Runners Injuries Signs,Symptoms & Treatment
A blog post from FreshFit MK
Black Toenail (Sub-Ungual Haematoma)
How to recognise it, how to overcome it
Symptoms
You’ll notice a painful, hot toe after a run in new shoes or without socks.
This may then cause discomfort in any shoes.
Signs
Your nail turns dark red or black due to blood underneath. This happens because
the constant bruising during your run causes the blood vessels under your nail
to leak. No medical investigations are required.
What else could it be?
A mild case could be confused with an ingrowing toenail, fungal nail infection
or other disease such as psoriasis.
Self-treatment
If you’re courageous enough, make a needle red-hot and let it burn through the
centre of the nail, about 3-5mm up from the base to relieve the pent-up blood
underneath. You can squeeze out the rest of the blood by hand.
Medical treatment
If you’re lacking bravery, let your doctor perform the above operation! They
may then prescribe antibiotics to prevent infection, and you can take
paracetamol for pain.
Can you run through it?
Yes, to an extent, though pain will prevent you from overdoing it. If you don’t
treat the problem, it will bleed more and you’ll probably lose your toenail.
Recovery time
You should be able to run a few days after treatment, especially if you use a
plaster to tape the nail down (this may later drop off to be replaced by new
growth). To prevent recurrence, make sure that your shoes are comfortable,
spacious and properly worn-in – and wear socks.
Symptoms
You’ll feel tenderness over the inner side of the joint between your first
metatarsal (MT) and big toe, or hallux, and notice that the end of the toe
starts to point outwards, forming an angle of up to 90 degrees with the MT.
Pressure of any sort over the joint can cause both redness and pain.
Signs
The deformation is obvious, and underlying this will be wear and eventual
arthritis of the first metatarso-phalangeal (MTP) joint. The space opened out
by the splitting of the joint is filled by a thick-walled bursa – the bunion.
Bunion-sufferers often lose their transverse arch under the metatarsal heads,
which exaggerates the problem.
Medical investigations
An x-ray is unnecessary, and blood tests will only exclude differential
diagnoses.
What else could it be?
Gout, and occasionally other rheumatic conditions, may arise within the first
MTP joint.
Self-treatment
Correcting the loss of the transverse arch with a metatarsal pad, or wedging
the first and second toes apart with cotton wool will delay the progression of
the condition. Protecting the bunion with felt or foam pads, if your shoe is
large enough to permit it, will ease your pain.
Medical treatment
The worst bunions can ultimately be corrected only by surgery. Various
operations have their proponents; none prevents some disability in terms of
mechanical efficiency, but all should leave you pain-free! Meanwhile, anti-inflammatory
drugs, cortisone injections, mobilisation and exercises will give some relief.
Can you run through it?
Running through bunions without podiatric modifications is possible, though you
will probably feel some pain, which is likely to progress over the years.
Recovery time
After surgery, you should be able to begin light training after six to eight
weeks, and be on the road in 12
Calcaneal Bursa
How to recognise it, how to overcome it
Symptoms
Where the tendon joins the calcaneal bone, friction can cause the spaces
between the tendon, bone and skin to swell and inflame with bursitis. This
constitutes a calcaneal bursa. Apart from swelling over the back of the heel,
you’ll feel acute tenderness and pain when you move it or even apply light
pressure.
Signs
Your swollen heel may look more red than the other one, and the swelling is
often so hard it can feel like bone – partly because it sometimes is, as a bony
overgrowth can occur in chronic cases.
Medical investigations
Probably unnecessary, except to exclude differential diagnoses.
Differential diagnoses
Both stress and complete fractures equal a calcaneal bursa in intensity and
pain, so must be eliminated by x-ray or scan.
Self-treatment
If you avoid pressure you will ease the pain, so bigger shoes, soft padding, or
avoiding heel backs by using sandals or running without shoes can help.
Non-steroidal anti-inflammatory tablets and ice are the other staple
treatments.
Medical treatment
If physio and self-administered therapy fail, a cortisone injection into the
bursa may deflate it, although surgery to remove the bursa and excess bone may
be the final solution.
Can you run through it?
With pain, runners sometimes do, but probably at the expense of worsening the
bursa.
Recovery time
After surgery, the usual rehabilitation and training downgrade mean that racing
will be three to six months away.
Calf Muscle Tear
How to recognise it, how to overcome it
Symptoms
Unlike compartment syndromes, this injury hits you with sudden pain, like a
kick in the back of the calf. Trying to rise on tiptoe, let alone walk
normally, hurts.
Signs
The doctor will certainly find a tender area in the calf, often with a change
in density due to the burst blood vessels and formation of a bruise which may
sometimes become visible.
Medical investigations
These are usually unnecessary, unless the tear is particularly slow to heal.
What else could it be?
There is a long list of possible alternatives, including: stress fractures,
muscle pulls and tears, tibial periostitis, nerve and artery entrapment and
blockage, referred pain from a lumbar disc, infections, tumours, and pronation
syndromes of the foot.
Self-treatment
RICE,
periodically, for the first 48 hours at least. Later, gradual stretching and
strengthening, as with any other muscle injury.
Medical treatment
Ultrasound and, in the convalescent stage, massage by a physiotherapist, should
restore full, painless movement. The tear should not be surgically drained.
Since there is a chance that the damage to the calf could involve myositis
ossificans (a formation of bone within a large bruise), treatment should never
be over-enthusiastic.
Can you run through it?/Recovery time
One to four weeks, depending on the severity of the tear. The risks of
worsening the injury are far greater than any benefit you might obtain from
running through it.
Hallux Rigidus
How to recognise it, how to overcome it
Symptoms
Hallux rigidus refers to osteoarthritis of the first MTP joint. You’ll feel
pain in the joint, worsened by pushing or pulling the toe up and down.
Signs
Although the joint may be swollen, there is often little to see.
Medical investigations
X-rays will confirm wear of the joint cartilage, which exposes roughened bone
surfaces to each other
What else could it be?
Gout.
Self-treatment
You should gently try to mobilise the joint, pulling and pushing it into
extension and flexion and holding in discomfort, which will increase your range
of painless movement.
Medical treatment
Severe cases which are not helped by short-wave diathermy rely upon surgery to
create either a completely stiff or completely free and mechanically useless
joint.
Can you run through it?
Running through bunions without podiatric modifications is possible, though you
will probably feel some pain, which is likely to progress over the years.
Recovery time
After surgery, you should be able to begin light training after six to eight
weeks, and be on the road in 12.
Hamstring Injuries
How to recognise them, how to overcome them
Hamstrings are unusual in that they pass over two joints, the hip and the knee. They are therefore most likely to be injured when the hip is bent and the knee fully straightened. Further stretching may cause an injury that varies from a strain to a classic rip.
Hamstring Strains
Although the hamstrings run down the back of the thigh, injury to the lower part may well be felt behind the knee, either on the inside or outside.
Symptoms
Not only may there be pain behind the knee, but, depending on whether the
muscle sheath higher up the thigh is breached, there may or may not be visible
tracking of blood down the thigh.
Signs
While the knee is bent and the area is not under pressure, there may appear to
be little wrong. Straightening the knee and stretching the hamstrings, however,
should show all the classic signs of a hamstring injury.
Medical investigations
Are probably not necessary unless the condition, as may happen with hamstring injuries,
fails to resolve.
What else could it be?
A bursa around the hamstring insertions, a Baker’s cyst or
ligament strains may all cause pain in roughly the same site. Careful examination
should eliminate these.
Self-treatment
Following the 48 hours of obligatory RICE, any
bleeding should have died down and you can start to stretch. If it's painful
still, see Hamstring tears.
Medical treatment
Combining the use of ice and educated stretching with interferential
physiotherapy or ultrasound should bring about a complete cure.
Can you run through it?/
Recovery time
This sort of minor hamstring tear ought not to bother a runner for more than
three or four weeks and the more obsessive among us will find ways of limping
through training that may be of doubtful value.
Hamstring Tears
Symptoms
You feel sudden pain when the muscle is over-stretched – for example, when
hurdling an obstacle or sprinting at the end of a race. It then hurts when you
straighten the knee, and running will be slow, if not impossible.
Signs
The professional can usually put a finger on the site of a tear and induce
appropriate discomfort. There may be a gap within the muscle, or hardened
bruising, but it is encouraging if there is visible bleeding under the skin and
tracking of the blood flow towards the knee. This indicates that the sheath of
muscle has been breached, blood has escaped and healing will therefore be more
rapid. Pain occurs if bending the knee is resisted, or if the patient attempts
to stretch the muscle.
What else could it be?
Damage to the sciatic nerve by a lumbar disc is a well-recognised red herring
which causes pain in the back of the thigh. The doctor will also wish to
exclude those infections, tumours and bone and muscle disease which strike
these areas once in his professional lifetime.
Self-treatment
You cannot go wrong with RICE, always remembering that this should be continued
through rehabilitation, as the muscle is stretched and power is regained. Not
only is the commonest cause of hamstring injury an unrehabilitated prior tear,
but a weak hamstring muscle also predisposes to knee injury.
Can you run through
it?/Recovery time
Recovery time may be days, weeks or months, depending on the severity of the
tear and how rapidly you treat it. Running through it is unwise, but that is
unlikely to stop the masochists among you.
Hoffar's Syndrome
How to recognise it, how to overcome it
Symptoms
You will tend to notice a tender swelling in the hollows normally found between
the patella and the lower leg. As the discomfort may be worse after runs, it
may limit training.
Signs
Your doctor will see exactly the same as yourself, although he may be more expert
than you at eliciting tenderness!
Medical investigation
As the diagnosis is often obtained from the history and requires little in the
way of investigation, a detailed training history is important. It is an
over-use injury, more noticeable at the end of a run or if you have increased
your mileage too quickly. A sudden switch to hill training may bring it on.
What else could it be?
All the other causes of anterior knee pain may need to be eliminated, such as patellar problems,
and cartilage tears and strains,
as well as arthritis and internal damage, which produces fluid on the knee.
Self-treatment
Rest, ice and anti-inflammatories with training modification may well be
sufficient to settle the problem.
Medical treatment
If physiotherapy, usually in the form of ultrasound, fails to settle Hoffar’s
syndrome, a cortisone injection will usually suffice. A need for surgery is
unlikely.
Can you run through it?/Recovery time
Training modification and sticking to sensible terrain may well be all that’s
required, and some athletes don’t let it interrupt the flow of their training.
Ingrowing Toenail
How to recognise it, how to overcome it
Symptoms
You’ll feel pain down the side of the nail of the big toe (hallux), especially
to the touch.
Signs
The signs are obvious – and unpleasant. There’ll be reddening, festering and
ultimately discharge of pus, caused by the side of the nail growing into the
adjoining skin.
Medical investigations
A swab of the pus will usually confirm the growth of bacteria.
What else could it be?
IGTN could be confused with an infection of the nail bed, or with sub-ungual
haematomas (stubbed toes) – see below.
Self-treatment
Proper nail care is the key. Cut them squarely and not in a curve, lift out the
edges gently twice a day and support these raised sides with little cotton wool
balls or slivers of silver foil. Clean around your nails with an antiseptic
wash, pat them dry with tissues, then put on a protective dry dressing and
clean socks.
Medical treatment
A swab will usually confirm that antibiotics are the right course of action. If
the condition becomes recurrent, removal of the nail and growth bed is a
drastic but definitive solution.
Can you run through it?
You may be able to run if you wear shoes with plenty of toe space to prevent
pressure and pain. You should definitely avoid racing until the condition has
been cleared up. Without treatment, the signs and symptoms will worsen.
Recovery time
Antibiotics should have you back to full speed within a week, but this will at
least double if surgery is required.
Iliotibial Band Syndrome (ITBS)
How to recognise it, how to overcome it
Symptoms
This mouthful causes a pain on the outside of the knee when the lower end of a
sheet of gristle running from the thigh rubs over the bony prominence on the
side of the knee. It only hurts when the knee is moving through a particular
angle, and it is more common when running downhill.
Signs
Pressing on the tender area and moving the knee should be enough to convince
you, but your doctor will want to see your running action and to check whether
you are bow-legged or supinate. If you have pain on one side only it may be
because you always run on a camber or have legs of different lengths!
Medical investigations
Unless the doctor thinks that there is internal damage, he will probably just
check your gait and shoes. A scan can confirm the diagnosis.
What else could it be?
A pain in the outer side of the knee can also be due to a strain of the lateral
collateral ligament, which hinges the knee joint, or a trapped synovium (knee
lining).
Self-treatment
Ice it, ice it, then ice it some more. Also, check that you are not wearing old
shoes, and try running on the other side of the road if the pain is one-sided.
Lower your mileage.
Medical treatment
If your footwear or gait is causing ITBS, you may need orthoses or build-ups to
the outer side of your shoe. Exercises which stretch the band can help, while
ultrasound or a cortisone injection should cure the problem. Although massage
is often recommended, it sometimes makes the inflammation worse.
Can you run through it?/Recovery time
Improving your biomechanics can make a dramatic difference, and you could be
running properly again after a week. Ignoring the pain will probably make it
worse, unless you switch to better shoes or training terrain!
March Fracture
How to recognise it, how to overcome it
Symptoms
This is a stress fracture of the second (or sometimes third) metatarsal. You’ll
feel pain in the middle of the long bone(s) of your foot, which will slowly
increase with distance, reaching a crescendo as you end your run. The pain will
return earlier during the next session and become severe sooner, forcing a
premature finish. This pattern will continue.
Signs
You may be able to feel or see a little swelling around an established stress
fracture, though an early one may simply be painful if stressed by pressure, or
when you move the fractured halves in opposition to each other.
Medical investigations
When pain alone is the symptom, a bone scan may be the only way to convince the
athlete that a stress fracture exists. X-rays will show healing callus in an
injury which is more than four weeks old, while doubters may respond to
ultrasound testing by a physiotherapist – it causes real discomfort if
positive!
What else could it be?
Few injuries show crescendo pain apart from a stress fracture. Muscle injuries
and strains may occur between the bones, but you can often run with them,
unlike a stress fracture.
Self-treatment
Rest! You may be able to swim or cycle as long as it doesn’t provoke pain, but
running – which caused the injury – is out.
Medical treatment
This is as much psychological as physical – you need constant reassurance that
time (probably about six weeks) will heal the injury. A plaster cast is rarely
required. Biomechanical gait analysis may prevent further injury, though
recurrence of a stress fracture at the original site is very uncommon.
Can you run through it?
No. Full stop.
Recovery time
Five per cent of stress fractures fail to heal as expected and some form of
malunion occurs. A very small percentage need bone grafting.
Medial Collateral Ligament Injury
How to recognise it, how to overcome it
Symptoms
Although any force from the outside may sprain the medial collateral, the usual
cause in runners is a twisting of the knee while the foot is stuck in a pothole
or if the foot has suddenly slipped on a greasy surface. This will cause acute
pain on the inner side of the knee. In some runners a more chronic injury can
occur if they have knock-knees, or those who always run on a camber. Continuing
to run will not only prolong your pain but could cause secondary injuries
through a change in your gait.
Signs
Although it may be sore to pressure, your doctor may not be able to demonstrate
any local swelling. Depending on how severe the sprain is, there may be an
effusion. However, runners who sprain their medial collaterals use their
quadriceps muscles less as a result, and develop wasting, particularly of the
inner quads. Your doctor will need to exclude cartilage and cruciate injuries,
as they often occur in conjunction with collateral tears.
Medical investigation
As these are mainly directed to exclude other injuries they are only going to
be appropriate if the sprain does not resolve. An X-ray with the knee stressed
inwardly may demonstrate a complete tear, but arthroscopy or scans of the knee
are necessary to eliminate further damage.
What else could it be?
Any condition affecting the area around the inside of the knee should be
excluded; meniscal cartilage tears
and cruciate ligament injuries
may be obvious; damage to a hamstring muscle insertion
or a bursa may spring less readily to mind.
Self-treatment
Any runner not using RICE
by now must have been living on another planet! In this case, ice is a mainstay
not only of treatment but also of rehabilitation. If you cannot walk with the
injury you may require crutches in the early stages, but try not to become too
reliant upon them. A severe tear may be strapped initially to immobilise it.
Medical treatment
While it is important to heal the torn ligament, rehabilitation should also
involve the restoration of power, strength and bulk to the quadriceps muscles
which take the elastic strain when the knee is forced inward and hence protect
the ligament from further injury. As full movement is restored, the
physiotherapist will use quadriceps contractions and ultrasound with
progressive cycling-type exercises. Proprioception, described as an awareness
of where the body is in space, must be restored with specialist exercises
before the injury can be considered fully cured.
Recovery time
Depending upon the severity of the injury and any associated problems, cure can
take any time between a few days and several weeks. Minor injuries may heal if
not raced through and some training might be possible while rehabilitation
exercises are being diligently performed (one hopes!).
Meniscal Cyst
For completeness’ sake, one should include this cyst, which can form on the lateral side of the knee joint.
Symptoms
You will notice the formation of a painful, solid swelling on the outer side of
the knee joint. You may have had some direct trauma on the site some time
previously.
Signs
The visible swelling is most prominent when the knee is held in a slightly bent
position. It feels so solid that it may be mistaken for bones.
Medical investigations
Investigation of the cyst is rarely required beyond observation at surgical
removal.
What else could it be?
A tear of the collateral ligament over the cyst or an iliotibial friction band problem should be fairly easy to rule out.
Medical treatment
Self-treatment
is impractical – medical attention will be surgical if the injury causes enough
pain to warrant it. It is not always practical to remove the cyst without also
taking some of the underlying cartilage.
Can you run through
it?/Recovery time
As pain is the limiting factor, some runners will attempt to run through a meniscal
cyst. Surgery and appropriate physiotherapy with quadriceps exercises should
mean that you can be running fluently within a month or so.
Meniscal Injuries
How to recognise them, how to overcome them
Half-moon snap-in cartilages form a buffer in the centre of the knee joint and allow some rotation. These are known as menisci and are placed either medially or laterally.
Injury can occur to normal and ageing menisci; it tends to occur in the posterior portion and is seven times more common on the medial side, which bears the brunt of your weight. There are various types of tear to the menisci, depending on the cause, but the effect is usually the same – pain and disability.
Symptoms
You will be lucky if a suddenly-torn meniscus doesn’t cause intense pain,
probably following a twisting injury, but not uncommonly after full bending of
the knee. The pain is usually on the joint line and the knee may feel unstable.
It is realised now that a meniscus tear frequently occurs in conjunction with
other damage to the collateral or cruciate ligaments, so the knee may swell
with an effusion of clear serum and/or blood, and a tear which twists on itself
can cause the joint to lock. You may well have been a rugby or football player
in the past, and have suffered previous knee injury.
Signs
Your doctor will be able to demonstrate your knee tenderness and find swelling.
The McMurray test involves flexing and extending the knee slowly, while
rotating the limb below the knee. If positive, it will hurt you. Quadriceps
wasting rapidly occurs with disuse.
Medical investigation
The diagnosis is not always clear-cut, so an x-ray will help to eliminate
complications and arthrography with a dye injection into the knee can improve
diagnostic accuracy.
What else could it be?
Even the most experienced practitioners may have difficulty in excluding an anterior cruciate ligament tear, a collateral ligament tear or arthritis. Also, loose tissue that may float off within the damaged
joint, – there’s quite a choice.
Self-treatment
Although RICE and a
change of activity could ease the symptoms, self-help is probably not going to
relieve any but the most minor and trivial of meniscal injuries.
Medical treatment
With the advent of arthroscopy, in which a tiny fibre-optic television camera
can be used to examine a joint, the diagnosis and treatment of meniscal
injuries has been transformed. No longer is the whole knee joint exposed at
operation, and all the cartilage removed, but two tiny incisions are made, one
for the arthroscope and the other to stretch and fill the joint with sterile
water, allowing accurate visualisation of the injury. Delicate snipping away of
as little of the injured meniscus as possible limits the advance of
degenerative changes in following years. In some individuals it has been shown
that the meniscus has the ability to repair itself, and meniscal replacement
and regrowth are potential treatments for the next millennium. After surgery,
physiotherapy and rehabilitation are vital to gain full, pain-free function.
Can you run through
it?/Recovery time
Running through a meniscal injury is an open invitation to long-term
disability. Following arthroscopic treatment you would hope to be fully
rehabilitated and running freely, even if not racing fit, well inside three
months.
Muscle Hernia
How to recognise it, how to overcome it
This condition comes about in the lower leg when a sheath containing a muscle bursts and allows the muscle to bulge out.
Symptoms
There will be swelling over an area of muscle, often with a reduction in pain
of the compartment that has been under pressure.
Signs and alternative
diagnoses
Your doctor will see and feel the same enlargement that you do, and will want
to rule out infections, tumours, foreign bodies and other causes of unexpected
bumps.
Medical investigations
These will only be used to eliminate the alternative causes.
Self-treatment
You probably need to do very little, unless RICE is needed
to ease local discomfort.
Medical treatment
Unless you wish to pay a large sum of money, the doctor will be unwilling to
treat a defect which is purely cosmetic, and risk causing a compartment
syndrome.
Can you run through
it?/Recovery time
It is unlikely that you’ll need to have much time off, if any, and the
permanent swelling will probably become just another object of mirth at the
club!
Osgood-Schlatter's Disease
How to recognise it, how to overcome it
Osteochondritis is an inflammation of developing bone in children, in which an area becomes softened and deformed in the lower limbs or back. Osgood-Schlatter’s disease is a form of this which occurs at the upper front of the tibia (shin bone), where the patellar tendon from the knee joins it.
Symptoms
You are probably aged between 10 and 14, play a variety of sports, and have
developed a painful bony swelling below the knee. It will hurt with strenuous
activity, particularly when you kick a ball or contract the quadriceps muscle,
to which it is connected through the kneecap.
Signs
It’s easy to confirm the swelling of the tibial tubercle, and your doctor will
ensure that the joint is not involved.
Medical investigations
Many experienced doctors do not now bother to x-ray the area, as the disorder
is easy to identify and ultimately heals itself.
What else could it be?
Infections and tumours affecting the same spot are so rare that they can be
discounted. Nothing else will produce a similar swelling at this site.
Self-treatment
Rest from painful activity, accompanied by ice packs and ibuprofen after
exercise, should provide you with relief. You shouldn’t take medication prior
to exercise, though, as it could mask a worsening situation.
Medical treatment
If you get no relief, your doctor may very occasionally inject steroid, or even
immobilise the leg in plaster. Physiotherapy to ease the pain should not be
used as a cover to increase training.
Can you run through it?/ Recovery time
Although full recovery can take years, this is unusual, and time away from
sport is more usually measured in months. Many youngsters will surreptitiously
continue to exercise through the pain, and while this isn’t to be applauded,
you can’t blame them, as they inevitably make a full recovery…
Patellar Tendinitis
How to recognise it, how to overcome it
Symptoms
Just because it is also known as ‘jumper’s knee’, runners are not immune from
this sudden pain that strikes at the base of the patella (kneecap) because of a
partial rupture of the ligament below it.
Signs
You may not be able to touch the painful area, as it is the back of the tendon
near the patella which is most commonly affected. If you bend your knee, your
doctor may be able to stretch the injured part – and it will hurt!
Medical investigations
A soft-tissue x-ray may show swelling and calcification of the tendon, while a
scan will give more detail if required.
What else could it be?
You need to be sure that the injury is not to the patella itself, such as a
stress fracture or a congenital defect, and that it is not caused by a cyst on
the tendon. Osgood Schlatter’s disease can occur at the lower end of the patellar tendon in younger athletes.
Self-treatment
Whilst rest, ice and anti-inflammatories may give temporary relief,
self-treatment is usually ineffective in the long term because the tendon heals
slowly.
Medical treatment
A particularly acute case may require weeks in plaster before rehabilitation
can begin. Laser treatment may be more effective than ultrasound therapy, while
deep massage and steroid injections are sometimes used to control the
condition. A small number of people require surgical removal of the scarred area
of tendon before they recover fully.
Can you run through
it?/Recovery time
Although it varies, recovery is likely to take months rather than weeks.
Running through it, especially on hilly ground, is likely to make things worse.
Peritendinitis
How to recognise it, how to overcome it
Symptoms
The Achilles tendon is surrounded by a paratenon to help lessen friction with
movement. You will notice swelling, thickening and tenderness in comparison
with the other tendon, due to friction on the paratenon.
Signs
Your doctor may also be able to demonstrate crepitus, a crackling sensation in
the tendon between finger and thumb as the ankle is moved.
Medical investigations
Soft tissue x-ray should confirm what is already obvious, but may also show
thickening in Kagar’s triangle, the area between the front of the tendon and
the back of the tibia.
What else could it be?
It could be Achilles tendinitis, although it is important to remember that you may be suffering from
several conditions at once.
Self-treatment
Ice and gentle stretching should be the mainstay of your management after you
have eliminated friction between tendon and shoe back.
Medical treatment
This is one of only two conditions in which a steroid injection near the
Achilles can produce dramatic relief. Provided your doctor inserts it into the
paratenon and not the tendon, you can achieve a rapid resolution of symptoms
and signs. However, if it is inserted into the tendon, there is a high risk of
tendon rupture.
Recovery time
You should have a mandatory week’s rest after the injection, but if more
conservative methods of treatment are used, training can be increased
accordingly as the crepitus and swelling subside.
Plantar Fasciitis
How to recognise it, how to overcome it
Symptoms
Pain under the heel centre at the origin of the plantar fascia. This is a
fan-like web of tough fibres which spreads across the underside of the foot and
attaches to the origins of the toes, and its main purpose is to maintain the
shape of the longitudinal arch. (This arch, along with the transverse arch
which stretches across the metatarsal heads, allows proper pronation, which
helps to absorb landing forces and provides some elastic recoil as your foot
pushes away from the ground.) The pain is worse when running or walking, and
often particularly bad first thing in the morning.
Signs
You won’t experience any swelling, but press the underside of your heel and
you’ll probably feel acute pain. A flat longitudinal arch (or a high, rigid
arch – both are at the limit of their elasticity) that is suddenly stretched
when the whole length of the foot falls on uneven ground, can induce acute
pain. New shoes or inappropriate orthotic support can also cause pain which
will appear after a long run. Although x-rays may show a calcaneal spur, this
is irrelevant as many that are found accidentally are not associated with
plantar fascia pain, and many with pain have no spur.
What else could it be?
Other causes of the pain could be a fracture or stress fracture of the calcaneum
(heel bone), bone disease and local infection, or simply bruising of the heel’s
fat pad.
Self-treatment
Rest aside, ice packs, good heel cushioning and a heel cup to firm up and
thicken the under-heel fat pad, may relieve symptoms. Massaging the area by
gently rolling the heel on a golf ball is popular in the USA. You should ensure
that your shoes have good midfoot flexibility and an arch support.
Medical treatment
Supporting a flat foot with a proper orthosis can bring relatively dramatic
improvement, but you should be professionally assessed first. NSAIDs
(non-steroidal anti-inflammatory drugs such as ibuprofen) can ease, but not
cure, the condition. Physiotherapists can use exercises to improve the
intrinsic or small muscles of the foot to ease the condition, and
interferential or other electrical treatments may reduce the pain, though not
affect the cause. If there’s any evidence that your condition is becoming
chronic, you should quickly be given an injection with hydrocortisone or a
similar appropriate steroid.
Can you run through it?
If you change your shoes and use an arch support, you may find that some
running is possible, but you should not run through any pain that’s severe
enough to cause you to limp.
Recovery time
One week to two years! Ignoring the condition initially is asking for long-term
pain, so take steps to stop it early!
Posterior Compartment Syndrome
How to recognise it, how to overcome it
Symptoms
You will have developed an increasing ache deep in the calf, probably after a
long run, as the muscle within the sheath is restricted from the natural
expansion that exercise produces.
Signs
An experienced practitioner should be able to put their fingers on the site of
the pain, though they shouldn’t discover any acutely tender denser areas. If
the cause isn’t a compartment problem, you may also notice colour changes or
weakness within the leg.
Medical investigations
If there is doubt about the diagnosis, you may need the usual x-rays and scans,
not forgetting that the pain may originate in a disc lesion in your back.
Damage to the veins can be excluded using a Doppler, a test using sound waves.
What else could it be?
There is a long list of possible alternatives, including: stress fractures,
muscle pulls and tears, tibial periostitis, nerve and artery entrapment and blockage, referred pain from a lumbar
disc, infections, tumours, and pronation syndromes of the foot.
Self-treatment
RICE as usual,
but ice to reduce inflammation and elevation to eliminate gravity are the most
appropriate. As it settles, gradually stretching the calf will speed healing,
while you should also look back over your training diary for a cause.
Medical treatment
Although most cases recover with rest, ultrasound treatment will hasten
matters. There is an extremely small chance that you’ll need surgery to release
the sheath if biomechanical changes by a podiatrist are ineffective.
Can you run through
it?/Recovery time
In most cases you should be running fairly normally, though not racing, after a
week. The more obsessive among you will run through it – painfully!
Quadriceps Injuries
How to recognise them, how to overcome them
The quads and hams, to be colloquial, surround the knee in a tripod-like fashion, the quadriceps through the patella and its tendon acting to straighten the knee, while the hamstrings at the back of the thigh diverge, to be inserted behind the knee on the inside and outside to complete our tripod. If you think of them as being like the guy ropes of a tent, a tightening of one group will stretch the other, and it is this alternate movement that enables the knee to function.
The quadriceps muscles may be torn anywhere from hip to knee.
Symptoms
The common acute tear will cause sudden pain, accompanied by weakness which may
make you stumble or fall. It is more likely to occur if you are pushing off to
jump a hurdle or obstacle, or to go uphill.
Signs
Little difficulty is usually experienced in the diagnosis of a quadriceps tear.
There is pain at the site of injury and any resistance to straightening of the
knee will cause pain at this site. As a bruise forms, there is thickening of
the muscle, which becomes hard and tender, although, if the muscle is severed
completely (a not uncommon situation) a gap may be visible when the muscle
contracts.
Medical investigation
Because the diagnosis is so obvious, investigations are rarely required unless
the condition becomes chronic, with the risk of the scar changing to bone
(myositis ossificans). An x-ray will confirm whether bone is forming within the
scar tissue.
What else could it be?
Other causes of pain in the thigh are rare, though it is not impossible for a
stress fracture of the femur, an adductor muscle tear or referred pain from the lower back to appear as quadriceps pain.
Self-treatment
The basic principles of RICE apply to
early management. This should occupy 48 hours, with ice being applied for 15
minutes per hour, as often as feasible. This will limit bleeding and aid later
rehabilitation as you attempt to stretch, then strengthen the damaged muscle.
Medical treatment
Apart from professional guidance as to the optimum time-scale for
patient-initiated treatment, some forms of electrical therapy may further speed
up healing. The risk is always of over-enthusiastic treatment and the
complications mentioned above.
Can you run through
it?/Recovery time
While a simple tear may recover in a week, a complete rupture or deep tear of
the muscle may have effects for several weeks. If there is a complete rupture,
surgical repair is not necessary, as accessory muscles will take the strain and
build power and strength to mimic the actions of the injured muscle. A return
to full strength may take three months.
Runner's Knee
How to recognise it, how to overcome it
The knee is basically a hinge joint, allowing backwards and forwards motion, but it is also able to rotate slightly in on itself. The bending and straightening is controlled by the hamstring and quadriceps muscles at the back and front of the thigh bone respectively, and their size and position affects the angles the legs move at, and particularly the way that the patella (kneecap) moves. Your anatomy and the patterns of your muscle use determine many of the injuries you will suffer.
‘Runner’s knee’ used to be known as chondromalacia patellae, but is now more often referred to as patello-femoral pain (PFP). It occurs when the patella fails to move smoothly and centrally through the femoral groove at the lower end of the thigh bones. This is sometimes due to muscle imbalance or abnormal anatomy, but it can also be the result of another injury which causes you to favour one leg in some way.
Symptoms
You’ll either suffer a persistent ache in the kneecap, which worsens with
certain exercise, or you’ll feel a sudden, stabbing pain in the knee while
running, which eases off when you rest. Sitting with your knees bent prior to a
race can make things worse, as can running on hills or hard surfaces.
Signs
Despite the acute pain, your joint may look normal. Your knee may swell up, but
this is more often due to other knee problems, such as a bursa or Hoffa’s
syndrome, in which the fatty pads around the patella become swollen. You will
probably have wasted inner quadriceps muscles (the vastus medialis), knock
knees (genu valgum), overpronation, flattened longitudinal arches or a twisted
tibia. More women suffer from the problem than men, and it often occurs in
people with jobs which involve lots of sitting with knees bent.
Your doctor may try Clarke’s test, in which they’ll pull the kneecap towards your toes while inviting you to gently straighten your knee. You’ll feel pain; they’ll feel a roughness or grating as the uneven rear surface of the patella moves through the femoral groove. The doctor will also want to look at the wear of your running shoes.
Medical investigations
Sophisticated tests aren’t normally required. A ‘sunrise’ x-ray of the flexed
knee will show if your patella is abnormal, roughened or displaced, and there
is little need for scans. As many cases are the result of anatomical
variations, having your running gait analysed may enable appropriate
corrections to be made to alleviate the problem.
What else could it be?
While primary PFP is simply that, there may well be other influences.
Disruption of the ligaments within and outside of your knee, arthritis in its
many forms and ankle, shin, thigh and hip injuries may all affect knee movement
and produce secondary PFP.
Self-treatment
One factor in knee pain may be an inability to lock out the knee. Trying to do
so stimulates the inner quadriceps muscles which strengthen and pull the
patella straight. In most cases, little harm comes from performing this
exercise, however it can make PFP worse if there is an imbalance in your
quadriceps muscles and you perform knee extensions on a machine. You will
therefore need to perform straight-leg exercises. Change your shoes if they
have become worn, and correct any biomechanical abnormalities with orthoses or
other appropriate aids.
Medical treatment
Thankfully, steroid injections and surgery aren’t often used to treat PFP. Some
physiotherapists successfully tape the patella, drawing it back towards the
mid-line, and can teach you how to do this yourself. Knee supports may
effectively shift your patella towards the middle, but probably at some
biomechanical cost which may itself cause injury. If our maker had wanted us to
use knee supports, we would have been born with them. In fact, he did and we
have; we have just forgotten how to develop and use them. Other forms of
physiotherapy will ease PFP, but controlled exercises form the mainstay of
treatment.
Can you run through it?/Recovery time
Within certain limits, the more you do the correct knee-strengthening
exercises, the quicker your recovery will be. As for running through it,
masochists will have no problem, though probably at the ultimate cost of a worn
patella, potential arthritis and other injuries through favouring the limb.
Treating the injury makes a lot more sense in the long run.
Stress Fractures
How to recognise them, how to overcome them
Because stress fractures of the calcaneus (heel bone) and tibia and fibula (lower-leg bones) share similar symptoms, investigations and treatments, we’re grouping them together here.
Symptoms
As with all stress fractures, you’ll feel crescendo pain, which grows in
intensity the longer and further you run, probably reaching an intolerable peak
just before you stop. In the textbook case, the pain comes on sooner and more
severely with each successive run.
Signs
It’s important that your GP listens to your description, for there is often
little to feel at the site of the fracture. A ‘pinch test’ can confirm a stress
fracture of the calcaneus (heel bone) earlier than you’d be able to feel the
swelling of healing callus in the tibia or fibula.
Medical investigations
An x-ray may not reveal the early stages of a stress fracture, so an ultrasound
test or scan is a better option. This can be particularly useful for headstrong
athletes who may continue to run through the pain and tenderness until the bone
snaps completely.
What else could it be?
A variety of illnesses, infections or even growths can cause bone pain –
various tests can confirm or eliminate the possibility of their existence.
Self-treatment
Rest! (This doesn’t mean you shouldn’t work out your cardiovascular system and
the rest of your body with exercise that doesn’t make the fracture hurt.)
Medical treatment
Despite your protests, your doctor will continue to emphasise the need to rest
the fractured limb. If the fracture hasn’t healed within six to eight weeks,
they’ll need to check that bony union is in fact occurring – if it’s not, they
may have to consider further measures, including surgery and bone grafting. On
a positive note, a healed stress fracture is usually stronger than the original
bone.
Can you run through it?
No. Any runner who attempts to run through a proven stress fracture probably
needs their head examined, as the chances of worsening the injury are so high.
Recovery time
A stress fracture usually recovers in half the time that a complete break of
the same bone would, ie six to eight weeks.
Achilles Tendinitis
How to recognise it, how to overcome it
Symptoms
Simple pain in the Achilles tendon on contraction, particularly if you tip-toe
or run, although it may settle after a couple of miles. It is often stiff on
first getting out of bed.
Signs
There may be little or no thickening of the tendon, which can be tender to
touch. Many runners have uncorrected pronation which makes the tendon spiral
slightly under running conditions and cause unequal stresses within it.
Medical investigations
A scan will confirm a chronic unresolved tendinitis and gait analysis with a
video will show whether your pronation needs treatment.
What else could it be?
Other more severe injuries to the tendon, lower calf muscle tears or simple heel tab bruising can all produce pain within the tendon.
Self-treatment
This should include a heel raise of Sorbothane or foam, ensuring that heel tabs
do not impinge upon your tendon when your toes are pointed (cutting the heel
tabs off will certainly help, too). Applying ice in the form of a pack or
massage and very gentle stretching will prevent shortening of the tendon.
Medical treatment
Your medical adviser should ensure that you have appropriate footwear, have
pronation corrected, use ice, massage and possibly ultrasound most judiciously.
Rarely, in the chronic case, you may need the tendon surgically decompressed.
Can you run through it?
Running through it is fraught with risk, though that does not stop many
attempting it.
Recovery time
Promptly treated, a few days; left untreated, it may extend to years.
Tibial Periositis
How to recognise it, how to overcome it
Symptoms
There is pain and tenderness along the inside of the lower tibia (shin). You
are probably an overpronator with uncorrected feet and may have begun more hill
sessions or speedwork.
Signs
A light touch to the bone by your doctor may cause you to overreact! Your
injured leg probably looks no different to the other, although running through
long-term injury may cause muscle-wasting and alter its appearance.
Medical investigations
As above, although x-rays are generally negative and bone scans positive.
Biomechanical assessment is readily available, and you should certainly seek it
if you have a recurrent or chronic injury.
What else could it be?
All the other lower-leg conditions. There is much overlap between periositis
and stress fractures.
Self-treatment
Rest is probably the most important element of RICE, as ice
itself sometimes causes more pain. Make sure you have appropriate shoes, which
will almost certainly include some sort of orthoses to limit your pronation.
Medical treatment
If reducing and modifying your training and correcting your biomechanics do not
cure the condition, you might need a few non-weight-bearing weeks on crutches,
or even an operation called a fasciotomy to relieve the muscle strain.
Can you run through
it?/Recovery time
If you have a mild case and make appropriate footwear changes, you may only
lose a few days. But if you continue to run uncorrected, and then need surgery,
there could well be a three-month gap in your training diary.