“I have ligament tears in both my knees and I can still run a marathon, and have been doing so, despite advice to the contrary from my doctor,” said a gentleman in his sixties who came up to our stall last year during Run Powai Run, a local marathon event. Frankly, I did not know whether to applaud him or admonish him. As doctors, we can opine and advise about the human body, but the human spirit and its trappings elude us.
In my short span of practice here and in the USA, I have worked with and treated athletes at all levels—from weekend warriors to professional NHL and NFL players—and the one thing common to all of them is their passion for sports. They don’t want to give up the sport and life they love. There is an old joke in the medical community…
Patient: “Doc, it hurts only when I move my arm like this.”
Doctor: “Then don’t move your arm like this.”
In sports medicine, however, we take every restriction in movement seriously.
Most serious runners have to deal with some niggling aches or pains almost all the time and it is really the passion for running that keeps them going. In sports medicine, the goal is to achieve the ideal scenario, where every step of every mile is pain-free and more often than not, this is achievable with the correct approach.
The most common reasons for injury in runners are usually one or more of the following: sudden increase in the intensity, change in running surface, change in footwear, or flaw in the running technique or form.
There are two main types of injuries sustained during running:
- Acute injuries, which include fractures, dislocations, ligament tears and tendon ruptures. You should always seek urgent medical help here.
- Chronic injuries like aches in the hamstrings, heel or groin.
Here, I discuss about the common injuries, mostly chronic, seen in runners, and enumerate the red flag symptoms where urgent medical help should be sought.
The most common reason for heel pain in runners is plantar fasciitis, which is the inflammation of the tissue in the sole of the feet. It is experienced in both feet. Usually, the pain is severe during early morning hours and after a period of rest, and improves with activity. This
condition is usually seen in runners who run with a heel strike. The best approach for treating this condition is to reduce the intensity and duration of running and maintain fitness with other non-impact exercises like cycling and swimming. Use proper footwear and supervised rehab exercises. It is alright to run through pain in this condition.
Red flag symptoms: Inability to bear weight on the affected side, swelling or discolouration of the foot and ankle.
Pain in the heel cord
This is also called Achilles tendonitis. Achilles is a major tendon in the body that connects calf muscles to the heel bone. The most common reasons for Achilles tendonitis are: the sudden increase in the intensity of running and uphill running. Usually, the pain is severe enough to restrict the training. The best way to treat it is to take a break from running. Have a physiotherapist supervise your rehab, avoid walking or running uphill and use shoes that fit properly.
Red flag symptoms: There is a more sinister variety of tendonitis, where the pain does not subside after rest, there is a thickening of the heel cord, and day-to-day activities become painful. Seek medical help urgently in this situation as the tendon is prone to rupture.
Shin splints are one of the commonest pains experienced by runners. It is an innocuous condition in which pain is felt in both the shins only after running a certain distance. Treatment for shin splints usually includes rehab and modification of running technique. It is however, tough to treat. Most of the serious and passionate runners who get this condition keep running despite the pain. It is fine to adopt this approach as well since there is little or no risk of damaging any tissues.
Red flag symptoms: Shin splints must be differentiated from the more serious situation, which is stress fracture. In stress fractures, pain is more severe and does not get relieved after rest. There might be swelling as well. In case of these red flag symptoms, seek medical help immediately. Stress fractures can occur in other parts of the foot and ankle as well. The main symptom is pain with weight bearing and swelling. Treatment for stress fractures includes complete sabbatical from running and switching to other flexibility exercises to maintain fitness. Sometimes, complete immobilisation in a cast or boot and surgery may also be needed.
According to a recent survey almost 50 per cent of all runners have knee pain at some stage of training. Though a variety of conditions can cause knee pain, the most common ones are patellar tendonitis, IT band syndrome and patello-femoral pain syndrome. Treatment for all of the above is supervised physiotherapy, assessment and modification of the running technique and reduced intensity of running. Uphill running relieves patellofemoral pain syndrome as well.
Red flag symptoms: The red flag signs in knee pain are swelling of the knee, painful clicking, and locking of the knee. These are signs of possible cartilage tear in the knee, which sometimes needs arthroscopic surgery.
Hamstring and calf pain
Another very common injury in runners, it may range from niggling pain in the buttock to a full-blown tear, which is thankfully rare in runners. Poor flexibility and poor strength are usually blamed for this condition. If the pain is mild, rehab and supportive clothing reduce the pain but in severe cases, running and impact activity should be stopped along with appropriate rehab. Healing may take few weeks to months as this is a tough injury to treat.
The most common reason is degenerative intervertebral disc. Usually a break from running or reduced intensity and proper rehab will help to improve the symptoms.
Red flag symptoms: The red flag signs are radiation of the pain to the whole leg, and severe stiffness of the back. Seek medical attention as it might be a sign of prolapsed intervertebral disc.
Pre-participation evaluation includes a complete medical and musculoskeletal check up of the athlete specific to each sport. This concept was born in the USA to avoid catastrophic situations on the field and keep sport managers legally safe, but it has now evolved. Today, it not only serves its original purpose, but also helps athletes and coaches understand and improve the areas of deficiency in training. The musculoskeletal exam includes evaluation of the kinetic chain. In this concept, the body is thought to be a chain or complex system of multiple joints and ligaments, muscles and bones. The weakness of muscles away from a certain area can also lead to injuries in that area, for example increased incidence of knee and foot injuries due to weak hip muscles. It sounds counterintuitive at first but makes perfect sense when you really think about it. In the recent years, a number of studies have implicated weak core muscles as cause for many a sports injury.
First aid is the common antidote for most sports injuries. It includes:
- Rest [to avoid aggravating activities]
- Ice pack application [15 minutes, 2 – 3 times a day]
- Compression dressing [crepe bandage]
- Elevation of the limb
Muscles, joints, ligaments, and tissues repair as you sleep. If you don’t get enough rest and sleep each night, your body takes some time to bounce back from an injury. The key is not rushing your recovery. Avoid strenuous activities temporarily and give your body sufficient time to heal completely. Of course, the time frame will depend on the severity of your case.
Ice application constricts your blood vessels in the affected area, decreasing blood circulation to the site of injury to reduce swelling. Aside from this, the cold temperature can reduce pain. You may also want to cover the ice pack with a light absorbent towel to prevent frostbite during ice application.
Compression wrapping can reduce the swelling of the injured body part. A compression wrap controls blood flow and pushes out excessive fluid to reduce swelling. Doing this first aid is especially critical for players who suffer from leg wounds as gravity makes moving fluid out of the wounded area difficult. Make sure that compression dressing is snug but not too tight to stop or interrupt the blood flow.
You also need to elevate the limb during the ice application when treating sports injuries. Ideally, it should be at or above the level of the heart. Elevation makes it difficult for the blood to reach the injury, thus, reducing the bruising and inflammation of the area.
Over-the-counter painkillers can also be used. But if the pain persists even after all these measures, do not hesitate to visit the competent authority.
The various techniques used for treatment of sports injuries are:
- Physiotherapy [Rehab]
These techniques are used in a variety of combinations depending on the nature of the injury. Surgery for sports injuries was revolutionised after the introduction of arthroscopy or key-hole techniques with small incisions. The recovery period is shortened after these minimally invasive procedures—a very important factor for injured athletes eager to get back to the sport and life they love.
Finally, all the running injuries are just hurdles to be crossed to reach the finish line, sometimes with the helping hand of your sports medicine expert. These experts can be your allies to speed up your recovery and prevent further injuries in the future. So, when the need arises, reach out immediately to experienced therapy clinics, such as Petroski Physio or other reliable sport medicine experts in your area.
Some dos and don’ts
- Always warm up before running
- Cool down after work out
- Stretch post exercise
- Wear proper fitting shoes
- Run on familiar tracks
- Don’t run through pain
- Know the limits of your body
- Don’t overdo any exercise
- Use good safety gear
- Work on your own to improve your technique and form.
This was first published in the January 2014 issue of Complete Wellbeing.
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