1. Common Running Injuries
…And When to Seek Medical Treatment!

2. Types of Common Injuries
Stress fractures
Hamstring strain
Iliotibial band syndrome
Patellofemoral syndrome
Shin splints
Plantar fasciitis
Achilles tendinitis

3. Why Do These Injuries Occur?
Progressing too quickly in mileage and speed
Lack of regular stretching
Not changing out running shoes frequently enough
Imbalance between opposing muscle groups

4. Stress fractures What is it? An overuse injury
Occurs when muscles become fatigued and are unable to absorb added shock
Fatigued muscle transfers the overload of stress to the bone causing a tiny crack

5. Stress Fractures Causes
Result of increasing the amount or intensity of an activity too rapidly
The impact of an unfamiliar surface
Improper equipment (shoes)
Increased physical stress
Women > men

6. Stress Fractures Signs and Symptoms
Sharp pain in the weight-bearing bones of the lower leg and foot while running
Mild swelling
Tender to the touch

7. Stress Fractures Treatment Rest and ice
Engage in a pain-free activity during the six to eight weeks it takes most stress fractures to heal
Use of a bone stimulator

8. Stress Fractures Prevention Slowly increase any new sports activity
Maintain a healthy diet, including calcium
Do not wear old or worn running shoes
If pain or swelling occurs, immediately stop the activity and rest for a few days
If continued pain persists, see an orthopedic surgeon

9. Hamstring Strain What is it?
A tear in one of the hamstrings muscles (semitendinosis, semimembrinosis and biceps femoris)
Can range from small micro tears in the muscle to a complete rupture

10. Hamstring Strain Causes Frequently occur during sprinting
Can occur during an isolated athletic activity (acute) or result from persistent repetitive stress (chronic)

11. Hamstring Strain Signs and Symptoms
Sudden sharp pain at the back of the leg
Muscles going into spasm
Swelling and bruising
If the rupture is very bad you may feel a gap in the muscle

12. Hamstring Strain Treatment
Use a compression bandage or heat retainer until you feel no pain
Ice, compress, elevate, use crutches
Physical therapy
Surgery for complete rupture

13. Hamstring Strain Prevention Gradual conditioning program
Incorporate a proper warm-up and stretching session into your conditioning program and athletic competition

14. Iliotibial Band Syndrome
What is it?
Condition characterized by pain localized over the lateral femoral epicondyle that occurs during vigorous walking, hiking or running
Pain is usually relieved by rest and by walking with the knee held in full extension

15. Iliotibial Band Syndrome
Causes
Overuse may cause shortening of the ITB
Knee goes from flexion to extension and excessive pressure from the ITB causes friction over the lateral femoral epicondyle
This repeated motion produces inflammation of the underlying structures and causes pain

16. Iliotibial Band Syndrome
Signs and Symptoms
Pain localized over lateral femoral condyle
Discomfort initially relieved by rest
Pain may radiate toward the lateral joint line and proximal tibia
Worse if a person continues to run
No symptoms of internal derangement
Symptoms frequently develop during downhill running

17. Iliotibial Band Syndrome
Treatment
Rest
Ice
Stretching of iliotibial band
Anti-inflammatory medicine
Orthotics (if appropriate)
Ultrasound
Local steroid injection

18. Iliotibial Band Syndrome
Prevention
Adequate stretching of the IT band
Massage therapy
Avoid hills, shorten stride, and run on alternate sides of road

19. Patellofemoral Syndrome
What is it?
The term used to describe pain on and around the patella or kneecap
Common cause is damage to the surface underneath the kneecap
Can be started by an impact or it gradually comes on from rubbing on the bone underneath

20. Patellofemoral Syndrome
Causes
Malalignment of the patella on the femur
Weakness of the quadriceps muscles
Tight structures on the lateral aspect of the knee
Pronation of the feet

21. Patellofemoral Syndrome
Signs and Symptoms
Pain may be felt behind or around the knee cap
Grinding noises may be heard during bending or straightening the leg
The knee may feel like it gives-way without any particular reason
Pain occurs while going up and down stairs, as well as after prolonged periods of sitting

22. Patellofemoral Syndrome
Treatment/Prevention
Anti-inflammatories
Ice/heat
Strengthening the quadriceps
Stretching the hamstrings

23. Shin Splints
What is it?
The name given to pain at the front of the lower leg
Also known as medial tibial stress syndrome
Inflammation of the periostium of the tibia (sheath surrounding the bone)

24. Shin Splints Causes Weak anterior leg muscles Hard running surface
Recent increase in running speed or distance
Unsupportive shoes
Fallen arches

25. Shin Splints Signs and Symptoms Tenderness over the inside of the shin
Lower leg pain
Occasional swelling
Lumps and bumps over the bone
Pain when the toes or foot are bent downwards
A redness over the inside of the shin

26. Shin Splints Treatment Ice 10-15 minutes for 2-3x per day
Anti-inflammatory drugs
Active rest - participate in activity that does not stress the affected area but maintains cardiovascular fitness, such as bike riding

27. Shin Splints Prevention Keep anterior leg muscles strong
Correct pronation with the use of custom made or over-the-counter orthotics
Run on a forgiving surface, such as a treadmill
Increase speed and distance gradually

28. Achilles Tendinitis What is it?
Inflammation of the large tendon at the back of the ankle which connects the large calf muscles (gastrocnemius and soleus) to the heel bone (calcaneus)

29. Achilles Tendinitis Causes Sudden increases in running
Excessive hill running or a sudden addition of hills and speed work
Excessive tightness of the posterior leg muscles
Soles of shoes too stiff, or excessive heel cushioning of the heel

30. Achilles Tendinitis Signs and Symptoms
Pain in the tendon during exercise
Swelling over the Achilles tendon
Redness over the skin
You can sometimes feel a creaking when you press your fingers into the tendon and move the foot

31. Achilles Tendinitis Treatment Anti-inflammatories
Begin ice after exercise
Use small heel lift in shoe
Rest for two weeks after the aggravating activity
Begin stretching regimen for gastrocnemius and soleus complex

32. Achilles Tendinitis Prevention
Regularly stretch the posterior calf muscles
Increase training gradually
Correct pronation

33. Plantar Fasciitis What is it?
Inflammation of the strong tissue that runs along the bottom of the foot and connects the heel to the base of the toes

34. Plantar Fasciitis Causes Weak foot muscles Tight Achilles tendon
Flat or high arches
Poor shoe support
Sudden increase in activity level
Sudden increase in weight

35. Plantar Fasciitis Signs and Symptoms
Heel pain that is worse in the morning with the first few steps
Since it is difficult to rest the foot, this problem gradually worsens
Pain may start interfering with activities of daily living

36. Plantar Fasciitis Treatment Temporary decrease in training
Gentle Stretching of calf muscles
Check shoes for flexion stability
Perform 20 seconds of "toe curls" to strengthen your foot muscles.
Ice 15 minutes, 10 minute break x 2 each day
Consider rolling your foot over frozen water bottle
Do not go barefoot in your house or at any other time for 6 weeks.
Try over the counter orthotics

37. Plantar Fasciitis Prevention
Wear orthotics to prevent excess pronation and prevent lengthening of the plantar fascia and continued tearing of the fascia
Stretch regularly

38. Summary
Most mild conditions will resolve with conservative treatment as outlined above
For conditions that persist or are refractory to conservative treatment, evaluation and treatment by a professional may be warranted

39. Questions?