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Top 10 Running Injuries and Prevention Strategies
Spring 2007 Rocky Mountain Sports article manuscript

1.        Plantar fasciitis

a.        Primary risk factors: Rapid increase in intensity or uphill running followed by sleeping on your stomach or tightly tucked sheets. This causes nocturnal contracture of the plantar fascia in a shortened toe-pointed state.  Build volume before intensity. Ensure you're sleeping with your ankles in a neutral non-toe pointing position. Consider obtaining a tibial night splint from a sports medicine professional.

b.        Secondary risk factors: Overly flexible running shoes (racing flats!) or work shoes, excessive mileage on your shoes, overly flattened arches/overpronation. Train moderate distances in a moderate weight shoe and race in a flexible fast racing flat if desirable. Obtain an orthotics consultation from a professional sensitive to the needs of a runner. A 4oz orthotic in a 10-ounce shoe adds up. Wear quality rigid supportive shoes like Danskos to your office on that carpeted concrete floor.

c.        Tertiary risk factors: Weak intrinsic muscles of the feet. Perform toe gripping and toe walking activities to bring these muscles endurance up to speed with the rest of your program.

2.        Patellar tendonitis

a.        Primary risk factors: Rapid increase in intensity, downhill running, or pseudo-downhill running (over striding). Build volume before intensity before downhill running. Lean forward on the flats and downhill running. Land with your foot level with the ground rather than leaning backwards with toes up trying to decelerate oneself. Oscillate side to side on steep downhill running to disperse deceleration forces side to side into your IT bands rather than patellar tendons. When looking down at your kneecap as you run, your sternum should be on top of your kneecaps and your kneecaps on top of your second toe. Poor alignment from either flat feet causing toe out or weak groin adductors or hip abductors cause excessive side to side tension on patellar tendon. Increase arm back swing on the side opposite the problem to aid in forward propulsion and lessen deceleration forces.

b.        Secondary risk factors: Inflammation exceeds healing rate causing kneecap to become distended with fluid. Ice daily with non-moist ice bag directly on kneecap with compression.

3.        Iliotibial band

a.        Primary risk factors: Identical to patellar tendonitis. High arches or excessive outward bowing on knees are inherent to ITB development. Same treatment approach as patellar tendonitis except one should add hip abductor endurance activities on symptomatic side to minimize inherent hip sagging on side opposite symptoms during heel strike. Running on loose sand and dirt surfaces also surprisingly increase incidence of ITB due to the natural behavior of pausing during heel strike to establish firm surface to push off from.

4.        Hamstring strains

a.        Primary risk factors: Over striding (Not leaning forward at heel strike), doing speed work on hamstrings that are already suffering from delayed-onset muscle soreness/hypertonic, weak adductor and gluteus maximus causing hamstring overemphasis. Fix or identify over striding, never do speed work on hypertonic hamstrings, limit hamstring weight training the day before a track workout, ice hamstrings after every workout to lessen natural hamstring tone, perform adductor/gluteus maximus facilitation activities as demonstrated by a knowledgeable sports medicine professional.

5.        Trochanteric bursitis/gluteus medius tendonitis

a.        Primary risk factors: Rapid increase in intensity and steep climbing in preseason before tendon thickness is adequate, over striding, excessive hip sagging opposite symptomatic hip at heel strike. Poor hip abductor group endurance. Build volume before intensity, Stairmaster walking before skyrocketing up Green Mountain, carrying 20lb child in backpack on level surfaces before attempting a straight ascent up a mountain, shorten stride and lean forward, increase opposite arm back swing to increase forward propulsion without overloading same side abductors, hip abductor/side-kicking endurance program, ice hips daily before they become symptomatic.

6.        Shin splints

a.        Primary risk factors: Intensity before Volume, over striding/not leaning forward/landing with a level foot at heel strike, poor endurance of front of shin muscles, overly rigid or flexible shoes, running the same direction every day around a track, running downhill with unusual weight on your back.  Perform volume before intensity, get a gait analysis performed to identify/correct over striding, perform shin endurance activities, get a shoe prescription and don't put more than 300 miles on a pair of shoes, alternate directions around a track, ice daily with compression to decrease shin compartmental pressure.

7.        Stress fractures in your feet

a.        Primary risk factors: Relative excess volume combined with premature intensity, overly flexible training shoes, toe running/landing on mid to forefoot during heel strike, rapid increase in downhill running, rapid transition from trail running to pavement running. Again, build volume before intensity and listen to your body. You know best what weekly mileage threshold you get stress phenomena. Train in a moderate weight training shoe and race with a flexible flat if needed. If you come from a booted sport background like hockey and are new to distance running, take a year to build up to the marathon distance as you likely don't have the bone density yet necessary to train marathon distance on hard pavement.

8.        Achilles tendonitis

a.        Primary risk factors: Relative excess volume combined with premature intensity, rapid increase in hill running on surfaces where heel is unsupported followed by sleeping at night with toes pointed down like mentioned in plantar fasciitis, new shoe that places a unique pressure point from the heel cup padding on the underlying tendon, new motion control shoes that are excessively rigid in the midfoot making a long lever of resistance. Again, build volume before intensity before finally unsupported uphill running (run stairs first where heel is supported if you choose to introduce uphill running early in the season), don't wear a heavy pack on steep uphill scrambles where your heel is unsupported, don't sleep on your stomach or on your back with your sheets tucked tightly, evaluate shoes for being overly rigid or placing excessive pressure on tendon. Ice daily with non-moist ice bag directly on tendon with compression.

9.        Sacroiliac joint pain

a.        Primary risk factors: Premature intensity/speed work, asymmetric stride length (not leg length which is more important during standing) in which one leg strides out further than other causing excessive loading of longer side, running same direction around track during speed workouts, poor lifting mechanics when lifting children or carrying otherwise heavy loads, generalized failure to engage core stabilizing muscles, excessive mileage on running shoes (greater than 300 miles). Build volume before intensity, have stride length and force symmetry at impact evaluated by a qualified gait analysis professional, alternate directions around track, lift heavy loads by lunging perpendicular to the object you are picking up to limit lumbopelvic loading, take an entry level core stability class, rotate running shoes so mileage on any pair never exceeds 300 miles. Ice daily with non-moist ice bag directly on joint with compression.

10.     Gastrointestinal distress

a.        Primary risk factors: Consuming excessive carbohydrates in too short of a time period, consuming solid foods without accompanying liquids or reserve body hydration to allow absorption, consuming a carbohydrate or protein type that your bowels are not accustomed to or even may have a digestive intolerance to, and finally attempting to consume energy sources at too high of an intensity level ie on the uphills. During exercise of marathon pace intensity, the bowels can only absorb approximately 250 simple carbohydrate calories per hour. Any carbohydrates in excess of this value or too short-chain actually cause GI discomfort as undigested carbs draw water from the body into the bowel causing mild diarrhea-like symptoms. All energy sources should either be pre-dissolved in liquid form before consumption or consumed with liquids to allow rapid absorption. Once the body is excessively dehydrated, bowel absorption rates and blood pressures drop as blood flow to the bowels diminish. This is actually a mild form of hypovolemic shock.  In its later stages the bowel motility becomes flaccid and absorption ceases completely requiring intravenous rehydration in the medical tent. In summary, consume at least 10 ounces of water per hour with recommended 250 calories of moderate glycemic index (non-simple sugars) carbohydrates like maltodextrin found in many commercial energy replacement products. Time your consumption to the down hills and flats as absorption decreases dramatically on the more intense up hills.

Find out months in advance what brand of energy drink and foods that will be provided on the racecourse and do every long run with that specific combination until your physiology makes changes to necessary digestive enzymes thus allowing efficient absorption of that carbohydrate type. If you never develop tolerance to that combination after repeated attempts, pass on the racecourse provided energy drinks and use electrolyte replacement capsules with your own race food creations that you can easily carry. For very unresponsive cases, consider being evaluated by a nutritionist or gastoenterologist/internal medicine specialist for various digestive intolerances including lactose and gluten.


Dr. Jeremy Rodgers is a popular sports chiropractor and board-certified athletic trainer at the Colorado Sports Chiropractic Center in Boulder County who specializes in the management of overuse running injuries. He is a nationally ranked adventure racer having competed internationally in the Eco Challenge and Raid World Championships and is currently training for the US National Wildwater Kayak Team. Among his many roles in the Front Range sports medicine community, he is the medical director for 5430 Sports and Boulder Peak Triathlon.

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