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Running Injuries

5.15.08 Justin A. Glass, MD Emory Family Medicine. Running Injuries. Exercise in Residency?. Injuries Happen…. Stephen J. Carrera/European Pressphoto Agency. Running Injuries. Objectives: You will be able to give general advise regarding preventive care of runners

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Running Injuries

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  1. 5.15.08 Justin A. Glass, MD Emory Family Medicine Running Injuries

  2. Exercise in Residency?

  3. Injuries Happen… Stephen J. Carrera/European Pressphoto Agency

  4. Running Injuries • Objectives: • You will be able to give general advise regarding preventive care of runners • You will understand how to evaluate and treat common running injuries • You will be inspired to exercise for your personal health and as a role model for your patients

  5. Running Demographics • 15.1 million regular runners (>100 day/yr) • 3.65 billion runs (2006) • 8.5 million race finishers (2006) • Sex: M 53% / F 47% • Average age: 44 • College graduate: 74% http://www.runningusa.org/cgi/index_largest_races.pl

  6. Running Paradox • To prevent arthritis, you should run. True / False

  7. Arthritis and Running • No link between running and arthritis in anatomically normal joints • Modifiable risk factors for osteoarthritis • Weight • Certain sports / Occupations JAMA 1986 Mar 7;255(9):1152-4 J Rheumatol 1993 Mar;20(3):461-8 Menopause 2007 Sept-Oct; 14(5): 830-4

  8. Running Injuries • Mechanism of injury Stress = Load x Intensity Load = Distance Intensity = Speed

  9. Running Injuries • Prevention • Surface • Shoes • Frequency • Mileage • Speedwork • Clothing

  10. Prevention: Proper Shoes • Wear patterns

  11. Injury Prevention: Frequency / Distance • Limit mileage increase to 10% / week • Hold steady every third week • Frequency needs individual tailoring

  12. Injury Prevention: Intensity • Speedwork • Most running at easy pace (65-80% HR max) • Minority of time spent running at “quality level” • Marathon pace training: 80-85% HR max • Occas component of marathon program • Tempo training: 85-92% HR max • Use: limit to 10% of total weekly mileage • Interval training: 98-100% HR max • Use: limit to 8% of total weekly mileage

  13. Running Injury Prevention • Weather appropriate • Reflective • Road safety awareness

  14. Hardrock 100 Silverton, CO

  15. Running Injuries • Case #1: 24 yr old female recreational runner develops bilat knee pain while running. Worsening over past 2 months. Running 3-4 days week. Pain also now while using stairs.

  16. Running Injuries • Case #1 - Exam • Gait normal • Knee ROM normal • No knee effusion • No joint line pain. • Mild pain with patellar manipulation • Ligaments / meniscal testing normal

  17. Patellofemoral Pain Syndrome • Females > Males • Maltracking of patella www.afp.org

  18. Patellofemoral Pain Syndrome • Treatment • Rest / Reduce mileage • Pharmacologic • Naprosyn short term help (B Recommendation) • PT • VMO strengthening (B Recommendation) • Ultrasound • Stretching (B Recommendation) • Orthosis (B Recommendation)

  19. Patellofemoral Pain Syndrome Patellar Brace www.aafp.org/afp/20070201/342-f2.jpg

  20. Patellofemoral Pain syndrome McConnell Taping

  21. Running Injuries • Case #2: 31 yr old male presents with a two week history of lateral knee pain. Pain occurs with running. He is planning to run a marathon in six weeks.

  22. Running Injuries • Case #2 - Exam: • Gait normal • No knee effusion noted • No pain w/ patellar manipulation • No joint line pain

  23. Running Injuries • Ober’s Test www.aafp.org/afp/20050415/1545_f2.jpg

  24. Illiotibial (IT) Band Syndrome www.aafp.org/afp/20050415/1545_f1.jpg

  25. IT Band Syndrome • IT Band Syndrome Treatment • Reduction in mileage • Icing • Stretching (B recommendation) • Hip abductor strengthening (B recommendation)

  26. IT Band Syndrome • Best Stretch www.aafp.org/afp/20050415/1545_f4.jpg

  27. IT Band Syndrome Another Stretch: • Iliotibial band and buttock stretch (right side shown). Position yourself as shown above. Twist your trunk to the right and use your left arm to "push" your right leg. You should feel the stretch in your right buttock and the outer part of your right thigh. Hold the stretch for 10 to 20 seconds. Do the exercise 5 to 10 times.

  28. IT Band Syndrome Gluteus Medius Strengthening www.aafp.org/afp/20050415/1545_f4.jpg

  29. IT Band Syndrome • IT Band Syndrome Treatment • Reduction in mileage • Icing • Stretching (B recommendation) • Hip abductor strengthening (B recommendation) • Immobilization x short duration • Injection • Surgery

  30. IT Band Syndrome www.aafp.org/afp/20050415/1545_f4.jpg

  31. Running Injuries • Case #3: 37 yr old male runner presents with heel pain progressively worse over past month. No clear trigger. Worse in the morning.

  32. Running Injuries • Exam: Achilles tendon wnl. Ankle joint wnl. Medial heel tenderness on palpation

  33. Medical Care of the Runner • Plantar Fasciitis – Treatment • Stretching (B recommendation) • Ice massage • Shoe change • Motion control shoe • Inserts • Night splints (B recommendation) • Injection

  34. Plantar Fasciitis • Treatment • Stretching

  35. Plantar Fasciitis • Night Splints • - Need to use consistently • Does not replace daytime stretching • Tolerance varies among patients www.treatplantarfasciitis.com/plantar-fasciit

  36. Running Injuries • Case #4: 42 yr old male presents with medial R knee pain. Planning to run half marathon in 2 weeks. Tripped and fell one week before pain onset on training run.

  37. Running Injuries • Case #4: Exam • R knee: No effusion No joint line pain Tenderness to palpation 4 cm below joint line medially.

  38. Pes Anserine Bursitis • Case #4: Pes Anserine Bursitis • What in the world is the pes anserine bursa?

  39. Pes Anserine Bursitis • Treatment • Ice • Rest / Reduction in mileage • Stretching • Corticosteroid Injection (consider as early intervention)

  40. Hardrock 100: Green Mt (mile 88)

  41. Running Injuries • Case #5: 16 yr old female on h.s. x-country team. Develops pain in R mid-foot with running in mid-season. Able to race. Comes to see you the week before district meet due to increased pain.

  42. Running Injuries • Case #5: Exam • R foot without edema • Tenderness over mid-metatarsal area. • Ankle join wnl

  43. Running Injuries • Case #5 Foot xray www.rad.msu.edu

  44. Stress Fractures • Distribution • Tibia 50% • Metatarsal 25% • Fibula 10% • Femoral neck 4% • Femoral shaft 2% • Navicular <2% • Calcaneal <2%

  45. Tibial Stress Fracture

  46. Stress Fractures • Treatment • Activity modification • Plus consideration of: • Short course non-weight bearing • Pneumatic splint (tibia) • Surgery • Non-union www.anklebrace.info/aircast/leg-brace-big.jpg

  47. Running Injuries • Case #6: 36 yr old male training for first half marathon. Avid hiker. Began running eight weeks prior to race. Developed upper L thigh pain with running two weeks prior to race. At mile six of race had increased pain, but kept running. At mile 13 had excruciating pain in L thigh and could not run further. Needed help to walk to finish line.

  48. Running Injuries • Femoral Neck Fracture

  49. Femoral Neck Stress Fracture http://www.emedicine.com/sports/topic37.htm

  50. Femoral Neck Stress Fracture http://www.emedicine.com/sports/topic37.htm

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