Resources - Injuries

 

 

 

Signs and Symptoms

by Sheila Dugan, MD PT

GENERAL OVERUSE

Overtraining

  • Signs and Symptoms
  • Reduced desire
  • Loss of appetite
  • Elevated resting heart rate, or abnormally high exercise heart rate
  • Overall stiffness
  • Inability to recover even after easy days or day off
  • Loss of menses in females

Prevention

  • Monitor your morning heart rate
  • Log your perceived exertion with training, on scale of 1 to 10. May shoot for the 8-10 range once a week, not 3-4 times a week or more.
  • Any loss of menses should be monitored by your Ob-Gyn physician

LOCALIZED INJURIES PREVENTION

Blisters

  • Vaseline, donuts or mole skin to hot spots
  • Socks that wick moisture away
  • Properly fitting shoes and socks, avoid bunching
  • Toe nail loss or blister below

Toenail loss or blister below toenail

  • Shoe fit with toe room, consider half size bigger than dress shoes
  • If lots of hill work or trail running, try to avoid bearing all weight via toes

Nipple or inner thigh chafing

  • Vaseline
  • Band-Aid
  • Avoid pinning number to chest
  • Do not wear new, unwashed shirt against skin, have soft fabric near skin
  • Avoid seams over tender skin areas

MUSCULOSKELETAL INJURIES

Low Back Pain

Most likely mechanical but can be related to nerve impingement

Red flags of more serious problems include radiation of pain from the back to the leg or back pain greater than leg pain, loss of sensation or strength in the legs, change in ability to control urination or defecation, history of disc herniation or nerve root impingement, history of cancer in the past, history of leg length difference, extreme pain at night, or severe pain that is not responding at all to NSAIDS, rest or cutting back on miles or cross-training, ice, massage, etc.

Prevention

  • Flexibility exercises of lumbar spine and lower extremities
  • Frequent change of shoes, run on surface with shock absorption
  • Avoid uneven ground with same uneven direction
  • Postural attention, during run and otherwise

Iliotibial Band Syndrome

  • Painful sensation as ITB slides over lateral femoral condyles as knee flex/ext
  • Change in running surface or training on unleveled surfaces
  • History of leg length discrepancy
  • Pronated feet
  • Tight ITB with lateral hip soreness

Prevention

  • Stretch ITB, hip flexors, gluteal muscles
  • Orthotics
  • Avoid uneven terrain
  • Strengthen opposing muscles like groin and medial quadriceps

Femoral Stress Fractures

  • Occurs most commonly in female distance runner
  • Overtraining, poor biomechanics or reduced bone density (amenhorrhea)
  • Anterior thigh pain, difficult to localize. May be tenderness over shaft of femur
  • Pain increases with activity, lingers, continues to hurt at rest if progressed

Prevention

  • Gradual training
  • Change shoes every 300-350 miles

Patellofemoral syndrome

  • Usually chronic overload injury with cellular damage, degeneration and scar formation rather than frank tendinitis
  • Can be caused by local factors (patellar position, muscle imbalance of quad and hams, tight lateral retinaculum or ITB, etc.),
  • Can be caused by proximal factors (increase lumbar lordosis, femoral anteversion, tight hip flexors, etc.)
  • Can be caused by distal factors (tibial torsion, tight Achilles, pronated foot)
  • Occasionally presents with acute pain and inflammation requiring 24-48 hours of acute treatment with NSAID's, ice, e-stim, relative rest of knee with ongoing cardiovascular conditioning (high seat, low tension on exercycle), isometric quad exercise, SLR with very low PFJRF, passive stretch of lateral retinaculum and distal ITB

Prevention

  • Regain lost flexibility (especially ITB, Rectus Femoris, Hamstrings, Gastroc-Soleus, spine extensors,etc.)
  • Avoid loading of knee in flexion (greatest PFJRF at 40°flexion),
  • Preferentially perform resistive exercise (especially VMO and adductors-medial patellar stabilizers) avoiding loading as above
  • Perform kinetic chain and functional exercises aimed at improving patellar tracking and neuromuscular reeducation
  • McConnell taping, infrapatellar strap or knee sleeve can be adjunct treatment.
  • Maintain flat training surface, slowly progress mileage and monitor shoe wear

Shin Splints / Tibial Stress Fracture

  • Anterior compartment muscle involvement with pain lateral to the tibia
  • Posterior compartment muscle pain medial to tibia.
  • Continuum of tissues involved with variable symptoms. For example, actual stress fracture may have localized, sharp pain that is constant or increasing with exercise or jumping activity. It may ache at night. Vs. Stress syndrome with achy pain and minimal tenderness that occurs with exercise but decreases with rest.
  • May be at higher risk of stress fracture if high arched rigid foot that does not shock absorb well-need shoe with more padding and shock absorbing.
  • May be at higher risk of stress syndrome or reaction if flat, pronated feet where muscles have to contract longer and harder to resist pronation after heel strike and harder and longer at toe-off to accelerate supination. May also have weak foot and ankle muscles to begin with. This can progress to stress fracture.

Prevention

  • Correct shoe type for your foot type-rigid, straight last shoes for pronated foot versus more padded, semi-curved slip-lasting shoes for supinated, arched foot
  • Maintain normal flexibility of ankle especially calf muscles because restricted ankle dorsiflexion cause increased pronation.
  • Slow progression of training miles with monitoring of miles on shoes
  • Train on soft surfaces

Plantar Fascitis

  • Pain in heel or arch with first step in am frequently the worst
  • Long history with insidious onset
  • Pain may be localized to the medial heel, increased with palpation with great toe extended

Prevention

  • Maintain plantar fascia and Achilles length
  • Can use a heel lift for pain relief

GENERAL TREATMENT ISSUES

  • Ice
  • Cross friction massage
  • NSAID's if no contraindication
  • Proper training and shoe wear-fit and schedule
  • Flexibility and strength of the entire kinetic chain
  • Relative rest and cross training
  • Good pain versus bad pain