to apply the stretching force.

If you do develop ITBS, get medical advice that goes beyond rest and anti-inflammatory medications. Symptoms will continual to return if the cause is not addressed. If you know that you overpronate, get good motion control running shoes. Try to run on flat roads and do your hill runs during low mileage weeks when your legs are strong.

Muscle Pulls

Muscle pulls can happen to any muscle in the body at just about any time. The most common ones for runners are in the upper and lower leg muscles--calves, quads, adductors, hamstrings, thighs, etc. You get the idea. No matter how hard you try to warm up, cool down, or stretch conscientiously, there's still overuse and even fatigue that can cause a muscle pull. Accidents can also happen.

A muscle pull means that a sudden force has been applied to the muscle and its fibers were stretched beyond their capacity. A muscle pull is not as severe as a muscle tear--only a few fibers are involved, not all of them.

Muscle pulls are all treated in the same way: ice the injury and rest the muscle until swelling and pain subside. An anti-inflammatory can be helpful to reduce pain and inflammation . Apply the ice for twenty minutes on and twenty minutes off as frequently as you can in the days immediately following the injury. The pain should disappear in a few days. If not, it's time to see a medical professional.

Try gentle stretching as soon as the muscle will tolerate it. It the muscles are not gradually re-lengthened, you may pull the muscle again because it will heal in a shortened state. Be careful not to overstretch as it might cause the muscle to spasm. When the muscle can be stretched pain free as far as the healthy one on the other side of the body, you can return to normal activity.

Depending on the muscle and the severity of the pull, it can take anywhere from a week to a month for the injury to heal sufficiently to return to your training program.

Patellofemoral Pain Syndrome

Patellofemoral Pain Syndrome describes pain around the kneecap (patella) or dull, aching pain in the knee. It is thought to be a result of improper tracking of the patella on the femur (thigh bone) when the knee is bent. It is a common overuse problem for runners because of the constant bending and straightening of the knee. Other things that can affect patella tracking are a strength imbalance in the quad muscles, tight muscles and tendons, and a flat foot, which can cause an inward rotation of the tibia, stressing the joint. It is often experienced by runners who start out too quickly in a training program.

Most often patellofemoral pain can be treated without surgery. Treatment usually includes icing, anti-inflammatories, switching to non-impact activities, strengthening exercises, and sometimes wearing a special sleeve that corrects the tracking of the patella. If you have flat feet a change in running shoes and sometimes custom orthotics are needed.

The best way to avoid patellofemoral pain is to regularly stretch and strengthen the quadriceps. Many people do not stretch the quads correctly. You may see them bend their kneecap up behind them and, grabbing the ankle, pull their heel toward the buttocks and lean forward, arching the back. This moves the pelvis in the direction of the stretch and defeats the purpose of the stretch. The pelvis should remain fixed--the rectus femoris, the muscle which flexes the hip and straightens the knee, attaches at the front of the pelvic bone and gets more of a stretch when it is stabilized. Instead of leaning forward and arching your back, perform a posterior pelvic tilt by tightening your stomach muscles and tipping the top of your pelvis up and back. Your thigh bone will move out in front of you. Hold the pelvic tilt as you slowly pull your thigh backwards. You should feel a stretch in the front of your thigh. Continue to stretch the muscle at low intensity for twenty seconds, then progress to a more intense stretch for thirty seconds. Repeat this three to five times with each thigh.

The best way to strengthen the quads is the squat. Sit on the edge of a chair with your back straight, hands on the hips, with your feet flat on the floor and shoulder width apart. Lean forward slightly, keeping an arch in your lower back until you feel you can stand up using only your quads. Keep your back as straight as you can. Stand all the way up keeping a slight bend in your knees, then lower yourself back to the seat using the same technique. Repeat this several times until you feel the front of your thighs warm up. If this is too much for your knees, start from a higher chair.

Another great exercise for the quads is what some people call the “poor person's Stairmaster.” It's easy and convenient: step up a stair using your right leg to lift you up and back down. Repeat this several times and then switch to the other leg.

The various leg extension machines on the market today are also another way to stretch the quads. The key is to move through the full range of motion at a slow and controlled pace. Begin with a light weight and increase the amount of weight slowly as extension machines put an additional amount of force on the kneecap.

Plantar Fasciitis

Heel pain is a frequent problem among long-distance runners, and plantar fasciitis is one of the most common causes. The plantar fascia is not a muscle but a dense band of fibrous connective tissue that runs the length of the foot, from the heel bone to the toes. It is made up of three different compartments that contain the muscles, nerves and blood vessels of the toe. Some of the small muscles of the foot are attached to it. It's primary purpose is to create and support the arch of the foot.

When you put too much stress on the plantar fascia, it becomes inflamed you will feel pain in your heel and sometimes, in the middle part of the arch of your foot. This type of pain rarely presents itself suddenly in a run but develops slowly. There can be several causes--having a flat foot or too high of an arch, shoes that do not fit properly or simply do not have enough shock absorption, or as can be the case in training for a marathon, beginning a new training routine too quickly.

Because the plantar fascia is not a muscle, no kind of strength training can make it stronger. However, you will benefit from stretching it regularly. Here are a couple of stretches:

The first one is very simple. Sit on a chair and cross your right leg over your left knee. Place your left hand on the arch of your right foot. Point your toe and you will feel some of the muscles in your foot contract. Feel around for a tight, firm band that is about half -an-inch wide. That is your plantar fascia. Then, still feeling with your left hand, grab the big toe with your right hand and pull it backwards. You will feel the plantar fascia tighten up under your left hand.

Here is another way to stretch--open a door and face the doorjamb. Grab the jamb with both hands so that each hand is in a different room. Place your right toes three inches above the floor, against the jamb. Keep your knee straight--this will cause you to lean backwards. Balance with your left leg, making sure your left foot is facing forward as well. Using your arms, pull your body towards the jamb keeping your right knee straight. Your big toe should be bent backwards, pulling on the plantar fascia. Don't be surprised if you also feel a stretch in your calf muscle. Repeat on the other side.

A bone spur or heel spur is often associated with pain in this area. The pain, however, is from the plantar fascia, and the presence or absence of a bone spur does not affect treatment of the problem. If you are having this kind of foot pain, the first steps should be oral medication, ice, stretching and rest. If the pain continues, see a medical professional. Some common treatments are taping of the arch and night-resting splints. Custom foot orthotics are sometimes prescribed.

Shin Splints ( medial tibial stress syndrome)

Long distance runners are not the only group of athletes to suffer from shin splints. They can occur in any sport that involves running. The term refers to pain which occurs along the tibia, or shinbone. The pain may be accompanied by tenderness or mild swelling.

Shin splits are caused by an overload on the shinbone and connective tissues. With runners, the cause can be worn-out running shoes. Remember to replace your shoes every 400-500 miles. Athletes with flat arches are also at risk. If this is the case, try arch supports or other orthotic aids. But shin splints can also be caused by training too hard or too long--this needs to be a consideration for runners who are just beginning their training for long distance runs. Running downhill or on a banked or tilted surface can also be the source of this type of pain.

At the first sign of shin pain, stop running and take a break. Most shin splints can be treated with rest, ice and anti-inflammatories. And, if you take the proper steps to address the cause, you can prevent them from happening again. Remember, it is important to seek medical attention if the swelling continues to worsen, your shin appears to be hot or inflamed, or if the pain follows an accident or fall.

Other measures which can help prevent shin splints are cross training, strength training, and a few simple stretches. Cross training is an important part of active recovery. On light or rest days consider activities that do not place as much stress on the legs. Swimming, bicycling or walking are excellent choices.

Adding strength training to your workouts is also important. In the case of shin splints, try toe raises. Begin in a standing position. Rise up onto your toes slowly, and then lower your heels to the floor. When this is easy to do, you can hold progressively heavier weights. Leg presses and other exercises for your lower legs can also help.

There are two stretches for the back of the legs that can also be useful--one stretches the Gastrocnemius muscle and the other the Soleus.

The Gastrocnemius muscle begins above the knee and attaches to the back of the heel at the Achilles tendon. The other is the Soleus which starts below the knee.

Gastrocnemius Stretch

Stand facing a wall with your left leg forward and your right leg back as if taking a step. Reach forward so that the palms of your hands are on the wall. Keep the right knee straight and the heel on the floor. Gradually lean forward against the wall until a gentle pull is felt in the upper 1/3 or ½ of the lower leg (knee to mid-calf). Repeat 2-3 times

Soleus stretch

Stand again facing the wall with your palms against it. The right knee is bent and pushes towards the floor while staying over and just in front of the right foot. The left knee is slightly bent. Lean towards the wall .A gradual pull should be felt in the lower one-third of the leg. Hold three times for ten seconds. Repeat using the other leg.

Sprained Ankles

A sprained ankle is the most common sports injury. A sprain means that a ligament--a dense strong band of connective tissue that stabilizes a joint--has been torn, usually by a sudden and powerful force.

Sprains are graded according to the severity of the tear. A grade one tear involves approximately 25 percent but not more than 50 percent of the ligament's fibers. Grade two tears involve 25-75% of the fibers. And grade three tears are the most serious, involving 75-100% of the ligament's fibers. More tears in the ligament indicate more instability in the joint. Ligaments can tear in the middle or on either end.

There are two different types of sprained ankles: the inversion type when the ankle rolls out and the sole of the foot faces upward, and the eversion sprain--when the ankle rolls inward and the sole of the foot faces outward. The inversion sprain stresses the lateral ATF and CF ligaments. The eversion sprain stresses the medial deltoid ligament.

Runners are not the only athletes to get a fair number of sprained ankles. Just about anyone can--hikers, football, soccer or tennis players--the only sport that is pretty much exempt is alpine skiing where the foot is well-encased in a stiff boot. Causes can be poor footwear that allows your ankle to slide sideways, irregular surfaces--including such hazards as curbs and potholes, wet conditions, or even your sense of balance.

A sprained ankle is obvious immediately as there will be great pain when you try to take a step. There is also usually swelling, tenderness, and bruising. The immediate treatment is ice, rest, and elevation. More severe sprains will require an ace bandage wrap or brace. Depending on the severity, healing can take from two weeks to ten months. If you suspect a sprained ankle--you can't walk on it at all--or swelling or pain is not resolved in a few days, you need to see a medical professional.

The best prevention is proper footwear with a stable outer sole and a firm heel counter. High-top shoes, braces, and taping can also prevent injury. Balance and resistive exercises to the outer calf can help as well.

To improve your balance, stand on one leg with your eyes closed. Try to hold the stance for 30 seconds, then switch to the other leg. Repeat 5 times.

To strengthen your outer calf muscle, sit with your legs extended in front of you. Point your toes and rotate your feet outwards toward the baby toe. Hold this isometric contraction for 10 seconds and repeat the movement 10 times. Make sure only your feet rotate and not your legs, and be sure to keep your toes pointed. You will only be able to rotate an inch to three inches and you will feel a burn on the outsides of your lower legs.

Stress Fractures

Most stress fractures occur in the bones of the lower legs and feet. Runners are particularly at risk for stress fractures because of the pounding nature of each stride--all of your weight lands on your lower legs over and over again. Stress fractures usually occur for runners in the tibia (the inner and larger bone of the leg below the knee), the femur (thigh bone), in the sacrum (the triangular bone at the base of the spine) and in the metatarsal (toe) bones of the foot.

A stress fracture causes pain, tenderness and swelling in the area of the fracture. The most common causes are overloading the bone, continuing to run when muscles are over-fatigued, or changing running surfaces frequently, such as mixing up runs between pavement, dirt roads and a track. Sloped running surfaces will also cause excessive stress to one leg more than another.

If you feel this kind of pain in your legs, you should see a medical professional for accurate diagnosis. Stress fractures usually can not be diagnosed with an x-ray. An MRI can be used or you might have another x-ray in a month when it can pick up signs of new bone growth. The only safe thing to do with a stress fracture is rest. If you absolutely can not live without running, the doctor might allow you to continue to stay fit by running in water.

Stress fractures for women can be different than those for men. Women can be particularly at risk because overall, they have less muscle mass for shock absorption than men. Also, a woman's hips come under more stress than a man's, as does the pelvic area when running. Hormonal differences and menstrual cycles also serve to weaken bones and some women may need to add calcium and vitamins to their diet to prevent stress fractures. Sometimes the condition is referred to as “the female athlete triad,” because a combination of eating disorders, poor nutrition and an infrequent menstrual cycle can put women at risk for osteoporosis. This kind of thinning of the bones can increase the likelihood of a stress fracture. Some studies advise that supplementing estrogen is helpful in preventing fractures and some doctors have advised the use of bone-strengthening supplements.

Stress fractures to the lower leg bones, particular the tibia ,can be prevented by combining running with a strength training program. Also, make sure you have well-cushioned running shoes. Running on soft surfaces such as grass, bark, dirt or sand instead of pavement or concrete can also help.