Knowing When to Say When: Five Common Injuries
by Holly Fitzgerald
Those of you who have been running for a while can most likely name with little effort at least five common injuries that plague runners. Why is that you might ask? Well, for one the repetitive stress of running creates an environment where it is very easy to get injured. More importantly, most running injuries are not so debilitating that you canÛªt run through themÛ_ so you do. You never read an article titled: ÛÏTraining Through a Dislocated PatellaÛ_Û or ÛÏGetting Your PR on a Fractured Femur.Û
Sounds ridiculous, but is it? As a runner and a clinician I understand that if the pain is such that you CAN physically run from point A to point B without dying, chances are you will.
Unfortunately, this sets up a vicious cycle of injury, limited recovery, reinjury and so on. My intention with this piece is to better arm you with the tools to know when to say when. Truth be told, there are some conditions that it is just not smart to run throughÛ_even if you can.
The primary reason being that, if you choose to push through the pain, you better get very friendly with it because it will be around a long time. Chronic pain related to repetitive stress causes physical changes in the integrity of the injured tissue. Over time the tissue can actually lose the ability to repair itself and you are left with a permanent injury.
A prime example of this is the dreaded IT band syndrome. Since most of you are very familiar with what IT band syndrome is I will not bore you with the details. In summary, symptoms begin as sharp pain along the outside of the knee. Typically, if you rest, ice and stretch you can get back to training fairly soon.
The problem is that usually it is too soon. You may notice that the sharp pain that halted you at mile two on your last run doesnÛªt come on until mile five and the intensity is less. Therefore it is getting better right? Not necessarily.
Next thing you know it has been eight months and you are still fighting the same IT band problem, and now it might be starting in your other leg. I encourage you to get it examined. IT band pain typically is a result of one or a combination of a few things: poor training, improper footwear, faulty alignment or weakness somewhere in the chain.
The sharp pain you experienced at the onset of your symptoms is merely your body telling you something, somewhere is wrong. If you chose to push though the pain during the acute phase without really investigating why it happened in the first place, chances are you will set up a situation of ongoing compensation, soft-tissue adhesions and joint restriction with the potential for damage that will force you to stop running.
Another example is in the case of chronic shin splints. It is common to diagnose all shin pain as shin splints; however, the pain may be masking a much bigger issue. In general, at onset the pain of shin splints is more muscular/soft-tissue in nature.
This means that when you move your foot in different directions you can reproduce your symptoms with by contracting or stretching the muscles at fault. In addition, you can usually palpate an area either on the inside or outside of your shin that is actually tender and may even feel good if you rub it a bit.
If your symptoms donÛªt correlate with this, the pain you are feeling may be related to a stress fracture. Both types of pain can start as a result of poor training, (too much too soon), improper footwear or weakness in the leg. The difference is that with shin splints, using ice, stretching and modifying your training regiment will typically correct the issue and help to condition the weak musculature.
With a stress fracture, running will purely worsen the condition. Think about itÛÓyou are running so much, or so poorly, that you are actually causing your own bones to break. The good news is that stress fractures are easy to treatÛÓyou simply stop the activity that caused the fracture for 6-8 weeks to let the fracture heal.
If you donÛªt it will likely get bigger and may never heal. Off weight or pain free exercise is usually OK. You can switch to elliptical, bike, water running, etc. to keep your cardio up.
Sharp pain associated with catching, locking or giving way is also not to be ignored. Typically, this will happen either at the hip or knee in the running population. These symptoms correlate with what is likely to be an internal derangement within the joint itself. It could be cartilage or a ligament that has torn and when trapped between the bony surfaces, locks the joint.
Running on this joint will not improve your symptoms. In the case of giving way, a torn tissue may be giving you the sensation of instability because a ligament that was holding the joint together no longer is. Continuing to run undiagnosed and untreated can set you up for further joint damage down the road. Once thoroughly examined it is likely you will be able to return to running with proper care.
The inspiration for my last example comes from two cases I have seen recently in the clinic. I know you are all familiar with an arm or foot that has ÛÏfallen asleep.Û You shake it out and everything is fine. This temporary sensation is not what I am about to discuss.
Though I am surprised I have to actually print this, prolonged nerve-like symptoms are nothing to mess with. Undiagnosed neurological conditions such as numbness, pins and needles, or weakness are not something you should self-treat.
I recently evaluated two women, both with a past history of foot drop (nerve impairment that creates loss of the ability to bend up the ankle) and both were able to keep running through the dysfunction. Now in their defense they did seek medical attention and recovered from the condition. But it got me thinking that people actually run even if they physically canÛªt lift their own foot off the ground.
Your body can compensate for many conditions; however, in the long run in this instance, it is not a good idea. If you are experiencing neurological symptoms it is in your best interest to investigate the cause.
Compression on nerve tissue for prolonged periods of time can cause permanent damage with the possibility of both strength and sensory involvements. After all, it is your nervous system that controls all bodily functions. What starts as numbness can progress to loss of motor control like bowel or bladder function.
You can, however, take comfort in the fact that some causes of neurological symptoms can be as simple as muscle tightness or joint stiffness. More serious pathology could be related to disc herniation or systemic disorders like diabetes. DonÛªt play around with this one. Seek the opinion of a professional.
Runners run through pain. I get it. Bottom line is that if you have self-treated without results for more than 3-4 weeks get it, whatever it is, checked out. We all know time flies by and you donÛªt want to be sitting at dinner with friends talking about this pain or that ache that you have had for a year. Give in now to invest in future years of happy and healthy running.
Holly Fitzgerald is an orthopedic physical therapist whoÛªs practiced in the Boston area for 10 years. She owns and operates Fitzgerald Physical Therapy Associates with locations in Malden and Woburn, MA. Holly is a four-time Boston Marathoner and soccer player with special interest in recovery from athletic injury and troubleshooting for the complicated patient. Her email is Hollymspt@aol.com with additional information at www.fitzgeraldpt.com.