Dr. Michael Moses
Dr. Michael Moses is a Chiropractor practicing in Arlington, Virginia. He can be reached at 703 671-6038 or by email at caprehab@gmail.com.  Visit www.novapainnadrehab.com

While these tips are designed to help MCM runners identify common injuries, always see a  doctor before beginning any treatment plan to avoid misdiagnosis or serious injury.


1. Hip Bursitis


What is hip bursitis?
Hip bursitis is a common injury often seen in runners or athletes who participate in running-oriented sports (e.g. soccer, football, etc.). A bursa is a fluid filled sac that allows smooth motion between two uneven surfaces. For example, in the hip, a bursa rests between the bony prominence over the outside of the hip (the greater trochanter) and the firm tendon that passed over this bone. When the bursa sac becomes inflamed, each time the tendon has to move over the bone, pain results. Because patients with hip bursitis move this tendon with each step, hip bursitis symptoms can be quite painful.

How is hip bursitis diagnosed?
The diagnosis of hip bursitis is made most reliably on physical examination. When a patient has pain directly over the location of the trochanteric bursa, then the diagnosis of hip bursitis is the most common problem.

An x-ray is often obtained to ensure there are no bone spurs or calcifications that could be contributing to the problem. Occasionally, your doctor may obtain an MRI if the diagnosis is unclear or if the problem does not resolve with treatment.

What is the treatment of hip bursitis?
The best treatment for hip bursitis, or any form of bursitis is to rest the affected area. This usually means a period of time not participating in sports or activities that aggravate your symptoms. As a general rule of thumb, any activity that causes hip bursitis pain should be avoided--this only contributes to inflammation of the bursa.

Oral anti-inflammatory medications (e.g. Motrin, Aleve) may help control the inflammation. Icing the area of hip bursitis may help control symptoms. Once the initial symptoms are controlled, some strengthening and stretching exercises may be helpful.

Most patients who are faithful about treatment get better within about six weeks. Patients who do not rest from their activities until the inflammation subsides often have a return of hip bursitis symptoms. Also, patients who return too aggressively (not a gradual build-up) may also find that their symptoms return.

2. Iliotibial Band Syndrome

Iliotibial band syndrome is due to inflammation of the iliotibial band, a thick band of fibrous tissue that runs down the outside of the leg. The iliotibial band begins at the hip and extends to the outer side of the shin bone (tibia) just below the knee joint. The band functions in coordination with several of the thigh muscles to provide stability to the outside of the knee joint.

What is iliotibial band syndrome?
Iliotibial band syndrome (ITBS) occurs when there is irritation to this band of fibrous tissue. The irritation usually occurs over the outside of the knee joint, at the lateral epicondyle the end of the femur (thigh) bone. The iliotibial band crosses bone and muscle at this point; between these structures is a bursa which should facilitate a smooth gliding motion. However, when inflamed, the iliotibial band does not glide easily, and pain associated with movement is the result.

What are the symptoms of iliotibial band syndrome?
As stated previously, the function of the iliotibial band is both to provide stability to the knee and to assist in flexion of the knee joint. When irritated, movement of the knee joint becomes painful. Usually the pain worsens with continued movement, and resolves with rest.

Why did I get iliotibial band syndrome?
People who suddenly increase their level of activity, such as runners who increase their mileage, often develop iliotibial band syndrome. Others who are prone to ITBS include individuals with mechanical problems of their gait such as people who overpronate, have leg length discrepancies, or are bow-legged.

What is the treatment for iliotibial band syndrome?
Treatment of ITBS begins with proper footwear, icing the area of pain, and a stretching routine. Limiting excessive training, resting for a period of time, and incorporating low-impact cross-training activities may also help. Anti-inflammatory medications may be prescribed by your doctor to help decrease the inflammatory response around the area of irritation. If these treatments do not solve the problem, working with a Chiropractor or Physical Therapist to develop a more focused stretching and strengthening routine may help. Cortisone injection into the area of inflammation may also be attempted, usually after these other treatments fail. If all else fails, surgery is an option, but only in very rare circumstances.

3. Shin Splints

What are Shin Splints?
Shin Splints are a common problem seen in runners and individuals that stand on their feet for long periods of time (e.g., runners). This condition is most often characterized by pain over the “shin” bone (tibia) and tends to be increased with standing, walking or running.

How did I get Shin Splints?
Although the pain associated with this condition is due to a chronic contraction of the muscle at the front of leg (tibialis anterior), the cause of this problem is usually related to improper biomechanics of the foot and knee. Such a situation can cause a twisting of the shin bone forcing the tibialis anterior to work much harder than should be necessary. This twisting is called tibial torsion and, if left untreated, can cause significant damage to the cartilage pad of the knee called the meniscus.

What is the treatment for Shin Splints?
The only effective way to recover from shin splints is to correct the underlying cause of the pain. Treatment focuses on returning the biomechanics of the foot and knee to proper function reducing strain on the tibialis anterior allowing it to heal. Foot orthotics may also be necessary depending on the nature of the foot dysfunction. To accelerate the healing process and ensure complete recovery, deep tissue muscle therapy for the tibialis anterior and calf is often used to reduce spasm and scar tissue within the muscles. Deep tissue massage is a treatment method that often provides immediate and dramatic results. Runners often notice improvement in their levels of pain, flexibility and strength within seconds following the treatment.

Related conditions may also need to be addressed in order to achieve complete resolution of your symptoms. Problems that tend to occur along with Shin Splints include Plantar Fascitis and Runner’s Knee.

4.Stress Fractures

What is a stress fracture?
A stress fracture is a common overuse injury most often seen in athletes. Usually, a fracture, or broken bone, is caused by an acute event, such as a car crash or a fall. When this is the case, the bone experiences a very high force that causes the stress fracture.

A stress fracture occurs when the forces are much lower, but happen repetitively for a long period of time; these injuries are also known as "fatigue fractures." Stress fractures are commonly seen in athletes who run and jump on hard surfaces, such as distance runners, basketball players, and ballet dancers.

A stress fracture can occur in any bone, but is commonly seen in the foot and shin bones. They rarely occur in the upper extremity because your arms do not support the weight of your body as it is in your legs.

How is a stress fracture diagnosed?
Physical examination and history are important in diagnosing stress fractures Because these overuse injuries have a typical course and common physical findings, the history and examination can be critical in the diagnostic evaluation. X-Rays usually do not show a stress fracture, but they may show evidence of bone attempting to heal around the stress fracture.

How did I get a stress fracture?
Bone is constantly undergoing changes to adapt to its environment. When astronauts go into space, they are known to develop a thinning of the bone similar to osteoporosis. Stress fractures are usually seen in athletes who increase their level of activity over a short period of time. The increased demand placed on the bone causes the bone to remodel and become stronger in the areas of higher stress. However, if the response of the bone cannot maintain the pace of the repetitive demands, a stress fracture may result.

Another factor that can contribute to the development of a stress fracture is dietary abnormalities and menstrual irregularities. Because both factors contribute to bone health, any problems with diet (e.g. poor nutrition, anorexia, and bulimia) or menstruation (amenorrhea) may place an individual at higher risk for these injuries. This is one reason that adolescent female athletes are at particularly high risk for development of a stress fracture.

What is the treatment for a stress fracture?
The best treatment is almost always resting the injured leg. If there is no evidence that the stress fracture may displace, then avoiding the overuse activity may be sufficient treatment. However, if there is a concern of displacement of the stress fracture, then weight bearing should be avoided and a cast may be placed. One rule of thumb is if there is pain, don't do it. This means if running causes pain where you have a stress fracture, don't run. If walking causes pain in that location, use crutches.

5. Achilles Tendonitis

What is Achilles Tendonitis?
The Achilles tendon is fibrous tissue that connects the heel to the muscles of the lower leg: the calf muscles. Leg muscles are the most powerful muscle group in the body and the Achilles tendon is the thickest and strongest tendon in the body. Contracting the calf muscles pulls the Achilles tendon, which pushes the foot downward. This contraction enables: standing on the toes, walking, running, and jumping. Each Achilles tendon is subject to a person’s entire body weight with each step. Depending upon speed, stride, terrain and additional weight being carried or pushed, each Achilles tendon may be subject to up to 3-12 times a person’s body weight during a sprint or push off

How do I get Achilles Tendonitis?
Overuse, misalignment, improper footwear, medication side effects, and/or accidents can all result in Achilles tendon injuries. Multiple causes often contribute to the same Achilles tendon injury.

How do I prevent Achilles Tendonitis?
The best way to prevent an Achilles tendon injury is to a) stay in overall good shape, and b) warm-up, stretch, and strengthen the Achilles tendons. The best way to prevent an Achilles tendon injury from getting worse is to address the injury immediately: it will get worse if not addressed

The undue strain could be caused by a variety of factors, including: tightness or weakness of the leg, knee, hip, or back; high or low arches; uneven leg lengths; alternating between high (2”) heels and exercise shoes; and/or sudden (rather than gradual) increases in training, such as running faster, further, or up steeper hills.

The most common Achilles tendon injuries are Achilles tendinosis (formerly called Achilles tendonitis) and Achilles tendon rupture. Achilles tendinosis is a soreness and stiffness that comes on gradually and continues to worsen until treated. It often starts with stiffness and creaking when first getting out of bed in the morning. Lightly pinching the Achilles tendon with the forefinger and thumb will indicate soreness. Achilles tendinosis is a common injury among middle and long distance runners. Achilles tendon rupture is a partial or complete tear of the Achilles tendon. It comes on suddenly, sometimes with a popping sound, and is debilitating. Partial and full Achilles tendon ruptures are most likely to occur in sports requiring sudden eccentric stretching, such as sprinting and racquet sports. Partial Achilles tendon tears are also common among middle and long distance runners. Achilles tendon ruptures are most likely to occur to middle age athletes who have not been training or who have been doing relatively little training. It is sometimes difficult to distinguish between Achilles tendinosis and a partial Achilles tendon tear.

How do I treat Achilles Tendinotis?
Treatment for Achilles tendonitis includes: relative rest, muscle strengthening, physical therapies (i.e. Ultrasound, and electrical stimulation), and ice. Treatment for an Achilles rupture includes complete immobilization, or in the most severe cases: surgery. Consult a physician to be sure.

Running Shoes
Correct footwear can be one of the keys to preventing, recovering from, and preventing the reoccurrence of, Achilles tendon injuries. Incorrect footwear can cause or exacerbate Achilles tendon injuries. Selecting the right shoe or sneaker in terms of cushioning, arch height, and pronation is always beneficial. Some people experience a tremendous temporary benefit from a little extra padding or cushioning under the heel.

6. Running Injuries Prevention Tips and Techniques

• Run on Softer Surfaces
  Running injuries are minimized when you run on soft surfaces, such as packed dirt and grass, whenever possible. Running on packed dirt and/or grass, however, doesn't prepare you for the pounding of city streets that most of your training and races are run on. In that case, avoid concrete (such as sidewalks) and look for asphalt.



 

• Avoid Tight Turns
  Tight turns and indoor tracks are a common cause of running injuries. Look for slow curves and straight paths. Shins are especially stressed on indoor tracks due to the combination of a hard surface and tight turns.



 

• Pay Attention to Injury Warning Signs
  If you think you might be injured, immediately begin preventative measures in order to keep damage to a minimum and to speed your full recovery. Depending on the type of injury, this could mean using the RICE ( Rest, Ice, Compression, and Elevation) method to enhance recovery, taking anti-inflammatory medication (aspirin, ibuprofen), and taking a day or two off of running to allow the injury to heal. Secondary running injuries often occur by continuing to run through pain, favoring the injured area, and thereby changing your natural running style.



 

• Run in Shoes with Proper Cushioning and are Right for Your Feet
  Improper and/or inadequate shoe cushioning will quickly lead to running injuries. It is imperative that you train in the right running shoe that does not have an inordinate amount of wear and tear (i.e. greater than approximately 400 miles). Only Run Miles Needed to Meet Your Goals. Accumulating additional Junk miles is a sure way to cause a body to break down and for running injuries to occur. Run only the miles you need to meet your goals. Following the mantra, more must be better will lead to injury.



 

• Stay Hydrated
  To avoid heat injury while running, remember to drink plenty of non-dehydrating fluids such as water, orange juice, or a sports drink. But don't overdo it, either. When running, drink until you hear sloshing in your stomach or feel that your stomach is full. When the sloshing sound goes away, resume drinking.



 

• Use Fresh Shoes
  Running on worn out shoes is a prime cause of many running injuries. When the mileage totals from your running shoes reach approximately 400 miles, it's time to purchase a new pair of shoes. High mileage shoes are a quick way to get injured. The shoe breaks down, and in turn, throws off your running stride. One tip to increase the life of your shoes is to purchase and use more than one pair of shoes. Running in different shoes on alternating days more evenly distributes the stress on your feet and legs.



 

• Stretch Regularly
  Lack of stretching or improper stretching can lead to running injuries. Stretching is an important complementary aspect of any running program. We know that running creates stress on certain muscle groups. Soon after you stop running, muscles that have been stressed begin to tighten. The best way to avoid stiffness and eventual soreness from stressed, tightening muscles is to stretch after your run.



 

• Cross-Train
  Cross-Training is a great way to avoid running injuries. Be sure to include some cross-training/aerobic exercises that supplement your regular running program. Cross-training will develop parts of your body that running neglects, fights muscle imbalance injuries, burns additional calories, and increases aerobic capacity. Some examples of cross-training include cycling, swimming, cross-country skiing, stair machines and hiking.



 

• Make Use of Recovery Techniques Take time to take care of yourself. Common recovery techniques can help you avoid running injuries. Some ideas for recovery from stressful runs and the cumulative effects of hard training include getting a massage, pouring cold water on tired legs after a long run or race, soaking your legs in a cold water whirlpool, going for a walk or taking an easy bike ride.