Run Injuries Flashcards
Plantar Fasciitis
If an athlete experiences pain along the bottom of the heel that feels worse in the morning upon waking, the cause of the discomfort may be plantar fasciitis.
The pain is usually located on the inner or medial side of the heel, but athletes may experience pain toward the center of the bottom of the heel or farther up toward the arch.
The pain limits the athlete’s ability to push off during the terminal stance when running.
Cause
The plantar fascia is a band of connective tissue that runs along the bottom of the foot, from the heel bone to the metatarsals.
Excess tension or pulling of the fascia causes inflammation, usually at the calcaneal tuberosity.
If untreated, micotears can develop in the inflamed tissue.
Athletes with high-arched feet can be more prone to this injury.
Tight calf muscles can pull on the Achilles, which pulls on the calcaneus, which pulls on the plantar fascia.
Treatment Options
Athletes can continue training, as long as the foot is pain free.
To reduce inflammation athletes should ice their foot.
If approved by a qualified healthcare provider, anti-inflammatory medication can also help reduce inflammation and pain.
1.Loosen Fascia
Athletes can try to reduce the tension on the plantar fascia by rolling the arch of the foot over a foam roller, golf or tennis ball. Athletes should NOT roll the ball over the bone where it hurts.
Pumping the ankle up and down 10-15 times before getting out of bed can also help loosen the Achilles and fascia.
2. Stretch Calves
Athletes can stretch their calf muscles to lesson tension along the tendo-Achilles complex.
Prevention
Though plantar fasciitis is a foot injury, the key to preventing it is a strong kinetic chain.
Prevention begins by strengthening the glute muscles, hip flexors, quadriceps and core.
Barefoot walking and running drills can help strengthen the muscles in the foot.
If the athlete’s running evaluation revealed any stride or cadence issues, improving these can also help prevent plantar fasciitis.
Additional Advice
Foot splints worn while sleeping have been shown to help some athletes.
If the pain hasn’t improved after two weeks the coach should encourage the athlete to schedule an appointment with a qualified healthcare provider.
Achilles Tendinitis
Achilles tendinitis refers to inflammation and swelling of the Achilles tendon, located at the back of the lower part of the leg, directly above the heel.
Symptoms of Achilles tendinitis include soreness anywhere from the back of the heel up to where the tendon joins the calf muscles.
Cause
Poor Achilles tendon strength, a lack of calf-muscle strength, improper recovery between workouts, failure to stretch the calf muscles and Achilles tendon, excessive hill running or speed work, and overly ambitious advances in training volume, intensity, and/or frequency are all risk factors for Achilles-tendon injury.
Excessive stress on the tendon forces the collagen fibers that comprise the tendon to separate and misalign.
Treatment
If the athlete experiences Achilles soreness they should treat it right away.
When successfully treated the athlete can expect to return to running pain-free in six to ten weeks.
If they ignore the symptoms, recovery could take three to six months, or longer.
1. Dynamic rest and proper nutrition
Athletes can continue to train as long as they are pain-free during their training sessions. Swimming and biking are permitted, but athletes should not run. The only exception is water running. During this time coaches should encourage athletes to continue with upper-body strength training.
There are several nutrients such as Vitamin C, manganese, and zinc that play an important role in increasing collagen production. Vitamins B6 and E have also been linked to tendon health. A well-balanced diet rich in fruits and vegetables, whole grains, and lean protein will supply sufficient amounts of these vitamins.
- Icing and stretching
Athletes should apply ice to the sore area for fifteen minutes, four to six times a day. If they can stretch without pain, suggest straight-leg and bent-leg calf stretches. They can also use a foam roller to loosen the calf muscles, but should avoid rolling directly on the sore tendon.
Prevention
In addition to treating Achilles tendonitis, proper stretching and exercises that strengthen the calves and Achilles tendon in a running-specific way can help to prevent Achilles Tendinitis.
After the period of rest, coaches should prescribe eccentric calf strengthening exercises. Not only will these exercises strengthen the calf muscle and tendon but they also help to heal the tendon by stimulating collagen production and realigning the collagen fibers.
1.Strengthen calves
Athletes can lessen the stress on their Achilles tendons by strengthening their calves. Plyometric lower-body work including squats, multidirectional lunges and squat thrusts can help to strengthen calf muscles. Athletes should also use a foam roller daily to prevent their calves from becoming too tight.
Unilateral dumbbell calf raises, unilateral bent-knee calf raises and the farmer’s walk on toes are also good exercises for preventing this type of injury.
2. Check stride
A longer stride increases the eccentric load on the plantar flexors (gastrocnemius and soleus). Use cadence drills to help athletes develop a shorter, quicker stride that can help prevent injury.
Additional Advice
Remember to follow the 10% rule: Don’t increase an athlete’s running volume by more than 10% each week.
Overly ambitious advances in training volume, intensity, and/or frequency are all risk factors for Achilles-tendon injury.
Iliotibial Band (ITB) Syndrome
Athletes who suffer this injury will feel pain on the lateral side of the leg just below the knee where the bone bulges out, or along the Iliotibial band.
The pain may develop five to seven minutes into the run and subside after stopping.
Cause
There are several possible causes of ITB impingement syndrome.
Tight hip abductors (especially the TFL) and excessive internal rotation of the tibia can cause ITB syndrome.
Weak glutes and core muscles can cause an athlete’s hips to drop while running. This can cause valgus knee and result in tension increasing along the ITB.
Overpronation can also affect the movement around the knee, which stresses the ITB.
A tight IT band is another potential cause of ITB syndrome.
Treatment
It is possible for athletes to continue running with this type of injury, but they should only run up to the point of pain or until the pain forces a change in their running gait.
Coaches can supplement run training sessions with cycling, swimming or another activity to maintain cardiovascular fitness.
1. Loosen ITB
A good stretch for loosening the Iliotibial band is to stand upright and cross one leg behind the other. Lean slightly forward and toward your front leg until you feel a stretch on the outside of your back leg. Hold for 30 seconds and repeat three times. Switch legs and repeat.
2. Strengthen Core and Glutes
Strong core and glute muscles (gluteus minimus, glute medius, gluteus maximus) and external hip rotators improve stability during stance phase of running and reduce the stress on the ITB. Glute hip bridges and plyometric jump squats are good for strengthening the glutes. Planks are a good exercise for strengthening the core.
Prevention
A good way to prevent it is for athletes to strengthen their glute and core muscles.
Hip bridges, lateral lunges, and lateral band walks are all good exercises to incorporate in the strength and conditioning plan.
Athletes may also need to work on increasing their running cadence and shortening their stride to reduce ground contact time.
Additional Advice
If an athlete is unable to recover from this injury, coaches should encourage the athlete to seek advice from a qualified healthcare provider.
Runner’s Knee
Patello-femoral knee syndrome, or runner’s knee, involves pain or aching beneath the kneecap.
The patella is located between the quadriceps tendon, which connects to the quadriceps muscle, and the patellar tendon, which attaches to the tibia.
The underside of the patella is covered in articular cartilage, which allows smooth movement of the kneecap over the joint. (Articular cartilage is not to be confused with the meniscus cartilage that cushions the area between tibia and femur.)
When the patella repeatedly moves out of alignment during running, the articular cartilage beneath it becomes irritated.
Cause
There are a few different ways that the patella can fall out of alignment.
Tightness or weakness in the quadriceps and knee extension weakness are associated with patellofemoral pain syndrome.
Overpronation has also been known to increase stress along the inside of the patella.
Weak glute and core muscles can cause an athlete’s hip to drop while running, causing the patellae to fall out of alignment.
Weak quadriceps
Treatment
Athletes can typically continue to run while treating runner’s knee, but should refrain if the injury causes a change in running gait.
The strategy is to reduce the pain while trying to determine the cause of the injury.
1. Loosen Quads
Coaches should encourage the athlete to use a foam roller to loosen tight quadriceps. Dynamic stretches, like the walking butt kick hold are recommended as well.
2. Ice
Athletes should ice their knees for 15 minutes, four to six times a day.
Prevention
The best way to prevent runner’s knee is with a strong and healthy kinetic chain
Athletes should work on strengthening the muscles in their quadriceps, hips, glutes, and core during training.
Good exercises for strengthening these muscles include plyometric jump squats, and walking lunges.
Coaches can evaluate an athlete’s gait to check for overpronation or stride issues and integrate drills to address these issues during the athlete’s training sessions.
Additional Advice
If athletes are still experiencing pain after two months of rest and treatment, or if swelling develops, they may want to have a doctor conduct an MRI to look at the cartilage.
If the athlete is older than 50, he or she should see a doctor to rule out patellofemoral arthritis (a wearing down of the cartilage beneath the kneecap).
Shin Splints
Many runners will experience shin splints, which involve pain in the front of the lower part of the leg.
Both muscular and bone-related shin pain can cause “shin splints”.
Approximately 90% of shin splints occur in the bone.
If athletes feel pain when pressing on the inside of their shinbone after running, it may be a sign of posterior medial tibial stress syndrome.
If the pain is in the softer muscular tissue toward the outside of the tibia, it may be exertional compartment syndrome.
ECS accounts for 10% of shin splint injuries.
Cause
The causes for both types of shin splints are similar.
1. Bone-Related
Bone-related shin splints occur when there is excessive load or stress on the tibia causing bone irritation. This injury is common among new runners still adapting to the demands of the sport. Experienced runners may develop bone shin splints when the volume of running increases too quickly.
Athletes who feel pain in the tibia need to treat it immediately. Continuing to run will increase the irritation and swelling Eventually leading to a stress fracture.
In addition to overtraining, poor running mechanics, wearing improperly fitted running shoes and low bone density can contribute to the development of bone-related shin splints.
2. Muscle-Related
Muscle-Related shin splints (ECS) results from swelling within the anterior compartment in the lower leg that consists of muscle, nerves, and blood vessels wrapped in fascia. Because fascia is inflexible, when the tissue within the compartment swells, it pushes against the fascia, causing pain.
As with bone-related shin splints, a sudden increase in running, wearing improperly fitted running shoes, and poor running mechanics can lead to a buildup of stress that causes swelling in the muscle.
Treatment
If the pain is mild and an athlete can run without altering their running mechanics, then they can continue with scheduled training.
If the athlete’s running gait changes to accommodate the pain, the coach should remove the running workouts from the training plan to allow for recovery.
1. Bone-Related
If a stress fracture has been ruled out, the best way to treat this injury is to apply ice to the area for 15 minutes, four to six times per day.
2. Muscle-Related
Manual massage and the use of a foam roller on the tibialis anterior, gastrocnemius and soleus can help loosen the muscles attached to the fascia and alleviate pain. If these interventions do not alleviate the symptoms, the coach should encourage the athlete to seek advice from a qualified healthcare provider.
Prevention
As with many injuries, a good strategy for prevention is to follow the 10% rule.
1. Bone-Related
Hip and core strengthening exercises can reduce the risk of this injury. Athletes can also work on stride length and increasing cadence to reduce ground contact time.
2. Muscle-Related
Athletes can use a foam roller on their shins and calves daily.
Additional Advice
If x-ray results from a doctor’s visit confirm a stress fracture, athletes may want to consider a bone density scan depending on severity and family history.
The coach should educate the athlete on the relationship of calcium and Vitamin D to bone health.
Piriformis Syndrome
Athletes suffering from piriformis syndrome will feel pain deep within their glutes on one side.
This pain will intensify when the athlete is seated.
It can also become a shooting pain, again on one side, that travels down to the hamstrings.
Cause
The piriformis is a small muscle that lies deep within the buttocks and right next to the sciatic nerve. Its role in running is to help stabilize the hip as the athlete lands during gait.
When the piriformis becomes too tight, it squeezes the sciatic nerve, causing pain.
Tightness in the piriformis is caused by weakness in one or more of the muscles in the kinetic chain.
Overpronation can also be an issue.
One of the jobs of the piriformis is to help prevent the knee from rotating too much. Too much pronation creates too much rotation and tension along the piriformis.
Treatment
Athletes can continue running with this injury unless the pain begins to alter their running mechanics.
Anti-inflammatory medications can be taken to ease the pain and will allow the athlete to comfortably stretch and roll the muscle.
Athletes should stretch the piriformis muscle daily. They can use a foam roller to roll the glutes and relax the muscle around the nerve.
Prevention
There are a variety of exercises that athletes can perform to help prevent piriformis syndrome.
These include standing resistance-band hip abduction, lateral band walks, plyometric jump squats, planks and fire hydrant’s.
Athletes can also use a foam roller every day to keep muscles loose and work out any tight spots.
Additional Advice
If athletes don’t feel better within a week, they should see a doctor to confirm a diagnosis.
If conservative treatments fail, the provider may suggest alternative treatment methods.
Strained/Pulled Hamstring
There are two common types of hamstring strains or pulls that can result from running.
If the athlete experiences pain near the glutes that’s especially uncomfortable during the terminal stance phase of running, the injury may be a proximal hamstring strain.
A sudden, sharp pain closer to the knee that occurs during a run and forces the athlete to stop is due to a pull or strain in the middle third of the hamstring.
The pain athletes experience when loading their hamstrings may be mild or excruciating, depending on the severity of the strain.
Cause
This injury occurs when athletes stretch their hamstring muscles too far, when athletes put a sudden and heavy load on their hamstrings, or a combination of both.
If the loaded hamstring is weak or fatigued, or both, the result may be a strain or pull.
1. Middle Third
Most hamstring strains occur in the muscle where it connects with the tendon down toward the athlete’s knee. These types of strains are typically mild and easily treated. If the muscle is torn it will take months to heal.
2. Proximal
In the case of a proximal hamstring strain, the injury occurs where the muscle connects to the tendon and the pelvis (the ischial tuberosity.) Since there is very little blood flow in the tendons, healing takes longer than with a strain to the muscle.
Treatment
Whether the injury occurs in the middle third of the hamstring or is proximal, the athlete should ice the area as soon as possible after the injury has occurred.
Apply ice the area for 15 minutes, and continue to apply it for 15 minutes four to six times a day for the first two days.
A few days after the injury, the athlete can begin gently doing the standing hamstring stretch and the lying glutes stretch several times a day.
1. Middle Third
It is recommended that athletes with this injury take refrain from running for a few days, and focusing on swimming, cycling and upper-body strengthening.
2. Proximal
Athletes with this injury may keep running on flat surfaces, but they should use a shorter stride. Coaches may encourage athletes to focus on increasing the cadence in order to shorten the stride.
Prevention
Coaches should prescribe exercises that strengthen the glutes, hip flexors, quads, core and hamstrings to prevent strains and tears.
Exercises to include in strength and conditioning sessions include the hip raise, the reverse hip raise, the walking lunge, planks and the dumbbell step-up.
Interval training, hill running, and stair climbing are other excellent activities for building hamstring strength.
As with other injuries, the use of a foam roller is recommended to prevent muscle tightness.
Additional Advice
If an athlete with a middle third strain is still in pain after 8 weeks, the coach should recommend he or she should seek advice from a qualified healthcare professional.
If a proximal injury isn’t healing after four to five months of treatment and strength training, the athlete may have a partial tear or chronic tendonosis.
