Treatment of Lower Extremity Pain in Runners

1. Treatment of Lower Extremity Pain in Runners Dick Evans PT, OCS 10-11-07

2. 60-65% of all runners are injured in an average year • Runners miss approximately 5-10% of their scheduled workouts due to injury • 65% injury rate & 10% absent rates could be significantly lowered if some simple adjustments were made in training schedules • Possibly decreasing injury rates 25%

3. Five Anatomical Hot Spots • Knee-25 to 30%~endurance runners • Calf & Shin~20% • Iliotibial band~10% • Achilles tendon~8 to 10% • Foot & ankle~10 to 15%

4. 25% of running injuries require medical care

5. 75% of those who seek medical care have good to excellent recovery

6. 2 to 3% of running injuries have work absences

7. 65% of runners report they are running pain free after 8 weeks of treatment

8. Males & females have the same injury rates per hours of training • Males tend to train longer so appear to have more injuries • No direct correlations between • Speed training • Race speed • Running surface or • Body weight

9. Warm Up, Cool Downs & Stretching may not prevent injuries First time runners had a higher injury rate compared to those who had trained many years

10. Location of Injury • Marathon runners~knee & foot • Middle distance~back & hip • Sprinters~hamstrings

11. Spring & Summer are high injury seasons For example if May was a high mileage month you may have potential break down in June

12. Total training mileage is an excellent predictor of injury.More miles you accrue per week, the more time you spend running & the higher the risk of injury

13. Injury risk is linked with inexperience runners who have trained less than 3 years were more likely to have an injury

14. Significantly more injuries occur when training more than 40 miles per weeknovice runners have a harder time handling larger increases in training volume

15. 2 best predictors of injury • If you have a previous injury, you have a 50% chance of recurrence importance of short term care –rice and longer term care related to strength training and specific program related to return to running • Number of consecutive days of training; by reducing consecutive days of training, injury rates are lowered

16. Run Monday through Friday5 consecutive days, 6 miles 5 x 6 = 30 run mon, wed, fri, sat , 2 consecutive days 4 x 7.5 = 30

17. The key is to develop training strategies which promote healing of injured body parts • Have fewer consecutive days of training • Reduce mileage if problems occur • Incorporate running specific strength and flexibility training • Add intensity vs. mileage

18. Common Injury Sites in Runners • Hip & Thigh Injuries • Trochanteric bursitis • Hip abductor pain syndrome • Iliotibial band syndrome • Quad & Hamstring Pulls

19. Knee Injuries • Patellofemoral Pain Syndrome • Meniscal Tears

20. Leg Injuries • Shin Splints • Stress fractures • Compartment Syndromes

21. Ankle Injuries • Ankle Sprains • Achilles Tendonitis

22. Foot injuries • Plantar fasciitis • Central heel pain • Over pronation-arch pain • Supination –stress fractures • Metatarsalgias, sesamoidittis, • Post tib tendonitis • Peroneal tendonitis • Subungual hematoma – nail bed bleeds

23. Acute phase – rice , rom, pain control modalies, swelling control, activity modification, open chain strengthening when indicated Advance to closed chain strengthening Gradual return to impact –monitor closely Balance – agility drills Sports specific /running specific progressions. Treatment of injuries in runners

24. Avoiding injuries also include importance of proper shoe wear, cross training considerations, specific stretching and strengthening considerations and good running form – gait lab evaluation

25. Thanks for your time and attention.