Every runner's guide to preventing and treating 10 common pains and sprains.
By Denise Mann
Reviewed By Charlotte Grayson, MD
"Don't run and you'll heal," are the words that every diehard runner dreads hearing.
"Runners don't want to stop running, and the good news is that you can run through most pain without causing permanent damage," says Lewis G. Maharam, MD, medical director of the New York Road Runners Club, the New York City Marathon, NYC Triathlon, the Suzuki Rock 'n' Roll Marathon -- among others. "But," he cautions, "if pain changes your running style, stop and see a sports doctor."
Most common running injuries are due to overuse, overtraining, or a biomechanical flaw in body structure and motion.
Here's how to prevent and treat the 10 most common running injuries so you never get sidelined again:
1. Runner's knee
Runner's knee is a wearing away of the back of the kneecap, causing pain in the knee. This can occur because of decreased strength of middle quadricep muscles, or shoes that do not give proper support when you come off of your forefoot on the inside. What to do? Maharam says the condition is typically treated with a full-length sports orthotic and strengthening exercises directed at the middle quad muscle. Talk to a sports medicine doctor about getting into physical therapy and learning about the best stretches to heal runner's knee.
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, says sports podiatrist Stephen Pribut, DPM, clinical assistant professor of surgery at the George Washington University Medical Center in Washington, D.C. 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.
"The more the miles, the greater the stress," says Maharam. And this is one injury you should not ignore. "Stress fractures are like a hardboiled egg," he explains. "The shell is cracked and next stop is a full-fledged fracture." See a doctor who specializes in treating running injuries, Maharam advises. "We only tell runners to stop when they have a fracture or a stress fracture and then we put them in a pool for water-running because stopping exercise is unacceptable to (most) runners."
3. Iliotibial band syndrome, a.k.a. ITBS
Marked by a sharp, burning knee or hip pain, ITBS is a very common running injury among marathoners. Indeed, it's responsible for as many as 80% of all overuse pains on marathon day. The ITB is a ligament that runs along the outside of the thigh -- from the top of the hip to the outside of the knee. It stabilizes the knee and hip during running, but when it thickens and rubs over the bone, the area can become inflamed or the band itself may become irritated -- causing pain. "ITBS may be caused by running on a banked surface that causes the downhill leg to bend slightly inward and stretches the band, inadequate warm-up or cool-down, running excessive distances, increasing mileage too quickly or certain physical abnormalities," says Pribit.
The best stretch? Place the injured leg behind the good one. If the left side is sore, cross your left leg behind your right one. Then lean away from the injured side toward your right side. There should be a table or chair that you can hold onto for balance. Hold for 7 to 10 seconds and repeat on each side 7 to 10 times, prescribes Pribut. Anti-inflammatory drugs such as ibuprofen (some brand names are Motrin and Aleve) can help get the swelling down, he says.
4. Shin splints
The most common type of shin splints happen on the inside of legs. These medial shin splints are a running injury that results from a biomechanical flaw in your foot (which can be made worse by a shoe that doesn't offer enough support) and/or overtraining.
"Your best bet is to switch to a motion control or thicker shoe and a make sure to stretch out your calf muscles" before and after running, says Michael Fredericson, MD, doctor for the Stanford Cross Country and Track Team and an assistant professor of orthopaedic surgery at Stanford University School of Medicine. Do this by standing with your rear foot approximately two to three feet away from the wall. Your rear leg should be straight, the front leg bent and your hands touching the wall. Your feet should point ahead with heels on the ground. Hold for 10 seconds and repeat 10 times on each leg. Now do the same thing with your rear leg (that was straight) slightly bent at the knee. You should feel this stretch lower down.
Also known as pain in the middle of arch of the foot, plantar fasciitis is a running injury most frequently caused by an abnormal motion of the foot or too-tight calf muscles. Normally, while walking or during long-distance running, your foot will strike the ground on the heel, then roll forward toward your toes and inward to the arch, Maharam explains. "Your arch should only dip slightly during this motion but if it lowers too much, you have what is known as excessive pronation." What to do? "It is usually corrected with an orthotic and calf stretches" before and after running, Maharam says.
6. Achilles tendonitis
Achilles tendonitis is a running injury that typically occurs from abnormal foot stroke in push-off and too-tight calf muscles. "If you are pronating to the side and pulling at an improper angle, it becomes stressed and inflamed. That's why getting an orthotic to correct the biomechanics of your foot stroke at push-off is key," Maharam says. Also, he suggests doing the same stretch recommended for shin splints.
7. Muscle Pulls
Whether hamstring, quads, or any other muscle, pulls come from not being flexible and/or overexerting specific muscles. "Basically, pulls occur because you haven't stretched or because you are trying to beat your 18-year-old son in a sprint and you are 45," Maharam says. Pulls are basically small muscle tears, and the best way to treat a pull is to do more stretching before and after a run. To prevent hamstring pulls, place one leg on a chair and get your knee straight and bend over. Hold for 15-20 seconds. For an acute injury, ice and anti-inflammatory medication is helpful.
8. Ankle sprains
Ankle sprains occur because runners don't always watch where they are going. "They can step off curb or into pothole," Maharam says. "Pay attention to where you are running or run on a really good, level track where there is less chance of finding a gopher hole." When and if an injury does occur, ibuprofen and ice can help reduce swelling and pain.
"Most runner's drink too much, not too little" water, Maharam says. This can cause overhydration -- also known as diluting -- which lowers sodium levels in the body and stresses the kidneys. Common symptoms of diluting are nausea, vomiting, and dizziness. To avoid these problems, Maharam suggests: "Drink about one-cup (8 oz.) of fluid every 20 minutes while running. This way you will avoid becoming diluted."
One of the most common sports injuries, blisters on the feet are usually caused by friction combined with excessive moisture. Avoid them by choosing synthetic socks -- such as those by Nike Dryfit -- that wick away moisture," Maharam says.
Remember, Pribut says, that "about 90% of running injuries are due to overtraining, so a very slow buildup is important, and so are rest days." You'll save yourself pain and reach your goals, Pribut says, if you "avoid the 'terrible toos' -- training too much too soon, too often, and too fast."
Originally published Aug. 11, 2003.
Medically updated March 29, 2004.
SOURCES: Lewis G. Maharam, MD, medical director, New York Road Runners Club, New York City Marathon, and NYC Triathlon. Michael Fredericson, MD, team physician, cross country and track team, Stanford University. Sports podiatrist Stephen Pribut, DPM, clinical assistant professor of surgery, George Washington University Medical Center, Washington, D.C.
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