Speed work in endurance sports is a valuable asset and enhances performance. However, it is not with out a price. As Andy Stewart and other coaches have espoused, it requires discipline and direction but has to be tempered with a healthy dose of restraint. In my practice the common denominator in running-related injury is a “change”. Whether it is “change” of shoes, “change” of terrain, or a “change” in training technique, it always involves “change”. Speed is one of those “changes” that “gets” runners. It should be approached cautiously and gently integrated into a running program well after a strong “base” has been established. Consult a qualified coach before joining a speed-workout group to make certain that you are ready for it.
Regardless of your stage of development in running you should be alert to and aware of some of the pitfalls that lie ahead. Running injuries are, to some extent, inevitable in most serious athletes due to the personalities involved. Most are over-achievers and focused on their success beyond the “cost”, or they simply feel too good to interrupt their activity and as they ignore aches and pains that normally would interrupt them in less enjoyable activity.
I have compiled the following information below utilizing a variety of sources published on the internet and have abridged that information to suit this short article. This is by no means an exhaustive treatise; however, it might serve as a stepping-off point for your own research toward understanding and preventing running injury.
The piriformis syndromeThe piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats. The piriformis muscle assists in abducting and laterally rotating the thigh. In other words, while balancing on the left foot, move the right leg directly sideways away from the body and rotate the right leg so that the toes point towards the ceiling. This is the action of the right piriformis muscle.
Stretching the muscle often duplicates the pain. To do the piriformis stretch, lie on your back, and flex the right hip and knee. Now, while grasping the right knee with your left hand, pull the knee towards your left shoulder. This adducts and flexes the hip. In this position, grasp just above the right ankle with the right hand, and rotate the ankle outwards. This applies internal rotation to the hip and completes the stretch. Another way to do this stretch is to stand on your left foot and place the right foot on a chair, such that the right knee and hip are flexed at about 90 degrees. Now, using the right hand, press the right knee across towards the left side of the body while keeping the ball of the right foot on the same spot on the chair.
Another good
piriformis/gluteal stretch is demontrated in below.
Anatomically, the piriformis muscle lies deep to the gluteal muscles. It originates from the sacral spine and attaches to the greater trochanter of the femur, which is the big, bony "bump" on the outside top of the thigh. The sciatic nerve usually passes underneath the piriformis muscle, but in approximately 15% of the population, it travels through the muscle. It is thought that acute or chronic injury causes swelling of the muscle and irritates the sciatic nerve, resulting in sciatica. Patients with an aberrant course of the nerve through the muscle are particularly predisposed to this condition.
The piriformis syndrome is diagnosed primarily on the basis of symptoms and on the physical exam. There are no tests that accurately confirm the diagnosis, but X-rays, MRI, and nerve conduction tests may be necessary to exclude other diseases. Some of the other causes of sciatica include disease in the lumbar spine (e.g. disc herniation), chronic hamstring tendinitis, and fibrous adhesions of other muscles around the sciatic nerve.
Once properly diagnosed, treatment is undertaken in a stepwise approach. Initially, progressive piriformis stretching is employed, starting with 5 seconds of sustained stretch and gradually working up to 60 seconds. This is repeated several times throughout the day. It is important that any abnormal biomechanical problems, such as over-pronation of the foot or other coexisting conditions, are treated. This stretching can be combined with physical therapy modalities such as ultrasound. If these fail, then injections of a corticosteroid into the piriformis muscle may be tried. Finally, surgical exploration may be undertaken as a last resort.
A good sports medicine physician with experience in caring for athletes with the piriformis syndrome can help direct appropriate management. With proper diagnosis and treatment, there is no reason for this syndrome to be dreaded.
Iliotbial Band SyndromeThe iliotibial band is a thick, fibrous band that spans from the hip to the shin; it lends stability to the knee joint, and is attached to muscles of the thigh. ITBS is caused when the band becomes inflamed and tender. ITB pain is always lateral or on the “outside” of the knee about an inch from the patella. It frequently occurs when shoes over supinate (bowleg) your knee or when you extend your running past your usual tolerance. Have qualified shoe expert check your shoes and consult a coach to adjust your training program. Stretching, ice and anti-inflammatory meds usually help but won’t replace insightful training, good biomechanics and proper shoe wear.
Pulled HamstringA pulled hamstring is a common sports injury, seen most commonly in sprinters. A pulled hamstring is a injury to the muscle called a hamstring strain. This can occur acutely from a sudden burst of speed or chronically due to repeated over-stress in submaximal efforts. Avoidance is the best choice by judicious increases in intensity, warm up and stretching. Treatment of a pulled hamstring is important for a speedy recovery and includes active rest including cross-training, ice and physical therapy.
Patellofemoral SyndromeAlso, called "Runner's Knee," problems associated with the patella, or kneecap, are common in runners. The term runner's knee may refer to several common injuries such as chondromalacia,
patellar tendonitis, or
generalized knee pain.
Depending on the diagnosis this is usually not a surgically treatable problem. Usually the disorders are non-surgically managed with rest, ice and anti-inflammatory meds and a modified/cross-training program.
Plica syndrome
Plica syndrome occurs when there is irritation of the lining of the knee joint. Part of the lining (synovium) of the knee joint is more prominent in some individuals, and can form a so-called plica shelf. If this tissue becomes inflamed, it can cause knee pain. The old RICE (rest, ice, compression and elevation with the addition of anti-inflammatory meds) treatment commonly works for this but occasionally arthroscopic removal of the ”shelf” is necessary.
Shin Splints
Shin splints, like runner's knee, is a term that describes a set of symptoms, not an actual diagnosis. Shin splint pain can be due to problems with the muscles, bone, or the attachment of the muscle to the bone and is. It is critical to differentiate this from the next topic, Stress Fracture, usually accomplished by xary, bone scan or MRI.
Stress Fractures
Stress fractures of the hip are usually seen in long distance runners, and much more commonly in women than in men. Other stress fractures are rather commonly seen in the foot (metatarsals) and the leg (tibia and fibula) though more uncommon are stress fractures of the pelvis. These are painful sometimes vague injuries with radiation of the pain to other regions of the extremity. These injuries are sometimes seen in endurance athletes with deficient nutrition or eating disorders, but can occur in normal athletes who push the limits of their abilities and training state. Prevention is paramount and treatment is strict rest with some allowance for cross-training techniques. Sometime crutches or braces are recommended. When in doubt x-ray, bone scan and/MRI is worth the cost. The result of “completing a stress fracture into a full blown fracture can be costly and sometimes disastrous.
Achilles Tendonitis
Achilles tendonitis is a painful condition of the tendon in the back of the ankle with tenderness and sometimes swelling in the tendon itself. The cause is always overuse and over-stress (ask Andy about this one). Left untreated, Achilles tendonitis can lead to an increased risk of Achilles tendon rupture. Early treatment involves active rest and anti-inflammatory med, sometimes bracing and physical therapy. Rarely, in chronic conditions or rupture, surgery is necessary.
Arch Pain
Arch pain is a common foot complaint. Arch pain, also sometimes called a strain, often causes inflammation and a burning sensation under the arch of the foot. Treatment of arch pain often consists of a flexibility/stretching program for the toes and ankle, adaptive footwear and inserts.
Tips for Injury Prevention
Wear Proper Shoe Wear
1. Have your feet measured by a qualified salesperson.Many people jump ahead to trying on the shoes without checking the length and width of each foot. It is important to know to proper size of your feet and if your feet are slightly different sizes.
2. Shop for the larger foot.If your feet are different sizes, buy a shoe that best fits the larger foot. If you need, buy an insole to fill space in the other shoe.
3. Make sure the shoe fits your heel and your toes.The toe box should provide ample wiggle room, and the heel should not slip up when walking.
4. Go for a walk in the store.Make sure the shoe is comfortable for a short walk around the store--any pain is only going to be worse on a long walk.
5. Don't think a shoe will 'break-in.'This is a common misconception that shoes should be purchased snug so they can break-in. Wrong! Shoes should fit when you buy them.
Tips:
1. Stand up when measuring your feet.Do your footwear shopping towards the end of the day after you've been up and walking for a few hours. Under these conditions your feet will be slightly larger than in the morning. End-of-the-day shopping is the best way to buy footwear.
2. Remeasure your feet each time you buy new shoes.Measure your feet each visit as your shoe size can change over time. And never buy a shoe based on size alone--try them on!
Stretch Properly
1. Know your sport.Whether you're in the gym, on the track, or anywhere else, know what your workout will involve. Understanding which muscles will be worked is the only way to know how to best stretch out.
2. Focus on those muscles.While a good overall routine is helpful, your emphasis should be on the muscles that will be most heavily involved in your workout.
3. Warm up before stretching.Just some easy walking or a light jog will be sufficient to warm up your muscles, but it will make the stretching session much more valuable.
4. Begin slowly.You don't need to touch your toes right away--begin slowly and push yourself as your muscles loosen up. Stretching too much too soon can be painful and potentially harmful.
5. Hold the stretch.Once you feel your muscles reaching their limit, hold the position for a count of 10. Then push yourself a little further and hold again for a count of 10.
6. Don't rush your stretching routine.If you're going to have to cut your workout short, don't skip or shorten the stretching. This is more important than an extra set of reps or another half mile.
7. Do it again.Once you're finished working out, stretch again. Not only is it an excellent way to cool down from the workout, but this is the time that you will improve your flexibility the most.
Tips:
1. Don't bounce!You will get the best stretch, and prevent injuries if you avoid bouncing. Instead, hold the stretch, and feel a constant pull in the muscles.
2. Stretch both sides.Many people have a tendency to under-stretch the 'healthy' side after an injury. Use the same stretches, for the same amount of time, for both sides of your body.
3. Get professional help.Gym trainers, physical therapists, exercise instructors will all know great ways to stretch. When you're getting started, have someone knowledgeable watch your routine and offer their suggestions.
Crosstraining Cross training is a great way to condition different muscle groups, develop a new set of skills, and reduce boredom that creeps in after months of the same exercise routines. Cross training as allows you the freedom to vary the stress placed on specific muscles or your cardiovascular system. After months of the same movements your body becomes extremely efficient performing those movements, and while that is great for competition, it limits the amount of overall fitness you possess and reduces the actual conditioning you get while training. Rather than continuing to improve, you simply maintain a certain level of fitness. Additionally, cross training is extremely helpful at reducing the risk of injury from repetitive strain or overuse.
The term cross training refers to a training routine that involves several different forms of exercise. While it is quite necessary for an athlete to train specifically for their sport if they want to excel, for most sports enthusiasts, cross-training is a beneficial training method for maintaining a high level of overall fitness. For example, you may use both biking and swimming each week to improve your overall aerobic capacity, build overall muscle strength and reduce the chance of an overuse injury. Cross-training limits the stress that occurs on a specific muscle group because different activities use muscles in slightly different ways.
Benefits of Cross Training:
Reduces exercise boredom
Allows you to be flexible about you training needs and plans (if the pool is closed, you can go for a run instead).
Produces a higher level of all around conditioning
Conditions the entire body, not just specific muscle groups
Reduces the risk of injury
Work some muscles while others rest and recover
Can continue to train while injured
Improves your skill, agility and balance
What exercises should make up a good cross training routine?
Cardiovascular Exercise (Think about adding three different exercises from the list below):
Running
Swimming
Cycling
Rowing
Stair Climbing
Rope jumping
Skating (inline or ice)
Skiing
Racquetball / basketball / other court sports
Strength Training
Calisthenics (push ups and crunches and pull ups)
Free Weights
Machines
Tubing and Bands
Flexibility (stretching, yoga)
Speed, agility, and balance drills
Circuit training, sprinting, plyometrics and other forms of skill conditioning
With cross training, you can do one form of exercise each day, or more than one in a day. If you do both on the same day, you can change the order in which you do them. You can easily tailor cross-training to your needs and interests; mix and match you sports and change your routine on a regular basis.
For more information and treatment of sports related injuries contact Dr. Calvo at 281-890-7773 or refer to www.tri-doc.com