Podiatry: Running Injuries

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Running - injury-prone runners

Running as a sport will always be accompanied by injuries. Pulled Achilles Tendons, shin splints, knee pain, the list is seemingly endless. Most will respond to treatment, but it's frustrating when an accomplished runner can't regain former fitness after a lay-off, and in fact this was the basis of a question posed to me by Runners World magazine recently.
The runner in question had originally been able to run 10 miles a day, but after a layoff had been plagued by injuries as she tried to up her mileage. A calf tear responded well to her physiotherapy treatment, but subsequent injuries developed in the knees and Achilles Tendons. Her foot and leg mechanics were suspected as being behind the recurring injuries, hence bring on the podiatrist.
Its very easy to jump to conclusions when given a potted medical history second-hand, and although I can think of two excellent reasons why the mechanics may have changed (remember the patient was originally able to run 10 miles a day with no problems), I had several other avenues of investigation open to me before I wanted to commit to making a diagnosis.

Lower limb mechanics can change when

• The patient ages, and although this particular patient may not have aged very much, she may have crossed the threshold where tissue simply becomes less elastic (around the age of 30), and less able to cope with stresses and strains.
• The patient is pregnant. In the last three months of pregnancy ligaments become more lax, to allow some movement in the pelvic area at birth. This, combined with increased weight (baby + fluid), can adversely affect lower limb mechanics. Any difference in lower limb mechanics would certainly be mild, but perhaps enough to cause symptoms in a runner.

What else to look for

• Being able to run ten miles a day is a statement of fitness and determination. I would guess that this runner may be trying to regain her fitness too quickly.
• Is there an undiagnosed systemic condition present? Some rheumatological conditions can produce symptoms which may mimic sports injuries. One would hope that this would be picked up by the physiotherapist, but its amazing how easy it is to miss symptoms when a forceful patient presents with something which has the appearance of a sports injury.
• Has the patient changed her running shoes. Is she wearing a worn pair of shoes, or new shoes of a style or type which don't suit her running action?

What to do

• Stop her running, but short-term only.
• Initiate a good stretching programme. Pilates would be one of my top choices.
• Carry out a full biomechanical examination, and advise on footwear/fit foot orthoses as appropriate.
• Gym-work, with a good instructor will identify and rectify and weak or imbalanced muscle-groups.
• Start a controlled running programme on a gentle gradient, and monitor on a regular basis.

Provided there is no systemic disease present, this course of action will cover all bases, and fitness should be regained over a period of months.

The moral of this tale?

• When training, always, always go at your body's own speed. Push yourself, but push sensibly. If you push too hard, you'll become injured.
• Don't be frightened to seek professional help if you do sustain an injury, and don't take it personally. Everyone who trains will sustain an injury at some stage in their lives. Training, after all, is a balancing act between overloading your muscles, skeleton and cardiovascular system so that you become fitter and healthier, and over-overloading your body so that you become injured.

Please feel free to use the enquiry form at www.ortho-pedclinic.com for all foot-health and foot-related matters.
David Holland BSc(Hons), MSc(Dunelm), MChS
Consulting Podiatrist.