<img style="float: right;" src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2008-11_04\/step.jpg" hspace="4" vspace="4" \/>\r\n\r\nRunning has been referred to as the king of all\r\nworkouts. It is an activity that has been embraced at varying\r\nlevels of competence by nearly 11 million adults in the United\r\nStates alone, according to the American Running Association.\r\nRunning doesn't require the purchase or use of expensive equipment;\r\nit is possible to do it indoors or outdoors, usually year round.\r\nNot only does running provide a fantastic cardiovascular workout,\r\nit allows you to burn calories and clear your mind, leaving you\r\nwith that relaxed, feel-good sense for many hours afterward.\r\nHowever, to reap these benefits on an ongoing basis, it is\r\nimportant to take precautions to prevent debilitating injuries.\r\n\r\nFor all the benefits of this great activity, there is no doubt\r\nthat the repetitive nature of the stress it places on key joints\r\ncan lead to breakdown. While there is some debate about what\r\nconstitutes an injury, it has been estimated that up to 70 percent\r\nof runners will sustain some form of overuse injury during any\r\none-year period. Anyone working in the orthotics, biomechanics, or\r\nsports medicine professions will see his or her fair share of\r\nrunning injuries. These injuries can be broadly classified as\r\n<i>acute<\/i> or <i>chronic.<\/i> Acute injuries are those due to\r\nsudden motions or twisting, such as an ankle sprain, which lead to\r\nsoft tissue and\/or osseous injury. These need to be treated\r\nimmediately and allowed to heal.\r\n\r\nChronic injuries develop over time and are the result of\r\nrepetitive stress that eventually leads to breakdown; e.g.,\r\npatellofemoral syndrome. Chronic injuries account for well over 80\r\npercent of running injuries, and they can develop from either an\r\nanatomical cause or a biomechanical issueand sometimes a\r\ncombination of both. Because of its impact forces on the body,\r\nrunning greatly magnifies the extent of these anomalies. When\r\nexperienced runners develop a chronic injury, it is often necessary\r\nto investigate what they have changed in their training\r\npractices.\r\n\r\nTo get a clear picture of any injury, it is necessary to do a\r\nfull biomechanical exam. Evaluate the patient in stance and motion,\r\nnon-weight bearing and weight bearing, in shoes and out of shoes.\r\nIt is vital to follow the entire kinetic chainnot just treat the\r\nsymptomto investigate the root cause of the problem. John Connors,\r\nDPM, a New York-based sports-medicine specialist, insists on\r\nwatching his patients function in order to determine underlying\r\ncauses. He will even run with his world-class patients in order to\r\ndiagnose their etiology.\r\n<h3>Common Running Injuries<\/h3>\r\n<b>Heel pain:<\/b> Heel pain is a common complaint\r\namong runners. This is hardly surprising, given that the majority\r\nof runners who train on level ground at low to moderate speeds are\r\nheelstrikers. This running style produces an impact-force peak\r\nearly in the stance phase, which can range from one-and-a-half to\r\nfive times the runner's body weight. These impact forces are\r\nconsidered a primary cause of overuse injuries.\r\n\r\nThe classic sign of plantar fasciitis (PF) is heel pain that\r\npresents first thing in the morning and then decreases with\r\nactivity. In the early stages, the patient usually can still\r\nexercise, only to be faced with more severe pain following a run.\r\nTypically, pain will be felt at the plantar-medial aspect of the\r\ncalcaneus or at the middle aspect of the calcaneus.\r\n\r\nThere are other causes of heel pain that should not be ruled out\r\nwithout further radiographic examination. A calcaneal stress\r\nfracture may present like PF, but typically the pain does not\r\nsubside as the day progresses. A positive calcaneal compression\r\ntest can indicate the presence of such a fracture. Other\r\nconsiderations for heel pain include tarsal tunnel syndrome,\r\nneuritis of the first branch of the lateral plantar nerve, and\r\ntendinitis of the flexor hallucis longus.\r\n\r\n<b>Achilles tendinitis (AT):<\/b> Achilles tendon\r\ninjuries may be due to inflammation of the paratenon or the result\r\nof the degeneration of the tendon itself. It is broadly classified\r\ninto two groups: insertional (occurring at the tendon\/bone\r\ninterface) and non-insertional (occurring proximal to its\r\ninsertion, in or about the tendon proper). A physician's diagnosis\r\nwill confirm the location and type of condition. AT can develop\r\nwhen the tendon contracts and tightens and is then over-stretched\r\nduring exercise. There may also be a biomechanical component to the\r\ncondition, given the tendon's broad insertion on the posterior\r\ncalcaneus. Due to the cyclic rotation of the STJ from pronation\r\nthrough supination, there can be increased tension on the medial\r\nand lateral aspects of the tendon's insertion.\r\n\r\n<b>Iliotibial band syndrome (ITBS):<\/b> This is a\r\ndebilitating injury that presents as pain along the lateral aspect\r\nof the knee joint. It is sometimes accompanied by a clicking\r\nsensation. Current thinking is that ITBS results from weak core and\r\nhip muscles that fail to prevent tightening and strain the IT\r\nband.\r\n\r\n<b>Medial tibial stress syndrome (MTSS):<\/b> Commonly\r\nknown as "shin splints," this pain is typically noted along the\r\nlower third of the posterior medial surface of the tibia. It can\r\noften result from improper biomechanics or by not following the\r\ntraining considerations described earlier.\r\n\r\nThere are many other injuries that you are likely to see in\r\nrunners such as posterior tibial tendon pain, knee pain, and a\r\nvariety of stress fractures. Forefoot pathologies can include\r\nfunctional hallux limitus, sesamoiditis, and second metatarsal\r\nphalangeal joint (MPJ) capsulitis, in addition to regular blisters,\r\ncorns, and neuromas. Much has been written on each of these\r\nconditions and their specific rehabilitation treatments. "How to\r\nDetect and Treat Running Injuries," by Brian Fullem, DPM,\r\n<i>(Podiatry Today,<\/i> May 2005) covers the basics. It is an\r\nexcellent resource.\r\n<h3>Preventative Measures<\/h3>\r\nOver the years, I have developed a great love for running, so I\r\ncan say from personal experience as well as patient interaction\r\nthat nearly all running injuries result from training errors. I try\r\nto follow my own advice on injury prevention as outlined above. I\r\nbegin a run by forcing myself to stretch; I change out my running\r\nshoes as necessary, even if they look almost new; and I vary my\r\nworkouts with swimming, yoga, and sometimes bicycling to ensure\r\nadequate rest. I am pleased to say that I am injury free. However,\r\nwhen injuries do occur, treatment will generally follow a protocol\r\nof relieving pain, resting, icing, stretching, focused\r\nstrengthening, and improving biomechanics. Good support from shoes\r\nand orthotics, good running form, and good training habits, such as\r\nalways stretching, will prevent the return of many of these\r\ninjuries. I believe foot orthotics, whether custom or not, play an\r\nessential role in keeping a runner injury free by aligning the body\r\nproperly. Regardless of foot type, appropriate orthotics will\r\nincrease shock absorption and prevent end-of-range-of motion, thus\r\nprotecting tendons, muscles, and joints.\r\n\r\nAnother strategy for preventing running injuries is to advise\r\nyour patients to modify their running style. Recently, I have begun\r\nusing a technique called ChiRunning\u00a9\u00a0( <a href="https:\/\/opedge.com\/3160">www.chirunning.com<\/a>). In essence, ChiRunning\r\naims to lessen the forces that most runners experience by\r\nintroducing a slight forward lean and a biomechanically efficient\r\nflow to their running style. It advocates running with relaxed\r\nlower legs and using a mid-foot strike to avoid the braking and\r\nimpact of heel strike. Since adopting the ChiRunning approach, I\r\nhave found running even more enjoyable, not to mention less\r\nstrenuous.\r\n\r\nHopefully, armed with this information and more, you can help\r\nyour runners achieve their goals.\r\n\r\n<i>S\u00e9amus Kennedy, BEng (Mech), CPed, is president and\r\nco-owner of Hersco Ortho Labs, New York, New York. He can be\r\ncontacted via e-mail at<\/i><i><a href="mailto:firstname.lastname@example.org">email@example.com<\/a><\/i><i>, or\r\nvisit<\/i><a href="https:\/\/opedge.com\/2966"><i>www.hersco.com<\/i><\/a>\r\n<h3>Training Considerations<\/h3>\r\n<img style="float: right;" src="https:\/\/opedge.com\/Content\/OldArticles\/images\/2008-11_04\/step2.jpg" hspace="4" vspace="4" \/>\r\n\r\n<b>Increasing mileage and\/or speed:<\/b>\r\nMake any changes in distance or tempo gradually.\r\n\r\n<b>Breaking in new shoes:<\/b> Break in new shoes\r\nslowly over a few runs. Ensure that the last and sole design match\r\nthe runner's foot type; i.e., pronator, supinator, or\r\nnormal\/neutral.\r\n\r\n<b>Running in old or worn-out shoes:<\/b> It is\r\nrecommended that runners switch out their sneakers every 300-500\r\nmiles. If sneakers are over-worn, they lose shock absorption and\r\ntheir ability to control rearfoot and subtalar joint (STJ)\r\nmotion.\r\n\r\n<b>Running on unforgiving surfaces:<\/b> Elite runners\r\nusually avoid running on roads too often due to the unrelenting\r\nhard surface and the banked edges. It is best to look for firm\r\ntrails with some forgiveness, such as dirt, woodchips, fields, or\r\nboardwalk. Slightly uneven terrain also helps avoid an exact\r\nrepetition of each stride.\r\n\r\n<b>New running style:<\/b> Any change in running\r\ntechnique should be applied slowly, to allow the body to adapt.\r\n\r\nBe aware that a change in weight, and even aging, can contribute\r\nto the onset of an injury.