By Tim Richardson –
A marathon or a triathlon may seem like an impossible achievement for recreational athletes but many people nowadays have completed one of these races. If you haven’t already done one, you may have set a goal to run one in the near future.
The increase in popularity of these races and other competitions, like “mud runs,” has also increased the incidence of runners’ injuries. The most common runners’ injuries are hip, knee and ankle injuries. Many of these runners’ injuries are known as overuse injuries – that is, they are brought on by too much running, too fast or on too hard a surface, such as concrete. Overuse injuries can often get better with simple rest. One or two weeks of limited or no running is often sufficient to heal the injury. Ice, not heat, to the injured area will speed recovery. Running is resumed at a slower pace or with fewer miles to prevent a re-occurrence.
Occasionally, the athlete will not recover spontaneously or the injury will persist as a nagging pain, despite lower mileage and reduced training intensity. When this happens the athlete may begin to, naturally, have questions.
Am I injured? How did this happen?
Is my form wrong?
When these questions arise one of the athlete’s first reactions is too seek professional help. In our society, the physician is most peoples’ first contact with the healthcare system and in some cases the physician is still the best professional to evaluate the runner’s recalcitrant injury. For the majority of runners’ injuries, however, the physical therapist is fully qualified and licensed to evaluate and treat overuse injuries. In cases where the injury is more severe, the physical therapist will refer the athlete to the most appropriate physician.
Ultimately, it should be the athlete’s decision about which healthcare professional she chooses to evaluate her injury and that decision is helped by knowing one simple fact: does my physician or physical therapist treat many runners or are they runners themselves?
The running therapist or physician will understand the athletes’ unique motivation to run and will help, not just physically, to manage the athlete through their rehabilitation and return to running.
The physical therapist or physician should first ask about weekly mileage, training intensity, race frequency, running surface, typical schedule and training partners. Any or all of these factors can contribute to errors in training volume or intensity that can cause or contribute to a running injury.
Evaluation from the ground up.
The physical therapist will then evaluate the runner from the bottom to the top. This means an examination of the shoes and the wear pattern on the sole. Uneven wear on the bottom of the shoe can indicate a muscle imbalance or, much more rarely, a leg length discrepancy.
Shoe type errors may also be a factor in runners’ injuries. Shoe type errors are much less common today than they were twenty years ago. Marketing by shoe manufacturers has contributed greatly to athlete’s awareness of proper footwear.
Next, the therapist will examine the shape of the foot – high, rigid arches are associated with a higher incidence of ankle sprains, bone stress fractures and shin splints. A program of rest, massage, joint mobilization and arch mobility exercises can improve this type of foot pain.
The Achilles tendon and the calf muscle are next up the line. Tight Achilles tendons are very common and, in women, are made worse by working women who wear high heels when they are not running. Simple stretching exercises can correct this type of problem.
The knee is the next link in the chain. The physical therapist will examine the dynamic alignment of the knee. This means the therapist will ask the athlete to squat, kneel, lunge, stand on one leg and twist on one leg while observing the kneecap from various angles. The therapist may ask the athlete to jump, hop or step down from a box to observe the knee, leg and foot in action. The therapist may then examine the soft tissue mobility around the kneecap.
Frequently, this soft tissue is stiffened from overuse and injury and the mobility of the kneecap is restricted. Gentle massage and stretching is often very effective.
The hip is closely related to the knee and all of the just mentioned tests are also used to assess the hip. The therapist will observe for several telltale signs that the hip is contributing to leg pain in the athlete by looking for a valgus or inward motion of the hip during the aforementioned step down test. In this test, the therapist watches the athlete step down from a 6” box while observing her kneecap from the front. If the kneecap moves more to the inside than the big toe then the hip is almost surely causing problems during running.
How’s your stride?
A video treadmill analysis will reveal the inward motion during the stance, or landing phase, of the runners’ stride. This inward motion implies the very common hip abductor weakness that presents in many runners as a sharp pain at the outermost point of the lateral hip, called the greater trochanter. Many runners have had this diagnosed as trochanteric bursitis also known as iliotibial band friction syndrome. This is treated with strengthening the weakened hip abductor and with gentle stretching of the leg muscles.
Finally, no examination of an injured athlete should be complete without a screening of the lumbar spine, torso, neck and shoulders for restrictions or weaknesses that may contribute to or amplify the athlete’s pain. This screening may be accompanied by the treadmill analysis, with or without video, to examine the athlete as she runs at various speeds on the treadmill. The treadmill will also be used in subsequent therapy sessions to examine top running speed.
Quickly determine if treatment is working.
The duration of the therapy program will depend on the athlete’s initial injury but most physical therapists will tell their patients that an indication of recovery should be apparent within the first two weeks. In other words, the athlete will know, within two weeks of starting therapy, whether or not the therapy is helping. At that point, the athlete and the therapist must decide together how quickly she is to be returned to her training program and how soon she will be able to race again.
Request Physical Therapy, with four locations in Bradenton, is staffed with running physical therapists who are active participants in running races, triathlons and mud runs. All four of the clinics are equipped with the necessary tools for a full evaluation of the injured runner, including video analysis and playback, if necessary. The clinics are open five days per week from 8am to 5pm and accept most types of insurance.
Call the office nearest you for a free consultation to learn how physical therapy may help you.
2722 Manatee Ave W, #2
701 Manatee Avenue West, #103
1922 53rd Avenue East
506 4th Ave West