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First things first - injuries happen for a reason. Sometimes it's hard to determine what the underlying causes are but there are always factors involved in the onset of the injury. Generally there are several things involved; and more often than not it will take several interventions to get the problem resolved. There are some factors that are so often present in the onset of injuries that they seem to be the first place to look when you're searching for the cause. Let's do a quick overview of the most common factors involved:

Flexibility - Muscles need to be flexible enough so that when you perform your activity of choice you're not working at the end of their available range. Left to their own devices, muscles do two things over time: get shorter and get weaker. If you train regularly they'll likely get shorter faster! (It's not fair but it happens). You have to do some maintenance if you want to keep your muscles flexible. Stretching daily is a good start. Be gentle about it - harder won't get you anywhere! Stretch all the muscles of your legs - calves, hamstrings, quads, gluteals, hip flexors, etc. 

Strength - Muscles need not only strength, but also an appropriate balance of strength between opposing muscle groups. As you train, you may be working one group harder than another and over time you may find that the weaker muscles aren't doing their part to keep your system in balance. Strength training doesn't have to mean pumping iron at the gym. Functional strength training doesn't require anything other than gravity! Strength training 3 times a week can go a long way to maintaining optimum muscle balance and strength. 

Biomechanics - This is a term that is used to describe the intricate chain of events that happens when your foot hits the ground. Your foot has to "unlock" (referred to as pronation) so that your leg and foot can absorb shock. Around mid-stance your foot needs to "re-lock" so that you have a stable platform to propel yourself forward. A foot that stays pronated (unlocked) too long can really contribute to a whole host of injuries. A foot that doesn't pronate enough can cause injuries in another way. This is really a case of Goldilocks... too much or not enough... either way can be problematic. You can help the situation by making sure the shoe you're wearing is correct for your foot type. Replace your shoes often - every 6 months at least.

Training errors - Perhaps the most common factor involved in injuries! Common ones include adding distance too quickly, doing too many hills, doing too much speedwork, or the most commonly overlooked one: going out the door too close to target race pace every day. Train smart. Incorporate rest days into your week. Use speedwork and hill work judiciously. Build endurance first, then speed.

Common Injuries

Now let's hit the high points of some of the most common injuries. This isn't a detailed analysis - just an overview. 

  1. Plantar Fasciitis - Most common symptom is pain in the heel when you first get out of bed in the morning. Pain is generally better after you've moved around a bit, but may return later in the day. Common factors to consider - lack of adequate calf flexibility is perhaps the most common factor, but also check the hamstrings and hip flexor muscles as they're often involved. Training errors are often involved. Making sure that the shoe you wear supports your foot is a big issue - excessive pronation or pronation that is prolonged into the push off phase of gait can put a tremendous strain on the plantar fascia.
  2. "Shin Spints" - The technical name is really more accurate: "Medial Tibial Stress Syndrome". This can be one of the more frustrating injuries to deal with, as the symptoms are often easy to run through in the beginning and doing so will generally make things worse. The most common symptom is pain in the shin area, generally to the inside of the leg. Symptoms show up as you first start to run, then may get better as you warm up - but they'll often return in the later stages of your run. Pain that doesn't resolve at rest may be indicative of a stress fracture. Common factors to consider - flexibility issues in the calf, hamstring and hip flexor region, strength issues in the lateral hip and gluteals, pronation that isn't being adequately controlled by your shoes, and of course the ubiquitous training errors. Check your log to see if you've recently ramped up your mileage or intensity.
  3. Achilles Tendonitis - Really it should be called Achilles Tendiopathy since inflammation isn't usually the primary issue... degeneration of the tendon is often more the case. This one can be serious and if left untreated can rob you of your running for a very long time. Most common symptom is pain in the Achilles Tendon where it attaches to the heel, or just up from there. The pain is felt when you first get up, and when you first begin your run. Like many of the other injuries, the symptoms can sometimes ease up as you warm up, but may return later in the run. Factors to consider include: tight calves and hip flexors (as well as other muscles), weakness in the hip region, and not wearing a shoe that is right for your foot. Shoes that are too stiff and shoes that aren't stiff enough have both been associated with this problem. Training errors usually focus around mileage or intensity increases that took place too quickly, or perhaps a sudden change to a more challenging terrain (trails or hills). With this injury, stretching is VITAL but often has to be put off until the tendon has settled down some since stretching while you're in a flare up will usually make things worse. Many practitioners now emphasize eccentric strength training to stimulate the tendon to regain it's strength. This is not one you can easily self -treat.
  4. Morton's Neuroma - Most common symptom is pain in the forefoot region, especially when walking barefoot on a hard floor. The pain can sometimes be localized to between the second and third or sometimes between the third and fourth metatarsal. Common factors to consider - tight calves are often an issue, as is the lack of adequate support from your shoes. Often use of an orthotic support is needed to give the foot the support it needs; sometimes use of a shoe that offers more motion control is enough. Wearing shoes that are narrow in the toe box (like most women's dress shoes) can make the condition worse.
  5. Iliotibial Band Syndrome - Most common symptom is pain in the outer knee area that comes on early in a run, then may subside a little as you warm up. Left untreated it will usually get worse. Contrary to common "wisdom", a tight iliotibial band is rarely the issue and stretching the ITband may or may not offer much in the way of relief. Common factors to consider - Weakness in the core muscles that support the hip are a primary factor for most people. Especially important are the sides and back of the hips. Flexibility issues include tight hip flexors and hamstrings, as well as tight calves. Biomechanically the most common issue is generally excessive or poorly timed pronation that isn't being adequately supported by the shoes or shoe/orthotic combination. Training errors sometimes include running on a sloped surface, but more often it is a sudden change in intensity (speedwork) that sets people off.
  6. "Runner's Knee" - Can describe a multitude of symptoms around the knee and knee cap. Most common symptom is pain in the front area of the knee, and it's usually worse when going down steps or running down hill. Common factors to consider - Flexibility issues are usually focused around tight calves and hamstrings, but the hip flexors and occasionally the quads can also play a role. Strength issues (like most injuries) seem to focus on the core stabilizing muscles of the hips and thighs. Performing "standard" weight training exercises like knee extensions and leg curls can actually make this condition worse. Strength training will need to focus on more functional exercises that emphasize hip strength without placing undue strain on the patella.  Biomechanical issues are usually related to a foot that pronates too far or stays pronated too long. Wearing shoes that control pronation often helps if that is the case - but sometimes custom orthotics are needed.
  7. Stress Fractures - Depending on which bone is fractured, the time course for recovery can be as short as 6 weeks or as long as a year. As a general rule of thumb, the bones that heal the quickest are in the feet and lower legs, but stress fractures of the femur (thigh bone) or pelvis can take months to heal. Most common symptoms are pain that is localized to a specific area of a bone, and it tends to get worse as you continue to run on. Diagnosis is made by symptoms, and through the use of a bone scan. X-rays will often be "negative" for several weeks in spite of the presence of the stress fracture. Common factors to consider - Training errors rank at the top of the list on this one. Building mileage too quickly or increasing workout intensity are two of the more common causes of stress fractures. Second on the list is Biomechanical issues - if you haven't had a gait analysis done, it may be worthwhile to do to make sure you're in the correct shoe and to help determine if orthotic support might be a good choice for you. Strength issues focus on the core stabilizers of the hips, and flexibility and muscle balance are important.
  8. Hip Pain in Runners - There can be numerous causes for hip pain in runners so it is important to see your medical professional to help determine the source of your pain. Low back issues can cause pain into the buttock and front of the hip, stress fractures of the femur, the pelvis and the sacrum can be determined through a bone scan or other diagnostic imaging. Determine the source of the pain, then you can adequately deal with the cause. Strength training with functional exercises, regular attention to flexibility exercises and following a sound training progression will be part of the treatment for nearly all sources of hip pain. 

    To your success on race day! - Coach Janet Hamilton, MA, RCEP, CSCS


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