Preventing and Treating Running Injuries

By: Seamus Kennedy, BEng (Mech), CPed

Running has been referred to as the king of all workouts. It is an activity that has been embraced at varying levels of competence by nearly 11 million adults in the United States alone, according to the American Running Association. Running doesn't require the purchase or use of expensive equipment; it is possible to do it indoors or outdoors, usually year round. Not only does running provide a fantastic cardiovascular workout, it allows you to burn calories and clear your mind, leaving you with that relaxed, feel-good sense for many hours afterward. However, to reap these benefits on an ongoing basis, it is important to take precautions to prevent debilitating injuries.

For all the benefits of this great activity, there is no doubt that the repetitive nature of the stress it places on key joints can lead to breakdown. While there is some debate about what constitutes an injury, it has been estimated that up to 70 percent of runners will sustain some form of overuse injury during any one-year period. Anyone working in the orthotics, biomechanics, or sports medicine professions will see his or her fair share of running injuries. These injuries can be broadly classified as acute or chronic. Acute injuries are those due to sudden motions or twisting, such as an ankle sprain, which lead to soft tissue and/or osseous injury. These need to be treated immediately and allowed to heal.

Chronic injuries develop over time and are the result of repetitive stress that eventually leads to breakdown; e.g., patellofemoral syndrome. Chronic injuries account for well over 80 percent of running injuries, and they can develop from either an anatomical cause or a biomechanical issueand sometimes a combination of both. Because of its impact forces on the body, running greatly magnifies the extent of these anomalies. When experienced runners develop a chronic injury, it is often necessary to investigate what they have changed in their training practices.

To get a clear picture of any injury, it is necessary to do a full biomechanical exam. Evaluate the patient in stance and motion, non-weight bearing and weight bearing, in shoes and out of shoes. It is vital to follow the entire kinetic chainnot just treat the symptomto investigate the root cause of the problem. John Connors, DPM, a New York-based sports-medicine specialist, insists on watching his patients function in order to determine underlying causes. He will even run with his world-class patients in order to diagnose their etiology.

Common Running Injuries

Heel pain: Heel pain is a common complaint among runners. This is hardly surprising, given that the majority of runners who train on level ground at low to moderate speeds are heelstrikers. This running style produces an impact-force peak early in the stance phase, which can range from one-and-a-half to five times the runner's body weight. These impact forces are considered a primary cause of overuse injuries.

The classic sign of plantar fasciitis (PF) is heel pain that presents first thing in the morning and then decreases with activity. In the early stages, the patient usually can still exercise, only to be faced with more severe pain following a run. Typically, pain will be felt at the plantar-medial aspect of the calcaneus or at the middle aspect of the calcaneus.

There are other causes of heel pain that should not be ruled out without further radiographic examination. A calcaneal stress fracture may present like PF, but typically the pain does not subside as the day progresses. A positive calcaneal compression test can indicate the presence of such a fracture. Other considerations for heel pain include tarsal tunnel syndrome, neuritis of the first branch of the lateral plantar nerve, and tendinitis of the flexor hallucis longus.

Achilles tendinitis (AT): Achilles tendon injuries may be due to inflammation of the paratenon or the result of the degeneration of the tendon itself. It is broadly classified into two groups: insertional (occurring at the tendon/bone interface) and non-insertional (occurring proximal to its insertion, in or about the tendon proper). A physician's diagnosis will confirm the location and type of condition. AT can develop when the tendon contracts and tightens and is then over-stretched during exercise. There may also be a biomechanical component to the condition, given the tendon's broad insertion on the posterior calcaneus. Due to the cyclic rotation of the STJ from pronation through supination, there can be increased tension on the medial and lateral aspects of the tendon's insertion.

Iliotibial band syndrome (ITBS): This is a debilitating injury that presents as pain along the lateral aspect of the knee joint. It is sometimes accompanied by a clicking sensation. Current thinking is that ITBS results from weak core and hip muscles that fail to prevent tightening and strain the IT band.

Medial tibial stress syndrome (MTSS): Commonly known as "shin splints," this pain is typically noted along the lower third of the posterior medial surface of the tibia. It can often result from improper biomechanics or by not following the training considerations described earlier.

There are many other injuries that you are likely to see in runners such as posterior tibial tendon pain, knee pain, and a variety of stress fractures. Forefoot pathologies can include functional hallux limitus, sesamoiditis, and second metatarsal phalangeal joint (MPJ) capsulitis, in addition to regular blisters, corns, and neuromas. Much has been written on each of these conditions and their specific rehabilitation treatments. "How to Detect and Treat Running Injuries," by Brian Fullem, DPM, (Podiatry Today, May 2005) covers the basics. It is an excellent resource.

Preventative Measures

Over the years, I have developed a great love for running, so I can say from personal experience as well as patient interaction that nearly all running injuries result from training errors. I try to follow my own advice on injury prevention as outlined above. I begin a run by forcing myself to stretch; I change out my running shoes as necessary, even if they look almost new; and I vary my workouts with swimming, yoga, and sometimes bicycling to ensure adequate rest. I am pleased to say that I am injury free. However, when injuries do occur, treatment will generally follow a protocol of relieving pain, resting, icing, stretching, focused strengthening, and improving biomechanics. Good support from shoes and orthotics, good running form, and good training habits, such as always stretching, will prevent the return of many of these injuries. I believe foot orthotics, whether custom or not, play an essential role in keeping a runner injury free by aligning the body properly. Regardless of foot type, appropriate orthotics will increase shock absorption and prevent end-of-range-of motion, thus protecting tendons, muscles, and joints.

Another strategy for preventing running injuries is to advise your patients to modify their running style. Recently, I have begun using a technique called ChiRunning© ( www.chirunning.com). In essence, ChiRunning aims to lessen the forces that most runners experience by introducing a slight forward lean and a biomechanically efficient flow to their running style. It advocates running with relaxed lower legs and using a mid-foot strike to avoid the braking and impact of heel strike. Since adopting the ChiRunning approach, I have found running even more enjoyable, not to mention less strenuous.

Hopefully, armed with this information and more, you can help your runners achieve their goals.

Séamus Kennedy, BEng (Mech), CPed, is president and co-owner of Hersco Ortho Labs, New York, New York. He can be contacted via e-mail atseamus@hersco.com, or visitwww.hersco.com

Training Considerations

Increasing mileage and/or speed: Make any changes in distance or tempo gradually.

Breaking in new shoes: Break in new shoes slowly over a few runs. Ensure that the last and sole design match the runner's foot type; i.e., pronator, supinator, or normal/neutral.

Running in old or worn-out shoes: It is recommended that runners switch out their sneakers every 300-500 miles. If sneakers are over-worn, they lose shock absorption and their ability to control rearfoot and subtalar joint (STJ) motion.

Running on unforgiving surfaces: Elite runners usually avoid running on roads too often due to the unrelenting hard surface and the banked edges. It is best to look for firm trails with some forgiveness, such as dirt, woodchips, fields, or boardwalk. Slightly uneven terrain also helps avoid an exact repetition of each stride.

New running style: Any change in running technique should be applied slowly, to allow the body to adapt.

Be aware that a change in weight, and even aging, can contribute to the onset of an injury.

 

Recovery strategies to enhance performance and reduce injury

By Shawn Talbot, PhD.
In the realm of elite sport, scientists, coaches and athletes are aware that a hallmark of top-level athletic performance is an outstanding ability to recover from intense workouts and competition. And understanding how nutrition is linked to recovery is essential. For trail runners, full recovery after a big day pounding the dirt is often the difference between staying healthy and injury free or being stuck indoors due to illness or chronic pain. The Downside to a Good Workout An exhausting trail run can leave your body dehydrated, depleted of glycogen (carbohydrate) stores, overexposed to free radicals (leading to cellular damage) and cytokines (leading to inflammation) and suffering from tissue damage (mostly leg muscles and lungs). This "depletion" is what causes sore muscles, stiff tendons, creaky joints and low energy levels for a day or two following a hard effort. Studies from the Australian Institute of Sport and from Appalachian State University show that after a middle-distance race (five to 13 miles) as much as 70 percent of participants experience an upper-respiratory tract infection such as a cold, flu or sore throat due to a temporary exercise-induced suppression of the immune system. An ideal recovery strategy involves immediately replacing what your body lost during exercise through proper recovery nutrition. Nutritional Recovery Triad Three aspects to optimal post-exercise recovery are hydration, glycogen replacement and "biochemical balance," which involves reducing inflammation in joints and muscles, reversing oxidation, repairing tissue and restoring the immune system. Oxidation and inflammation are related chemical reactions that cause cellular damage, leading to problems such as fatigue, infections and muscle soreness. Since it can be difficult to drink enough during long, intense sessions, assume your body is dehydrated post-run and drink more than your thirst demands. Electrolyte beverages with a low sugar concentration are superior to water in the body’s ability to absorb and retain the fluid. Despite the wide variety of bars, gels and beverages, the bottom line is to select something that tastes good and your stomach can tolerate. A post-exercise snack immediately replaces the sugar stores burned off during exercise. Consuming carbohydrates and protein in liquid form (such as one-percent chocolate milk) is a convenient way to refuel and rehydrate simultaneously. As a rule of thumb, consume around 300 to 500 carbohydrate calories as soon as possible following exercise. Great snacks are banana with yogurt, a handful of nuts and an apple or a bowl of whole-grain cereal topped with berries and one-percent milk. Wash down solid food with plenty of water or sports drink. While rehydration and glycogen replacement replaces what your body lost, biochemical balancing restores the body’s chemistry to normal levels. Exercise-induced inflammation and oxidation damages muscles, lung tissue and temporarily suppresses the immune system. Until you have rested, you are at increased risk of colds, flu and other respiratory tract infections, injuries such as tendonitis, strains, stress fractures and overtraining which characterized by lethargy, depression and general moodiness. Anti-oxidant-rich berries (blueberries, blackberries and raspberries), most fruit juices (orange, grape, and apple) and dietary supplements containing flavonoids and inflammation-reducing enzymes help repair tissues. Foods containing these nutrients are pineapple and papaya, roasted soy nuts and other soy products containing immune-balancing beta-sitosterol. Powerful Protein Although regular moderate exercise is associated with strengthening the immune system, intense training and competition suppresses immune function. The longer the event, the longer this affect can last. A marathon-distance run can leave an athlete susceptible to infection and viruses for up to two weeks, during which time the body cannot effectively fight off infections or repair exhausted muscles and joints. Protein is made up of amino acids and is essential for rebuilding damaged muscle tissue and restoring immune system function. Protein-packed foods, such as milk or yogurt (non low-fat varieties) or a palm-sized portion of beef, poultry, fish or legumes (beans), provide amino-acid building blocks for tissue repair. The immune system uses proteins made up of glutamine and the three branched chain amino acids (BCAA) as fuel. Whey protein, found in some post-exercise recovery drinks and dairy products, is a decent source of all four essential amino acids, but some studies suggest that amino acid uptake is faster when consumed as isolated nutrients in the form of dietary supplements. Look for products that deliver effective levels of BCAAs (1500mg) and glutamine (1000mg) in the proper ratios for post-exercise immune system support. Don’t fall for the "more is better" gimmick, but instead look for products that back up their formulations with research studies on runners. All protein-containing foods will have some BCAAs and glutamine, but dairy products (because of their whey component) are a particularly good food source. Recovery-enhancing nutrition may be the most reliable method to improve your trail running. Don’t just eat something after coming off the trail; instead, give some thought to "functional eating." When to Eat What Immediate after-workout snack Within two hours of your run, consume an easy-to-digest carbohydrate- and protein-containing snack with plenty of fluid. A peanut butter and jelly sandwich is a great choice, but eat to satisfy your personal tastes. Immediate post-exercise snacks jumpstart your body’s repair process. Evening Post-Workout Meal Your post-run dinner is a major source of tissue-repairing nutrients. This meal should include adequate protein (such as a palm-sized portion of chicken breast), carbohydrates (one or two fist-sized portions, such as pasta), antioxidants (two handfuls of brightly colored fruits or vegetables, such berries or citrus) and some added fat (a golf ball or shot-glass sized portion of full-fat salad dressing or olive oil or butter). Over the Next Week Before the Next Big Outing Continue taking your amino acid supplements–BCAAs and glutamine–to ensure adequate immune system function and repair any lingering muscle or lung damage. Dehydration can persist for several days following a long run and even modest levels of dehydration can inhibit recovery, so be sure to hydrate adequately (indicated by clear urine) before your next trail run. Shawn Talbott holds a PhD in nutritional biochemistry and MS in Exercise Science, and practices recovery principles after his trail runs in Utah’s Wasatch Mountains. He can be reached at smtalbott@supplementwatch.com.

‘Superfoods’ Everyone Needs to Stay Alive and Healthy

 

Experts say dozens of easy-to-find ‘superfoods’ can help ward off heart disease, cancer, cholesterol, and more.

Imagine a superfood — not a drug — powerful enough to help you lower your cholesterol, reduce your risk of heart disease and cancer, and, for an added bonus, put you in a better mood. Did we mention that there are no side effects? You’d surely stock up on a lifetime supply. Guess what? These life-altering superfoods are available right now in your local supermarket.

"The effect that diet can have on how you feel today and in the future is astounding," says nutritionist Elizabeth Somer, author of Nutrition for aHealthy Pregnancy, Food & Mood, and The Essential Guide to Vitamins and Minerals.

"Even people who are healthy can make a few tweaks and the impact will be amazing," Somer says. "I’d say that 50% to 70% of suffering could be eliminated by what people eat and how they move: heart disease, diabetes, cancer, hypertension can all be impacted."

You don’t need specific foods for specific ailments. A healthy diet incorporating a variety of the following superfoods will help you maintain your weight, fight disease, and live longer. One thing they all have in common: "Every superfood is going to be a ‘real’ (unprocessed) food," Somer points out. "You don’t find fortified potato chips in the superfood category."

Top Superfoods Offering Super Health Protection

 

• Beans
• Blueberries
• Broccoli
• Oats
• Oranges
• Pumpkin
• Salmon
• Soy
• Spinach
• Tea (green or black)
• Tomatoes
• Turkey
• Walnuts
• Yogurt

Blueberries — Antioxidant Superfood

Packed with antioxidants and phytoflavinoids, these berries are also high in potassium and vitamin C, making them the top choice of doctors and nutritionists. Not only can they lower your risk of heart disease and cancer, they are also anti-inflammatory.

"Inflammation is a key driver of all chronic diseases, so blueberries have a host of benefits," says Ann Kulze, MD, of Charleston, S.C., author of Dr. Ann’s 10-Step Diet, A Simple Plan for Permanent Weight Loss & Lifelong Vitality. When selecting berries, note that the darker they are, the more anti-oxidants they have. "I tell everyone to have a serving (about 1/2 cup) every day," Dr. Kulze says. "Frozen are just as good as fresh." Be sure to include lots of other fruits and vegetables in your diet as well. Remember too that, in general, the more color they have, the more antioxidants.

Omega 3-Rich Fish — Superfoods for the Heart, Joints, and Memory

"We know that the omega 3s you get in fish lower heart disease risk, help arthritis, and may possibly help with memory loss and Alzheimer’s," Somer says. "There is some evidence to show that it reduces depression as well."

Omega-3s are most prevalent in fatty, cold-water fish: Look for wild (not farmed) salmon, herring, sardines, and mackerel. Aim for two-to-three servings a week. Other forms of omega 3s are available in fortified eggs, flax seed, and walnuts. These superfoods have the added benefit of being high in monounsaturated fats, which can lower cholesterol.

Soy — Superfood to Lower Cholesterol

A study reported in The Journal of the American Medical Association (2003) showed that a diet of soy fiber, protein from oats and barley, almonds, and margarine from plant sterols lowered cholesterol as much as statins, the most widely prescribed cholesterol medicine. "Look for tofu, soy milk, or edamame — not soy powder," says Somer. In other words, soy sauce won’t do the trick. One caveat: If you have a family history of breast cancer it is not recommended that you eat extra soy.

Fiber — Superfood Aids Weight Loss and Checks Cholesterol

A diet high in fiber will help you maintain healthy cholesterol and blood sugar levels. As a bonus, because fiber helps you feel full longer, it’s a great tool in weight management. Whole grains, beans, fruit, and vegetables are all good sources. Try throwing some beans in your salad, recommends Kulze. "Fresh, frozen, or dried are the best. You can use canned, but they tend to be higher in sodium," Kulze warns.

Tea — Superfood for Lowering Cholesterol and Inhibiting Cancer

"The overall antioxidant power of black tea is the same as green tea," says Kulze, "but green tea does have ECGC, a powerful antioxidant that we really do think is quite special." A recent Japanese study on green tea found that men who drank green tea regularly had lower cholesterol than those who didn’t. Researchers in Spain and the United Kingdom have also shown that ECGC can inhibit the growth of cancer cells. For a double health whammy, replace sugary sodas with tea.

Calcium

OK, OK, you know the drill: Calcium helps build strong bones and prevents osteoporosis. Look for it in dairy products or supplements. Added bonus: Some studies show that calcium helps with weight loss. Here are the calcium levels recommended for adults by the USDA:

• Age 9 to 18 — 1,300 mg
• Age 19 to 50 — 1,000 mg
• Age 51 and over — 1,200 mg

And Finally, the Yummiest Superfood Yet … Dark Chocolate

New research has shown that dark chocolate is packed with antioxidants and can lower blood pressure. Kulze recommends that you look for chocolate with 60% or higher cocoa content; the darker, the better. In addition, the darker it is, the lower the fat and sugar content. Now that’s our kind of health food!

 

Acid Reflux in Baby: Keeping Your Baby Protected

 

Acid reflux, which is also termed as gastroesophageal reflux, is one of the most frequent problems among infants. Babies with acid reflux often suffer from a range of conditions, from a mild degree to a severe one, such as recurrent spitting up, abdominal pain, and night waking.

This discussion would be more comprehensive with the understanding of the physiological or the mechanical aspect of the condition. The body has a band of muscle in a circular structure that is called the lower esophageal sphincter. This muscle detaches the esophagus from the stomach. When food comes into the stomach, it closes so as to prevent the stomach acids and contents from backing up into the esophagus or regurgitating. But in the case of some babies, the lower esophageal sphincter has grown immature. As such, the partially digested food and digestive acids are allowed to be refluxed. This condition causes irritation in the esophagus lining which results to inflammation that is also commonly called as heartburn.

Acid reflux among babies usually develops when they are between two to four weeks old. Doctors usually prescribe medicines that minimize the production of digestive acids. Within six to nine months, the acid reflux starts to naturally subside. At this time period, the babies spend most of their time in an upright position. This is to apply the law of gravity on the food taken in; that is, the food stays down more naturally and reduces possible regurgitation.

The following are helpful pointers on feeding and positioning of babies to lessen acid reflux:

Prepare smaller feedings recurrently. It makes sense to feed your baby more than usual but less than the accustomed. If lesser volume of milk goes into the stomach, the digestion will be faster and there will be fewer amounts of contents available for regurgitation.

Maintain the baby in an upright position after feeding. As discussed earlier, gravity helps to keep the digestive contents down. Position your baby seated in your lap while his head rests on your chest. Keep this position for at least half an hour after feeding.

Breastfeeding helps a lot. Breast milk is well-known to have many advantages over other commercial formula, mainly for babies with acid reflux. Breast milk can be digested faster, which of course lessens spitting up, and it has special enzymes that assists digestion. In addition to that, breast milk does not trigger allergy to babies compared to other milks available in the market. But for those who are formula-feeding, it is advisable to use milk with a hypoallergenic formula as advised by a doctor. Aside from having higher tolerance with sensitive intestines, hypoallergenic milk can also be digested faster by the stomach so as to minimize refluxes.

Set your baby in a comfortable position when asleep. Since when a baby lies flat when sleeping, gravity cannot help in keeping the food down in this set-up. As a result, a baby with acid reflux often has to endure a sore night waking. If a baby can sleep soundly, then there will be no need to call for a change in his habit. But some babies become restless, which can be noted by abdominal pain, acid breath, and wet burps. In this case, it is recommended to elevate the baby’s crib to about 30 degrees. This will be enough to reduce the regurgitation. You may also try to train him to sleep on his left side. It is in this position where the inlet of the stomach is higher than the exit. This will also help to keep the food down.