Transcription:
How to Prevent Common Running Injuries

Melanie Cole (Host):  If you’re a runner, you know those little aches and pains that come with the territory. However, there are things you can do to prevent some of those injuries and help to keep you running. This is BayCare HealthChat. I’m Melanie Cole and today, we’re discussing how to prevent common running injuries. Joining me is Dr. Keven Elder. He’s Board Certified in Sports Medicine and Family Medicine at BayCare. Dr. Elder, it’s a pleasure to have you back on with us. Let’s talk about running injuries today. What are some of the most common running injuries that you see?

Kevin Elder, MD (Guest):  Common running injuries we can see are I guess you would categorize them by areas of the body. So, for example, the knee, we can commonly see degenerative meniscus or maybe a meniscus tear. Also in the category of the knee something called chondromalacia or runner’s knee. We can also see patellar tendon issues and if we move on to the foot, we can commonly see Achilles tendon, you can see stress fractures, we can see neuroma which is a swelling of the nerve or a nerve type pain in the toes. Plantar fasciitis is another foot injury. And then in the leg, of course you have shin splints, stress fractures can also be an issue in the leg and then finally, in the hip area, there can be stress fractures, hip bursitis, and then we can get some actual gluteus muscle tendinopathy or actual injuries to those muscles.

Host:  Thanks for that list. So, as we know, runners are a dedicated bunch and not much keeps them from taking their run. But tell us about some of the things that they might be doing, risk factors as it were that will predispose them for some of those injuries whether it’s a poor gait when they run or footwear which we know and you’ve described from the bottom up, all the injuries that can happen once we start with improper footwear or pronation or all of these unsupported areas and then it goes up the body. So, tell us about some of those things that they’re doing that could predispose them to these injuries.

Dr. Elder:  There’s certainly some areas that can lead to higher rates of injury. One of those you mentioned was if they have a natural tendency towards overpronation for example and they don’t have the proper footwear or if they do have the proper footwear and maybe there’s some aspect of overtraining. So, I certainly don’t tell people don’t run or running is bad for you because I think that’s not accurate advice. But I do think sometimes if somebody – especially they have overpronation or they have certain issues, they may need to cross train so they may need to do something in addition to running for example.

Also allowing appropriate time for rest, looking for things like, do they have any vitamin D deficiency because that can make them more susceptible to injury than they should be. Other things such as you mentioned footwear and then having proper balance of the muscle groups, that’s very important. A lot of people don’t realize that just because they run, they may have certain muscle groups that are quite strong, but others may be in comparison, weak and then you get an imbalance and that’s where you can sometimes get some injury.

Host:  So, then let’s start with what a runner would notice. As I said in my intro, Dr. Elder, runners feel these little aches and pains all the time and run through them or not. These are pretty common. So, what is it that they would feel that you would say as a sports medicine specialist, it’s time to address that. If they are starting to feel pain in their arch or their knee starts to hurt, or their ankle keeps twisting. What would tell you okay now you need to really look at those risk factors we’ve discussed and see what we can narrow down?

Dr. Elder:  I think the simple rule of thumb for that is that if somebody has pain that comes on while they’re exercising, and it might as you mentioned go away; that’s pretty common. We can get some muscular soreness or tightness that is going to be pretty common in any activity especially with running. Pain to some degree is a little bit part of it that goes away. Now on the other side of the coin, if we have pain that is present all the time, or before the activity even starts or it prevents the activity for example, somebody just says you know I can’t run because my ankle hurts so much. Well that’s clearly a reason to get some evaluation and it’s gone beyond a nuisance or a nagging thing that maybe is just a little muscle soreness into something that’s actually classified as an injury.

Host:  And if it is just general injuries as you say a little pain comes with this particular sport; what do you want people to do if they start to feel that? What are some things that they can try at home care before they would visit a doctor about this? Are you a heat guy, ice, bracing, modification? What do you like them to do?

Dr. Elder:  There’s lots of options for somebody to try. Stretching, doing some self-massage, getting an actual sport massage, maybe trying a little bit of anti-inflammatories. As far as heat or ice, I think the interesting thing about that is if you ask ten people, you’ll get ten answers even in the sports medicine world. I think there’s not really any stone tablet out there that says though shall not use heat. I think it’s particular to the patient. I think some people have some tightness and muscular spasm, let’s say they have real tight hamstring or glutes and they might feel that using heat works great for them because it brings blood flow and makes it feel better and they can stretch and kind of get things moving. You might have another patient who for example they get tightness around their IT band up in their outside hip or outside their knee and ice is the only thing that works for them and heat doesn’t do anything.

So, what I always recommend to patients is that they experiment with each and sometimes frankly alternating the two is the answer.

Host:  What about things like we mentioned footwear before, and runners generally know what kind of shoes work for them. But they don’t always know if their foot is properly situated in that shoe as far as orthotics and that can just lead to these really chronic runner’s injuries. What do you want them to know about looking into serious orthotics should that be what they need?

Dr. Elder:  So, there’s some first line steps that they can do. Most people have access these days to at least go to an area where there’s a proper running store. And they are going to do some proper fitting. So, at least give somebody an idea of what type of arch and what do they need to be looking for in a shoe. Outside of that, experimenting with some off the shelf orthotics might also be helpful. But there are people indeed who need to have some custom work done and custom orthotics and there certainly are orthotists and foot specialists and podiatrists that can help them in that regard. When you start getting into custom orthotics, you’re certainly getting into something that’s going to carry a bit more cost but I think that this is one of these things that if this is their big activity and it’s a major benefit to them from a health standpoint and not only physically but mentally; then it may well be worth their while to make sure they do it right. And I think this is definitely an area where we don’t want to skimp on equipment. If you think about it, you don’t really need much more equipment than a pair of shoes to go do this. It’s not like you have to get a full uniform and even have a ball or anything. You’re just kind of putting shoes on and have some sort of outfit and off you go wherever you are at.

Host:  What a great point about the fact that this has health benefits both physical and psychological. Because for runners, this is really a mental thing especially for those long distance runners. Wow they need a lot of mental strength to do that. So, now prevention. I’d like your best advice, Dr. Elder, and I know that one of the things I’ve heard in my practice for so many years, do I stretch before, do I stretch during or do I wait and stretch after? So, give us some of your prevention tips and speak about when proper stretching is really the thing to do to help.

Dr. Elder:  I think one of the important things from a prevention standpoint is warming up and warming up is pre-exercises almost your form of stretching as it were. We’ve really, in sports medicine world, gone away from static stretching or cold stretching as it were. I think what you’re going to see the recommendations be is more a casual light warm up, getting the joints moving, getting the blood flowing and then kind of progressing into your activity.

Now post activity, it may well be beneficial to be doing some of that I guess static stretching as it were or you even see sometimes in the midst of a run, you mentioned the distance runners, where they start to kind of have something tighten up on them and that might be a good place that you maybe stop for a minute and take a little time and do some range of motion and do some stretching because to ignore something like that in the midst of like let’s say a long run and then the gait pattern changes and then this just gets amplified. This is where you can encounter some other issues, or a secondary issue not even related to the tight muscle groups. So, I think the bottom line is proper warm up, getting the blood flowing, thinking about if you are already sore, maybe today is the day you do a shorter run instead of another long run, kind of planning out the week in your head then post doing some stretching. If you are feeling really tight and you can’t seem to get things loose that might be time to go get some preventative therapeutic massage or do some other treatments, maybe some ice or heat as we mentioned. Or if we’re actually dealing with an injury, it might mean it’s time to actually try a little physical therapy or something else.

Host:  Great advice. And certainly true and since runners don’t want to stop running, give us your best advice about hopefully preventing those common running injuries, kind of summarize the whole segment for us, Dr. Elder, and what you would like them to know about when it’s time to really look at what their doing and possibly see a physician to assess the situation.

Dr. Elder:  So, I think that running has a lot of benefits not only physically but psychologically, mentally. It’s certainly a valuable activity. It helps a lot of people with their health. Important to plan out the activity appropriately as it goes. Understand that there’s a need to do more than just run. If somebody wants to exercise every day, you want to probably do some cross training. If we only run and we only run the same route and run the same amount every time, you’re virtually guaranteed to have an injury.

So, you want to mix it up. You want to build in rest days. You want to do some other things. Make sure you are warming up appropriately. Thinking about your body. If we are having a little bit of pain or discomfort, that’s not uncommon. If we’re having more pain in a particular area, we might want to think about why as it pertains to equipment or positioning or maybe mileage. And then if these things are holding someone back, and wherever it is, it could be in the shin, it could be in the hip, it could be in the foot, it could be in the knee; then it doesn’t mean it’s all over and it’s the end of the world. I think that’s the point where unfortunately a lot of people go to, they say oh no they’re fearful. I think that’s where you want to see the appropriate person, see a good sports medicine specialist who is going to figure out what’s going on. They are going to understand that you want to get back to running and see if we can make some modifications and make that happen.

I think where the mistake happens is if you wait too long and allow the injury to magnify, then that’s a situation where we can get in these instances of a more significant injury or stress fracture and then we are having to take months off and that’s what we want to try to avoid.

Host:  It’s great information. So important. Thank you so much, Dr. Elder, for coming on. You’re a great guest as always. And that concludes this episode of BayCare HealthChat. To learn more about BayCare Sports Medicine Services, please visit our website at www.baycare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other BayCare podcasts. I’m Melanie Cole.