Before the marathon

Training. You might think that to prepare for a marathon, you’ll need to simply run greater distances. While increasing your on-the-road endurance should be part of your training, don’t neglect gym exercises. Working with a trainer on a routine designed to strengthen your calves, work on hip extensions and other strength training will help you prepare. Yoga, biking/spinning and pool running are additional ways to become more fit and improve your flexibility.

Also, work on interval workouts at race pace or longer runs that finish at your goal pace the last couple of miles when your legs are tired. And be sure to scope out the marathon course ahead of time, as well.

Suit up. Proper footwear is a must, of course, and not just shoes, but socks as well.

Good socks should protect your feet, not slip or bunch up and should wick away moisture away from your feet. If you know which socks you’ll wear on marathon day, be sure to bring a pair when trying on new shoes.

When purchasing shoes, go at the end of the day when your feet swell the most to ensure you get a proper fit. Wear the shoes for at least one extended run of 10 miles or more to ensure a proper fit before marathon day.

Your clothing should be made of fabric that wicks away sweat and should be a something you’ve worn on a long run before, that you know won’t irritate your skin. Don’t be tempted to wear the give-away marathon T-shirt. Its cotton construction will stifle your skin.

Running analysis. Do you experience pain after or during a run? I often suggest that my patients work with one of our physical therapists to perform a thorough running analysis (also sometimes called a gait analysis). This high-tech assessment can detect what, if any, physical issues might be causing pain. For example, the patient might be overpronating (rolling the foot toward the instep too much). Poor posture or subconscious bad habits could be to blame (leaning the torso forward or back too much, a stride that’s too short or too long, etc.). The running analysis is video recorded and a plan to remedy any problems is put in place. Often, the solution is as simple as pointing out and correcting posture or fitting the patient with orthotics to correct a pronation issue.

During the marathon

Hydrate. Be sure to drink plenty of non-caffeinated liquid prior to the marathon, and ensure you have adequate means to hydrate along the way. Find out ahead of time what organizers have planned to provide to runners. You don’t want to try an energy gel for the first time on marathon day and learn that it doesn’t agree with you.

Cramping? Stop and start stretching. A common problem for first-time marathon runners is lack of adequate hydration which results in cramping. If and when you start to cramp, just stop and take a moment to stretch while you hydrate. If you try to press on and keep going, the cramps are likely to worsen and you might need to stop and drop out completely, so taking a moment to stop and stretch while hydrating is a far better option.

After the marathon

Stretch. Another good tip for first-time marathon runners is to keep moving. You might feel like sitting down or even taking a nap, but your muscles will thank you later if you stretch or take a victory lap to cool down and keep your muscles loose.

Rehydrate and refuel. Sports drinks and gels are a good idea, but as soon as you think you can manage it, try to eat something. If you consume carbohydrates, along with some protein shortly after the race, you’ll be better able to refill your muscles’ primary energy stores of glycogen.

Run. That’s right. If you raced in the morning, take a short evening jog, otherwise, get back to it the next morning. Even a 10- or 20-minute run will help loosen your muscles and keep you from getting too stiff and sore. And don’t forget to stretch beforehand.

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Like Ware when he suffered a similar fracture in 2013, George landed awkwardly and sustained an open tibia fibula fracture. In other words, both bones in George’s lower leg were fractured and broke through the skin. Open fractures of the lower leg are common, as the skin covering the tibia (shin) is quite thin.

George underwent surgery almost immediately. Most people with this type of injury are treated with a surgical technique involving the insertion of a rod in the marrow canal of the tibia which passes through the fracture and holds the bone in position. Screws (also known as intramedullary nails) are then used to further secure the bone as it heals. Another technique involves attaching a metal plate with screws to rejoin the bone segments.

There is speculation that both Ware and George may have sustained stress fractures that, over time, created weak points in these critical weight-bearing bones. Athletes often sustain stress fractures from the repetitive stress sports put on their bones.

But athletes aren’t the only ones susceptible to stress fractures.  Weekend warriors (individuals who spend leisure time doing athletic activities), marathon runners, women, pronators and all highly active individuals are prone to problems affecting the lower legs. Here are a few examples, discussions on diagnosis and treatment, plus prevention tips.

Stress Fractures

The tibia is the strongest weight-bearing bone in your body. It’s about four times as strong as concrete, and like the concrete in your driveway, constant stress and pressure can cause tiny cracks over time.

Cause and symptoms of stress fractures

Stress fractures of the tibia often result from repetitive stress or activities, but can be caused by a sudden increase in activity, such as when an ordinarily sedentary person takes on a strenuous exercise regimen or an active person dramatically increases their training routine. Muscle fatigue can play a role in stress fractures, also. Both muscles and bones serve as shock absorbers. However, when muscles become fatigued after running for a long distance, for example, they lose their ability to dampen shock and this puts the bones under greater stress, increasing the risk of fracture.

Symptoms include pain along the front (anterior) lower leg when bearing weight that increases during exercise or activity. The pain usually subsides during rest, but might be constantly present if the fracture is severe.

Diagnosis and treatment of stress fractures

Since stress fractures can be small, X-rays don’t always reveal new stress fractures, so a CT scan or MRI may be required for an exact diagnosis. Rest is the first and best option for healing most stress fractures. Only rarely do severe stress fractures require surgical correction or pinning at the fracture site.

Prevention of stress fractures

First, be aware of your risk factors. Women athletes are at a higher risk of sustaining stress fractures, in part, because of a well-documented phenomenon known as the “female triad” of disordered eating, amenorrhea (absence of menstruation), and osteoporosis. Inadequate calorie intake, low calcium levels and low estrogen levels put any woman at risk for stress fractures, regardless of whether she falls into the “female triad” category.

Pronators should be diligent about wearing orthotics, especially during physical activities.

Those with osteoporosis should include a calcium supplement and vitamin D in their diet.

Stress fractures are often caused by sharp increases in training or activity. Try to stick to the widely accepted rule of thumb of increasing workouts by just 10% per week to give your body ample time to keep up with the added stress.

Strengthening exercises for the calves and shin muscles will prevent them from becoming fatigued quickly, allowing the muscles to absorb the strain of activity for longer periods of time.

Most importantly, if you feel pain localized on or next to the bone that eases upon rest and increases during activity, see a doctor. Stress fractures, if not diagnosed and given time to heal, can lead to much more serious fractures and debilitating injuries.

Shin Splints

Shin splints, medically known as medial tibial stress syndrome (MTSS), develop after physical activity and also usually occur after an individual intensifies or changes their training routines. The muscles, tendons and bone tissue become overworked by the increased activity.

Medial tibial stress syndrome (MTSS) is defined by the American Academy of Orthopaedic Surgeons as “pain along the inner edge of the shinbone (tibia).”

Cause and symptoms of shin splints

Let’s talk about what’s actually happening inside the leg during a shin splint. While the exact cause is unknown, shin splints can be caused by overloading the lower leg due to biomechanical irregularities, in addition to an increase in stress on the tibia from overuse. The pain associated with shin splints is caused from a disruption of the connective tissue (Sharpey’s fibres) that connect the muscles to the tibia. With repetitive stress, the impact forces creates repeated tibial bending or bowing; thus, contributing to shin splints. Running uphill, downhill or on uneven or hard surfaces, such as concrete can worsen this impact.

Risk Factors and Prevention of Shin Splints

Shin splint risk factors include:

• Pronation (flat feet).
• Tight calf muscles.
• High-impact exercises on hard surfaces (ex: running on asphalt or concrete).
• Smoking and low fitness levels

To Prevent Shin Splints:

• Orthotics can help reduce the risk of developing shin splints for individuals with flat feet.
• Warm up before exercise and be sure to stretch your calf muscles as part of this routine.
• Stop your activity as soon as your shins begin to hurt. Trying to “play through the pain” doesn’t really work with shin splints.
• Don’t run or play on hard surfaces like concrete.

Diagnosis and treatment of stress fractures

In most cases, a doctor’s diagnosis is not required and shin splints can be treated with rest, ice and other self-care measures. Wearing proper footwear and modifying your exercise routine can help prevent shin splints from recurring. However, if you have lower leg pain that does not respond to this treatment, be sure to see your doctor, as a more serious underlying injury or condition may be the cause.

Lower Leg Pain

Several other conditions can cause lower leg pain, including tendinitis, popliteal aneurysm and chronic exertional compartment syndrome.

Popliteal Aneurysms

The popliteal artery is located behind the knee and aneurysms (ballooning of the artery) can occur in this location. Patients often have few or no symptoms and the cause of these aneurysms is unknown. They tend to occur in older men and women (more common in men) and occur in both legs about 50% of the time. It is important that these aneurysms be closely monitored or corrected surgically, as they present a risk of blood clots.

Tendinitis

Tendons attach muscles to bones. Tendinitis is an inflammation and irritation of the tendons often caused by repetitive motion or injury. Rest, ice and anti-inflammatory medications are common treatments, although corticosteroid, physical therapy or surgery may be considered for more severe cases. An MRI may be needed to determine if you have a tear that might require surgical repair.

Chronic Exertional Compartment Syndrome

Chronic Exertional Compartment Syndrome is an exercise-induced muscle and nerve condition that causes pain, swelling and sometimes even disability in affected muscles. Symptoms include aching, burning or cramping pain in the affected limb — usually the lower leg –tightness, numbness or tingling.

Excessive pressure within an isolated segment of muscle (a muscle compartment) causes chronic exertional compartment syndrome. Exercise increases the blood supply to working muscles and makes them expand. Connective tissue called fascia holds muscles together in compartments within the body. If this fascia doesn’t expand along with the muscles, pressure builds up in the compartment and can cut off the blood supply to the group of muscles, leading to chronic exertional compartment syndrome. Surgery is the primary and most effective treatment.

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Arthritis: Arthritis is one of the most common causes of knee pain. It is a degenerative condition that can cause symptoms such as fatigue, pain, stiffness, redness, swelling and loss of mobility. The main goal is to treat arthritis pain while increasing strength and mobility. Individualized treatment options may include medicine, exercise, heat/cold and possibly surgery.

1. Osteoarthritis- is the most common type of arthritis, which affects more than 27 million adults in the US. It can be caused by sports injuries and natural wear and tear. It is most likely to occur in adults over 50 and causes pain, stiffness, swelling of the joint, tenderness, deformity and weakness.
2. Rheumatoid arthritis- is the most debilitating form of arthritis,. This type of arthritis can occur at any age and symptoms may include fatigue, low fever, loss of appetite, muscle, and joint aches, stiffness, swelling, tenderness and pain in joints.
3. Post-traumatic arthritis- often occurs in patients years after they have suffered a sporting injury. It is seen in about 12% of arthritis patients and symptoms usually include pain, swelling, and stiffness and a decreased tolerability for walking, sports, and other activities.

Knee Injuries: Knee Injuries are another common cause of knee pain. These injuries may affect ligaments, tendons or fluid-filled sacs (bursae). Pain, swelling, redness and warmth are typical symptoms associated with a knee injury. Some knee injuries can be successfully treated through bracing and rehabilitation exercises. However, other injuries may require surgery to correct.

4)  Ligament injuries- are knee ligament sprains and tears, commonly sports related injuries. Ligament injuries are typically more serious than cartilage tears and often require a combination of surgery, pain management treatment, and physical therapy.
 
5) Knee Cartilage injuries- are meniscal tears and other injuries to the cartilage in the knee that often cause pain, swelling and inflammation. This type of injury is very common and can happen to patients of all ages and activity levels. In most cases, these injuries may require a combination of surgery, pain management, and physical therapy.
 
6) Tendinitis-is a very common cause of knee pain. It is the inflammation of the tendons, often caused by repeated movement of a joint. Pain while moving is the most common symptom associated with this condition. Tendinitis rarely requires surgery and can typically be treated with rest, physical therapy and pain management.

7) Knee bursitis- creates inflammation in the bursae, which are the small sacs of fluid that cushion the outside of your knee joint. Bending, kneeling and overuse can cause the bursa to become irritated and inflamed causing warmth, pain, and swelling.  Knee bursitis can typically be treated with a combination of rest, anti-inflammatory medication, and pain management treatment.

• As you can see, not all knee pain is created equal. There are many different causes of knee pain and a large number of treatment options available. Most importantly, you should never ignore your pain. Seeking diagnosis will help you receive the most targeted treatment possible that get you back on your feet sooner. If you or a loved one are suffering from knee pain, don’t ignore the symptoms, schedule a consultation with our office and learn about the many treatment options that are available.

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Sprained Ankles

A sprained ankle is a very common injury for young athletes. Sprains are injuries to the ligaments that connect bones to one another. An ankle sprain occurs when the ligament is stretched or torn. The signs and symptoms of an ankle sprain include pain, swelling around the joint, and the inability to walk or put weight on it.

It’s impossible to prevent all ankle sprains, but by taking certain precautions, sprains will be less likely. Keeping ankles flexible and muscles strong by stretching before playing sports will help reduce the likelihood of having a sprain. It is also important to pay close attention when walking to avoid uneven turf or holes.

The best treatment for a sprained ankle includes (R.I.C.E.)-Rest, ice, compression, elevation. Ibuprofen may also be given to manage the pain and reduce swelling. If your child is having difficulty walking, excessive swelling, and pain after 48 hours contact our office.

Muscle Strains

Muscle strains are the over-stretching of a muscle which can result in muscle pain. The muscle may be sore to the touch or appear slightly bruised or swollen. This typically occurs as a result of fatigue or improper use of a muscle. Strains can happen in any muscle, but they’re most common in your lower back, neck, shoulder, and hamstring. The best prevention is proper stretching before and after exercise or sports activities.

Treatment of muscle strain includes:  (R.I.C.E.) Rest, Ice, Compression, Elevation. If your child is in a lot of pain, you can give him some Ibuprofen for the pain. Contact our office if your child’s muscle pain does not get better, the pain is severe and accompanied by swelling, warmth, or redness.

Shin Splints

Shin pain occurs most frequently in young athletes involved in running, jumping, or high-impact sports. Shin splints and stress fractures are caused by repetitive stress or overuse, which happens gradually over time rather. Most commonly seen in runners, shin splints cause aching pain and tenderness after running.

The best treatment for shin splints is rest. Ice, massage, and rehabilitative exercises such as lower leg stretches and heel walking can also help. An anti-inflammatory medication such as ibuprofen may be given to reduce pain. Never try to run through the pain, it will only get worse and may to progress to a stress fracture. Choose soft level surfaces for running, use properly cushioned shoes, and allow time for increasing mileage or higher levels of activity may help prevent shin splints. Running activities may be resumed once the pain has subsided.

ACL Injuries

An ACL injury is the over-stretching or tearing of the anterior cruciate ligament (ACL). The ACL is tissue that connects the thighbone to the shinbone, at the knee. ACL injuries are common and occur especially in young athletes most often during sports like football, basketball, soccer, baseball, skiing and tennis. Symptoms may include popping, knee swelling, instability, and pain. If your child has injured their knee, they should stop all activity to prevent further injury and seek immediate medical care. Keep the area iced and elevated to prevent swelling.

Treatment of the ACL depends on the type of injury and age of the patient, but most often it involves some type of surgery and physical therapy. Anti-inflammatory or pain medicine may also be prescribed to help kids deal with the pain and feel more comfortable.

Back to Sports Safety Tips

Back-to-School means Back-to-Sports, so remember these simple safety tips to help prevent injuries from occurring this season:

• Make sure your child receives a physical exam before participation
• Be sure your child warms up and stretches before all practices and games
• Hydrate and drink plenty of water during and after play.
• Learn the signs and symptoms of dehydration and heat-related illnesses.
• Make sure your child has the appropriate, properly fitted, sports gear.
• Make rest a priority and take breaks during practices and games.
• Be sure to take off at least one or two days each week from any particular sport.
• Learn the signs and symptoms of a concussion.
• When in doubt, sit them out.

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