There are two types of injuries which a runner may sustain: acute trauma, or an overuse injury.
The acute trauma is sudden, such as a torn ligament or broken bones. The most frequently problem encountered by chiropractors is injury through overuse. Here is an overview of the most common injuries a chiropractor will see.
The plantar fascia is a band that runs from the heel to the base of the toes. It provides support for the arch of the foot and assists in the biomechanics of walking and running.
- Stretching or tearing the connective tissue on the bottom of the foot where the tissue attaches to the heel.
- Over pronation (stretching of plantar fascia)
- Under pronation
- Leg length inequality
- Faulty biomechanics (reduced ankle motion)
- Muscle imbalances (reduced muscle strength)
Localized tenderness and pain in a specific area on the bottom of the foot towards the heel, possibly radiating to the arch and towards the ball of the foot. The foot feels tender early in the morning and becomes less painful with movement. Symptoms are worse with weight bearing after a period of rest or immobility (first step in the morning).
- Stretching (plantar fascia and calf muscles)
- Night splints (91% success after 12 weeks)
- Orthotics (correct foot bio-mechanics)
- Avoid uphill and speed work
- Evaluate footwear
- Identify and address training errors
Bursitis or Tendonitis:
Common problem areas include the knee and ankle. It is an irritation of the bursa (fluid filled sac which sits under the tendon) or tendons from friction, trauma, pressure or dysfunction.
- Symptoms: Pain and stiffness on movement with no visible swelling at first, but swelling as the condition worsens.
The achilles tendon connects the calf muscles (gastrocnemius and soleus) to the heel bone. It transmits the powerful forces of the calf muscle to the foot to allow heel lift. Injury to the tendon can be inflammatory (tendonitis) or degenerative (tendinosis).
- Greater rear foot pronation
- Reduced ankle muscle strength
- Running more miles per week
- Been running for more years
Pain or tenderness can be localized along the tendon. Stiffness may be present in the morning. Stretching or contracting the calf muscle can be painful. Running hills, speed-walking or jumping can aggravate this problem. A complete rupture of the tendon can occur if there is a sudden unexpected movement and requires immediate medical attention (surgery). There is a complete gap in the tendon and you will be unable to push off with the ankle because the calf will no longer be attached to the ankle.
- Rest (pool running, cycling, swimming)
- Heel lifts (reduce stress on tendon)
- Stretch calf muscles
- Eccentric (contacting muscle during stretch) heel drops
- Correct muscle imbalance (anterior and posterior lower leg muscles)
- Orthotics (correct rear foot pronation)
- Evaluate footwear
- Avoid hills
NB: To prevent a chronic problem, do not run through pain. If your Achilles tendon is sore, get it treated immediately. Again, it is also important that the feet are assessed for any biomechanical problems. Orthotics or insoles may also be prescribed and the use of soft heel-lifts are effective as part of chiropractic treatment.
Shin Splints (Tibila Stress Syndrome):
During running, repetitive stresses can cause small tears in the attachment of the muscle to the shin bone (tibia). Tibialis anterior (anterior shin splints) and tibialis posterior (posterior shin splints) muscles are involved in limiting pronation during foot strike.
- Faulty foot, knee, or hip mechanics
- Muscle imbalances (tight or weak)
- Training errors (overuse)
Tenderness pr pain along the front or inside/outside the shin bone is typical. Symptoms are similar to tibial stress fracture and caution is needed to diagnose the injury and make the appropriate treatment.
- Reduce mileage
- Correct muscle imbalances (weak or tight lower leg muscles)
- Evaluate footwear. Wear good shoes with shock absorbing features.
- Orthotics (correct foot mechanics)
Stress fractures occur most frequently in the shin bone (tibia), foot (metatarsal), and hip (femur or pelvis). For new runners, cardiovascular fitness comes after 10 weeks whereas bone fitness requires 10 months. Stress fractures are a result of the bone not adapting fast enough for the increased stresses put on it.
- Female (12 times more likely)
- Amenorrhea (6 times more likely)
- Low dietary calcium (8 times more likely, best predictor)
- Low bone density
- Race (Caucasian)
- Leg length inequality (73% in long leg: femur, tibia, metatarsal; 60% in short leg: fibula)
- Competitive (female)
- Over pronation
- Muscle imbalance (weakness)
- Training errors
The pain comes on suddenly and there is no history of trauma. Persistent pain and local tenderness, even after rest, ice and decreased training is suggestive of stress fracture. Hopping on the injured leg is painful and running is unbearable. Tibial stress fractures can mimic shin splints and is often incorrectly diagnosed. With continued running, this problem can lead to a complete fracture.
X-rays will usually not show any signs of a fracture (57% are negative in the first 3 weeks). A bone scan will show increased activity (hot spot) where there is an active repair process of the bone presently underway. CT scan is best to visualize the small bones of the foot.
- Restricted weight bearing (pneumatic leg brace)
- Alternate activity (pool running)
- Orthotics (foot mechanics)
- Evaluate footwear
- Identify and address training errors
Most stress fractures will heal after 6-8 weeks depending on the site (longer for the bones higher up the leg). Continuation of activity to a complete fracture will require 6-8 months of rest. This is a longer healing time than a regular fracture (6-8 weeks) because the blood supply and hence the healing ability of the bone is compromised.
Ankle Sprain / Strain
Running on level ground rarely results in an ankle sprain but cross country running, trail running and stepping in a pot hole all could potentially lead to an ankle sprain.
- Treatment: Treat immediately. Rest Ice Compression (gentle) Elevation.
Note: Ice should be applied for about 15 minutes at a time, with at least 15 minute intervals between application.
This essentially means softening of the cartilage of the knee cap. Portions of the cartilage may then be under either too much or too little pressure. This may result in cartilage deterioration at the inner part of the knee cap. Pain is usually also felt after sitting for a long period of time with the knee bent.
Iliotibial Band Syndrome
This is pain or aching in the outer side of the knee and usually happens in the middle or at the end of a run and is often seen in runners who train only on a track or on uneven ground. Read more about Chiropractic treatment for Iliotibial Band Syndrome.
How To Avoid Injuries
The majority of running injuries occur from over-training. Avoid doing too much too soon. An unrelenting increase in mileage from one week to the next will ultimately result in a breakdown.
- Progress in mileage and speed should be gradual
- Mileage should only be increased by approximately 10% per week. Every third week drop back a small amount
- Intersperse hard days and easy days each week
- Devote one or two days each week to rest or non-running activities to allow the body to recover
- Regular stretching may help reduce injuries
- Have a chiropractor assess your running technique and running posture
- Pain is a warning; stop running and consult a chiropractor immediately.
Preventing Sports Injuries
At the initial consultation at the clinic, Dr. Pisarek will take a full medical history, investigate lifestyle, posture etc, carry out a thorough examination and take x-rays when necessary. Once the diagnosis is made, a treatment plan is prepared.
Chiropractors use gentle, specific manipulation and adjustment techniques to free stiff joints, restore normal movement and remove spinal irritation. Chiropractors may also use modalities such as low-level laser therapy (LLLT), ultrasound and interferential treatment.
Treatment is generally painless, although some short-term discomfort may sometimes be felt around the injured area.
Once painful symptoms settle, the chiropractor will encourage you to follow a program of rehabilitation exercises to help strengthen the injured area, improve flexibility and prevent recurrence of the problem.
At Advanced Healthcare, our chiropractic treatment aims to restore normal function to your joints and muscles
as well as your nervous system which will increase control, co-ordination and muscle strength.
Give us a call @ (416) 633-3000 today to schedule an appointment with Dr. Pisarek.