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Running Injury
Aka: Running Injury, Jogging Injury- Epidemiology
- Risk Factors
- Prior lower extremity injury
- Weekly mileage exceeds 20 to 40 miles (50 to 100 km)
- Causes: Running Injury
- Training Error
- High intensity Exercise without rest days
- Sudden increase in mileage or intensity
- Single intense training episode or competition
- Overtraining related conditions
- Anatomic Error
- Overweight patient
- Leg Length Discrepancy
- Femoral neck anteversion
- Weak or inflexible quadriceps or hamstrings
- Genu Valgum or Genu Varum
- Q Angle exceeds 15 degrees
- Tibial torsion or tibia varum
- Gastroc-soleus insufficiency
- Patella alta
- Pes cavus with high soft tissue arch >3.1 cm
- Pes Planus or flat feet (low injury risk)
- Functional Error
- Over pronation (most common cause)
- Excess supination without compensatory pronation
- Higher risk in pes cavus foot
- Associated with Iliotibial Band Syndrome
- Extrinsic Factors
- Shoe Problem
- Inadequate heel wedge or heel counters
- Inflexible soles
- Narrow toe boxes
- Lateral heel wear
- Old Running Shoes with lost shock absorption
- Limit to 500-700 km (312-438 miles) per pair
- Running surface or terrain
- Shoe Problem
- Training Error
- Causes: Common Running Musculoskeletal Injuries
- Pelvis and thighs
- Adductor Strain
- Hamstring Strain
- Iliac Apophysitis
- Piriformis Syndrome
- Consider for Sciatica in runner
- Knee
- Patellar Tendinitis or Patellar Tendinopathy (most common Knee Injury in runners)
- Patellofemoral Syndrome (26%)
- Iliotibial Band Syndrome (4%)
- Foot, ankle or calf
- Stress Fracture (2-3%)
- Tibial Stress Fracture (41%)
- Similar presentation to Shin Splints
- Metatarsal Stress Fracture, Freiberg's Disease (29%)
- Consider for chronic Metatarsalgia in adolescent
- Fibula Stress Fracture (18%)
- Cuneiform Stress Fracture (6%)
- Tarsal Navicular Stress Fracture (6%)
- Consider for persistent medial arch pain
- Tibial Stress Fracture (41%)
- Pelvis and thighs
- Management: Injuries
- Standard Injury Management
- Modify training regimen
- Reduce or eliminate pain triggering activities
- Reduce speed and mileage
- Week 1: Slow run, every other day for 1/3 distance
- Week 2: Slow run, every other day for 2/3 distance
- Week 3: Slow run, every other day for full distance
- Week 4: Baseline pace every other day
- Consider straight-away runs instead of curved track
- Add rest days to training schedule
- Move runs to a softer training surface
- Cross-Train with other aerobic activities
- Wet vest
- Biking
- Swimming
- Stair climbing (Stairmaster)
- Ski machine (Nordic Track)
- Strengthen and rehabilitate involved Muscle groups
- Consider physical therapy or athletic trainer
- Modalities
- Education on stretches and Exercises
- Ultrasound (and Phonophoresis and Iontophoresis)
- Eccentric Exercises (tendon stretch while loaded)
- Prevention: Overuse Running Injuries
- See Overtraining
- Find the right Running Shoes
- Change Shoes every 500 miles or every 6 months
- Consider Orthotics
- Flat foot (Pes Planus)
- Over-pronation
- Strengthen the quadriceps Muscles
- Maintain flexibility
- Stretch before and after Exercise
- Assess knee extension in clinic
- Patient supine with hip flexed to 90 degrees
- Expect knee extension within 15 degrees of full
- References