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Knees Leg injuries

IT Band – The Injured Runner

IT Band Syndrome or Iliotibial Band Friction Syndrome is a condition that results in pain on the outer side of the knee. The iliotibial band is a thick band of tissue along the outer side of the thigh. It attaches to the Tensor Fascia muscle on the front, outside area of the hip and the gluteus maximus muscle of the butt. As the IT band courses down the side of the leg it covers the boney area on the outside of your knee. Symptoms arise at the spot where the band rubs against the outer side of the knee joint.

Certain body mechanics and muscle imbalances may cause increased friction and result in symptoms. Initially, you will experience the pain only after running a certain distance and the pain will subside after the run. As symptoms progress, walking or going up and down stairs becomes painful and running is quite painful.

Treatments:

  • Recent research conducted on runners at Stanford University has shown promising results. These athletes performed a series of gluteal strengthening exercise. These muscles may help reduce strain on the and allow the area to function more efficiently.
  • Frequent stretching of the ITB and gluteal muscles can improve your symptoms.   Spend at least five to ten minutes twice per day working the area. There are several contortions described as ITB stretches. Try them all until you find a position that stretches the area near the pain.
  • Arch supports or orthotics (custom foot supports) may be able to support the foot in a way that reduces strain on the IT band. If you have a high arch you may benefit from an insole that provides more cushioning.
  • An anti-inflammatory cream could be used to reduce the pain and inflammation. Talk to your doctor about transdermal anti-inflammatories.
  • Deep tissue friction massage is a treatment that some brave (or desperate) runners try. There is actually a study that reported this type of treatment to be ineffective. However, we know runner’s that will tell you it made a difference for them – so you will have to make your own choice on that one.
Categories
Leg injuries Recovery Running form

Hamstring Tendonitis treatment – The Injured Runner

Hamstring Tendonitis is a pain that is felt on and just below the boney part of your butt that you sit on. The hamstring tendon attaches to this bone and can become painful. I have seen this develop after a runner stumbles and catches them self from falling forward. The hamstrings tighten to prevent the trunk from falling forward and may result in a pulled tendon in this area. Speed training can also lead to this condition especially if you have a running style where you run very erect and “pull” yourself forward with the hamstrings. So that’s why we are looking at hamstring tendonitis treatment – focusing on things you can try today!

Treatments

  • If you stumbled, ice application will be particularly helpful.
  • Running technique – if you heel strike during speed workouts you may want to consider altering your style to striking with the mid or forefoot.
  • Core Strengthening – try the plank position for a quick, all around program. These are even good enough for women’s marathon record holder Paula Radcliffe who was photographed performing the side plank position.
  • Agility – sidestepping, grapevine, and sideways zipper (stepping forward and backward while moving sideways). Try three sets of one minute.
  • Single leg stand windmill touches – while standing on one leg, bend forward at the hip keeping your other leg in a straight line with your back, keep your arms out to the side and rotate your trunk so that your right hand would touch your right foot (or left to left). This exercise is excellent for balance, hamstring strengthening and flexibility.
  • Stretching – avoid direct stretching. Instead of standing and bending forward to touch your toes, slide your hips to the right and then bend forward. Next, slide your hips to the left and bend forward for the stretch.
  • Massage can helps speed recovery and promote proper healing.
  • An anti-inflammatory cream may help reduce the pain and inflammation.
Categories
Leg injuries Recovery

Shin Splints – The Injured Runner

Shin Splints are a condition that result in pain along the boarder of the tibia (shinbone). These nasty little demons can be tamed with a little TLC. The pain is a result of the muscles tugging on the lining of your shinbone. If the stress of running exceeds your body’s ability to strengthen the area, your shin begins to hurt. Training errors and foot mechanics affect this area substantially. There are two locations that shin splints develop; the treatment is slightly different for each location.

A) Medial tibial stress syndrome is the term for shin splints that affect the inner border of the tibia (shinbone). If you firmly rub your finger along the inner border of the tibia you should be able to locate the sore area. Pain is more commonly felt in the middle third of the shin but can be higher or lower.

Treatments:

  • Insoles or orthotics (custom foot supports) may help support the foot so that the muscles that attach to the shin don’t have to work as hard or as long.
  • Gentle stretching of the calf muscles two to three times per day often speeds recovery. The bent knee calf stretch is particularly effective, you should stretch firmly enough to feel a gentle stretch in the painful area. See bent knee calf stretches and straight knee calf stretches.
  • Ice is particularly effective and should be applied after each run.
  • Don’t forget strengthening and balance training. You’ll be amazed at how well this works, especially if you have been struggling with shin splints for a while.
  • An anti-inflammatory cream could be used to reduce the pain and inflammation.
  • Massaging the muscle tissue along the border of the shin often speeds recovery. Simply use your thumb and some lotion to stroke upward along the shinbone. Some people will do this in the shower or tub to loosen it up at the start of the day.
  • Bare foot walking for 2-5 minutes helps to strengthening the foot muscles which will decrease the strain on the shin area. This works best in a grassy area but is also benificial if a pavement is your only option.

B) Anterior lateral tibial stress syndrome is the term for shin splints that affect the outer border of the tibia (shinbone). If you firmly rub your finger along the front, outer border of the tibia you should be able to locate the sore area. The muscles that attach to this portion of the tibia (dorsiflexors) lift your toes toward your shin. This group of muscles are actually the most used muscles during running – they are active for a greater portion of the running cycle than any other muscle.

Treatments:

    • Stretching does wonders to improve these shin splints. If your calf muscles are tight this will create more work for these muscles (dorsiflexors) and hence more stress on the bone. Perform the bent knee calf stretches and straight knee calf stretches. two to three times per day. Stretching the dorsiflexor muscles will also help workout the soreness in this area. See bent knee calf stretches and straight knee calf stretches. as well as dorsiflexor stretch.
    • Ice is particularly effective and should be applied after each run.
  • Strengthening of the dorsiflexors is often very effective for these shin splints. One way to strengthen them is by walking on your heels for a couple of minutes.  
  • Massaging the muscle on the front of the shin helps reduce the pain. You can massage your self by sliding your fingers along the front, outer border of the shin working upwards towards your knee.
  • An anti-inflammatory cream could be used to reduce the pain and inflammation. Talk to your doctor about transdermal anti-inflammatories.
  • Insoles, or orthotics (custom foot supports) may help support the foot so that the muscles that attach to the shin don’t have to work as hard or as long.
Categories
Leg injuries

Meniscuss Injuries – The Injured Runner

Meniscus injuries are the fourth most common injury in runners according to a study of over 2000 runners seeking medical care.

The meniscus is a crescent shaped structure that provides cushioning and stability in the knee joint.A tear in this cartilage may occur from twisting in a squatted position. Symptoms include a locking or catching sensation in the knee as well as swelling. The average age of runners with a menicsus injury is 43 years old and males are twice as likely to experience a tear. Degenerative meniscal tears are more common in older runners and may or may not cause any symptoms.

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Cross training Leg injuries Recovery

Tibial Stress Fractures – The Injured Runner

Stress Fractures are a condition where training load has exceeded your body’s ability to maintain bone structure, resulting in partial to complete breakdown of the bone. The most common sites for a stress fracture in the shin are the top inner portion of the shinbone (medial tibial plateau) and the central portion of the shin. Firm pressure on the bone in these two regions is usually distinctly painful.

Initially, you may be able to run without pain after you have warmed up; however, pain is often increased after the run. As the condition progresses the pain intensifies and will often leaves you limping. An X-ray will can be used to confirm the diagnosis after three weeks of symptoms (although this varies).

Whole food provided in the form of milk products with high potein, calcum and vitamin D is the best known nutritional guidance to prevent stress fracture and may speed recovery. Vitamin D (800iu per day) and Calcium (2g per day) intake has been shown to reduce the incidence of stress fractures in military cadets by 27% and should aid in quicker healing.

Treatments:

  • This condition requires more aggressive rest. Plan on at least six weeks of not running. Cycling, swimming or deep water running are the best cross training options because of the decreased weight bearing. If you are limping when you walk, using crutches until the limp is gone will dramatically speed recovery.
  • In my experience with basic trainees, doing hamstring and adductor stretches will speed recovery for a stress fracture of the medial tibial plateau.
  • Anti-inflammatories may actually delay bone healing. Use ice to get rid of the pain and alter your training so that it is pain free.
  • Vibration has been shown to accelerate bone healing. You can try using a vibrational massager by placing the massager on the bone a couple of inches away from the sore spot and holding it for 2-4 minutes twice per day.
Categories
Leg injuries Recovery

Calf Strain – The Injured Runner

Calf Strain is a strain of the calf muscles. You may feel this at the junction where the Achilles tendon blends into the muscle or right in the muscle itself. Symptoms usually develop during a race or hard work out. You may be able to run just fine at slower speeds and shorter distances, but as the distance or speed increases; watch out – it can bite. Be sure to fully recover before resuming progressive training.

  • Gentle stretching of the calf muscles will accelerate healing. Perform the bent and straight knee calf stretches two to three times per day.
  • Proper strengthening of the calf muscles is essential for a complete recovery from a calf strain. Let the calf recover for at least three days before starting a strengthening program. Try standing on the edge of a step, slowly lower your heel over the edge, and then return to the start position. Emphasize the lowering phase of this exercise. Perform this exercise for twenty to thirty repetitions with the knee straight and then with it slightly bent. Add weights if you are not fatigued after thirty repetitions.
  • Jumping rope is an excellent exercise to strengthen the calf after the pain is completely gone. Start with 20 hops with both feet, then 20 on your left foot then twenty on your right foot. Increase to 30, 40, 50 etc as your strength improves. Skipping this phase leads to compensations so be sure to feel equally confident hopping on each foot before returning to aggressive training.
Categories
Leg injuries

Treating Achilles Tendonitis – The Injured Runner

Achilles Tendonitis is a painful condition affecting the Achilles tendon. The Achilles tendon transfers forces equivalent to four to eleven times your body weight when running. Unfortunately, the body is not always able to tolerate that much force and the result is a painful Achilles tendon.

The most painful spot will usually be one to two inches above the heel. Initially (acute phase), a sheath around the tendon becomes inflamed, as the condition persist the inner substance of the tendon actually changes in structure resulting in weakness and pain (this is no longer an inflammatory condition).

  • A heel lift will help decrease strain on the tendon and should be worn in your shoes throughout the day. A heel lift is most effective during the first two weeks of symptoms. I prefer Tulli heel cups.
  • Physical therapists can apply a treatment called iontophoresis, which is the use of an electrical current to apply a steroid medication over the inflamed tissue. Research has shown this to be an effective treatment to decrease pain more quickly in acute Achilles tendonitis.
  • Ice is most important during the first few weeks. Chronic Achilles tendonitis is not an inflammatory condition and requires a different treatment approach.
  • Insoles or orthotics (custom foot supports) may be able to position the foot in a way that reduces rotational forces on the tendon.
  • Stretching of both calf muscles at least twice per day.
  • Proper strengthening of the calf muscles can actually reverse the structural changes associated with chronic Achilles tendonitis. Try standing on the edge of a step, slowly lower your heel over the edge, and then return to the start position. Emphasize the lowering phase of this exercise. Perform this exercise with the knee straight and then with it slightly bent.
  • For chronic achilles tendonitis a new massage technique called ASTYM may be helpful.
Categories
Knees Leg injuries Recovery

Outer Knee Pain Case study- The Injured Runner

David is a 42 year old runner that started feeling pain in the outer part of his right knee. He had run 11 marathons in the previous 2 years without any pain and then began to experience pain in his left knee. He cut back on his running for 2 months tried using a foam roller for his knee pain and then was able to get back into running.  At this point his left knee was fine but he could not run more than 3 miles before he experienced right outer knee / thigh pain. He had tried the foam roller and cutting back again on his running but nothing was working.

When I evaluate a runner I look at: the flexibility of 5 different muscle groups (calves, quads, hamstrings, gluteals and hip flexors); strength of the hip flexors, hip abductors, abdominals, hamstrings, lower back and gluteal muscles; balance; hopping ability: and running gait. David had the typical tight hamstrings and hip flexors but his gluteal muscles were half the flexibility as his left side. He had great abdominal and lower back strength but his gluteal and hip abductor muscles were disproportionally weak on both sides. His balance was horrible and he hopped like a rhinoceros but weighed a slight 150# at 6 ft. tall. His running gait was primarily heel strike but not overly hard and was essentially symmetric.

Usually when a runner has pain on the outer portion of the knee the diagnosis is IT Band syndrome but this was different. None of the tests that we use to diagnosis IT Band problems were positive. So instead of focusing on trying to give David a precise name for his condition we decided to go to work and address the issues discussed above. Specifically, we started with the gluteal flexibility because it was so tight that I was concerned he might be developing arthritis in his hip. Since David could run for 3 miles without hurting I suggested continuing to run but he had to stay in the pain free range.

David went to work on the stretching program for 2 weeks and then came back for a follow up. Luckily, the hip motion or gluteal flexibility was much better. Actually, it was the same as the other side and he had been able to increase to 4 miles 3 times per week.

Our next step in helping David get back to running was to improve the strength in his gluteal muscles. We chose one set of exercises that isolated the gluteal muscles and another set that required the gluteal muscle to work in synergy with the other leg muscles requiring dymamic movements and balance. Since he was doing so well with performing these in my clinic I decided to also advance him to rope jumping so that we could get a bit more spring in his step. David worked on these exercises for 4 weeks and then came in for his follow up.

David had run 13 miles the weekend before seeing me and was elated to be back on track. He told me that he felt transformed, he was running as a whole person – stronger and more balanced than ever.

Categories
Leg injuries Recovery stretches

Hamstring Strain – The Injured runner

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Hamstring Strain is a strain of the muscles on the back of the thigh and often a result of speed training or racing. You will usually feel a distinct tightening or pain in the middle third of the muscle. A hamstring strain can come on suddenly and send you limping off of the track or gradually as the result of cumulative strain from races or workouts.

A slight strain will allow you to continue running, but will recur if you begin speed training too soon. You are best off eliminating speed workouts for a week then resume gradually.

A more severe strain requires dedicated rehab since recurrence is so frequent with this injury. A recent study presented a promising new approach to hamstring rehab with quicker recovery and much lower recurrence. The authors of this study advocate having you work the hamstrings in different directions than they work with running. Trunk strengthening is also a component of this rehab program.

  • Core Strengthening – try the Plank for a quick, all around program. These are even good enough for women’s marathon world record holder Paula Radcliffe who was photographed performing the side position.
  • Agility – sidestepping, grapevine, and stepping forward and backward while moving sideways are great drills. In the study, participants performed three sets of one minute.
  • Single leg stand windmill touches – while standing on one leg, bend forward at the hip keeping your other leg in a straight line with your back, keep your arms out to the side and rotate your core to touch the toes – alternate arms. This exercise is excellent for balance, hamstring strengthening and flexibility.
  • Stretching – avoid direct stretching. Instead of standing and bending forward to touch your toes, slide your hips to the right and then bend forward. Next, slide your hips to the left and bend forward for the stretch.
  • Massage can helps speed recovery and promote proper healing.
  • Physical therapy treatments such as ultrasound and electrical stimulation may also speed recovery.
Categories
Leg injuries Recovery stretches

Hamstring Stretches – The Injured Runner

Many runners have tight hamstrings. Tight hamstrings may be related to knee pain, butt pain and perhaps even heel pain. A great way to stretch the hamstrings and also protect your back can be performed by lying on your back next to a taller object or wall. Position your self so that the leg you are stretching is supported up against the object or wall. You can modify where you feel the stretch by varying the bend in your knee. If your knee is straighter you will fill the stretch more towards your knee. If your knee is flexed you will feel it towards your butt. Adjust the tension by sliding your body forward or backward. If you have tight hamstrings spend more time with this stretch, perhaps 3 to 5 minutes.