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Category: E-news

What are “Shin Splints”?

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By Doug James – Physiotherapist and Podiatrist, intraining Running Injury Clinic

Shin pain is a common complaint seen at the intraining running injury clinic. When the injured runner is quizzed on what they think is wrong, they confidently say “Shin Splints”, and then quickly admit they have no idea what that means.

“Shin Splits” is a wide-ranging term for exercise-induced lower leg pain. It is very general in nature as the lower leg contains a number of different structures that can be responsible for this pain. The most common form of shin pain in runners is called “Medial Tibial Stress Syndrome” or MTSS.

Medial Tibial Stress Syndrome (MTSS)

MTSS involves pain and injury to the medial (i.e., left side of the right shin and vice versa) part of the main shin bone (the tibia) as a response to stress (usually some sort of impact exercise). This injury is a continuum where the severity can progress or regress based on the healing ability of the athlete, and the amount of stress the leg is exposed to.

Shin Bone Anatomy

Positioned along the outside of the tibia bone is a thin layer of tissue called periosteum which helps muscles attach to it. There are a number of muscles that attach to it, most notably being your calf muscle, which uses the tibia as leverage to provide the main forwards’ force when running as well as shock absorption on impact.

MTSS Stages

In the early stages of MTSS, the periosteum can become inflamed from the tension created by the deeper calf muscle – the Soleus – when contracting during movement. This can be felt as mild discomfort and is unpleasant to touch. With adequate healing time, pain management (ice packs, anti-inflammatory medication) and rest this will usually calm down in a few days. It may be uncomfortable to exercise on initially but will usually “warm up” within 10-15 minutes and be unnoticeable until the leg has cooled down again.

The more advanced and severe stages of MTSS more directly affect the tibia. This bone contains a hard outer layer (cortex) with soft marrow within it. Running subjects the tibia to different forces – compression along with flexion and twisting as the bone absorbs shock both directly and via its muscle attachments. A healthy bone will have a capacity to resist these forces and with regular, gradually increasing exposure, this capacity can increase too via the body’s repair process.  Where training load has exceeded the body’s ability to repair that stress, the bone marrow can become bruised and swelling accumulates within it –known as a stress reaction.

Stress Reaction Stage

This moderate stage of the injury tends to take longer to warm up and may become sore again during longer or higher intensity sessions. By reviewing a thorough history and performing some clinic testing, a Sports Podiatrist or Physio should be able to determine if the injury is in this stage. If in doubt, an MRI (not an X-ray or Ultrasound scan) can be used to detect the level of severity.

Reduced loading for a short period of time is usually recommended to allow the body a chance to repair the tibia properly. When the body repairs the tibia, it strips away part of the damaged bone which in turn makes it temporarily weaker and more prone to worse damage during this time. If training intensity and/or volume is resumed at a too great intensity and/or volume this can lead to the final stage of MTSS – a stress fracture.

Stress Fracture Phase

The final stage of MTSS involves damage to the cortical (outer) layer of bone. When a hairline fracture occurs within the tibia bone, weight-bearing exercising is usually consistently painful and swiftly becomes worse. The shin may also be painful when walking and at rest. Unfortunately, tibial stress fractures require complete rest from running and other impact activities. Recovery usually takes at least 8 weeks or more depending on the part of the bone affected. Upon return to training, load management is imperative and training in the early weeks needs to be resumed at a conservative level to prevent reoccurrence.

MTSS Risk Factors

The amount of training stress required to trigger MTSS varies across athletes. Where some runners can comfortably run 200km in a week, others may develop MTSS doing just 10% of that. The key is how well-conditioned each runner is. If an athlete has a long history of consistent running with minimal injuries, they generally will have stronger bones and more resilient muscles and periosteum. This strength and resilience provide protection against MTSS if the training load increases within a reasonable amount – approximately 10-20% of the previous week’s time or distance, though intensity also needs to be considered. Recovery is also critical for avoiding MTSS. This is not only periods of rest between running sessions, but also includes good nutrition (including calcium and Vitamin D), and 7-9 hours of sleep each night. It is important that footwear suits that athlete’s foot type and be in good condition (ideally <800km old).

Compartment Syndrome

A potentially more serious shin injury that can develop in runners is Compartment Syndrome. This occurs when the amount of pressure within the muscle compartment (formed by the muscle sheath) significantly restricts or occludes the flow of blood within it resulting in pain, swelling, and often numbness and coldness in the shin and foot. Direct trauma can cause it, however significant sudden increases in training load (often seen in new Army and Police recruits) can increase the muscle size and/or amount of fluid within the sheath which persists for hours or days after exercises. Where symptoms (particularly nerve and circulation symptoms) persist, emergency surgery is needed to release the compartment pressure by creating an incision in the sheath. While this injury is relatively rare, it has shared risk factors with MTSS and may be avoided with a carefully considered approach to training and recovery.

How to treat Shin Splints

Shin pain has a number of contributing factors. How you run, along with how often and how far you train, and what shoes you wear while running can have an important influence on the development of shin injuries. The Podiatrists and Physiotherapists at the intraining running injury clinic are experts at addressing these aspects. They are experienced in the assessment and treatment of shin and running injuries and are able to help you manage and avoid these issues. If you’re currently dealing with shin pain, or are looking to start or increase your running training, book in to see one of the running experts at the intraining running injury clinic to ensure you’re on the road to pain-free running.

MAKE AN APPOINTMENT HERE
Doug-James-Colour-2020

Doug James  – Physiotherapist  & Podiatrist 

Doug James is a qualified physiotherapist and podiatrist with special interest in running and sports injuries. He combines the two treatment approaches to achieve successful outcomes for clients of all abilities from non-athletes through to elite athletes.

Bachelor of Podiatry (honours), Master of Physiotherapy Studies.

Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment.

Doug is also a keen runner having completed the New York Marathon.

Saucony Endorphin Speed 3

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Saucony Endorphin Speed 3 Review 

“The Endorphin Speed 3 is an excellent update to what was already a great shoe… it feels like a shoe you could run some major kilometres in“

with Steve the Footman, Podiatrist, runner and owner of intraining Running Centre

Saucony has just released new editions of their Endorphin range of shoes.  The Endorphin Speed 3 is an excellent update to what was already a great shoe.

On my initial run with a Speed 2 on one foot and the Speed 3 on the other, the Speed 3 feels slightly softer and bouncier. There is also an unusual feeling of the midsole in the heel pushing in on both sides as I land adding stability. This may be a reflection of the increased midsole width in the Speed 3.

When comparing it to the Endorphin Pro 3 (their racing version) you can notice both the extra softness and flexibility thanks to nylon rather than carbon plate. It lacks the extra zippiness of the Pro 3 and feels like it has less stack height. However, it feels like a shoe you could run some major kilometres in.

The other very significant feature is the addition of a 2E width version making it the first super shoe available in widths.

 

My FOOTMAN RATING

    • Type Supershoe Trainer/Racer
    • Flexible vs Rigid = 7/10 – towards rigid
    • Firmness vs Soft = 3/10 – towards soft (Pebax midsole)
    • Durability = 4/5 but highest in the supershoe category
    • My Rating = 5/5 – This is an excellent update for an ultra cushioned lightweight trainer.

Similar Shoes available:

Asics Nimbus Lite, Brooks Hyperion Tempo, HOKA Mach 5

MAKE AN APPOINTMENT HERE
Steve Manning 1

Steve Manning – intraining Podiatrist & Level 4 running Coach

Steve Manning has worked since the 1980s to create opportunities for runners of all abilities to pursue their running goals, to establish and maintain a healthy balance of sport, health and work in their lifestyle and to connect with other like-minded and supportive runners. He has done this by creating a community of runners, coaches, sporting podiatrists, physiotherapists and a retail team with a large focus on inclusion and collaboration. He loves runners and what running can bring to people’s lives. Steve is the owner of the intraining Running Centre, a podiatrist, Associate Lecturer QUT, marathoner, Level 4 Running coach, member of the Queensland Sports Medicine board, and doting dad.

ASICS Kayano Lite 2 and Nimbus Lite 3

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A Shoe Review with Steve Manning: Podiatrist, runner and owner of intraining Running Centre

Snappy, responsive shoes that are easier to run fast in.

The barefoot running fad of around 10 years ago had a major beneficial impact on running shoe technology and design. In particular the move away from shoes that blocked movement like the motion control category towards lighter more flexible shoes that facilitated foot function.

While minimalist shoes did not live up to the hype they had a positive effect on current shoes. This has included many of the traditional shoes having a lite version.

From Asics two of these models, the Kayano Lite and Nimbus Lite have become very popular for runners wanting a lighter, faster version of the shoe they already love. These shoes are ideal for use in speed sessions and races while maintaining the fit and feel of the heritage shoes.

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Asics Gel-Kayano Lite 2

The Asics Gel-Kayano Lite 2 uses FLYTEFOAM BLAST midsole material to reduce weight and increase durability. It still has Gel in the midsole but it is hidden inside. Surprisingly the midsole itself is flared out, wider than in the Kayano 28. This adds to stability as a wider base of support but somehow does not make the shoe heavier. Stability is also enhanced with the Guidance line technology that cradles the foot from strike to toe-off. This is distinct from the Duomax midsole of the Kayano 28 and likely a significant contributor to why this shoe is lighter. Some weight saving is made in the engineered mesh upper but it still feels strong and durable. It fits like a sock making it very comfortable when first slipping it on. The outsole coverage and thickness are almost the same as the Kayano 28 so this may not be a major reason for the weight savings.

The difference in weight between the shoes is not as much as the difference in feel when running in them. It is easier to run fast in the Kayano lite and it has a more responsive snappy feel.

“The Kayano Lite 2 is one of my favourite running shoes because it feels so easy to run fast and super comfortable for my long runs. Plus, it fits my fussy feet!! I’d give these shoes 5 stars and hopefully they’ll continue to give me some great runs!” Margot Manning, podiatrist, marathoner

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Asics Gel-Nimbus Lite 3

The Asics Gel-Nimbus Lite 3 uses many of the same technologies as the Kayano Lite 2. The FLYTEFOAM midsole material, which is comprised of sustainable materials, keeps the shoe lighter and more responsive. The sidewall flaring of the midsole improves deformation at the footstrike. The major difference between the Kayano Lite 2 and the Nimbus Lite 3 is the construction of the midfoot support offering more torsional flexibility. This reflects the neutral nature of the Nimbus 24 in a lighter faster package.

So if you have liked the Asics Kayano and Nimbus come test run the Lite 2 & 3 versions on our 25m indoor track. The Asics Lite 2 & 3 versions are available now at the intraining Running Centre in Toowong.

SHOP ONLINE NOW
Steve Manning 1

Steve Manning – intraining Podiatrist & Level 4 running Coach

Steve Manning has worked since the 1980s to create opportunities for runners of all abilities to pursue their running goals, to establish and maintain a healthy balance of sport, health and work in their lifestyle and to connect with other like-minded and supportive runners. He has done this by creating a community of runners, coaches, sporting podiatrists, physiotherapists and a retail team with a large focus on inclusion and collaboration. He loves runners and what running can bring to people’s lives. Steve is the owner of the intraining Running Centre, a podiatrist, Associate Lecturer QUT, marathoner, Level 4 Running coach, member of the Queensland Sports Medicine board, and doting dad.

Bone stress injuries in runners

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5 Risk factors leading to Bone stress injuries in runners.

Doug James, Physiotherapist, Podiatrist, Marathoner.

A bone stress injury (BSI) is a painful and debilitating problem that affects runners and athletes. It usually occurs as a result of surges in training loads which often coincides with preparing for a competition or a race. Additionally, we’re finding athletes who had to take time off due to Covid-19 quarantine are at greater risk due to a marked reduction in loading during their isolation, and then an overcompensation when returning to running. Depending on the severity of the BSI, the injury may be season ending, or even career ending. The following article will discuss how BSIs develop and the risk factors associated with them.

How they develop

Bone stress injuries occur when the capacity of a bone is unable to deal with the amount of stress it is subjected to [5]. In runners, stress is most commonly generated from running training loads, but any and all physical activity can contribute. If the amount of stress and load is not adequately managed, this can lead to painful fractures developing within the bone. With impact exercises such as running, the bones in our feet, legs, hips and spine undergo stress from compression (jarring from impact when landing), and tension (from muscles absorbing impact, stabilising the body, and creating propulsion). When a healthy bone undergoes sufficient stress that is still within a tolerable level, a process is triggered within the bone to make it stronger. This process involves the removal of part of the bone’s support structure that is then replaced with remodelled and stronger bone.

Symptoms to watch for

In early-stage BSI, symptoms are usually mild – perhaps felt as an ache or light bruising sensation, and might only be felt at the start of physical activity, and/or after the athlete has cooled down. It is thought that at this stage of the injury there is usually only mild damage and a small amount of swelling around the exterior lining of the bone may be evident on MRI. At this stage, the bone’s capacity for loading and stress may be slightly reduced, so caution is needed with any higher risk activities (high-intensity sessions e.g. hills or intervals, or very long runs). If the training load (or other physical activity) continues to stress the bone in its weakened state, swelling within the marrow of the bone begins to develop. At this stage, the injury becomes more uncomfortable during running, but symptoms may still ‘warm up’ as the session continues.

If stress to the bone isn’t reduced sufficiently, the cortical or hard part of the bone begins to degrade and fractures can form within it. By this stage, the injury would be very uncomfortable to run on and is often accompanied by an aching sensation even at rest.

Common BSI sites

80-95% of all stress fractures occur in the lower limbs[1]. The majority of these lower limb BSI are found in the tibia (shin bone) 33[2]-55%[3], metatarsals (long toe bones in the forefoot) 20%[2], and the remainder in the hindfoot and femur (thigh bone).

Who is at risk

Bone Stress Injuries can account for 50% of injuries sustained by runners and military recruits [3]. Female runners are twice as likely as their male counterparts to develop a bone stress injury [3]. Aside from being female, there are a number of factors that have been identified as risks for developing a bone stress injury.

Risk factor: Training load

By their nature, a BSI requires stress to develop [3]. A rapid increase in training load, particularly in poorly conditioned athletes or those new to running will likely bring about sufficient stress to develop a bone injury. A long history of physical activity is protective [6] as this tends to improve bone density over time. Total training volume needs to be monitored over the course of weeks and months to ensure adequate recovery occurs in order for bones to strengthen. For runners that have taken more than 2 weeks off training due to illness and/or quarantine, a gradual return to pre-break levels is advised. Those that are new to running need to be careful if mirroring the training of more experienced runners.

Risk factor: Running technique

Running technique can play a part in the development and likely location of a BSI. Distance runners who land on their heels are more likely to develop a BSI in the tibia. In contrast, sprinters, and runners who land on their forefoot are more likely to develop a metatarsal (toe bones) BSI.

Runners that produce high ground reaction force (impact)[2,3,4] and had increased rearfoot eversion [4] (rolling in) were more likely to suffer tibial stress fractures. Gait retraining can be beneficial in cases of recurrent BSI but needs to be done carefully due to the risk of injury developing from an unaccustomed running style [6].

Risk factor: Footwear

Shoes can play a role in the development of a BSI. It was found that running in old or worn-out shoes increases the risk of BSI[8]. General footwear industry advice is to replace shoes within 600km of running, but keep in mind that shoes will also degrade over time irrespective of use.

A recent study has proposed that running in maximalist (thickly cushioned shoes such as HokaTM) may reduce the risk of tibial stress fractures in female (but not male) runners. By comparison, minimalist (thinly cushioned) shoes were linked to metatarsal stress fractures(10). The use of foot orthotics was found to help reduce the risk of developing BSI in military recruits[9].

Risk factor: Low energy availability

Tracking the amount of energy you consume compared to your daily energy expenditure can help determine if your body is in an energy deficit. This is where the amount of energy consumed is less than the amount expended. Low energy availability reduces the ability of bone to resist load and/or impairs its ability to repair micro-damage [6]. Sustained periods of energy deficit can have negative effects on the body and will compromise performance and recovery. In females, this can lead to disorders in their menstruation cycle [6,7].  

Assessing your attitude towards food can help to identify eating behaviours that may result in low energy availability. The Eating Attitudes Test (EAT-26) questionnaire is a simple screening tool that can help flag problematic eating behaviours [7]. Athletes that score 20 or higher on this test would benefit from professional guidance. The questionnaire can be found easily on google.

Risk factors: Vitamin D and calcium deficiency

Low vitamin D [1] and calcium levels were common findings in athletes that develop BSI [4,5,6]. Ensuring adequate levels via dietary intake or supplementation is an important factor, and a fairly easily achieved goal to help reduce BSI risk. 

  • 600 IU of vitamin D daily is suggested for ages 9 to 70 years
  • 800 IU of vitamin D daily is recommended for > 71 years or older
  • 1300 mg of calcium daily for ages between 9 to 18 years[11].

Conclusion

Bone Stress Injuries are painful injuries that are best avoided. It is important to be aware of the signs and symptoms of a BSI – particularly if you are new to running, have increased your training (especially after taking more than two weeks off running), and/or are at risk of any of the factors listed above. Developing a considered plan for your training load and recovery is crucial for avoiding this potentially season-ending injury.  If you suspect you have a bone stress injury or have had one in the past, contact the intraining running injury clinic for an assessment and to develop a plan on how best to avoid them in future.

By Doug James – Physiotherapist and Podiatrist at intraining running injury clinic.

BOOK AN APPOINTMENT HERE
Doug James Colour 2020

DOUG JAMES

PHYSIOTHERAPIST | PODIATRIST | L1 COACH

Doug James is a qualified physiotherapist and podiatrist with a special interest in running and sports injuries. He combines the two treatment approaches to achieve successful outcomes for clients of all abilities from non-athletes through to elite athletes.

Bachelor of Podiatry (Honours), Master of Physiotherapy Studies.

Doug has undertaken further training in dry needling, Pilates, and Rocktape and may incorporate these as necessary during treatment.

Doug is also a keen runner having completed the New York Marathon.

References:

  1. Alexandra Abbott, Mackenzie L. Bird, Emily Wild, Symone M. Brown, Greg Stewart & Mary K. Mulcahey (2020) Part I: epidemiology and risk factors for stress fractures in female athletes, The Physician and Sportsmedicine, 48:1, 17-24, DOI: 10.1080/00913847.2019.1632158
  2. Tavares, J., Jost, T., Drewelow, G., & Rylander, J. (2020). Do maximalist shoes mitigate risk factors for tibial stress fractures better than stability or flexible (marketed as minimalist) shoes? Footwear Science, 12(1), 63–74. https://doi.org/10.1080/19424280.2019.1708977
  3. Milner, C. E., Ferber, R. D., Pollard, C. S., Hamill, J., & Davis, I. (2006). Biomechanical Factors Associated with Tibial Stress Fracture in Female Runners. Medicine & Science in Sports & Exercise, 38(2), 323–328. https://doi.org/10.1249/01.mss.0000183477.75808.92
  4. Song SH, Koo JH.   Bone Stress Injuries in Runners: a Review for Raising Interest in Stress Fractures in Korea.   J Korean Med Sci. 2020 Mar;35(8):e38. https://doi.org/10.3346/jkms.2020.35.e38
  5. Miller, T. L., Kaeding, C. C., & Rodeo, S. A. (2020). Emerging Options for Biologic Enhancement of Stress Fracture Healing in Athletes. Journal of the American Academy of Orthopaedic Surgeons, 28(1), 1–9. https://doi.org/10.5435/JAAOS-D-19-00112
  6. Warden A, Davis I, Fredericson M. Management and prevention of bone stress injuries in long-distance runners. J Orthop Sports Phys Ther. 2014;44(10):749e765. https://doi.org//10.2519/ jospt.2014.5334.
  7.  Sanderson, S., Raab, S., & Moch, P. (2012). BMI and EAT-26, Predictors for Low BMD? SAGE Open, 2(1), 1–5. https://doi.org/10.1177/2158244012441604
  8. Gardner LI, Jr., Dziados JE, , Jones BH, , et al.. Prevention of lower extremity stress fractures: a controlled trial of a shock absorbent insole. Am J Public Health. 1988; 78: 1563– 1567.
  9. Snyder RA, , DeAngelis JP, , Koester MC, , Spindler KP, , Dunn WR. and Does shoe insole modification prevent stress fractures? A systematic review. HSS J. 2009; 5: 92– 98. http://dx.doi.org/10.1007/s11420-009-9114-y
  10.   Salzler, M. J., Bluman, E. M., Noonan, S., Chiodo, C. P., & de Asla, R. J. (2012). Injuries Observed in Minimalist Runners. Foot & Ankle International, 33(4), 262–266. https://doi.org/10.3113/FAI.2012.0262
  11. Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes. Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. 1997.

Avoid common running mistakes

Posted on by intraining

with Steve Manning, Level 4 running Coach, and podiatrist.

Many of the runners who I see for their first training program have been making the same mistakes…

The result is continually underperforming in races but also not enjoying their training.

Most of these mistakes can be described as doing too much or too little.

Check these four areas against your own training so you can avoid making the same common mistakes. I’ve highlighted after each common training mistake, the value each of these areas can help you become a better, and more confident runner.

Training Pace or Intensity:

Running your mileage too fast.

The most common mistake novice runners make is running too much of your mileage too fast. Runners often tell me they think that to run under 60 minutes for 10km then they should try to run all their runs at that pace. In fact, most of your training should be run at 30 to 60 seconds slower than your predicted pace for a marathon. If you do the bulk of your training too fast then you will not recover from the stress of the training and will not improve.

Lack of speedwork: ‘The mono-paced runner’

The other side of this training intensity is not doing any speedwork. Running all your training at the same pace will result in you being a mono paced runner. Speedwork is not sprinting but you need to learn to run shorter segments like kilometre repetitions at 10km pace, 5km pace and 3km pace. This gives you a better training effect while also improving pace judgement.

Training Load:

Training more and more

It is tempting to try and train more and more as you gain fitness and experience. The law of diminishing returns means that at some point adding extra distance will result in no improvement to your fitness or even worse a reduction in your performance. This will lead to constant soreness and tiredness and eventually illness or injury. The total training load should be progressed gradually.

Infrequent sessions

Not enough frequency of sessions or too many days off in a row is also a problem for runners. Regular running is needed for your body to be stimulated to adapt and grow stronger. When you have more than one day off your connective tissue gets tight and is more susceptible to a strain leading to injury. More running frequency can in fact lead to fewer running injuries.

Racing:

Not using lead up races

Usually, people are motivated to enter some major race in the future. It might be a new year’s resolution or a pact with a friend to do a marathon. This goal race is months away and they often put all their eggs in one basket having no lead-up races. You need to take many small steps up to your major goal race including some races at shorter distances. That way you can practice pace control in a big crowd and are less likely to make a pacing error in your major goal race.

Running every parkrun hard

Parkrun is a fantastic opportunity for runners of all abilities to regularly race in a group over a shorter distance that does not impact adversely on your general training. However, many new runners try and run fast every Parkrun. Most of the time they should be approached as Tempo runs not races. You trial different pacing strategies and perhaps once a month try and do a fast race. If you are always trying for a PB you will be frequently disappointed and become jaded when you can not perform at your best every race.

Footwear:

Running in old or inappropriate shoes

The biggest preventable mistake for new runners is wearing old or inappropriate shoes. They may not realise that their shoes are worn out because they are just looking at the outsole wear when the cushioning in the midsole is the most likely thing to wear out first. When they start running they will wear the shoes they have been using for Gym, hiking and wearing around casually. Your shoes will not have a large contribution to injuries in those activities but are a significant factor in running injuries.

As the owner of a running shoe store, I can guarantee there is no downside to having too many shoes!🙂 If you are running more than 3 times a week, running shoes specific to you different sessions and races makes a massive difference to your performance… and running mojo!!

I really love seeing runners enjoy your training and racing experiences. If you have any questions, make sure you connect with our running team at the intraining Running Centre in Toowong. You can also email us at [email protected].

Have a great year of running.

Steve.

Need further assistance with your training program, shoes, nutrition or injury advice?

BOOK AN APPOINTMENT HERE

Stay Injury Free this Season

Posted on by intraining

What to do when you are injured

by Steve Manning

Injury is a normal part of being a runner. Runners average between one and two injuries each year that are severe enough to force a reduction in running. On top of that little niggling pains come and go as you push your body to its limits.

Three major questions you need to ask are:

  1. How do you decide if you have an injury or a niggle?
  2. What should you do when you become injured?
  3. When should you seek expert advice?
  1. RATE SEVERITY AND TYPE:

The first thing you need to do is to rate the severity of the injury and to consider the injury history.  Identify if it is an Acute injury related to some kind of trauma or a Chronic injury related to overtraining. If you have turned an ankle or pulled a muscle during a run then this is very different to if you woke up sore the day after a long run or race.

When does it hurt? Is it from the first step running? Or does it hurt at the end of a run? Perhaps it warms up after running a few kilometres, or only hurts after you stop. Does the injury actually stop you from continuing running? Perhaps it makes you change your running style. Does it hurt you during the day while you are not running or make it hard to go to sleep? What are the other symptoms? Is there swelling or redness? Is there an open wound or general feelings of illness?

Injuries need appropriate treatment for them to resolve safely.  Niggles will resolve with a few days of rest and some self treatment.  Both severity and duration of your symptoms will determine whether you have a niggle or a more significant injury that needs a treatment plan.

2. MAKE AN INITIAL DIAGNOSIS:

Once you have determined how bad the injury is you need to make an initial diagnosis. The goal is to identify the location and type of tissue involved.

Try to reproduce the pain without causing any more damage. See if you can find a single point of pain or if it is in a general area. Identify if there are multiple sights of pain and if one site precedes another. Understanding some basic anatomy can then help to identify the types of tissues that may be affected. Push on different structures and see which ones hurt. If it is a joint then move the joint to see what position hurts most. Bones, joints, ligaments, muscles and tendons, nerves, blood vessels, skin and connective tissue can all be isolated so that you know what is actually injured. This is very significant to help you decide what to do next.

3. START INITIAL TREATMENT: P.R.I.C.E.R

PROTECT:  The first step with an injury involves protecting the injured area so you do not make it worse.  If you reinjure yourself the damage is usually much worse the second time.  This can be with strapping tape, a brace or even crutches.

REST:  You will find most injuries will resolve with rest from the aggravating activity.  Sometimes that means reducing running duration or intensity.  It may involve keeping to flat smooth surfaces.  Stopping running completely may give a niggle the chance to resolve in a few days.  Extended activity may prevent some injuries from healing properly.

ICE: If in doubt use ice. Ice works as an anti-inflammatory to reduce pain and swelling. It is able to do this by numbing the pain receptors and causing vasoconstriction (contraction of the small blood vessels).  It also reduces tissue metabolism.  This results in a reduced inflammatory response that can aid in a quicker recovery. Ice packs are appropriate for large muscles but will not work as well over bony prominences.  Immersion icing works better for feet and heels by cooling evenly around smaller areas.  You can use direct ice massage but need to avoid icing too long on one spot that could damage skin and superficial nerves.

COMPRESSION:  Compression with tape or bandages may reduce the amount of swelling while supporting the veins to help blood flow back to your heart.  Compression socks or leggings are better to use for extended recovery times.  

ELEVATION:  Elevation of the injured area may reduce swelling by preventing the accumulation of fluid in response to trauma.  Ideally, the injured area should be elevated above your heart level.  This can be achieved by resting the injured limb on a pillow while lying down.

REHABILITATION:  The final step in treatment is often skipped as pain and symptoms have subsided.  However, it is the most crucial in ensuring that you are back running safely and reducing the risk of reinjury.  The earlier you can start rehabilitation the better and usually, it will begin around 3 days after an acute injury.  You might start with non-weight-bearing mobilisation exercises and conclude with functional tests proving the return of full function.

4. SHaM Treatment:

There are a number of treatment options to avoid that can increase the damage from an injury and significantly increase the time to resolution.  When people have hurt something the first reflex is to stretch it.  Stretching is not a panacea for all injuries and will often cause more trauma and increased spasming.  If you cut yourself you would not try and pull the wound apart.  Muscle tears are like an internal would and the same principle should apply.  You can turn a simple muscle cramp into a tear by aggressively stretching the muscle.  Heat will increase the bleeding and swelling around an acute injury like a sprain.  It may be appropriate in Chronic injuries to use a heating modality as part of your treatment plan but it will make the inflammatory response worse in acute injuries.  A massage is a form of stretching where an external rather than internal force is applied. The same factors apply with massage as stretching with regards to an acute injury although massage may help in recovery for sore muscles after an intense effort and will help identify problems earlier for chronic injuries.

5. TREAT CAUSES:

Once the symptoms have resolved you need to look further at your biomechanics, foot structure, training, footwear, muscle balance and flexibility. The injury may just come back as soon as you start running if you do not do something about the underlying factors that led to the injury in the first place. Often the cause of injuries has multiple factors that all may need to be addressed.  It is much harder to identify the cause of an injury than to make a diagnosis.  An accurate diagnosis is critical to implementing the best treatment protocol but understanding the causes is critical to preventing re-injury.  This will often require a thorough check of your training diary, the wear on your shoes and your foot structure and function.

6. WEEK 50% RULE:

With any type of treatment that you are doing there needs to be a significant improvement in symptoms beyond what would happen if you had done nothing. You do have to give it an adequate trial but two weeks is enough for most injuries to get 50% better. If this has not happened, then you need to try something different or you may have made the wrong diagnosis. Remember also that rest is not always better. Too much rest can make an injury chronic and entrenched which will take much longer to resolve completely.

7. SEEK HELP:

If you think you have a good idea of what is injured and it is not too severe then you can begin to treat it yourself using the above suggestions.  If you are not sure what is wrong or if it prevents you from running then you might be better off seeing a sports medicine Podiatrist or Physiotherapist at the intraining Running Injury Clinic.

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