Sally John – Physiotherapy

Registered physiotherapist

Clinic; 1 Buckingham Blvd,

Collingwood, Ont

L9Y 3Y9

Tel; 446-1616

Running Injuries

This is a brief description of some of the injuries which occur with running and their advised treatment

When ice is mentioned; it should be applied through a damp terry towel. The ice should be in a plastic bag and should be applied for 10-15 minutes every hour.

Most injuries, if carefully cared for should take 4-6 weeks to improve. All except; plantar fasciitis as this is a very difficult and varied situation and varies from person to person depending on the level of damage and commitment to do the therapy. Should injuries be taking more than 4-6 weeks to improve, other anatomical structures should be evaluated.

Foot injuries;

Plantar Fasciitis (sometimes known as calcaneal fasciitis or can be mistaken for Heel spur)

Symptoms;

· Pain at the base of the heel, causing string like pulls towards the ball of the foot. Especially tender when palpating at the heel.

· Pain is usually along the inside of the foot. ( can be outside as well) aggravated by running or walking.

· Made worse by running on pavement and running downhills.

· Worse in the morning, when getting out of bed.

Treatment

Ice with orange juice can – rolling foot back & forth for 15 mins every hour

Massage from the base of the heel into the ball of the foot.( best done by a therapist)

Tape plantar fascia – (ask your friendly therapist)

Stretches – by lengthening the plantar fascia and calf muscle & use a night splint

Heel raises

Orthotics in day shoes – assess need for new running shoes

Assess need for new running shoes.

Achilles tendinitis

Symptoms;

· Pain at the back of the heel – always on the inside edge of the heel – sore upon palpation.. Usually occurs due to over-pronating

· Worse in the morning getting out of bed

· Heel raising causes pain at the heel and there is reduced strength

· Can be caused by shoes pressing on the back of the heel

Treatment

Place a 1cm heel raise under heel

Sally John – Physiotherapy 446-1616

Achilles tendinitis (cont)

Ice heel. 10mins every hour

Double heel raising and then go to single as heel pain dissipates. Every hour do 10x and increase number of repetitions to 40X

Reduce intensity of training. No Speed work.

Tendinitis of tibialis posterior / partial rupture

Symptoms;

· Pain at the mid arch of the foot, which can go up the inside of the lower leg from behind the ankle bone. This is made worse upon foot strike (may have felt a tear with training especially after or during speed work) – tender to palpate at the navicular.

· Aggravated by heel raise and especially painful with heel lowering from the heel raise.

Treatment

Ice foot 10 mins every hour

Tape muscle to reduce strain on the muscle.

Strengthen with heel raises

Reduce training and run on trail. No speed work.

Metatarsalgia

Symptoms;

Pain at the ball of the foot usually at the base of the 2^nd toe. Pain increases with push off in running or walking.

Pain is worse in the morning.

Treatment

Cool foot baths if tolerated

Use metatarsal pad ( made of foam) Eg; Spenco and tape to foot just behind the metatarsal heads.

Mobilisations to your toes and foot by your friendly therapist

Assessment of walking or running pattern

Fracture metatarsal

severe pain on impact of foot – usually shooting pain into toes and mid foot. (can be mistaken for severe metatarsalgia.

Xray may be necessary.

Treatment

Reduce weight bearing – no running – casting may be necessary for pain relief 4-6 weeks.

Then physiotherapy to regain movement at the 4-6 week mark.

Sally John – Physiotherapy 446-1616

Lower Leg Injuries

Shin splints/ stress fracture of the tibial bone

The former is the tearing away of the anterior tibialis muscle from the fascia onto the tibia. A stress fracture is usually only diagnosed by bone scan and it is the minute fracture of cortical bone

Symptoms;

· Pain usually caused by increased training

· Tenderness is at the front of the leg and about 1/3 up from the ankle between the tibia and fibula (a space between the muscles)

· Pain is aggravated with impact

Treatment

Ice – with ice-lolly along front of tibia. If pain increases with icing, then this may be a stress fracture. (See your doctor)

Reduce training intensity. Cross train – bike & swim

Do isometric contractions using a theraband. – progress to active

Lateral ligament tear of ankle.

Symptoms;

Athlete has gone over on his ankle when tripping over

tree roots.

Treatment

1. Reduce swelling of the ankle using ice.

2. Keep movement of the ankle moving

3. Increase strength of ankle muscles with heel raises

4. Work with balance exercise – throwing and catching to the wall

5. Progress to wobble board balance work.

Knee

Patellofemoral syndrome( anterior knee pain)

Symptoms;

Pain at the front of the knee cap which can radiate done the shin. Aggravated when the knee is bent to 90 degrees when sitting for long periods of time. (“movie goers knee”)

Aggravated by climbing hills or stairs. Knee can give way and can be confused with Meniscus problems (see below)

Problem – Knee cap is not in its correct track and may be positioned incorrectly at the start of the movement.

Treatment

1) Reduce pain with ice if particularly tender

2) Correct tracking with mobilisations and taping (see a therapist who knows Jenny McConnell’s techniques)

3) Check walking & running patterns to see if there is problems above or below. Hip/back or foot.

4) Check shoe wear – Is there a need for orthotics?

5) Vastus medialis rehab – Check with a therapist who knows (J.Mc work)

Sally John – Physiotherapy 446-1616

Patellotendinitis

Symptoms;

Acute pain at the front of the knee-cap but is below the knee cap. Usually caused by jumping

Treatment

1) Ultrasound or massage may help as might acupuncture to reduce tenderness. Also ice for short periods.

2) Use of Cho-pat (available at Pharmacies) or taping.

3) Isometrics to Quads and then gradual strengthening exercises. (See your friendly physiotherapist

Popliteus syndrome

Symptoms;

Point tenderness at the outer part of the knee – above the knee – not to be mistaken for iliotibial band tendinitis which is pain below the knee joint on the outer side.

This is aggravated by running downhill, or downstairs as the muscle acts as a check rein.

Treatment

1) Ice over area with ice cube or pack for about 5-10mins every hour

2) Work with co-contractions to hamstrings and quads to get activation of popliteus with help of muscle stimulation ( contact your local therapy unit for this)

3) Manual therapy

4) Correct downhill running. ( shorten steps – quick cadence.)

Torn Medial or lateral meniscus of knee

Symptoms

Pseudo-locking of knee or locks and has to be unlocked. Knee gives way.

Aggravated by duck walking, or squatting.

Treatment

This depends on the depth of the tear. Tears may go to arthroscopic surgery if constant locking. However, if pseudo locking and this appears to be lateral meniscus, this meniscus has a great blood supply and can heal.

See a therapist of physician for confirmation.

1) manual manipulation of the meniscus to relocate is possible but does not always stay in place and heal.

2) Isometric strengthening to increase blood supply for healing with the assistance of an EMS. (electrical muscle stimulator.) at different positions of knee bend without pain

3) When improved graduated weight bearing exercises which avoid twist, until later in the therapy.

Sally John – Physiotherapy 446-1616

Torn medial collateral ligament of the knee

Symptoms

Here is an injury, where there has to be a direct cause. Usually happens when tripping over something. Not often caused with running. Here, the inside of the knee hurts from the injury.

There is swelling.

The knee does not lock.

There is limited movement of knee bend and straighten.

Treatment

1) Reduce swelling with acupuncture, ice

2) Isometric quads/quads muscle strengthening - Progressed to squats

3) Movement exercises, - bend & stretch. Use of the bike when able

Hip Injuries

Piriformis Syndrome

Symptoms;

Pain at the buttock, which can cause sciatic type pain as the muscle can compress the nerve. Aggravated when the leg is turned when standing and turned out when the hip is above 90 degrees movement as in squatting below 90 degrees. Follows the line of piriformis. A line which is tender from the mid sacral region to the hip joint line.

This pain can be mistaken for low back pain from a facet joint problem. There is no back pain with this syndrome.

Leg is usually turned out for comfort and leading with the leg upstairs or uphill increases the pain.

Treatment

It is best to see a therapist who will also check your back and treat this condition. Pulling the leg with the leg turned in sometimes help.

4) Correct heel strike and swing through stage of gait as soon as possible

Hip Bursitis

Symptoms.

There is extreme tenderness over the hip joint either at the front of the thigh or else at the outside of the hip. The pain is made worse with climbing stairs of running uphill.

Treatment

1. Check walking/running pattern

2. Stabilization of the hip by re-training the glutei muscles. (see your therapist)

3. Check hip flexors for increased tone and reduce tone.

4. Check need for orthotics different running shoes.

5. Check training methods. (ie) running uphill with foot turned out increases hip flexor activity and not glutei work.

6. Break bad standing habits.

Sally John – Physiotherapy 446-1616

Quads or Hamstrings muscle tear.

Symptoms

Injury occurs either at the muscle over the front of the leg called the quadriceps muscle, often just above the inside part of the knee for the former injury or at the back of the leg, for the latter. These injuries usually occur after quick lunges or poorly warmed muscles in the beginning of a game or at the end of the game when the player is tiring.

There is usually a sharp pain, which ends in some amount of disability and the inability to continue to lunge.

Treatment

Immediate

· Ice the area immediately post injury with 10-15 minutes on & off with ice in a dampened terry cloth.

· While icing – co-contract muscles and move ankle up and down to promote circulation and fast heal

· Pressure bandage over the injury, which will develop into some degree of haematoma, which will keep the swelling down.

· Gentle knee bending without increasing pain

· Reduce weight bearing if necessary – use of a cane. Weight bear as tolerated. (no increase in pain)

Next day

· Repeat as above

· Gentle massage around the haematoma

· Isometric co-contractions of hamstrings and quads with the assistance of muscle stimulation, not enough to increase pain.

· See a therapist for further treatment advice who will put you on a graded exercise program. Recovery should be 4-6 weeks.

Iliopsoas Tendinitis.

Symptoms;

Pain at the hip into the groin especially with weight bearing, running up hill.

(cause often because the glutei muscles are not been correctly used and the hip flexor- iliopsoas catches on the pectineal eminence of the pelvic ring due to the angle of the pull in their attempt to stabilize the hip.

Treatment

1. Check walking/running pattern (over-rotation of the thoracic spine.)

2. Reduce tone in iliopsoas by using the opposite muscle group; the hip extensors - glutei

3. Strengthen glutei in side lying and standing to functional positions (see you therapist for help)

4. Check running shoes, assess the daily need for orthotics

5. Break bad standing habits.

6. Check training methods (as above)