SYMPOSIUM ON RUNNING

INJURIES
on 15 . 03 . 2010

V.PADMA SHEELA
MPT
IIYEAR
· Running Injuries - Running Injury
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 · Running Injury
- Common Injuries in Runners
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Running Injuries: An Illustration. Dr. Raju
TOPICS
Introduction
Biomechanics of running
Common Injuries and Treatments
Causes of Common Injuries
Measures to Avoid Injury

BIOMECHANICS OF RUNNING
 MOST COMMON RUNNING
INJURIES
 Acute Muscle  Ankle sprain
Tears  Plantar
 Low back pain Fasciitis
 Medial Tibial  Stress fractures
Stress syndrome  Hip bursitis
( shin  Groin pain
splints )
 Patello femoral
 Iliotibial band
pain syndrome
syndrome
 ACL / PCL injury
 Quads strain
 Meniscal injury
 Hamstring strain
 Prepatellar
 Runner ’ s knee
bursitis
 Runner ’ s cramp
 Popliteal cyst
 Peroneal
 MOST COMMON RUNNING INJURIES
Osgood o Turf toe
schlatter ’ s Calcanei
disease apophysitis
Osteoarthritis Morton ’ s
Side stitch neuroma
Athletes foot Metatarsalgia
Blisters Entrapment
Verruca ( warts ) syndromes
Hadelung Compartment
deformity syndromes
 


 CAUSES OF INJURIES
Caused by
 1) Training errors
 2) Inappropriate footwear
 3) Inadequate strength
 4) Inadequate flexibility
 5) Poor biomechanics
 FACTORS RELATED TO RISKS OF
RUNNING INJURIES


üPrevious injury
üLack of running experience
üCompetitive running
üExcessive weekly running distance
üLow body mass

 GENERAL EVALUATION

History
Shoe Assessment
Physical Assessment



 COMMON ANATOMICAL DISORDERS
ØReduced ankle
ROM
ØLeg- length
asymmetry
ØIncreased
quadriceps angle
ØBow legs
ØKnock knees, club
foot
ØSubtalar hyper
mobility
ØHigh arch/flat foot
OVER PRONATION
ACUTE MUSCLE TEAR


Treatment :


Ice
Strengthening
Stretching

 CHRONIC MUSCLE TEAR


Treatment :


Stretching
Strengthening

LOW BACK PAIN
Contributing


factors :


üWeak abdominals
üBack muscles
üTight hamstrings
üFoot imbalance
 SHIN SPLINTS

caused by :


ØRunning on hard
surfaces,
ØRunning on tip toes &
sports where a lot of
jumping is
involved.

ILIOTIBIAL BAND SYNDROME
 SITE OF PAIN-
ITBS

Signs / Symptoms :


Pain on outer side of

knee
Pain usually increases
with run
Subsides slowly after
run
 QUADS STRAIN
Grade I strain:
ü C/o tightness in thigh
ü Passive knee flexion
beyond 90 painful
Grade II strain :

ü Snapping/tearing
during explosive
activities
Grade III strain :

ü Extremely painful &

ambulation not
possible.
HAMSTRING STRAIN

Mostfrequently
strained muscles
in the body &
are typically
caused by rapid
contraction of
muscle during
ballistic
action/ violent
stretch.
RUNNER’S KNEE
CAUSES :


üOver pronation
üWeak quadriceps
üIncorrect/ worn shoes
üOver training

 RUNNER’S
CRAMP
cause of cramps is


 Occurs as lack of stretching/ loosening

of muscles
 Occur from dehydration/ electrolyte
deficiency
 shallow breathing which ultimately
leads to a lack of oxygen.
 cramps is eating too much / not
enough before a race or workout.
 Some foods that take longer to digest
could be in your stomach for hours
&will likely make their presence
known if you chose to “eat & run”.

 SIDE STITCH
Exercise-induced abdominal pain


Cramp of the diaphragm muscle



Occurs with fast running & uncomfortable

breathing


Treatment requires breathing out fully

rather than panting
PERONEAL TENDONITIS
TREATMENT :


üImmobilization
üMedications
üPhysical therapy
üBracing
 ACHILLES TENDONITIS

Definition :––
Inflammation of the
Achilles tendon
most often
occurring at the
insertion on the
back of the heel.

TOTAL RUPTURE OF ACHILLES
TENDINITIS
ØCommon in older
men who are
recreational
athletes.
CALF STRETCHES
ANKLE SPRAIN
CAUSES:


ØRunning on uneven
surface.
ØFoot imbalance
ØOver pronation
PLANTAR FASCITIS/ HEEL PAIN



ØThe Plantar Fascia
is a broad, thick
band of tissue
that runs from
under the heel to
the front of the
foot
PLANTAR FASCITIS/ HEEL PAIN

DEFINITION :


Inflammation of
plantar fascia most
often occurring at
the origin on the
heel (inside edge).

TREATMENTS OF PLANTAR
FASCIITIS
METATARSAL STRESS
FRACTURE
CAUSES :


Abnormal
concentration of
stress
Bones insufficiently
strong
Abnormal foot
structure / mechanics.

HIP BURSITIS
REHABILITATION :


Icing , NSAIDs ,
rest , u / s , IFT .
Strengthening
of hip
abductors .
Stretching for
ITB , hip
flexor ,
hamstring ,
gluteus .

 GROIN PAIN
TREATMENT:


Phase I :
Static adductor

exercise
Abdominal curls

Phase II :

Gluteal leg raise

Single leg squats

Slide board skating

PATELLOFEMORAL PAIN SYNDROME
 ACL INJURY
MANAGEMENT :


CPRICE
CROM within pain free
limits
CStrengthening exercises
CCV fitness
CBalance & proprioception
CFunctional activities.
C
 POSTERIOR CRUCIATE LIGAMENT
INJURY
SIGNS &


SYMPTOMS :
ØMilder cases :
Intense pain
& sense of
stretching .
ØTotal rupture :
characteristic
pop / snap is
felt .
ØEffusion &
hemarthrosis
occur rapidly .
MENISCAL INJURY
SIGNS & SYMPTOMS:


o Localized pain & joint

line tenderness.
o Pain will occur on
rotation & extreme
flexion of knee (deep
knee squats)
o May experience
popping,
grinding/clicking
sensation
PREPATELLAR BURSITIS
TREATMENT :


§ Ice therapy
§ A compressive wrap
§ NSAIDs
§ Avoid activities that
irritate the condition
§ Corticosteroid
injections.
 POPLITEAL CYST
 Baker cyst is swelling
caused by fluid from
the knee joint
protruding to the back
of the knee.
 When an excess of knee
joint fluid is
compressed by the
body weight between
the bones of the knee
joint, it can become
trapped & separate
from the joint to form
the fluid-filled sac of a
Baker cyst.
OSGOOD SCHLATTERS DISEASE

TREATMENT:


vReduce running &

jumping activities
vIcing
vStretching quads.
 OSTEOARTHRITIS
DEFINITION :


Osteoarthritis (also
called degenerative
joint disease) is the
degradation and
degeneration of this
articular cartilage
ATHLETE’S FOOT
CAUSES :


 Due to excessive sweat.

 Fungi thrive in warm,
moist environments .
 Not changing your
socks .
 A common port of
infection is in
changing rooms in
the gym as this
condition can spread
between individuals.

BLISTERS

ØBlisters can
occur anywhere
on the foot but
they are more
likely to occur
on the toes &
the sole of the
foot due to
friction &
traction forces.

VERRUCA (WARTS)
HAGLUND DEFORMITY
 Isa bony enlargement on
the back of the heel.
 The soft tissue near the
Achilles tendon
becomes irritated when
the bony enlargement
rubs against shoes.
 This often leads to painful
bursitis, which is an
inflammation of the
bursa (a fluid-filled sac
between the tendon and
bone).

FLAT FEET
CAUSES :


COver pronation
CHereditary factors
 TURF TOE

·Turf toe can occur

after a very
vigorous upward
bending of the big
toe
SEVER’SDISEASE/APOPHYSITIS
CALCANEI
TREATMENT:


ØRest
ØIcing, NSAIDs
ØHeel lifts, heel
cups
ØStrapping the
foot
ØFlexibility
exercise
ØStrengthening
exercise

 MORTON’S
NEUROMA
 SYMPTOMS:
1. Numbness / tenderness
in the foot
2. Pain, numbness,
burning & tingling
sensations can
radiate around the
foot.
3. Severe pain may be
present at weight
bearing.

METATARSALGIA
Mechanism of


Injury :


qFaulty distribution of
weight on the
forefoot.
qSudden trauma


 ENTRAPMENT NEUROPATHIES
Femoral Neuropathy
Sciatic Neuropathy
Meralgia Paresthetica
Common Peroneal
Neuropathy
Tarsal Tunnel Syndrome –
Tibial nerve entrapment
Sural nerve entrapment
Distal Peroneal
Neuropathy
 COMPARTMENT SYNDROMES

 Exertional
compartment
syndrome
 deep posterior
compartment (20-
30%)


 Lateral
compartment(10-
20%)
 Anterior
compartment
syndrome (50-60%)
HOW TO AVOID INJURY
·Proper shoes


·Warm-up


·Training methods


·Stretching


·Muscle strengthening

SIDELINE PREPARATION FOR TEAM
PHYSICIAN
 GOAL :
üAdequate onsite medical care
& the safety of every
athlete .
üThis goal can be accomplished
by intergrading medical
systems that include
üPreseason planning
üGame - day planning &
üPost - season evaluation
 DIETARY SUPPLEMENTS &
ATHLETICS
Reasons for taking supplements:
Recommended by family member/friend

Recommended by coach/trainer

Recommended by nutritionist/dietician

Recommended by physician/pharmacist

Inadequate diet

Improve athletic performance


Contd….
Feel better/increased energy levels
Prevent illness
Prevent disease
Build muscle
 THE AGING ATHLETE: RISKS &
BENEFITS OF EXERCISE
Physiological changes of cardiopulmonary
system that affect exercise.
Decline in cardiac output
Decline in max. HR
Decline in VO2 max
Decrease capillary- muscle peripheral
blood flow
Decrease myocardial muscle mass.

 Physiological changes in MS that affect
exercise after age 50.
Decreased collagen water content
Decreased lean body/muscle mass
Decreased strength
Decreased type II muscle fibres
Decreased type IX articular cartilage
Increased body fat

 SOME BASIC TIPS
CDo not increase mileage by more than
 10% a week.
CDo not run more that 45 miles a
week.
CDo not run / stand on uneven
surfaces.
CDo not run on sand.
CDo not run through pain.
CIce often.
CChange your running shoes every 450
miles.
CWork regularly on strengthening.