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Consultant foot and ankle surgeon at BMI The Clementine Churchill Hospital, Mr Htwe Zaw gives advice on how runners can best protect their joints, and Robert Waite, physiotherapy manager, discusses the importance of stretching before and after training.
Mr Htwe Zaw - How runners can best protect their joints
What parts of the body are most affected by running?
Most running injuries involve the joints in the lower limbs, especially the knee and ankle joints, along with the surrounding muscles, tendons and ligaments.
What are the main causes of running injuries?
Over-training is by far the commonest cause of injuries (too much, too soon, too fast). Ensure that any changes to your training programme are done in small increments whether this relates to distance, intensity, frequency or terrain.
Mal-alignment can predispose to running injuries, including knocked knees, bow-legged, tight Achilles tendon, stiff hip joint rotation.
Muscle imbalance around the knee, ankle and hip joints can often be corrected with targeted physiotherapy.
What advice would you give to people training for short distances, building up to longer distances?
- Footwear – ensure that you wear suitable lightweight trainers changed regularly (approx. every 6months depending on your level)
- Warm up/cool down – take sufficient time to stretch and warm up all muscle groups, as well as time to cool down
- Training – pre-condition the joints, bones and muscles to repetitive stress during training sessions to improve endurance, agility and balance
- Cross-training – (i.e. performing different sports as part of your training programme) is beneficial for pre-conditioning.
- Understand your own running style – (i.e. over-pronator, heel-runner, toe-runner, barefoot runner). Most experienced runners will assess their own technique but if you are not sure, seek advice from a specialist, either your trainer, physiotherapist, podiatrist or foot & ankle surgeon. Ensure that you use the correct footwear that fits your style of running
- Nutrition – check that you are replacing not just calories but essential vitamins, minerals and fluids. Balanced meals with complex carbohydrates, proteins and fats are essential.
What should runners look out for in the build-up to a race/during a race?
If you experience persistent pain during training/running it is advisable to stop. This could be a warning sign before a significant injury occurs, such as a stress fracture, cartilage damage or muscle injury. Apply the principles of RICE:
- Rest for initial 24hrs and weight-bear as pain allows
- Ice for <24hrs to relieve pain but not too long to inhibit healing
- Apply compression bandaging
- Elevate the foot
Take adequate pain relief, avoid bracing if possible and start simple knee, calf and ankle stretching exercises at home. If your symptoms persist beyond two weeks or you are unable to weight-bear initially, contact a healthcare professional (physiotherapist, GP, orthopaedic specialist).
What are the 5 most common running injuries and how are they caused?
This is pain at the front of the knee joint caused by increased pressure between the kneecap (patella) and thigh bone (femur); made worse by squatting, kneeling and walking downstairs. It's caused by mal-tracking of the patella and it can be treated with quadriceps strengthening in particular vastus medialis oblique (VMO) exercises to correct patella mal-tracking. Taping and bracing can also provide temporary support whilst training or during long distance running.
This is pain over the outer part of the knee joint from the thick fascial structure, ITB, which rubs against the outer part of the knee, creating inflammation. Pain is often reproducible at the same distance or after the same time of training. You can treat this with ITB stretches, deep tissue (myofascial) manipulation, hip abductor muscle strengthening and occasionally steroid injections.
This is pain over the inner part of the shin related to exercise or overuse and is caused by inflammation of either overlying muscles, tendons or the outer lining of the bone (periostitis). It is treated with stretching anterior and posterior calf muscles regularly, reducing your stride length and slight forward lean during running.
Pain in the back of the heel is caused by acute inflammation of a tight Achilles tendon and chronic formation of scar tissue (tendinosis). It can be treated with an eccentric stretching programme, night splint, shockwave therapy, high volume injections and surgery (open or keyhole).
Pain in the sole of the heel is caused by inflammation of the plantar fascia, a thick band of connective tissue stretching from the heel to the toes which supports the arch of the foot and acts as a shock-absorber. The repetitive pressure from running leads to inflammation and is classically worse with first steps of the day. It can be treated with eccentric and plantar-fascia-specific stretches, heel cushions, night splint, anti-inflammatory medication, steroid injections and shockwave therapy.
Robert Waite - The importance of stretching
Stretching is an important part of your training sessions, and should be an integral part of your weekly training, if not daily. Stretching will:
- Improve posture
- Increase flexibility
- Increase stamina
- Reduce the risk of injury
Stretching should be integrated as part of your training schedule. It should be a targeted programme, and with runners, should look at the hamstrings, ITB, and hip flexors in particular. Improving the flexibility of muscles will help to improve posture, especially when running and this will put the body in the best bio-mechanical position, and thus reduce the risk of injury.
It also helps to put the body in the correct bio-mechanical position for running and will correct imbalances in the body, which again could cause injury.
Stretching should always be done with warm muscles, and each stretch should last for approximately 30 seconds.
The importance of a cool down is equally important; especially when you want to train the next day.
A post workout stretch increases the blood supply to your muscles and washes out the lactic acid that has been produced within the muscles. It helps to prevent muscle pain, and promotes healing and nutrition of the muscles by oxygenating the muscle.
My top tips to avoid injury include:
- Regular stretching
- Good balanced nutrition
- Keep hydrated
- An appropriate food ideally high in protein within 1 hour of exercise
- Regular sports massage
- Correct shoes and possible use of orthotics
- Bio-mechanical assessment of running techniques
- Carry out running drills as part of your warm up
For more information including, running tips and injuries, download our free guide to running or take a look at our running injuries infographic.
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