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Running Injuries

More than 40 million people in the United States run regularly. Although there are many health benefits from running regularly, there is also a risk of injury. Injuries from running usually involve the muscles, tendons, joints, and bones of the legs. Most are due to repetitive activity rather than a single traumatic event.

COMMON RUNNING INJURIES AND SYMPTOMS

Knee pain is the most common symptom of injury in runners. The most common cause of knee pain in runners is patellofemoral pain syndrome. The hallmark of this syndrome is the gradual onset of pain in the front of the knee, near the kneecap. The pain is worse after sitting for a long time or when going up and down stairs or hills. Another cause of knee pain is iliotibial band syndrome, which affects the outside of the knee and can travel up the outer side of the thigh to the hip.

JAMA, Running Injuries

Other common injuries in runners include medial tibial stress syndrome, also known as “shin splints.” This causes pain over the shins and is more common in beginning runners. Long-distance runners can get stress fractures, small fractures of the bone that result from repeated “stress” on the bone, most often in the lower leg, hip, or foot. Other foot problems include Achilles tendinitis andplantar fasciitis. Achilles tendinitis causes pain along the heel cord (Achilles tendon) at the back of the ankle, whereas plantar fasciitis causes pain at the bottom of the foot or the heel itself. Plantar fasciitis usually feels worse after a period of rest, such as in the morning just after getting out of bed.

WHO IS AT RISK OF RUNNING INJURIES?

Certain groups of runners have a higher chance of becoming injured. These include beginning runners, runners with previous injuries, those who run more than 40 miles (65 km) a week, those who suddenly increase the speed or distance of their running, and women with low bone density (osteopenia or osteoporosis).

DECREASING RISK OF INJURY FROM RUNNING

Every individual is different, but some general recommendations include

  • If you are a beginning runner, start slowly and increase running time and distance gradually.
  • Include 1 or 2 “rest days” or days spent doing other types of exercise (strength training or cross-training) each week.
  • Choose a shoe that is comfortable with a proper amount of support, and change shoes every 350 to 500 miles.
  • Soft surfaces (eg, treadmill, track) are better than hard surfaces (eg, concrete, asphalt).
  • Although many runners like to stretch before or after running, stretching has not been shown to reduce injuries.

TREATMENT

The most important treatment for running injuries is rest, or changing activities, to allow for healing. Other treatments include ice, special devices such as splints or orthotics, and pain relievers such as nonsteroidal anti-inflammatory drugs. Physical therapy can also help for more serious injuries. Surgery is rarely needed.

If you have pain while running that lasts for more than a few days or is severe enough to make you stop running, see your doctor. Do not try to push through the pain.

 

 

Adaptado de la Hoja para el paciente de JAMA

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Fotografía —modificada— de François Abgraall, usada bajo licencia de Creative Commons

 

blog | El dilema de una lesión deportiva

 

La reciente lesión de rodilla de uno de nuestros más destacados futbolistas induce reflexiones interesantes. Todo un país, desde el más humilde colombiano hasta nuestro presidente, se preocupan sinceramente por la salud de Falcao, pero muy especialmente por su incierta recuperación para nuestra soñada participación en Brasil.

Las lesiones deportivas hacen parte de la vida de cualquier atleta, pero sin duda hay factores bien identificados que se asocian a lesiones más graves o más frecuentes. Desconozco los detalles del reciente incidente, pero la traumatología deportiva ha permitido reducir, en cierta magnitud este preocupante fenómeno.

En algunos casos, la minoría de ellos, se trata de mala suerte o una simple casualidad. El exceso de entrenamiento, en duración o intensidad, el aporte nutricional inadecuado, los implementos o técnicas deportivas subóptimas aumentan dramáticamente la probabilidad de un accidente. Con gran frecuencia, los rigores de la competencia a nivel profesional, dados por presiones económicas y políticas, llevan a nuestros virtuosos deportistas a desafiar los principios biológicos del entrenamiento. Se requieren músculos, corazón y hormonas entre otros factores para garantizar el óptimo desempeño.

Circunstancias tan sutiles y difíciles de controlar como la falta de un sueño reparador, la deshidratación, la fatiga por trabajo excesivo, un aporte bajo de proteínas o carbohidratos, sodio, potasio y otros nutrientes pueden predisponer a lesiones deportivas. Como en otras situaciones de la vida, por ejemplo en la aviación, sólo es posible minimizar el número y la gravedad de los accidentes con un abordaje integral, sistemático y objetivo.

Los protocolos rigurosos de prevención han mostrado resultados, tan palpables cómo el número de vidas salvadas por las multas a conductores ebrios. El deportista élite tiene derecho a un grupo técnico y médico que lo proteja y apoye a alcanzar sus metas, aun sacrificando a veces los deseos de fanáticos, directivos y empresarios que sólo ven los resultados a corto plazo y pueden arriesgar la carrera de un atleta profesional.

 

JD

 

Este blog fue publicado en el periódico El Espectador en febrero 1 – 2014

Fotografía de Joshua McKenna usada bajo Licencia de Creative Commons

Selecting and Effectively Using Running Shoes

 

Running shoes should be selected after careful consideration. With so many brands and styles of shoes on the market today, it is important to find the best fit for your feet and your needs.

Consider the following when choosing a running shoes:

  • Shoe size: the most common mistake in shoe selection is picking the wrong size. Be sure the shoe fits after break-in.
  • Past experiences with shoes.
  • Problems with your current shoes.
  • Biomechanical needs (arch type, pronation, orthopedic injuries).
  • Environmental conditions.
  • Running and racing requirements.

FINDING A SHOE TO FIT YOUR FOOT CHARACTERISTICS

Carefully select shoes that fit the length and width of your feet. Determine what shoe shape you require based on your foot type. The wet test can be used to determine your foot type. Moisten your foot with water, and stand on any surface that will leave an imprint of your foot.

Normal Arch: A normal foot has a normal-sized arch and leaves an imprint that has a flare but shows the forefoot and heel connected by a wide band. A normal foot lands on the outside of the heel then rolls inward (pronates) slightly to absorb shock. Runners with a normal foot and normal weight are usually considered biomechanically efficient. Stability shoes work best for a normal foot and normal arch.

Low Arch: Flat feet have a low arch and leave a nearly complete imprint of the sole of the foot, indicating an overpronated foot that strikes on the outside of the heel and rolls inward excessively. Motion-control shoes work best for a flat foot with a low arch.

High Arch: High-arched feet leave an imprint showing a very narrow band connecting the forefoot and heel. This type of foot is underpronated and is not an effective shock absorber. Cushioned shoes work for a rigid foot with a high arch. Old shoes also show a pattern of wear that helps determine running style. Examine the soles of your shoes for a pattern of wear. Next, put your shoes on a table and look from the back of the shoe to the heel. If your shoe tilts to the inside, you may have a low arch. If your shoe tilts to the outside, you may have a high arch.

GUIDELINES FOR PURCHASING SHOES

Purchase running shoes from a good running shoe store or from someone knowledgeable about matching the correct type of shoe to your foot type and stride pattern. They can help you find the perfect fit that meets your needs.

Watch for shoes with excessive wear. Worn shoes often amplify a foot problem, and injuries can occur when a shoe is worn too long before it is replaced.

Analyze the need to purchase new shoes based on the number of miles on your old shoes, not by the amount of tread left on the outer soles. Most estimates place midsole breakdown, and increased potential for injury, between 400-500 miles. For some, this means replacing shoes before they show major wear.

OTHER RUNNING SHOE CONSIDERATIONS

Most people (85 percent) wear shoes that are too small. Shoe size varies among manufacturers. Have the shoe clerk help you select the correct shoe size. The shoe should have adequate room at the widest part of the foot. The shoe shouldn’t be tight, but it shouldn’t slide around either. Your heel should also fit snugly into the rear of the shoe.

Try shoes on later in the day, and bring the socks you normally run in. Try on several pairs of shoes in the category closest to your foot type. Make sure you try on both shoes since the sizes of your feet can be slightly different, and keep them on your feet for about ten minutes to make sure they are comfortable. Most good stores will allow you to run up and down the block to experience what running will feel like in the shoes.

Consider purchasing two pairs of running shoes. Alternating their use increases the life expectancy of each pair.

Once you’ve purchased new shoes, run easily in the shoes for a short distance. It is important to allow sufficient time, between 60-70 miles, to break in the new pair.

After you have wisely selected your new running shoes, take them home, put them on and enjoy the run!

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Reprinted with permission of the American College of Sports Medicine. Copyright © 2011 American College of Sports Medicine. This brochure was created and updated by Shannon Crumpton and is a product of ACSM’s Consumer Information Committee. Visit ACSM online at www.acsm.org.

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Ankle Sprains and the Athlete

ACSM current comment

Summary

Ankle sprains are one of the most common injuries in the athlete. Accurate and rapid diagnosis, comprehensive treatment, and rehabilitation are critical in reducing the risk of re-injury or chronic disabling ankle pain. Prevention of injury should be a part of any training and exercise plan. The ultimate goal of any treatment program is to improve function without inhibiting the athlete’s performance

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 Reports estimate that 25,000 Americans suffer from an ankle sprain each day. Ankle sprains account for almost half of all sports injuries and are a common reason why athletes take time off from activities. Accurate diagnosis is critical, as some studies suggest that 40 percent of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Self-education is therefore important in order to decrease the risk of this disabling complication.

What is an ankle sprain?

An ankle sprain is an injury to one or more of the ligaments in the ankle. These strong fibrous bands hold together the bones of the ankle and are prone to injury during strenuous movement and repetitive activity. There are two categories of ankle ligaments: those on the outer and those on the inner surfaces of the ankle. The most common sites of injury are in the outer – or “lateral” – ankle ligaments.

Common Causes

More than 80 percent of ankle sprains are a result of inversion, or inward rolling, of the ankle. This is commonly experienced in athletic activities that involve running, pivoting and jumping. While sudden, forceful movements are certainly the cause of many ankle sprains, low-grade repetitive trauma can also weaken and injure ankle ligaments. Risk factors for ankle sprains include previous ankle injury, impaired balance/postural control, type of sport played, position, and muscle strength/range-of-motion deficits. Excess body weight may also be a risk factor for males.

Evaluation and Diagnosis

Obtaining a thorough, detailed history of events is critical in the evaluation of ankle pain in order to lead to an accurate diagnosis. Immediate evaluation is important to determine if there are any other injuries such as a fracture. Common signs and symptoms of an ankle sprain include swelling, pain, instability and bruising. Numbness or severe weakness may suggest a related nerve injury. Examination of the ankle for evidence of instability and localizing pain is part of the initial assessment. Clinicians may often obtain x-rays or MRIs for further evaluation. A widely validated and sensitive rule of the thumb for assessing ankle sprains is known as the Ottawa Ankle Rules. These rules recommend imaging for possible fracture if there is pain on the side of the ankle with palpation and the patient is unable to walk four steps without pain. Ankle sprains are generally categorized into three grades:

Grade I : The most common type; these are associated with a mild degree of swelling and pain related to stretching of the ligament.

Grade II : More commonly seen in athletic injuries, these are associated with a moderate degree of swelling and pain and are related to an incomplete tear of the ligaments.

Grade III : The most severe of ankle sprains; these are associated with significant swelling and pain and are related to complete tear of the ligaments.

Initial Treatment and Prognosis

After an accurate diagnosis is obtained, treatment will vary depending on the severity of injury. Early and comprehensive treatment remains the best predictor of a good recovery. Initial treatment includes four common concepts referred to as R.I.C.E. (Rest, Ice, Compression, and Elevation). Relative rest or discontinuation of athletics is often necessary. Ice bags applied at 20-minute intervals three times per day for at least 72 hours post injury, along with compression and elevation, can help reduce swelling and pain. A thorough evaluation by a medical expert will help determine other possible treatments, including bracing, taping and anti-inflammatory medications.

Prognosis is directly related to the severity of injury. Immediate evaluation and treatment will often lead to an increased chance of complete recovery. Surgery is rarely necessary, as most ankle sprains will heal with conservative management.

Rehabilitation

A comprehensive rehabilitation program is a critical part in the treatment of ankle sprains. With the guidance of an experienced physical therapist or athletic trainer, stretching and strengthening of the ankle joint and calf muscles will quicken the recovery time and decrease the risk of re-injury. To maintain cardiorespiratory fitness during recovery,walking or jogging in a pool or cycling is recommended, as the weight on the ankle is decreased. Re-training the muscle sensation (called proprioception) and postural control (balance) should be a critical component of any rehabilitation program. Balance training, using ‘wobble boards’, is an excellent rehabilitation technique that helps strengthen and stabilize the ankle, reducing the risk of re-injury. Returning to activities usually varies from a few days to two months, depending on the severity of injury.

Prevention of Re-Injury

Prevention in athletics is an important matter to discuss with a skilled sports medicine practitioner. Properly applied external ankle supports (tape, semi-rigid, and rigid braces) and balance board exercise training can reduce the risk of ankle re-injury by more than 50%. These prevention strategies are especially effective for those with a history of a previous ankle injury. External ankle supports do not adversely affect athletic performance. Semi-rigid and rigid ankle supports are most effective, widely available, and cost less than athletic tape.

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