Treatment of Lower Extremity

Pain in Runners

Dick Evans PT, OCS10-11-07

60-65% of all runners are injured in an average year

Runners miss approximately 5-10% of their scheduled workouts due to injury

65% injury rate & 10% absent rates could be significantly lowered if some simple adjustments were made in training schedules

Possibly decreasing injury rates 25%

Five Anatomical Hot Spots

Knee-25 to 30%~endurance runners

Calf & Shin~20% Iliotibial band~10% Achilles tendon~8 to 10% Foot & ankle~10 to 15%

25% of running injuries require medical care

75% of those who seek medical care have good to excellent recovery

2 to 3% of running injuries have work absences

65% of runners report they are running pain free after 8 weeks of treatment

Males & females have the same injury rates per hours of training

Males tend to train longer so appear to have more injuries

No direct correlations between Speed training Race speed Running surface or Body weight

Warm Up, Cool Downs & Stretching may not prevent injuries

First time runners had a higher injury rate compared

to those who had trained many years

Location of Injury Marathon runners~knee & foot Middle distance~back & hip Sprinters~hamstrings

Spring & Summer are high injury seasons For example if May was a high mileage month you may have potential break down in June

Total training mileage is an excellent predictor of injury.

More miles you accrue per week, the more time you spend running & the higher the risk of injury

Injury risk is linked with inexperience

runners who have trained less than 3 years were more likely to have an injury

Significantly more injuries occur when training more than 40 miles per week

novice runners have a harder time handling larger increases in training volume

2 best predictors of injury If you have a previous injury, you have a

50% chance of recurrenceimportance of short term care –riceand longer term care related to

strength training and specific program related to return to running

Number of consecutive days of training;by reducing consecutive days of training,

injury rates are lowered

Run Monday through Friday5 consecutive days, 6 miles 5 x 6 = 30

run mon, wed, fri, sat , 2 consecutive days

4 x 7.5 = 30

The key is to develop training strategies which promote healing of injured body parts

Have fewer consecutive days of training

Reduce mileage if problems occur Incorporate running specific

strength and flexibility training Add intensity vs. mileage

Common Injury Sites in Runners

Hip & Thigh Injuries Trochanteric bursitis Hip abductor pain syndrome Iliotibial band syndrome Quad & Hamstring Pulls

Knee Injuries

Patellofemoral Pain Syndrome Meniscal Tears

Leg Injuries

Shin Splints Stress fractures Compartment Syndromes

Ankle Injuries

Ankle Sprains

Achilles Tendonitis

Foot injuries Plantar fasciitis Central heel pain Over pronation-arch pain Supination –stress fractures Metatarsalgias, sesamoidittis, Post tib tendonitis Peroneal tendonitis Subungual hematoma – nail bed bleeds

Treatment of injuries in runners

Acute phase – rice , rom, pain control modalies, swelling control, activity modification, open chain strengthening when indicated

Advance to closed chain strengthening Gradual return to impact –monitor closely Balance – agility drills Sports specific /running specific

progressions.

Avoiding injuries also include importance of proper shoe wear, cross training considerations, specific stretching and strengthening considerations and good running form – gait lab evaluation

Thanks for your time and attention.