Running Injuries

Medical Disclaimer: The information in this book is intended as a general guide, and in no way should be seen as a substitute for your doctor’s own advice. All care is taken to ensure the information is free from error or omissions. No responsibility, however, can be accepted by the author, editor, publisher, or any other person involved in the preparation of the material for loss occasioned to any person acting or refraining from action as a result of the published information. Before commencing any new health program, diet or exercise, always consult your doctor.

Running Injuries

Treatment and Prevention

Jeff Galloway & David Hannaford DPM

Meyer & Meyer Sport

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

Jeff Galloway, David Hannaford

Running Injuries

Maidenhead: Meyer & Meyer Sport (UK) Ltd., 2010

ISBN 978-1-84126-737-1

All rights reserved, especially the right to copy and distribute, including the translation rights.

No part of this work may be reproduced – including by photocopy, microfilm or any other means – processed, stored electronically, copied or distributed in any form whatsoever without the written permission of the publisher.

© 2010 Meyer & Meyer Sport (UK) Ltd.

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Also available in print.

Print-ISBN 978-1-84126-284-0

E-Mail: info@m-m-sports.com

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Contents

by Dr. David Hannaford

About the list of injuries

Area 1 - THE FOOT AND TOES

Toe Nails – Discolored Toe Nails

TOE NAIL TRAUMA

Anywhere on Foot

BLISTERS AND CALLUSES

Toe Numbness, Pain and Tissue Damage

RAYNAUD’S SYNDROME

Front of Foot – Base of Toes, Occasionally Top of Foot

NEUROMA

Front of Foot on Bottom – May Include Toes

METATARSALGIA

The Second or Third Toe Joint

METATARSAL PHALANGEAL SYNOVITIS

-ALSO KNOWN AS CAPSULITIS, PRE-DISLOCATION SYNDROME, PLANTAR PLATE INJURY

Pain in Outer Top of Foot and Up to Ankle Crease

EXTENSOR TENDINITIS

Foot – Front to Middle

STRESS FRACTURE OF THE FOOT

Behind Big Toe – Top of the Foot at the Instep

FIRST METATARSAL-CUNEIFORM AREA

Pain that Is Deep Inside the Big Toe Joint

BIG TOE PAIN

Outside of Foot – Midway on the Prominent Bone

5TH METATARSAL STYLOID PROCESS INJURIES

Outer Side of Heel –

Also Below Ankle Bone Moving Toward Mid Foot on Outside

PERONEAL TENDON INJURY, OUTER HEEL AREA AND CUBOID SYNDROME

Inside of Foot – at Ankle Bone

TIBIALIS POSTERIOR MEDIAL FOOT/TARSAL TUNNEL

Bottom of Heel – May Extend Along Bottom of Arch all the Way to Front of Foot

PLANTAR FASCIITIS

Back of Heel – Sometimes Underneath

POSTERIOR HEEL PAIN

Area 2 - THE ANKLE

Outside of the Ankle Mostly – But Can Be Inside

ANKLE SPRAINS

On or Around the Outer Ankle Bone

OUTER ANKLE

Inside of Ankle – Just Above the Ankle Bone

TIBIALIS POSTERIOR ANKLE

Throughout the Ankle – No Specific Area

RECURRENT INVERSION SPRAINS AND ANKLE INSTABILIT Y

The Tendon Just Above the Back of the Heel Bone

ACHILLES TENDON

Area 3 - LOWER LEG BELOW THE KNEE

Front of the Lower Leg – Outside of the Shin Bone

ANTERIOR SHIN PAIN

Front of the Shin – on the Inside Inner Edge

MEDIAL SHIN PAIN

Outside of the Lower Leg, Above the Ankle to Just Below the Knee

LATERAL LOWER LEG PAIN

Various Pains in the Calf Muscle

CALF PAIN

Area 4 - THE KNEE

Pain at the Kneecap, or at the Muscle Attachment to the Kneecap

PATELLO-FEMORAL KNEE PAIN

The Area Directly Behind the Knee and Toward the Inside

POPLITEAL AND PES ANSERINUS PAIN

On the Outside of the Knee

ILIOTIBIAL BAND AND BICEPS FEMORIS INSERTION

Area 5 - UPPER LEG & BUTT

On the Inside of the Upper Leg – From the Groin or Lower Butt Muscle – In the Direction of the Knee

MEDIAL THIGH PAIN

Outside of the Thigh from the Bony Knob on the Outside of the Hip, Going Down

LATERAL THIGH PAIN

From the Upper Butt Muscle Down the Backside of the Upper Leg to the Knee

HAMSTRING PAIN

Front of the Hip, Where the Leg Attaches – Just Above or Just Below

HIP FLEXOR INJURY

Butt Muscle Pain from the Waist to the Lower Fold in the Butt

GLUTEAL PAIN AND PIRIFORMIS SYNDROME

Area 6 - THE BACK

Various Problems in the Lower Back

LOWER BACK PAIN

OTHER ISSUES

Over-the-counter Drug Issues

NON-STEROIDAL ANTI-INFLAMMATORY MEDICATION (NSAID)

USE IN SPORTS INJURIES

PHYSICAL THERAPY

The Galloway Run-Walk-Run ™ Method

The Right Pace/Run-Walk-Run Ratio Reduces Injury Risk Dramatically

The “Magic Mile”

Prediction Formulas

Choosing the Best Shoe for You

Injury-Free for Over 30 Years

by Olympian Jeff Galloway

Over 50 years ago I literally took the first steps in a life-changing experience: I started running. As a fat and lazy 13 year old, I enrolled in a required conditioning program at my school, fully expecting that running was going to hurt, and that I would quit after 10 weeks of punishment. To my surprise, I felt really good during and after most of my runs. My vitality and positive attitude was better than at any other time of the day. My new running friends were energetic, mentally alert and fun. As I pushed back the distance barriers, I discovered positive feelings and resources I had never experienced. When I was running correctly, I experienced a sense of freedom and well-being that was wonderful and unique. Running helped me be happy.

I became hooked on running and competition. But male ego and testosterone led me into a series of aches, pains and significant injuries. Not wanting to give up the wonderful benefits, and lacking perspective, I often went into denial at the onset of an injury and was forced to stop running after a few more runs due to breakdown of muscles, tendons, etc. The worst part was the psychological letdown during every “vacation” from running (about every 3-4 weeks). The withdrawal from endorphins inspired a desire to eliminate injury. This book is my latest step in that direction.

In 1978 I faced the reality that I would probably never run as fast as I had during my first 20 years of running. My new goal was to stay free of overuse injuries. I’m proud to say that for more than 30 years, I’ve done this. Chances are, you can be mostly injury free, too. In this book I will tell you the principles and steps that have kept me and over 250,000 clients away from the doctor’s office for the most part.

Every week most runners have some aches, pains or injury issues, or questions about whether they have an injury. When I give advice it is from one runner to another. Get medical advice from a doctor who has treated a great number of athletes with the same injury, successfully. Dr. David Hannaford is my top choice for almost any ailment associated with running. At my Tahoe running retreat I’ve seen him diagnose and treat injuries over and over that other specialists missed. He is as addicted to running as I am and wants to get every injured runner back on the road or trail as soon as possible. He has a gift for communicating his knowledge in ways that non-doctors can understand.

Both of us want you to understand why injuries occur, how to avoid them and that there are successful ways to prevent and treat them. We want you to gain control over your ailments.

Jeff Galloway

Why Do We Get Injured…

and How to Avoid the Risks

Plus: How to return to running... staying in shape while injured.... troubleshooting running form... and more.

by Olympian Jeff Galloway

What Causes Injuries?

Our bodies are programmed to adapt to running and walking, by making constant “upgrades” to withstand stress and perform more efficiently. Regular and small increases in workload, followed by recovery periods, promote rebuilding and improved capacity. The factor that is most commonly neglected is rest, but it is crucial: It is during the recovery period that the rebuilding takes place.

But each of us has a few “weak links” that take on more stress when we work out. These are the areas that ache, hurt or don’t work correctly when we start a new activity, increase training, or don’t provide sufficient rest after a hard workout. In some cases, pain-killing hormones, such as endorphins, will mask the damage. Most commonly, exercisers go into denial, ignore the first signs of irritation and continue training until the stressed area breaks down.

To sustain progress and avoid injury, we simply need to follow a simple pattern: 1) A slight increase in training produces a minor breakdown of tissue. 2) If the after-workout rest period is sufficient, the muscles, tendons, cardiovascular system rebuild/restructure to handle a higher level of performance. 3) All body parts continue to adapt in structure, efficiency and performance when there is a balance between workout stress and rest.

Be Sensitive to Your “Weak Links”

Most of the aches and pains experienced by my runners and walkers are located in their “weak link” areas—the muscles, joints, tendons, etc. that take more stress due to our individual range of motion. The process starts during a normal workout when micro-tears develop, in muscles and tendons, due to the focused stress of continued movement/irritation of these key parts. The number of these tiny injuries will increase on long or faster workouts, especially during the last third. But in most cases, the rest period after a workout will allow for healing of most or all of this damage.

Common Weak Links

Joints—knee, hip, ankle

Muscles—calf, hamstring, quadriceps

Tendons—Achilles, knee, ankle

Fascia—especially around joints, foot

Bones—foot and leg

Nerve tissue—foot and leg

Feet—just about any area can be overstressed

There is often no sensation of pain during or immediately after the workout because the body has a number of pain-killing mechanisms (including endorphins) which will temporarily mask the symptoms. But when a critical mass of these broken fibers has accumulated in one area, you have produced more damage than the body can repair in 48 hours—you have an injury.

Common Causes of Injuries

It’s a physiological fact that the constant use of a muscle, tendon, joint, etc., without a break, will result in earlier fatigue and reduced work potential. Continuing to run/walk when the muscle is extremely fatigued increases the quantity of micro-tears dramatically and is a major cause of injury.

By pacing conservatively and by inserting walk breaks early and often, you will gain a great deal of control over the fatigue process. You’ll empower the muscles to maintain resiliency and capacity. This lowers the chance of breakdown, by significantly reducing the accumulating damage that leads to injury. Here are some “tools” that can give you control over your aches and pains:

Aggravating Factors

Note: Studies show that runners have healthier joints and fewer orthopedic complaints than non-runners after decades of running. See RUNNING UNTIL YOU’RE 100 for more information.

Note: Those who have iliotibial band injury can often get relief from a few specific stretches that act as a “quick fix” to keep you running. Even when doing these, be careful. The foam roller treatment has been the mode that has reduced healing time for this injury. There is a picture on our website (www.jeffgalloway.com) that shows how to use this.

How Do You Know if You Are Injured?

Continuing to exercise when you feel that you might have an injury puts you at great risk of an extended layoff from running. In most cases that I’ve monitored, when I suspect that there is an injury, it usually is an injury. Be sensitive to your weak links. When you notice any of the symptoms below, take at least a day or two off from running.

You Can Take 5 Days Off from Running with no Significant Loss in Conditioning

It is always better to err on the conservative side of injury repair. If you take an extra day off at the beginning of an injury, you won’t lose any conditioning. But if you continue training with an injury, you may increase the healing time by a week or a month for each day you try to push through pain.

Quick Action Can Reduce Recovery Time Needed

Some minor irritation may require just one day off from running. As the pain level increases, so does the need for more recovery days, because there is usually more damage.

How to Lower the Chance of Injury

Staying in Shape when Injured

How to Return to Running

Injuries from Running Form Mistakes

While the body adapts and adjusts to the running motion, workouts or races that are long and strenuous can result in irregularities in our normal form. Since the body is not adapted to these “wobbles,” weak links can be irritated. Continued use, using an unaccustomed range of motion, can lead to injury. Here are some of the common ones. For more information see HALF-MARATHON, GALLOWAY’S 5K/10K RUNNING, RUNNING – A YEAR ROUND PLAN.

The “Shuffle”

The most efficient and gentle running form is a “shuffle”: The feet stay next to the ground, touching lightly with a relatively short stride. When running at the most relaxed range of the shuffling motion, the ankle mechanism does a great deal of the work, and little effort is required from the calf muscle. But when the foot pushes harder and bounces more, and the stride increases, there are often more aches, pains and injuries.

Speedwork Increases Injury Risk

Time goal runners need to run faster in some workouts, and this means some increase in stride length, greater bounce and foot pushing is needed. By gradually increasing the intensity of speed training (with sufficient rest intervals and rest days between) feet and legs can adapt. But there is still a risk of injury. Be sensitive to your weak links and don’t keep running if there is the chance that you may have the beginnings of an injury (see also p. 30).

Correct Posture Can Reduce Aches and Pains

Posture is an individual issue. Most of the runners I’ve worked with find that an upright posture (like a “puppet on a string”) is best in all ways. When runners use a forward lean there is a tendency to develop lower back pain and neck pain. A small minority of runners naturally run with a forward lean with no problems. In this case, one should run the way that is most natural.

Suggestions for Running Smoother, Reducing Irritation to Weak Links

Cramps in the Muscles?

At some point, most people who run will experience at least an occasional cramp. These muscle contractions usually occur in the feet or the calf muscles and may come during a run or walk, or they may hit at random, afterward. Very commonly, they will occur at night, or when you are sitting around at your desk or watching TV in the afternoon or evening. When severe cramps occur during a run, you will have to stop or significantly slow down. Medications, especially the statin drugs, often cause cramping during exercise. If this is a possible cause, talk to your doctor—there may be a medication that allows you to run cramp-free. An over-the-counter salt tablet called SUCCEED has been very effective.

Cramps vary in severity. Most are mild but some can grab so hard that they shut down the muscles and hurt when they seize up. Light massage can relax the muscle and allow it to get back to work. Stretching usually increases the damage from the cramp, tearing the muscle fibers, according to my experience.

Most cramps are due to overuse—doing more than in the recent past, or continuing to put yourself at your limit, especially in warm weather. Look at the pace and distance of your runs and workouts in your training journal to see if you have been running too far, or too fast, or both. Remember to adjust pace for heat: 30 sec a mile slower for each 5 °F of temperature increase above 60 °F—or 20 sec/kilometer slower for every 2 °C of temperature increase above 14 °C.

Continuous running increases cramping. Taking walk breaks more often can reduce or eliminate them. Numerous runners who used to cramp when they ran continuously stopped cramping with a 1 minute walk break after 1-3 minutes of running during a long or fast run.

During hot weather, a good electrolyte beverage (consumed during the day, during the 24 hours after a long or hard run) can help to replace the fluids and electrolytes that your body loses in sweating. Accelerade has been the most effective in my experience. Drink about 6-8 oz every 2-4 hours, throughout the day.

On extremely long hikes, walks or runs, (especially during hot weather) the continuous sweating can push your sodium levels too low and trigger a fatigue cramp more quickly. If this happens regularly, a buffered salt tablet has helped greatly—a product like Succeed. If you have any blood pressure or other sodium issues, check with your doctor first.

Here Are Several Ways of Dealing with Cramps:

Exercises that Can Prevent/Treat Injuries

Plantar Fascia and Foot Injuries—the Toe Squincher

This strengthens the many muscles in the foot, promoting a strong push off, reducing foot fatigue, and reducing foot damage. Point your foot down and contract the muscles of the foot, which will cause the toes to curl in. Keep the contraction until the foot cramps. This can be done when wearing shoes or not, 15-20 times a day.

Back and Shoulder Soreness and Pain—Arm Running/ the Crunch

Holding dumbbells (hand held weights) in each hand, go through a slightly exaggerated motion one would use when running, for a set of 10 (one left and one right equals one repetition). Pick a weight that is heavy enough so that you feel you have strengthened the shoulder and neck muscles, but don’t have to struggle to finish the last two repetitions.

I-T Band—Foam Roller

This is the only treatment I’ve found that can speed the healing of the I-T band. Use a cylinder of dense foam (illustrated on www.jeffgalloway.com). Lie down on your side, where the I-T pain is felt. Rest your body weight on the roller and move your body with your hands so that you’re rolling from below the pain site to just above it. Roll for 5 minutes before the run, 5 minutes after the run and 5 minutes before bed at night (probably the most effective).

Ice Massage for Achilles and Other Tendons Next to the Skin

Freeze a paper cup or Styrofoam cup. Peel off the outer layer at the top to form a Popsicle of ice. Rub the ice constantly over the tendon for 15 minutes. The area should be numb after the treatment.

Night Treatments May Help More than Others

Experts tell me that most healing occurs overnight. If you perform one of these treatments before you go to bed, you may speed up the healing process.

Preventing Speed Injuries

Running faster than your “comfortable” pace for that day will increase injury risk. The further and faster you go in a speed workout or race, the greater the risk. But since you must run faster during some workouts to run faster in races, here are some ways of reducing this risk.

Warm up thoroughly.

If you are sensitive to your weak links, take the appropriate walk breaks/rest days, stop training when there could be an injury, and treat a damaged body part, you may avoid all serious injuries. This will bestow the greatest reward from running: enjoyment of every run.

Jeff Galloway

www.RunInjuryFree.com

US Olympian

Treatment of Injuries

by Dr. David Hannaford

About the List of Injuries