Running away from injury

Running is a common way to stay fit — in theory, all you require is a good pair of running shoes. But running can also lead to a variety of injuries. Our experts talked to us about the most common running injuries and how to avoid them.

According to Jeff Rothstein, the Director of Sports Enhancement for the PT Center for Sports Medicine, a Physiquality clinic in Akron, Ohio, the most common running injuries are to the foot, knee and back. Jeff notes that having the right running shoes is essential for avoiding injury.

Lori Francoeur, a physical therapist at Foothills Sports Medicine Physical Therapy Center in Arizona, agrees. She explains that runners should wear a “good supportive shoe that will provide adequate support and cushioning for your arch and heel.”

For runners, back and knee injuries are often a result of weak muscles.Back and knee injuries are often a result of weak muscles, says Jeff, as many runners focus on running without strength training. He advises that runners strengthen their glutes, hamstrings and core to support the body while running. Otherwise, runners can be prone to imbalanced muscles, which can lead to a poor gait and possibly injury. (If you’re worried about your gait, many physical therapists do gait evaluations to help runners improve their form.)

A running coach and marathoner, Lori cautions runners to take a slow and steady approach to progressing distance. She advises any new runners to not start with more than 1 – 2 miles at a time, not necessarily running the entire time – just plan to be moving the entire time, whether you are walking or running at a slow pace. Keep track of each run’s distance, and don’t increase your mileage by more than 10% per week. There are plenty of ways to measure your distance these days, whether by using an iPhone or Apple watch, or a sports-specific monitor like those from Physiquality partner Polar.

Most runners don't stretch enough.Jeff also points out that most runners don’t stretch enough. “This will lead to progressive shortening of the major muscles involved in running,” he says, which can limit your joint’s range of motion and put you at a greater risk for injury. While stretching can be done before or after your run, Lori notes that stretching should be done when your muscles are already warm, making it better to stretch afterwards. This post-run stretch regimen from Polar lengthens your glutes, hamstrings and calves, and opens your hip flexors, all key muscles for running.

And don’t forget the importance of rest. Rest allows our muscles and joints time to recover from the pounding we endure from running, says Lori. As we’ve previously noted here, It is only after your workout, when you are resting and replenishing your body with protein and other nutrients, when the body heals and gets stronger.

Finally, any runner should listen to his body. While starting a new activity typically comes with muscle soreness and some aches and pains, notes Lori, an intense pain, or a pain persisting for multiple days that does not subside with rest, is one you should have checked out. Physical therapists are a great resource; many outpatient orthopedic physical therapy clinics offer free injury evaluations. A PT will be able to listen to your complaints and complete an assessment to determine what the problem is. Then she can create a strengthening and/or stretching program for you to perform to resolve the problem.

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What is minimalist running? Is it safe?

Trends come and go in fitness, and running is no exception. Minimalist running has been growing in popularity over the last decade, but some runners still question its safety. Barefoot or minimalist running is running that occurs either WITHOUT footwear, or with footwear that lacks high cushioned heels, stiff soles and arch support, a.k.a. minimalist footwear.

Lee Couret, a physical therapist and the owner of Southshore Physical Therapy in Louisiana, says there are many benefits to barefoot running. For example, he says, running barefoot can reduce the impact of the footfall when running. This is because most barefoot runners avoid landing on their heels, because it hurts! Landing with a heel strike is believed to be a potential cause of injury. A study published by the Skeletal Biology Laboratory at Harvard Medical School found that those runners that land on their heels while running were much more likely to suffer injury than those who land on the forefoot, or the ball of the foot. And Lee explains that reducing the impact can reduce running injures, as studies have found that people who run with greater impact often have more injuries.

Barefoot runners may actually be stronger.Aside from fewer injuries, barefoot runners may actually be stronger. Running without shoes can strengthen the muscles, tendons and ligaments in the foot while also stretching and strengthening the calf muscles, notes Lee. It can also improve balance and proprioception via activation of the smaller muscles in the legs and feet. And minimalist runners may experience increased efficiency, he says, as barefoot running requires less energy and oxygen consumption.

But don’t rush to throw out your running shoes without considering the cons. Running without shoes means that your feet aren’t protected, from either the elements, like cold, heat, snow and rain, or the variety of things you can find on the road — glass, pebbles, nails, and more. Barefoot runners will be more prone to blisters, points out Lee, and might be at a higher risk for Achilles tendonitis or plantar fasciitis while transitioning from running in shoes.

Be cautious as you transition from running in shoes to running barefoot.A conscientious uncoupling from your shoes is key to a successful transition, advises AlterG,. If you want to start running barefoot, think about talking to your physical therapist about it. She might be able to do a gait analysis to see whether your gait would need to be improved before you transition. If you run with a heavy heel strike, it may be difficult for you to switch to the forefoot strike essential for barefoot running. Lee suggests following these tips from the Spaulding National Running Center to make a healthy transition:

  • Land gently, with your foot relatively horizontal and under your hips (this will shorten your stride).
  • Transition slowly — see the full running plan from SNRC for guidelines.
  • Stretch your calves and Achilles tendon before and after running.
  • Buy low profile shoes (low heels, minimal arch support, flexible soles) to use when running barefoot is not safe.

And, above all, listen to your body! Don’t do anything that causes pain, and see your physical therapist or doctor if you have pain that lasts for more than a couple of days after running.

 

Lee Couret, PT, MSPT, CSCS Lee Couret, PT, MSPT, CSCS, is a physical therapist and the owner of Southshore Physical Therapy, a Physiquality network physical therapy clinic in New Orleans, Louisiana. A triathlete himself, Lee has served as the physical therapist for the University of New Orleans Privateers, a local triathlon team; the Swamp Dawg Multisport Team; and many local high school athletic programs.
Lee is a Certified Strength and Conditioning Specialist and has completed in many triathlons, including the Ironman Florida and Ironman France triathlons. He sends a special thanks to Irene Davis, Director of the Spaulding National Running Center at Harvard Medical School; much of this information is derived from a course he took with her in 2012.

For further reading, look through our selection of articles on running, in addition to the below links:

Bernstein, Lenny. Is barefoot running better for you? The Washington Post, May 9, 2014.

Physiquality.

The benefits of barefoot running. AlterG, June 10, 2011.

Reynolds, Gretchen. New York Times.

Crowell, Harrison Philip. Reducing impact loading during running with the use of real-time visual feedback. Journal of Orthopedic Sports Physical Therapy, April 2010.

Lieberman, Daniel et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature, January 28, 2010.

Barefoot running training tips. Spaulding National Running Center.

Milner, Clare E., et al. Biomechanical factors associated with tibial stress fracture in female runners. Medicine and Science in Sports and Exercise, February 2006.

Proprioception. Physio-pedia.com.


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Preparing for your first race

In theory, running is an easy sport to take up — it might seem that you could simply put on a pair of running shoes and run. But if you don’t take into consideration the proper form, training, shoes and nutrition, you could easily set yourself up for an injury.

While we all may have run around the playground as children, running is not a natural skill for most of us as adults. Many of us sit for hours at a time, in front of a computer at work or at home on the couch. So before you focus on improving your time, make sure that you have thought about your form. If you have tried running already, but have felt pain after or especially while running, consider seeing a physical therapist for a fitness assessment, as well as gait analysis, to determine whether improving your form can reduce pain and the chance of injury.

To stick to your running regimen, sign up for a race.Once you and your PT have come up with a training plan, one of the best ways to stick to your plan to run is to sign up for a race. Most metro areas host plenty of 5Ks throughout the year that may be convenient for you. Having a deadline makes it easier to train gradually, explains Ryan Bozant, a physical therapist at Moreau Physical Therapy in Louisiana.

Ryan cautions runners to think about training without overtraining, which can cause an overuse injury. He points to several online running plans that can help to set running goals and a running schedule. Most will recommend training over a two-month period. Here are a few of Ryan’s favorites:

Be sure to do an active warm-up whenever you run.Ryan also recommends doing an active warm-up whenever you run. This can be a series of running drills or simply walking for a few minutes before picking up the pace. A warm-up can also include simple exercises like squats and lunges, or getting on the ground for some sit-ups and push-ups. Any of these things will get your heart pumping and prepare the body to run.

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Buying the right shoe for whole‑body health

Whether you’re young or old, the wrong pair of shoes can lead to pain from (almost) your head to your toes. High heels can damage your back, knees and feet while increasing your risk for ankle sprains or breaks; they can also lead to arthritis, foot deformities, poor posture, plantar fasciitis and balance impairments. The lack of arch support and foot protection in flip-flops can lead to a number of issues, including tendinitis and stress fractures.

So how can you pick a pair of shoes that is good for your feet?

Look for flats or low wedges over high heels.Some women may not want to hear it, but the first step is to walk away from the high heels. Look for flats or low wedges; while a wedge helps to distribute the weight of your feet throughout the sole of the shoe, if its incline is more than an inch or two, it will still affect your body’s alignment, which can cause knee and back pain.

Both men and women should try to avoid thinking of comfortable or healthy shoes as orthopedic shoes. “The term ‘orthopedic shoes’ conjures up an image of a clunky, heavy and unattractive shoe to treat a medical condition,” says Brian Hoke, a physical therapist and a member of the Vasyli Medical Think Tank. This misperception is a big part of the problem in getting people into footwear that supports the natural anatomy and biomechanics of the foot. Brian notes that many manufacturers have embraced a much more fashion-forward approach to supportive footwear that blends fashion and function. Read more

 

What is plantar fasciitis?

Did you know that your feet are likely to walk as much as 75,000 miles by age 50? Healthy feet are key to a healthy life. Plantar fasciitis is one of the most common orthopedic problems that can wreak havoc on the foot.

On the sole of the foot, the plantar fascia is a thick piece of tissue that runs from the base of the heel to the tip of the toes, along the arch of the foot. When it is inflamed or irritated, the condition is referred to as plantar fasciitis. Its symptoms are typically severe pain along the arch of the foot and the heel.

What causes plantar fasciitis?

People with abnormal foot arches — either flat or high — are more prone to plantar fasciitis, as are those with tight Achilles tendons (the tendon connecting your calf muscle to your heel). More commonly, it is an overuse injury, caused by sports like running or basketball, or prolonged walking or standing. It can also be a result of shoes with poor arch support, or even obesity.

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Celebrating Family Health and Fitness Day

Americans young and old have been gaining weight and slowing down. A report on physical activity and health from the U.S. Surgeon General’s office in the late 1990s found that “nearly half of young people aged 12-21 are not vigorously active on a regular basis” and that more than 60% of adults aren’t as active as they should be.

(A more recent study in 2010 didn’t show any improvement, finding that only 15% of high school students achieve the recommendations set by the CDC for physical activity.)

These findings led to the creation of Family Health and Fitness Day on September 28, a celebration marking its 17th year in 2013 that celebrates activity for the whole family.

Why is this something Americans should commemorate?  Read More

How to train safely for a marathon

Running a marathon has become a common goal for even casual runners. Aside from giving runners a goal to work toward (and giving them a reason to continually train), it has become a sign of a Serious Runner, one who can complete the challenge of such a long-distance race. And while some people think training isn’t that important, most trainers agree that it takes months of steady preparation to ready your body for such a rigorous run.

“As soon as you sign up for your first marathon, your running transforms to actual training,” says Heidi Beasley, a physical therapist at Accelerated Rehab (a Physiquality member in Gilbert, Arizona). If you are new to the sport, she suggests, plan at least six months to complete your training; consistent runners should train for at least 10 weeks for a half marathon and 12-24 weeks for a full marathon. And any runner should check with her physician before engaging in training.  Read More

Choosing a running shoe

What should runners look for in a running shoe? Virginia Davis, a physical therapist and owner of Crescent City Physical Therapy (a Physiquality network member in New Orleans), acknowledges that it can be a daunting task to buy running shoes. She reminds runners to “find the best shoe for YOUR feet!” This means that you need to know a great deal about your physiology and your running stride before you make that purchase.

A physical therapist can help you understand these factors with a biomechanical evaluation. According to Laura Winslow, a PT and the clinical director of the Eastside location of Allegheny Chesapeake Physical Therapy (a Physiquality member with 10 locations in Pennsylvania), “A physical therapist can identify the anatomical type of your foot (i.e., whether you have stiff or flexible arches) and make suggestions as to the proper type of shoe for your needs.” Read More

How to switch from running outside to running inside on a treadmill

Answer: 

Running outside differs from running on a treadmill in that the surface is harder, there is a change in scenery, and your body will naturally adjust the speed as soon as you start to fatigue.  The treadmill has its own advantages as well.  Bad weather is never an issue when you run on the treadmill.  You can also maintain a certain speed without worrying about your body slowing down.  When transitioning from outside running to treadmill running, it is very important to choose a speed that you can comfortably maintain for the duration of your exercise and to remember not to veer off of the propelling treadmill belt.