Running away from injury

Running is a common way to stay fit — in theory, all you require is a good pair of running shoes. But running can also lead to a variety of injuries. Our experts talked to us about the most common running injuries and how to avoid them.

According to Jeff Rothstein, the Director of Sports Enhancement for the PT Center for Sports Medicine, a Physiquality clinic in Akron, Ohio, the most common running injuries are to the foot, knee and back. Jeff notes that having the right running shoes is essential for avoiding injury.

Lori Francoeur, a physical therapist at Foothills Sports Medicine Physical Therapy Center in Arizona, agrees. She explains that runners should wear a “good supportive shoe that will provide adequate support and cushioning for your arch and heel.”

For runners, back and knee injuries are often a result of weak muscles.Back and knee injuries are often a result of weak muscles, says Jeff, as many runners focus on running without strength training. He advises that runners strengthen their glutes, hamstrings and core to support the body while running. Otherwise, runners can be prone to imbalanced muscles, which can lead to a poor gait and possibly injury. (If you’re worried about your gait, many physical therapists do gait evaluations to help runners improve their form.)

A running coach and marathoner, Lori cautions runners to take a slow and steady approach to progressing distance. She advises any new runners to not start with more than 1 – 2 miles at a time, not necessarily running the entire time – just plan to be moving the entire time, whether you are walking or running at a slow pace. Keep track of each run’s distance, and don’t increase your mileage by more than 10% per week. There are plenty of ways to measure your distance these days, whether by using an iPhone or Apple watch, or a sports-specific monitor like those from Physiquality partner Polar.

Most runners don't stretch enough.Jeff also points out that most runners don’t stretch enough. “This will lead to progressive shortening of the major muscles involved in running,” he says, which can limit your joint’s range of motion and put you at a greater risk for injury. While stretching can be done before or after your run, Lori notes that stretching should be done when your muscles are already warm, making it better to stretch afterwards. This post-run stretch regimen from Polar lengthens your glutes, hamstrings and calves, and opens your hip flexors, all key muscles for running.

And don’t forget the importance of rest. Rest allows our muscles and joints time to recover from the pounding we endure from running, says Lori. As we’ve previously noted here, It is only after your workout, when you are resting and replenishing your body with protein and other nutrients, when the body heals and gets stronger.

Finally, any runner should listen to his body. While starting a new activity typically comes with muscle soreness and some aches and pains, notes Lori, an intense pain, or a pain persisting for multiple days that does not subside with rest, is one you should have checked out. Physical therapists are a great resource; many outpatient orthopedic physical therapy clinics offer free injury evaluations. A PT will be able to listen to your complaints and complete an assessment to determine what the problem is. Then she can create a strengthening and/or stretching program for you to perform to resolve the problem.

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What is minimalist running? Is it safe?

Trends come and go in fitness, and running is no exception. Minimalist running has been growing in popularity over the last decade, but some runners still question its safety. Barefoot or minimalist running is running that occurs either WITHOUT footwear, or with footwear that lacks high cushioned heels, stiff soles and arch support, a.k.a. minimalist footwear.

Lee Couret, a physical therapist and the owner of Southshore Physical Therapy in Louisiana, says there are many benefits to barefoot running. For example, he says, running barefoot can reduce the impact of the footfall when running. This is because most barefoot runners avoid landing on their heels, because it hurts! Landing with a heel strike is believed to be a potential cause of injury. A study published by the Skeletal Biology Laboratory at Harvard Medical School found that those runners that land on their heels while running were much more likely to suffer injury than those who land on the forefoot, or the ball of the foot. And Lee explains that reducing the impact can reduce running injures, as studies have found that people who run with greater impact often have more injuries.

Barefoot runners may actually be stronger.Aside from fewer injuries, barefoot runners may actually be stronger. Running without shoes can strengthen the muscles, tendons and ligaments in the foot while also stretching and strengthening the calf muscles, notes Lee. It can also improve balance and proprioception via activation of the smaller muscles in the legs and feet. And minimalist runners may experience increased efficiency, he says, as barefoot running requires less energy and oxygen consumption.

But don’t rush to throw out your running shoes without considering the cons. Running without shoes means that your feet aren’t protected, from either the elements, like cold, heat, snow and rain, or the variety of things you can find on the road — glass, pebbles, nails, and more. Barefoot runners will be more prone to blisters, points out Lee, and might be at a higher risk for Achilles tendonitis or plantar fasciitis while transitioning from running in shoes.

Be cautious as you transition from running in shoes to running barefoot.A conscientious uncoupling from your shoes is key to a successful transition, advises AlterG,. If you want to start running barefoot, think about talking to your physical therapist about it. She might be able to do a gait analysis to see whether your gait would need to be improved before you transition. If you run with a heavy heel strike, it may be difficult for you to switch to the forefoot strike essential for barefoot running. Lee suggests following these tips from the Spaulding National Running Center to make a healthy transition:

  • Land gently, with your foot relatively horizontal and under your hips (this will shorten your stride).
  • Transition slowly — see the full running plan from SNRC for guidelines.
  • Stretch your calves and Achilles tendon before and after running.
  • Buy low profile shoes (low heels, minimal arch support, flexible soles) to use when running barefoot is not safe.

And, above all, listen to your body! Don’t do anything that causes pain, and see your physical therapist or doctor if you have pain that lasts for more than a couple of days after running.

 

Lee Couret, PT, MSPT, CSCS Lee Couret, PT, MSPT, CSCS, is a physical therapist and the owner of Southshore Physical Therapy, a Physiquality network physical therapy clinic in New Orleans, Louisiana. A triathlete himself, Lee has served as the physical therapist for the University of New Orleans Privateers, a local triathlon team; the Swamp Dawg Multisport Team; and many local high school athletic programs.
Lee is a Certified Strength and Conditioning Specialist and has completed in many triathlons, including the Ironman Florida and Ironman France triathlons. He sends a special thanks to Irene Davis, Director of the Spaulding National Running Center at Harvard Medical School; much of this information is derived from a course he took with her in 2012.

 

For further reading, look through our selection of articles on running, in addition to the below links:

Bernstein, Lenny. Is barefoot running better for you? The Washington Post, May 9, 2014.

Physiquality.

The benefits of barefoot running. AlterG, June 10, 2011.

Reynolds, Gretchen. New York Times.

Crowell, Harrison Philip. Reducing impact loading during running with the use of real-time visual feedback. Journal of Orthopedic Sports Physical Therapy, April 2010.

Lieberman, Daniel et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, January 28, 2010.

Barefoot running training tips. Spaulding National Running Center.

Milner, Clare E., et al. Biomechanical factors associated with tibial stress fracture in female runners. Medicine and Science in Sports and Exercise, February 2006.

Proprioception. Physio-pedia.com.


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How to treat shin splints

Simply put, when you have pain in the shin bone or tibia (the front of your lower leg), you have shin splints. Most common in runners and dancers, shin splints can be caused by overuse or overtraining, or musculoskeletal issues like ankle instability or flat feet.

When you experience such pain, especially while exercising, it is best to back off from activity. If the pain continues, says Lisa Cox, “medical care should be sought sooner than later.” A certified athletic trainer at Clinton Physical Therapy Center (a Physiquality member in Tennessee), Lisa explains that those who wait 3 – 4 weeks to seek treatment often have longer recovery times than those who seek treatment sooner.

In addition, she says, some athletes who simply shrug off the pain as “just shin splints” end up having stress fractures, which must be treated by a physician and usually require a walking boot or cast. Such treatment also requires a complete break from activity until the fractures heal.

Injuries can never be completely avoided, but there are some stretches that can help to decrease your chances of shin splints.Injuries can never be completely avoided, but there are some stretches that can help to decrease your chances of shin splints. Lisa suggests doing calf stretches (that is, stretching the gastrocnemis muscle) before and/or after activity. This can be done by facing the wall with one foot behind you or by standing on a flight of stairs and then dropping your heels down.

Companies like Medi-Dyne, a Physiquality partner, also offer several tools to help avoid shin splints. Products like the ProStretch and ProStretch Plus help to stretch out the gastrocnemius and improve calf flexibility. And muscle massagers can help to increase circulation and reduce muscle tightness.

If shin pain does not disappear after a couple of days of rest, it may be time to see your physical therapist. “PTs specialize in recognizing muscle weaknesses that can cause pain and injury,” reminds Lisa. Not only can a physical therapist develop a plan to strengthen the gastrocnemius and ankle muscles, he or she can also evaluate your gait and stride to see if musculoskeletal variances are a part of your problem. If necessary, a PT can help you select orthotics to correct foot position and alignment during activity, which can decrease pain from head to toe.

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Buying the right shoe for whole‑body health

Whether you’re young or old, the wrong pair of shoes can lead to pain from (almost) your head to your toes. High heels can damage your back, knees and feet while increasing your risk for ankle sprains or breaks; they can also lead to arthritis, foot deformities, poor posture, plantar fasciitis and balance impairments. The lack of arch support and foot protection in flip-flops can lead to a number of issues, including tendinitis and stress fractures.

So how can you pick a pair of shoes that is good for your feet?

Look for flats or low wedges over high heels.Some women may not want to hear it, but the first step is to walk away from the high heels. Look for flats or low wedges; while a wedge helps to distribute the weight of your feet throughout the sole of the shoe, if its incline is more than an inch or two, it will still affect your body’s alignment, which can cause knee and back pain.

Both men and women should try to avoid thinking of comfortable or healthy shoes as orthopedic shoes. “The term ‘orthopedic shoes’ conjures up an image of a clunky, heavy and unattractive shoe to treat a medical condition,” says Brian Hoke, a physical therapist and a member of the Vasyli Medical Think Tank. This misperception is a big part of the problem in getting people into footwear that supports the natural anatomy and biomechanics of the foot. Brian notes that many manufacturers have embraced a much more fashion-forward approach to supportive footwear that blends fashion and function. Read More

 

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Choosing a running shoe

What should runners look for in a running shoe? Virginia Davis, a physical therapist and owner of Crescent City Physical Therapy (a Physiquality network member in New Orleans), acknowledges that it can be a daunting task to buy running shoes. She reminds runners to “find the best shoe for YOUR feet!” This means that you need to know a great deal about your physiology and your running stride before you make that purchase.

Your physical therapist can help you understand these factors with a biomechanical evaluation. According to Laura Winslow, a PT and the clinical director of the Eastside location of Allegheny Chesapeake Physical Therapy (a Physiquality member with 10 locations in Pennsylvania), “A physical therapist can identify the anatomical type of your foot (i.e., whether you have stiff or flexible arches) and make suggestions as to the proper type of shoe for your needs.”  Read More