Injury Prevention and Treatment

NOTE:  I am not a doctor, coach or running guru, but rather, just some dude who has been running for 40 years. I have coached some high school runners at times, but not currently. Anything written here is my personal opinion based on my life, observations and interactions with other runners, and things I have read about that I agree with.

Everyone who runs or exercises will eventually have some type of injury. You might think this will not happen, but do not delude yourself, it will happen. This trick is to try to prevent the injuries to begin with, but if they occur, to minimize them. For the purpose of this blog, I will mostly be talking about running related injuries. First and foremost, you should build up slowly with your miles and workouts. Some people recommend adding no more than 10% per week in mileage, and don’t do that every week. Secondly, stay flexible, stretch routinely, but not necessarily right before running. There is debate over how much to stretch before you run.  I don’t do a lot myself, but rather, prefer to warm up with a slower run. However, after running, I try to do some basic stretching. When I say basic stretching, I mean front to back leg swings, side to side leg swings, hamstring stretches with my legs on a raised surface, quad stretches by pulling my lower leg behind my upper leg, and hip stretches by crossing my legs and pointing one side of hip to the other direction. That is pretty much all I do after running. 5 minutes max.  But stretching does not have to be limited to when you are running. Do it in the morning, do it at night, stay flexible your entire life, your body will appreciate it. Additionally, strength training is beneficial for the runner. This does not mean you have to lift heavy weights or anything like that.  In fact, you don’t need weights to get a workout. You can do crunches, pull ups, pushups, dips, and other similar exercises to build strength.  However, I prefer to do some weight lifting myself.

Things I have learned the hard way that might help others (not in order of importance, everything is important) 

1. Run with good posture. If I don’t run with erect posture, my calves will be sore, as well as other muscles; bottom of my feet, etc. Sometimes to the point of not being able to run for a while! Even a slight lean can make a difference. Some people may be able to lean over when they run, but I can’t. When you run erect, everything is lined up above the hips and below. Your feet land below the hips on impact, everything is great. The calf muscles and achilles tendons are not stretched too far. No problems. Run erect, perpendicular to the ground. Keep this in mind when running uphill or downhill. Going uphill, it is almost impossible to not lean forward,  but do your best to lean back. Conversely, you might want to actually lean forward slightly going downhill. This brings me to number 2 below. Since finally getting my posture right, I don’t have calf problems anymore.

2. Don’t do steep downhill sprints, especially on irregular terrain. Make sure the slope is gentle and smooth. Otherwise, you are asking for trouble. It is easy enough to get injured, why multiple your risks by being stupid. First of all, running in general puts a lot of pressure on your knees and legs. This is exacerbated the heavier you are, and even more so when running downhill. Also, when running downhill, due the angle, runners have a tendency to hit heel first. Increased pressure and poor running form while running downhill can lead to patellofemoral pain syndrome (runner’s knee; http://www.eldoradopt.com/patellofemoral-pain-syndrome). Obviously, you will find yourself running downhill at times, but be smart. And, there may be some benefits to downhill running as far as “teaching” your body to run fast. But, be carefull, use good form, and don’t overstride. There is much mixed opinion about downhill sprinting in general, slope of the downhill, the distance the sprints should be done at, and the pace. Some research has shown that a slope of 5.8% and distance of about 40 meters is optimal (http://www.livestrong.com/article/473212-does-downhill-sprinting-make-you-run-faster/), but others recommend 75 to 150 meters and slopes of up to 10% (http://www.livestrong.com/article/159719-how-to-increase-running-speed-with-downhill-training/). I suspect that like any intervals, it depends on what and when you are training for. And, again, don’t do this on irregular terrain or somewhere with hard turns. I have witnessed runners suffer various injuries from this. Honestly, I seriously  question the need for downhill sprints for long distance runners, as the dangers outweigh the benefits (in my opinion).  With all this being said, most runners should probably limit their hill running and try to include some flat courses in their weekly runs. )

3. Don’t overstride. Instead, maintain a somewhat shortened, but faster stride. This equals softer landings. Easier on the knees. Doesn’t stretch your calves and achilles tendon as much either. Make sure your knees are slightly bent as you hit the ground.

4. Don’t run too fast in the morning in the winter when its cold. If you do, make sure that you have properly warmed up. Every serious injury I have had the last few years was indirectly or directly linked to a semi fast long run on a cold morning when I did not get a warmup jog in. New rule for me, no early morning runs in the winter unless its warm, or unless I can make myself go slow.

5. Almost all injuries I have had were due to a combination of doing something too hard with not enough warmup and stretching after, and then doing something else physical afterward such as 8 hours of yardwork or 4 hours of volleyball. Seriously, its stupid to run 13 miles at a 6:50 pace at my age (48) and weight (170 lbs) then go play volleyball for 4 hours. Fun, yes, but stupid.

6. As alluded to earlier, warmup is necessary for everything. For moderate to fast running such as with intervals or threshold running, a warmup jog is mandatory. Do it every time! Then some light stretches before the actual run. Then a cool down run. Then some stretching. Even an easy run should be started out a an easier pace. The same thing with lifting weights. You don’t start your first set of bench press with your max weight. You always want to warmup with lighter weights first.

7. Swinging leg kicks, both front to back and side to side. I always do these before and after running. Sort of a dynamic stretch I guess. They are difference makers. Do them!

8. Stretching. I have talked about stretching some already, but I think this bears repeating.  As I mentioned earlier, there has been great debate about how much to stretch, should you even stretch, when to stretch, what stretches to do, and on and on and on! I can only speak from personal experience and from my observations of others. When I first started running, I never stretched before began a run. I did do some routine stretching at other points in the day. When I went to races, I watched others doing all sorts of crazy stretches before they ran, especially the slower folks. I never had any injuries, and I was running pretty fast (relatively speaking). After a few years, I thought I would see what all this pre run stretching was all about. It was not long before I started having strained and pulled muscles. Nowadays, I do only very light stretches or dynamic movements before running and then start my run at a slower pace to warm up.  If I were doing a race, I would start with an easy warm up run, then would do a few leg swings, maybe some high knees, butt kicks, and possible some super light and not hard or long (duration) hamstring and quad stretches. After I run hard, I take a minute then do a cool down jog or walk, then do basically the same stretches or movements that I did before (i.e. leg swings, hamstring and quad stretches, plus light hip stretch). I might spend a total of 5 minutes stretching and I don’t stretch my muscles very hard before or after. I never do calf stretches any more. The hamstring stretch I do is good for my achilles tendon, and that seems to help more than calf stretches. Stretching the calf is tricky and at best risky. It turns into a crazy circle and never gets better. But, back to the rest of the story. My “stretching” movements are minimal and mostly done to loosen up. In fact, I am hard pressed to call what I do stretching. I think in general that lots of stretching, holding stretches for long periods of time, and over stretching (reaching as far as possible) are recipes for disaster for runners. Before running, your muscles are tight and stretching them is an easy way to strain them. After running, your muscles are tired, and stretching them overly could also be detrimental. Another reason to not overstretch, is that this added flexibility actually decreases muscular strength and takes away from our body’s natural ability to function like a spring as the legs hit the ground. Anyway, my recommendation is to do very light and minimal stretching. From what I have seen, the folks who are pulling muscles are mostly doing so because they are not quite ready for the pace they are going. Of course, there are exceptions, such as when when leg is much less flexible than the other. Sure, fix that. But, do it at another time of day instead of right before running.

9. Some weight lifting or something comparable such as push ups, chin ups, etc. will greatly benefit your running. Throw in some leg curls and extensions if you can. Abdominal exercises are crucial. You cannot be an effective runner if you don’t have a strong core. Also, some weight training will make your bones and joints stronger.  Two or three days a week is great. A good time to do this is after an easy run, or at a time of day when you aren’t running. If you run in the morning, do it in the evening.

10. Listen to your body. If you are tired, back off or take a day off. If you are injured, do something else for a while and ease back into it. I have a hard time with this, but am doing better.

11. Use good training shoes for your everyday mileage, only use racing flats for fast stuff. Racing flats do not give enough support for everyday running. If used every day, your calves will be screaming, shins may hurt, knees may hurt, etc. Also, do not over use shoes. When they are worn out, get some new ones.

12. Don’t run hard every day. Have easy days to recover from harder days. If you have to run hard two days in a row, do your harder workout the first day. Don’t run superfast more than once or twice a week. Periodize your training during the year. If you have a harder phase for 2 or 3 months, then have easier phases after for 2 or 3 months where the emphasis is on easy running and building a mileage base. That does not mean that during some of the easy phase you can’t do some interval based running or a threshold run once a week. But, no need for fast paced running during an easy phase.

13. Terrain. Most people recommend that you minimize the running you do on hard surfaces such as sidewalks, concrete tracks and walkways, and paved roads. If you can find some grassy place to run, ideal. For me, even a gravel road is better than a paved road, especially if you can run in the places worn by vehicle tires. Be careful running on gravel, its easy to twist an ankle. On the other hand, I think running on gravel may actually strengthen your ankles. Running on gravel also forces you to have better form, because if you lean forward too much, your legs are behind you and you tend to “spin out”. One thing I should point out, is that if you have good running form, and you have adequately built your mileage up, running on roads seems to be less of a problem. I don’t actually have any problem running on roads unless my shoes are worn out.

14. Blisters. Yeah, I have had some bad ones, usually around between my big toe and toe beside it or under those toenails. Have lost some toenails, but they came back. Pretty much every time this happened was when I was doing a long run (13-17 miles) in the summer when it was crazy humid. I live in Mississippi, and it is crazy humid every day of the summer. My socks are drenched with sweat after 3 miles, and my feet get soaking wet. I have to stop periodically to re-tie my shoes because they get loose.  To prevent the blisters I use foot powder, good wicking socks (which still get soaking wet), and sometimes I even I wrap my toes with pre-wrap. I only use pre-wrap because I keep it on hand for other taping in case somebody needs it (myself included). I wrap it around the problem toes, the put a piece of athletic tape on there to hold it in place. They sell gel toe caps specifically for this purpose too (http://www.feetrelief.com/feetrelief/gel_toe_cap.html). I don’t usually get blisters elsewhere on my feet, except for occasionally right after I get a new pair of shoes and am in the “breaking in” process. For the most part, if you have good running form, proper fitting shoes (not too tight, not too loose), and good wicking socks, you should be able to avoid most foot blisters. The “black toe” blisters under the toe nails, however, are a different story here in Mississippi. If you run long distance in this humidity, you will likely lose some toenails unless you don’t sweat, despite good running form. Many of the college runners here at MSU, for example, lose them as well. My son, for some reason, does not sweat nearly as much as I do, and he has no problem with this.

Below, I have listed links that may help deal with various running related injuries. I will be adding more links to this page as I get the time. 

Keeping you on the Road and Out of the Doctor’s Office, presented by T.J.Stites, PT, MSH http://www.runaboutsports.com/newsletters/lower_leg.pdf   This gives a great overview of common running injuries and how to treat them.

Achilles Heal or Calf Strains

A great video describing the process of wrapping the lower leg for mild to medium achilles or calf strains. http://www.youtube.com/watch?v=yrMii91x6ns&feature=related

Plantar Fasciatus (heel pain)

Stretches for plantar fasciatushttp://www.plantar-fasciitistreatment.com/plantar-fasciitis-exercises/plantar-fasciitis-stretches

Link to a video describing a wrapping  technique for plantar fasciatus  http://www.youtube.com/watch?v=jKGDhxcdtzE&feature=related

Sore hips ( Strained IT band and Iliopsoas muscles)

Foam Roller Exercises and Stretches for your Iliopsoas Muscle (hip flexors)  http://www.bodywindow.com/foam-roller-exercises-for-the-iliopsoas.html

Foam Rollers for sale http://www.colonialmedical.com/product.php?productid=19484

Blisters!!

Wiki page on how to prevent and treat blisters. Pretty useful. http://fellrnr.com/wiki/Blister_Prevention

Fixing your Feet -web site: http://www.fixingyourfeet.com/

How to apply Moleskin: http://www.livestrong.com/article/211100-how-to-put-moleskin-over-a-blister/

Gel caps for toes to help prevent blisters – http://www.feetrelief.com/feetrelief/gel_toe_cap.html

Foot powders, glides, etc. – http://running.about.com/od/injuryprevention/tp/productstopreventblisters.htm

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5 responses to “Injury Prevention and Treatment

  1. Rebekah

    I got really bad blisters on one foot around my big toe. I figure I just need the right shoes. It’s hard to find that when you have a limited budget.

    • The right shoes will probably help! Some definitely fit better than others. I get some pretty bad blisters in the summer when its super humid. I have had luck wrapping my bit toe and the one next to it with some pre-wrap that you can get at any athletic store. Good socks help too.

  2. Thanks for all the great information. I am getting blisters too with my new shoes and will look for the pre-wrap (I’ve never heard of it before).

    • You can buy prewrap (its a light foam wrap that you put on before you put athletic tape over an injury) at about any athletic store and most drug stores. http://soccer.epicsports.com/prod/1314/mueller-colored-foam-underwrap-roll-or-case.html In the summer, I just wrap the toes that bother me with it, just to create a cushion really and maybe stick just a bit of athletic tape on there to hold it in place. Basically make a little booty for your toe(s). I usually just do the big toe and the one beside it, as they are the ones i have problems with. I don’t know if it will work for everyone, but it has helped me.

      • After reading your post, I don’t think what I was talking about would help you much. Basically, I was just using the prewrap to fashion a “toe cap”, because I always have some prewrap around for other reasons. I should just order the gel toe caps or something comparable. I put up some new links to blister treatment and prevention, maybe there is something in there that might help you…

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