RUNNINGRUNNING INJURIES:INJURIES: PREVENTIONPREVENTION ANDAND REHABILITATIONREHABILITATION TopicsTopics ofof TonightTonight’’ss LectureLecture CommonCommon InjuriesInjuries andand TreatmentsTreatments CausesCauses ofof CommonCommon InjuriesInjuries MeasuresMeasures toto AvoidAvoid InjuryInjury MostMost CommonCommon RunningRunning InjuriesInjuries

Plantar Fascitis Caused by Achilles Tendonitis – 1) Training errors (too much too soon, for Tibial Stress syndrome too long) – AKA shin splints – 2) Inappropriate Iliotibial band footwear syndrome – 3) Inadequate strength Runner’s knee – 4) Inadequate Stress fractures flexibility Acute Muscle Tears – 5) Poor biomechanics CommonCommon AnatomicalAnatomical AfflictionsAfflictions ReducedReduced AnkleAnkle RangeRange ofof MotionMotion LegLeg--lengthlength asymmetryasymmetry IncreasedIncreased quadricepsquadriceps angleangle BowBow LegsLegs KnockKnock kneesknees SubtalarSubtalar HyperHyper MobilityMobility HighHigh--archedarched oror flatflat feetfeet FactorsFactors RelatedRelated toto RisksRisks ofof RunningRunning InjuriesInjuries ––PreviousPrevious injuryinjury ––LackLack ofof runningrunning experienceexperience ––CompetitiveCompetitive runningrunning ––ExcessiveExcessive weeklyweekly runningrunning distancedistance ––LowLow bodybody massmass HowHow ToTo AvoidAvoid InjuryInjury

ProperProper shoesshoes WarmWarm--upup TrainingTraining methodsmethods StretchingStretching MuscleMuscle strengtheningstrengthening

PesCavus/PesPlanusPesCavus/PesPlanus Pes Cavus associate with a more rigid foot and lateral leg injuries Pes Planus associated with hypermobile foot and medial leg injuries

Pes Cavus Pes Planus PlantarPlantar Fasciitis/HeelFasciitis/Heel PainPain

Definition: Inflammation of plantar fascia most often occurring at the origin on the heel (inside edge). Also may be associated with heel spurs (not necessarily the cause of the fasciitis) Chronic injury caused by repetitive overuse (changes in training levels) Plantar Fascia of Right Foot

Common Site for Pain of Plantar Fasciitis PlantarPlantar FasciitisFasciitis Etiology:Etiology: ––RepetitiveRepetitive stressstress (traction)(traction) duringduring weightweight bearingbearing and/orand/or pushpush offoff ––predisposingpredisposing factors:factors: rigidrigid pespes cavus,cavus, shortenedshortened achillesachilles tendon,tendon, hypermobilehypermobile forefootforefoot Pathology:Pathology: ––Microtrauma/inflammationMicrotrauma/inflammation atat thethe insertioninsertion ofof thethe plantarplantar fasciafascia intointo thethe calcaneouscalcaneous withwith w/outw/out bonybony exostosisexostosis formationformation (calcaneal(calcaneal spur)spur) PlantarPlantar Fasciitis/HeelFasciitis/Heel PainPain

Treatment: Symptoms: – Effective in 95-98% of people – Pain located in – Stage 1: middle to medial NSAID’s, stretching, heel aspect of heel pads, over the counter aspect of heel orthotics, physical therapy – Mornings bad, – Stage 2: improves slightly Steroid injection, night during day and splint, custom orthotics, worse by end of physical therapy day – Stage 3: – Pain is activity Surgical considerations after 6-12 months of failed dependent conservative RX, new “shock wave therapy” TheThe PainPain ofof FasciitisFasciitis TreatmentsTreatments forfor PlantarPlantar FasciitisFasciitis

Helps increase flexibility Prevents shortening of Plantar fascia. of fascia over night. Pronation of Talar and Subtalar Joints Soleus StressesStresses Tibial/Fibular Joints Achilles’ Tendon Deltoid Ligament Spring Ligament Tibia Fibula Longitudinal Arch of Foot Talus Transverse Arch of Foot Tibialis Posterior Muscle Anterior Tibialis Calcane Pronation FootFoot PronationPronation andand TibialTibial Torsion:Torsion: PreventionPrevention ofof OverOver PronationPronation

ProperProper ShoeShoe SelectionSelection Heel Wedge to Prevent Excessive Motion

StrengtheningStrengthening ofof Anterior/Anterior/ PosteriorPosterior andand Lateral/MedialLateral/Medial MusclesMuscles ofof LegLeg

StrengtheningStrengthening ofof ArchArch MuscleMuscle ofof FootFoot

ProperProper RunningRunning BiomechanicsBiomechanics AchillesAchilles TendonitisTendonitis

Definition:Definition: – Inflammation of the Achilles tendon most often occurring at the insertion on the back of the heel – Often associated with a “pump bump” or bone spur AchillesAchilles TendonitisTendonitis

Symptoms:Symptoms: Treatment:Treatment: – Morning – Morning – NSAID’s, physical stiffness stiffness therapy, heel lifts, – Pain with steps stretching, ice/heat (esp. down) (esp. down) – AVOID steroid – Pain with injections! activity activity – Casting if no relief – Pain can be with other located in conservative middle of treatment tendon as well tendon as well – Surgery as an and can produce and can produce absolute last resort a “nodule” CalfCalf StretchesStretches MedialMedial TibialTibial StressStress SyndromeSyndrome AKAAKA ShinShin SplintsSplints

ByBy definitiondefinition itit isis irritationirritation ofof thethe anterioranterior compartmentcompartment ofof thethe tibiatibia CanCan alsoalso occuroccur posteriorlyposteriorly oror alongalong thethe fibulafibula VeryVery broadbroad definitionsdefinitions dependingdepending onon youryour sourcessources ShinShin SplintsSplints Shin splints is the name given to pain at the front of the lower leg. The most common cause is inflammation of the periostium of the tibia (sheath Shin splint surrounding the bone). The injury is area of pain an overuse injury and can be caused by running on hard surfaces, running on tip toes and sports where a lot of jumping is involved. If you over pronate then you are also more susceptible to this injury. ShinShin SplintsSplints

Symptoms: Treatment: – Pain is activity – Modify training dependent schedules, change – Burning/deep ache routes along distal 1/3 of – Add cross tibia training/pool – Some numbness and workouts tingling may occur in – Ice, shoe the toes evaluation, – Need to be aware of possible orthotic pain localizing to one pain localizing to one intervention point as sign of stress fracture developing PatellaPatella FemoralFemoral StressStress SyndromeSyndrome MechanismMechanism SignsSigns andand SymptomsSymptoms KneeKnee AnatomyAnatomy

The knee’s stability and “health” is greatly dependent on the soft tissues that surround it, with muscle balance being a major factor Superior Iliac Crest QQ--AngleAngle

TheThe QQ--angleangle isis thethe angleangle formedformed byby aa lineline fromfrom thethe anterioranterior superiorsuperior spinespine ofof thethe iliumilium toto thethe middlemiddle ofof thethe patellapatella andand aa lineline fromfrom thethe middlemiddle ofof thethe patellapatella toto thethe tibialtibial tuberosity.tuberosity. MalesMales typicallytypically havehave QQ--anglesangles betweenbetween 1010 toto 1414o,, femalesfemales betweenbetween 1515--1717o.. AtypicalAtypical QQ--anglesangles

bowleggednessbowleggedness

knockknock--kneekneess TreatmentTreatment forfor RunnerRunner’’ss KneeKnee RestRest (relative(relative oror absolute)absolute) IceIce afterafter exercisingexercising NAISDsNAISDs StrengthenStrengthen quadricepsquadriceps StretchStretch IliotibialIliotibial BandBand StretchStretch hamstringshamstrings andand gastrocnemiusgastrocnemius andand soleussoleus IliotibialIliotibial BandBand SyndromeSyndrome

ITIT--bandband – thick strong band of ligamentous tissue Iliotibial band – connects tensor fascia latae to the lateral condyle of the femur and the lateral tuberosity of the tibia Patella ITIT--bandband rubsrubs againstagainst thethe laterallateral femoralfemoral condylecondyle whenwhen therethere isis excessiveexcessive tensiontension IliotibialIliotibial BandBand FrictionFriction SyndromeSyndrome

MechanismMechanism – Overuse – Running down hills – Over pronation – Worn out shoes – Running on cambered surface – Tight band – Bow legs – Weak quadriceps IliotibialIliotibial BandBand SyndromeSyndrome SignsSigns andand TreatmentTreatment TreatmentTreatment Signs/SymptomsSigns/Symptoms IceIce PainPain onon outerouter sideside ofof kneeknee RelativeRelative RestRest NSAIDsNSAIDs PainPain usuallyusually increasesincreases withwith ITBITB StretchesStretches runrun QuadQuad StrengthenignStrengthenign SubsidesSubsides slowlyslowly PelvicPelvic StabilityStability ExEx afterafter runrun ProperProper ShoesShoes ExcessiveExcessive pronationpronation increasesincreases internalinternal rotationrotation ofof thethe tibia,tibia, whichwhich accentuatesaccentuates thethe frictionfriction ofof thethe ITIT bandband andand femoralfemoral condylecondyle

TibialTibial alignmentalignment andand sizesize ofof femoralfemoral condylecondyle maymay alsoalso contributecontribute toto thethe developmentdevelopment ofof thisthis conditioncondition StressStress FracturesFractures

Symptoms:Symptoms: ––RapidRapid OnsetOnset ofof PainPain ––WellWell LocalizedLocalized ––UsuallyUsually ofof thethe lowerlower limblimb Causes:Causes: ––AbnormalAbnormal concentrationconcentration ofof stressstress ––BonesBones insufficientlyinsufficiently strongstrong AcuteAcute MuscleMuscle TearsTears ResultResult of:of: MuscularMuscular strengthstrength imbalanceimbalance InflexibilityInflexibility InadequateInadequate warmwarm--upup EccentricEccentric contractioncontraction AcuteAcute MuscleMuscle TearsTears Treatment:Treatment: IceIce StretchingStretching StrengtheningStrengthening ChronicChronic MuscleMuscle TearsTears Characteristics:Characteristics: GradualGradual ratherrather thanthan suddensudden ProgressesProgresses andand makesmakes runningrunning difficult,difficult, particularlyparticularly speedspeed workwork KnotsKnots appearappear inin affectedaffected musclemuscle CommonCommon inin calfcalf musclemuscle DevelopDevelop eccentriceccentric musclemuscle weakness,weakness, exposedexposed duringduring fasterfaster runningrunning ChronicChronic MuscleMuscle TearsTears Treatment:Treatment: StretchingStretching StrengtheningStrengthening CrossCross--frictionfriction massagemassage SideSide StitchStitch ExerciseExercise--inducedinduced abdominalabdominal painpain CrampCramp ofof thethe diaphragmdiaphragm musclemuscle OccursOccurs withwith fastfast runningrunning andand uncomfortableuncomfortable breathingbreathing TreatmentTreatment requiresrequires breathingbreathing outout fullyfully ratherrather thanthan pantingpanting SomeSome BasicBasic TipsTips DonDon’’tt increaseincrease mileagemileage byby moremore thanthan 10%10% aa week.week. DonDon’’tt runrun moremore thatthat 4545 milesmiles aa week.week. DonDon’’tt runrun oror standstand onon unevenuneven surfaces.surfaces. DonDon’’tt runrun onon sand.sand. DonDon’’tt runrun throughthrough pain.pain. IceIce often.often. ChangeChange youryour runningrunning shoesshoes everyevery 450450 miles.miles. WorkWork regularlyregularly onon strengthening.strengthening. WorkWork regularlyregularly onon flexibilityflexibility ofof ankle.ankle. Foot Rehabilitation Strengthening – A number of exercises can be performed Writing alphabet Picking up objects Ankle circumduction Gripping and spreading toes Towel gathering Towel Scoop DiscussionDiscussion ?? CommentsComments ?? QQ && AA