Injury Prevention

Experienced runners dedicate a lot of attention to injury prevention. In this section, you'll learn techniques for preventing injuries before they happen and treating them if they occur. You'll also learn a quick and effective stretching routine to be used before and after each run. Before you read about prevention techniques, answer the following questions.

Injury prevention checklist

Do your shoes fit properly?
Do your socks fit properly?
Are you warming up adequately before each workout?
Are you using the "rule of thumb" to identify potential injuries?
Are you cooling down after each workout?
Are you dressing (layering) properly to prevent chilling or overheating?
Are you getting enough rest between workouts?
Are you pushing yourself too hard?
Are you running even though you have an injury?
Are you following your runner's diet?
Are you hydrating properly?
Are you running on a dangerous course?
Streets with curbs and gutters?
Path with loose gravel?
Trail with sharp turns, drop-offs, wet grass?
Street or road with heavy traffic?

Hopefully by answering these questions you will be able to help prevent most potential injuries.

The #1 injury prevention technique for runners is proper stretching.

Not exactly your same old stretches!
Remember the exercises they taught you back in elementary and for some high school? The ones where you bounced up and down while you stretched? Those were ballistic stretches. Experts today recommend slow "active" stretches. Because they mimic basic running motions, these stretches are the most effective for runners. They build strength and increase flexibility by putting the muscles and joints through their entire range of motion. Stretching is the ideal way to prepare your body for your upcoming run, and for cooling it down afterwards. During your run, it increases blood flow to the muscles. After your workout, stretching maintains or increases your flexibility (range of motion) so you stay loose and supple. Stretching is essential for anyone who is physically active-especially runners. Whip through the routine here before and after each run, or any other time you want to relax the body and mind.

Stretch warm muscles!
If you stretch before a warm-up, you risk over-stressing cold muscles. If you don't stretch afterwards, muscles and tendons which may have tightened up during your run will stay short, increasing your chance of injury. Stretch after a light warm-up and/or after your workout.

Recognizing an injury that's about to happen: The Rule of Thumb
A key to avoiding an injury is to recognize the early warning signs. Here's a method for detecting potential problems. Runners call it the "Rule of Thumb." After each run or stretch, massage your leg muscles lightly with your fingers, especially your thumb. Get to know your muscles. Ask them how they feel. During this massage note any tenderness, irregular bumps or any differences from one leg to the other. Pain you might not notice during a run will show up during the "Rule of Thumb" test, signaling an injury about to happen. To treat it, use gentle massage and follow the directions in the next section.

Treating an injury that has already happened: R.I.C.E.
How does RICE help you treat injuries? Simply stated, RICE stands for Rest, Ice, Compression and Elevation. If you suffer an injury, or experience the pain or tenderness that tells you an injury is on the way, apply RICE immediately!

Rest
Modify your running program to allow the injured tissue to heal. Take an extra day off. If the pain persists, take two! Don't keep pushing and make the situation worse.

Ice
Ice helps decrease inflammation, allowing healthy nutrients to reach the injured site and begin the rebuilding process. You can apply ice in a variety of ways. Try ice cubes or crushed ice in a plastic baggy. Or fill small paper cups with water, then place them in the freezer. Once they're frozen, peel away the paper and apply the ice as a soothing ice massage. Try the frozen pea massage! Cool-paks are nice, but rather impersonal. The frozen margarita massage is popular in the Southwest. In any case, apply your ice of choice to the tender area for 10-15 minutes at least twice a day. If the ice touches the skin directly, cut your exposure time down to typically less than 10 minutes. Always ice an injured area after running.

Compression
Inflammation and swelling are nature's way of immobilizing an injured limb. They create a natural "cast" which keeps the limb from flopping uselessly in the breeze. To reduce swelling, apply compression to the injured area immediately. Use elastic bandages.

Elevation
As mentioned above, the goal is to get the healing nutrients to the injured area. Elevating the injured body part to the level of your heart, or slightly higher, encourages the flow of blood to and from the inflamed area. Damaged tissue is carried away. The nutrients and healing agents flood the area. You should apply the RICE principle to an injured area for 24 to 72 hours after you notice the pain or tenderness. After that, you can resume running with caution. After the initial 48-72 hours to facilitate blood flow, apply moist heat to the area prior to each run. Apply ice afterward to combat inflammation. If you don't notice any improvement within a week, or if the pain gets worse, check it out with a healthcare professional.

Don't ignore these little annoyances.
Muscle soreness
Every runner experiences muscle soreness now and then-usually for the first 2 or 3 days after you overdo it or try something new. Touch the muscle, it hurts. Move it, it hurts. Stretch it, it really hurts. Basically, you've asked too much of the muscle. The soreness signals the need for the body to increase its strength and resistance. It reminds you to be patient in your running program and progress gradually. That's the best way to avoid, or at least limit, sore muscles.

Blisters
These unpleasant little rascals, usually on the hands (racquet sports) or feet (running), are caused when too much friction is applied to the skin. The body responds by putting fluid between the outer and inner layers of skin. Avoid blisters by choosing the right running shoes and socks. Your socks should fit snugly and wick the moisture away from your skin (damp socks on damp feet cause friction!) In vulnerable areas such as the ball of the foot and toes, apply lubrication such as Runner's Lube®, Body Glide® or Vasoline®. If you get a blister, don't pop it. The skin underneath might get infected. Instead, let it heal naturally. Cut back a little on your running. Apply lubrication, or maybe a skin-like bandage. Second Skin® and Compeed® are made especially for blisters.

Callous
A callous is a thickening of the skin in areas where there is excess friction, but not enough to cause a blister. The body responds by laying down extra layers of skin to provide a tougher surface. This is just fine until a blister forms under the callous itself. The callous gets so big that friction develops between the tough outer layers and the more delicate layers beneath. To avoid these problems, reduce the callous occasionally with a file, pumice stone or other callous removers.

Chafing
The uncomfortable irritation called chafing occurs when your clothing rubs against your skin. Runners sometimes experience chafing between the legs and under the arms. For women runners, chafing can be a problem with some sports bras. To control chafing, make sure you're running in clothing that wicks moisture away from the skin and promotes evaporation. Dry clothing is less likely to chafe than damp clothing. Lubrication can prevent and relieve discomfort in vulnerable areas. Try rubbing baby oil, Runner's Lube® or Body Glide® on susceptible areas.

Side stitches aren't funny. Here's how to avoid them.
A side stitch starts as a slight irritation in the side just under the bottom rib. After a while it develops into a consistent sharp pain that interferes with your running motion and breathing. For years, no one knew what caused the side stitch, and as a result there were a lot of wild procedures for getting rid. Scientists finally figured out that the side stitch is caused by irritation of the lining of the abdominal cavity- from too much food in your stomach, dehydration or gas. You can prevent side stitches by avoiding large meals before your workout, staying well hydrated and avoiding high-sugar foods and drinks before running.

Treat the following immediately:

Plantar Fasciitis
Plantar fasciitis is heel pain caused by inflammation or a tear in the tissue on the bottom of the foot. You get plantar fasciitis from over-pronating (rolling your foot too far inward), from overly tight muscles and tendons in the feet and from overly tight calves (the muscles on the back of the lower legs). A sure sign of plantar fasciitis is extreme pain in the arch when you first step out of bed. Treatment includes RICE plus daily massage of the bottom of the foot either by hand or by rolling the foot over a golf or tennis ball or a sturdy metal can. Stretch your calves frequently and thoroughly. Stretch your feet by pulling back on your toes.

Achilles Tendonitis
The Achilles tendon is the thick cord just behind the heel and ankle. When you run, it undergoes a lot of stress and can become irritated and painful. If your Achilles hurts when squeezed, take action pronto. Throw RICE at it immediately, and begin an exercise program to stretch and to strengthen the calves. Be sure to treat your Achilles tendonitis quickly and properly. A torn heel cord will lay you up for months.

Shin Splints
If you notice a tenderness or pain on the front or inside edge of the shinbone- "tibia" -you've got shin splints. This nagging condition often strikes when you begin a running program or change your regimen by adding more running. The cause is usually over-pronation due to poor biomechanics, fatigue or improper footwear. Treatment includes RICE, stretching of the calves and strengthening of the shin muscles. Want an exercise to relieve shin splints? Lie on your bed, stomach down. Let your toes hang off the foot of the bed. Gently pull your toes toward your knees, squishing the mattress between your toes and the front of your shin. The mattress will provide just the right amount of resistance to strengthen the shin muscles.

Runner's Knee
If you experience inflammation and pain on the front of the knee, you may have developed runner's knee. It's caused by an imbalance of strength in your various leg muscles. As a result your kneecap goes wild and crazy and fails to track correctly when the knee is flexed and extended. Instead of gliding in its groove, it sways to one side (usually the outside) and rubs against the bone. Yikes! Treatment includes RICE and an exercise program aimed at strengthening the thigh muscles.

IT Band Syndrome
Another common knee injury occurs on the outside of the knee. It's called iliotibial band syndrome-or IT band syndrome. The IT band extends from the hip to the outside of the knee and provides major lateral support for the leg. Because it runs across, and can rub against, the outside of the knee, it can become irritated during running. IT Band Syndrome is caused by running on slanted roads, wearing worn-out shoes, under-pronation or bowed legs. Treatment involves RICE and exercise which promotes stretching of the IT band.

The difference between a strain and a sprain
You often hear of athletes who "sprain" an ankle or "strain" a hamstring. Ever wonder what the difference is? The distinction lies in the difference between tendons and ligaments. Ligaments attach bones to bones. Their function is to support and stabilize joints that otherwise would be very loose. Tendons attach muscles to the bones they move. A "sprain" is a tear (it could be a slight or a major tear) in a ligament. A "strain" is a tear in a tendon or a muscle. Sprains heal slowly due to poor blood supply, and the ligaments often fail to return to their original tightness, leaving the joint susceptible to future sprains. Strains heal quicker due to greater blood supply.

If you do get hurt, here's how to find a good running injury specialist: Like all runners, you have a variety of medical care needs, from normal health maintenance and treatment to specialty care for serious running injuries. The medical professionals who treat you must understand your mind-set. This includes your motivations and compulsions. They must also know the mechanics of running. As you look for medical assistance, you know one thing for sure: When you ask for advice, the one answer you don't want to hear is "stop running." A growing resource for finding a sports medicine professional as well as information about your injury is the Internet. Investing some time in learning more about your particular running injury and professionals available in your area can ensure that you get the most out of your office visit.