Beyond the Knee; knowledge is power (2)

@healthline.com

The human body is amazing in structure and capability; strong, resilient, and adaptable. Even so, it can be unsuspectingly fragile when put under rigorous pressure and repeated strenuous activity. In other words, superhumans we are not. But we try and though the results can sometimes be painful, it doesn’t faze us. And that’s ok because where’s the fun in living within the confines of the fear of getting hurt. Surely, it is better to move in knowledge and confidence taking proactive measures to guard against injury as much as it is within one’s power to do so. For this reason, I’ve opted to empower myself with the knowledge to help me move in a healthy and safe manner and inspire you to do the same.

Continuing from where I left off last post, today we’ll look at other common injuries that affect runners beyond the knee. Some are Shin splints, Plantar fasciitis, Stress fractures, Ankle Sprains, Tendonitis, Pull muscle/ muscle strain, and Back Pain.

  • Shin splints or medial tibial stress syndrome, are the most common cause of lower-leg pain in athletes. They are overuse injuries meaning they occur overtime through repeated use (Robert Wilder MD). Experts suspect shin splints affect anywhere from 5% to 35% of all runners. Shin Splints refer to diffuse pain along the inside of the shin. Pain is typically felt in the bottom 2/3 of the “Medial tibia” aka the inside of the shin. Common symptoms associated with shin splints are: dull pain affecting the lower inside of the shin, pain occuring during activity, tenderness of the area, calf muscles, and decreased ankle flexibility. According to Dr Wilder, Some causes and risk factors include: intensified training, hyperpronation, flat feet, improper footwear, running on hard air uneven surfaces, and bad running form. In addition, many experts believe shin splints are caused by inflammation or other minor damage to the calf muscles, tendon or tibia. While the exact root of pain may not be clear, treatment involves rest, icing, and over the counter NSAIDs.
  • Plantar fasciitis may be expressed in runners as a stabbing heel pain. Experts believe that when the plantar fascia is put under strain it becomes inflamed or develops tiny tears (micro-tears), or both. The plantar fascia is a thick band of fibrous tissue that runs along the bottom of the foot between the toes and heel. If the fascia becomes inflamed, it can cause painful symptoms ranging from mildly annoying to debilitating.  Conservative treatments, such as resting, stretching, and over the counter anti-inflammatory medications (e.g. ibuprofen), are successful in treating 90% of cases (Andrew Cole MD).
  • Stress fractures – A stress fracture is a small crack in a bone that occurs when bone tissue has to absorb more weight and impact than it can handle. This type of injury can occur over time in a well-conditioned bone that is overused, or suddenly in an underconditioned bone that is placed under undue stress in a short period. Stress fractures most frequently occur in the feet, ankles, and lower legs, though they can also occur in other parts of the body, such as the pelvis, hip, ribs, sacrum, clavicle, and upper extremities/ arms (Adam Yanke, MD, PhD). The symptoms of shin splints and tibial stress fractures can be similar. Shin splints differ from stress fractures in two ways: 1. Shin splints tend to cause dull or diffuse pain, in contrast to stress fractures, which tend to cause sharp pain that is concentrated to one area. 2. Shin splints cause pain on the inside of the shin, not the front of the shin. Pain on the front of the shin, or tibia, may represent a stress fracture. In his article, All About Stress Fractures, Yanke states that once the location and severity of the athlete’s stress fracture(s) is diagnosed, treatment can begin. Treatment protocols can range from simply a period of rest to casting, bracing, physical therapy, or even surgery, depending on the type and number of fractures, and/or the specific bone(s) affected.
  • Ankle sprains and strains – the ankle joint is a complex interconnection of ligaments, muscles, and tendons that makes it a relatively stable joint compared to other joints in the body. This stability is essential to its function. The ankle sustains 1.5 times the body’s weight in impact with every walking step, and up to 8 times the body’s weight with each step when running or jumping (Julia Bruene, MD). High-impact activities such as jumping, running etc can increase the risk of injury as well as sudden movements and twists and turns too far out of its normal range. In her article, “All About Ankle Sprain and Strains” on sports-health.com, Bruene highlights the difference  between ankle sprains and strains.      Ankle sprains are caused by direct or indirect trauma to the ankle ligaments. It can occur when the ankle is forced beyond its normal range of motion, such as when people twist their ankle when making a sudden stop on an athletic field or track, walking or running on an uneven surface, or when tripping over an obstacle. If not treated, or with repeated sprains of the same tissues, pain and dysfunction from acute ankle sprains can become chronic.                           An Ankle strain is an injury that occurs when ankle muscles and/or their connecting tendons are either stretched beyond their normal limits or torn outright. Often this occurs where the muscle connects to the tendon. Less common than ankle sprains, ankle strains often occur due to chronic overuse of the ankle as is seen in running long distances, repeated hard landings and articulations of the ankle as performed in ballet and gymnastics. Strains can also occur due to acute injury to the lower body (as can occur in high contact sports), overstretching of the ankle, or excessive contraction of the muscles. Treatment for Sprains and Strains are pretty similar with highly recommended rest for four to six weeks utilizing a combination of the R.I.C.E method and as needed use of NSAIDs for grade 1 and 2 ankle sprains and strains. Grade 3 sprains and strains are usually unstable and require longer healing, says Bruene. The following treatment protocol may be used: casting or bracing and rehab treatment including electrical stimulation, ultrasounds, and physical therapy/strengthening exercises. In severe and chronic cases of sprains and strains one or more types of surgery might be warrented.
  • Tendonitis – The Achilles tendon connects the calf muscles to the back of the heel bone, called the calcaneus. If the tendon becomes irritated and inflamed it is called tendonitis., Symptoms of Achilles tendonitis can include pain, skin redness, and swelling just above the heel. The area may also become stiff, limiting the ankle‚Äôs range of motion (Andrew Cole MD). Anyone can be suseptible to this but Achilles tendonitis frequently occurs in runners who ramp up their training too quickly or whose calf muscles are too tight. Symptoms may be worse first thing in the morning or after a workout. For treatment rest and other non-surgical treatments can usually relieve symptoms. However, blood flow is limited in this area of the body, so Achilles tendonitis can be slow to heal.
  • Pull calf (gastrocnemius) muscle/Muscle strain – The gastrocnemius muscle is the largest muscle in the calf, and it is prone to strains and tears in runners.2 These strains and tears may occur from ramping up a running routine without adequate training or from sudden motions such as jumping, pushing off or making a quick turn. Small tears in the muscle fibers may cause mild aching, stiffness and soreness. Light jogging and walking may be done though it may be uncomfortable. A severe muscle tear or a full rupture of the muscle, will be quite painful and cause bruising and swelling. A person with a severe muscle strain may not be able to walk normally and may require months to recover. In rare cases, surgery may be recommended (Andrew Cole MD).
  • Back pain – The repetitive impact of running can cause back pain, most commonly low back pain. Whether this pain is caused by strained muscles or by a problem with the spine’s vertebrae or discs may influence treatment and training (Andrew Cole MD). Cole states that a runner may experience the following symptoms if the soft tissues become fatigued and strained: the back may feel dull and achy, the affected area may be sore to the touch, flexibility may decrease, so that bending over or twisting at the waist is difficult and uncomfortable. Sometimes pulled back muscles will spasm, causing severe pain that prevents daily activities. In these cases, it is possible for the muscle to squeeze a nerve root and cause radiating pain to the arms or legs, known as radiculopathy or sciatica says Cole. While strained back muscles and ligaments are painful and can be temporarily debilitating, they are relatively benign. When provided adequate rest and treatment, pain should be gone within 2 to 4 weeks. According to Cole, further back pain can result from injury to the spine since both the spine’s vertebrae and intervertebral discs experience extra pressure each time a runner’s foot impacts ground. This impact can exacerbate an existing or developing back problem and can result in herniated discs, degenerative disc disease, and vertebral stress fractures. Significant pain can ensue but doesn’t generally require surgery.  Treatment will vary but it is recommended to seek a medical evaluation early on if pain doesn’t subside with rest within 4 to 6 weeks and/or if symptoms increase.

It’s a bit reassuring and aggravating, all at the same time, to see some of the symptoms I’m experiencing articulated here while still not experiencing the relief I’m working towards. I have to continuously remind myself that healing is a process and that I have to be patient and trust the process. Nothing good has ever been wrought in haste. Maybe, like me, you needed this little reminder and this post will encourage you to be more mindful of the power and responsibility you have. My hope is that the information that I’ve gathered together, from a couple of peer-reviewed articles and doctors in the field, will help us to be mindful in our exercise and running pursuits. Forwarned is forearmed after all.

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