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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The benefits of cold and compression therapy

If you’ve ever sprained your ankle or injured your elbow, you probably know that it’s been standard practice for decades to apply ice after injury to decrease swelling and pain. Dr. Gabe Mirkin coined the acronym “R.I.C.E.” in 1978 (Rest, Ice, Compression, Elevation), and this concept became the standard in treatment of acute injuries and post-surgical patients.

While there has been some debate about whether cold therapy should be used for all musculoskeletal injuries, most healthcare practitioners would agree that proper use of ice or cold therapy can reduce swelling and pain. Here are a few reminders about using cold therapy:

  • Apply ice for no longer than 20 minutes at a time.
  • Allow your skin to return to room temperature before applying ice again.
  • Place a thin towel between the ice pack and your skin to prevent irritation and even frostbite.
  • And never ice prior to activity — doing so may cause further injury.

PowerPlay cold and compression therapyAnother option is combining cold therapy and compression. Studies have shown that people who use cold therapy and compression therapy together, as opposed to just one of those therapies alone, recover from their injuries significantly faster. Compression, particularly intermittent compression, works to push swelling out of the injured site. This can limit tissue damage and aid in the removal of cellular debris and waste in the body. Active compression therapy mimics the body’s natural muscle contractions, pumping swelling out of the injured area. This increases blood flow and delivery of oxygen to the site, stimulating tissue healing and optimizing lymphatic drainage.

It has become almost routine for patients undergoing some types of surgeries (such as ACL repairs or joint replacement) to receive cold compression therapy post-operatively in the hospital or surgi-center through mechanical devices designed for this purpose. Some patients also receive treatment from these machines at home or in skilled nursing facilities in the weeks immediately following surgery, as ordered by their physician. In recent years, these devices have become available for people who wish to use this therapy at home for injuries, such as sprains, fractures and tears, for chronic pain and swelling, or to help reduce muscle soreness and fatigue.

Ice or cold therapy can reduce swelling and pain.For minor aches and pains, icing afterwards may be enough to keep your body healthy and to avoid serious injury. However, keep an eye out for the following red flags:

  • Pain that gets worse instead of better
  • Pain after resting for a few days, or when you wake up
  • Chronic swelling in your joints, or bruises that don’t heal
  • Knees or elbows (or other joints) that lock or are unstable

Any of these problems is a sign that you need to consult with a doctor or physical therapist about your pain or swelling. Trying to treat such issues at home with ice, compression and anti-inflammatories could end up making your problem worse instead of better.

 

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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Preparing for your first race

In theory, running is an easy sport to take up — it might seem that you could simply put on a pair of running shoes and run. But if you don’t take into consideration the proper form, training, shoes and nutrition, you could easily set yourself up for an injury.

While we all may have run around the playground as children, running is not a natural skill for most of us as adults. Many of us sit for hours at a time, in front of a computer at work or at home on the couch. So before you focus on improving your time, make sure that you have thought about your form. If you have tried running already, but have felt pain after or especially while running, consider seeing a physical therapist for a fitness assessment, as well as gait analysis, to determine whether improving your form can reduce pain and the chance of injury.

To stick to your running regimen, sign up for a race.Once you and your PT have come up with a training plan, one of the best ways to stick to your plan to run is to sign up for a race. Most metro areas host plenty of 5Ks throughout the year that may be convenient for you. Having a deadline makes it easier to train gradually, explains Ryan Bozant, a physical therapist at Moreau Physical Therapy in Louisiana.

Ryan cautions runners to think about training without overtraining, which can cause an overuse injury. He points to several online running plans that can help to set running goals and a running schedule. Most will recommend training over a two-month period. Here are a few of Ryan’s favorites:

Be sure to do an active warm-up whenever you run.Ryan also recommends doing an active warm-up whenever you run. This can be a series of running drills or simply walking for a few minutes before picking up the pace. A warm-up can also include simple exercises like squats and lunges, or getting on the ground for some sit-ups and push-ups. Any of these things will get your heart pumping and prepare the body to run.

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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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How to deal with ankle sprains

How to deal with ankle sprains

Ankle sprains are a common injury. They can occur during strenuous activity, like playing a sport, or something as simple as missing a step down from a curb.

If you’ve injured your ankle, Kate Chewning, a physical therapist at Allegheny Chesapeake Physical Therapy (a Physiquality member in Pennsylvania) reminds you to R.I.C.E.:

  • Rest. Kate recommends trying to stay off your feet. She says, “Don’t walk or put too much weight on your affected ankle, as this will only increase the stress to your ligaments,” increasing the time it will take to heal.Application of an ice can reduce inflammation while also helping with pain relief.
  • Ice. Application of an ice bag, cold gel pack, or similar item will aid in decreasing inflammation while also helping with pain relief. Kate advises making your own ice massager by freezing water in a paper cup. Simply tear back the edges of the cup to apply the ice to the skin in a circular motion. 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

Running inside: Things to keep in mind on a treadmill

As the first cold front crawls across the country, many people are transitioning from running outside in their neighborhoods to running inside on a treadmill. And while our experts point out that there physically should be minimal difference in your form whether running outside or inside, there are some factors that people should remember when coming indoors to a treadmill. Read More

Shoe inserts and orthotics: Are they right for you?

While people may downplay foot pain as nothing to worry about, it can be debilitating, forcing you to limit your time on your feet or even to see a doctor. Even worse, structural problems with your feet can lead to poor body alignment and problems like neck and back pain, all from compensating for foot issues. So if you’re having foot pain, you may want to consider using shoe inserts or orthotics to relieve pain and improve your alignment. Read More

Proper running techniques

Now that temps are warming up and more people are lacing up, it’s time to pay attention to how you run. Here are a few things to look at:

Your Form

“Poor posture while running can affect running efficiency, as well as breathing efficiency. Stand up tall with a big chest and your shoulders back,” says Jeff Rothstein, an exercise physiologist and Director of Sports Enhancement at the PT Center for Sports Medicine, a Physiquality network clinic in Akron, Ohio. Poor posture may also be a cause of side stitches, cramp-like spasms that will bring your run to a close quickly.

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