Runners Stretches

This type of injury is one of the most common in elite runners. Chronic recurring muscle tears are frequently misdiagnosed, and usually only respond to physical therapy. This type of injury is characterized by the following:

1. Gradual onset of pain, usually during or shortly after running.
2. Although it is initially possible to run through the pain, as the condition progresses the pain can become severe enough to limit running.
3. The tear usually involves the calf, hamstrings, groin, of glutes.
4. The pain during running can be severe, but always improves with rest.
5. Contraction of the involved muscle becomes very painful.
6. The runner can rest for months, but the pain will recur if running is resumed without physical therapy.
7. Upon palpation there is often a very tender "knot" in the involved muscle.

Chronic muscle tears are likely due to forcefull eccentric contractions and are usually noticed when there is a change in training either more speed or more distance. The connective tissues within the muscle lack the eccentric strength to withstand the forces in running. Once an initial small tear begins to develop it heals with scar tissue. This scar tissue is weak initially so quickly retears when running again. The knot that develops is likely muscle fibres surrounded by scar tissue.

Treatment involves manual cross frictions, ultrasound, and the appropriate runners stretches and strengthening by your physical therapist and can last several weeks. Usually the more chronic the injury, the longer the period of treatment required.

These injuries tend to recur so it is important for the runner to stretch adequately prior to running and especially the morning runs and the faster runs. It is also essential that at the first sign of reinjury that the runner seeks physical therapy immediately so as to speed recovery.

To prevent chronic muscle tears a good eccentric strengthening program is important. For example running backward down a hill will work the calves eccentrically.
The best method of preventing these chronic recurring tears is through  a program of appropriate eccentric training as well as runners stretches.

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A stress fracture is a small fracture that develops in the bone as a result of repetitive minor injuries that can occur over weeks or months. Stress fractures will occur in the bones that may be too weak to sustain the forces imposed on them during running.

in order of the frequency of occurrence the bones usually involved are:

1. Tibia
2. Metatarsals
3. Fibula
4. Femur
5. Navicular
6. Pubic bone

Pain associated with a stress fracture is usually tolerable at rest or with light exercises but quickly becomes intolerable with the impact forces involved with running. It will often even prevent running.
This type of injury is usually characterized by the following:

1. Pain usually starts without any apparent reason.
2. If the fracture is in the pubic bone the runner may find just standing on one leg to be painful.
3. Fractures in the other bones become painful with hopping on one foot.
4. Tenderness is felt at the site of the fracture.

Stress fractures can take six weeks of rest to heal, sometimes those of the pelvis can take longer.
Who is prone to stress fractures?

• Women are 12 times more likely to experience stress fractures than men and women with hormonal irregularities are particularly vulnerable if they have low estrogen levels.
• Stress fractures are more likely to occur in novice runners 8 to 12 weeks after training has begun.
• Runners who suddenly increase their distances, run very long races, or train too heavily are more at risk of developing a stress fracture.
• Runners who run in very hard running shoes or training spikes may also increase their risk of stress fractures.
• Runners with a high arch seem more susceptible to stress fractures of the femur and metatarsals.
• Runners with a low arch or a pronating foot are more susceptible to stress fractures of the tibia and fibula due to faulty biomechanics.

Treatment of a stress fracture is 6 to 12 weeks of relative rest to allow the bone to heal. Immobilization is usually not required unless the neck of the femur is involved, but this needs to be determined by and orthopaedic surgeon.

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Exertional cramps should not be confused with cramps that can accompany more serious disorders. For that diagnosis you must see a physician. Exertional cramps among runners usually occur in runners that increase their speed or distance more than what they are used to.
To prevent cramps be sure to stretch adequately before hand, remain well hydrated, and don't run too face early in a race. Stretching to prevent cramping should include a static stretching program 10 minutes per day involving the affected muscles.

Shin splints are one of the most common running complaints especially in distance runners and is otherwise know as bone strain.  There are typically four stages of injury:

1. Vague leg pain only after exercises.
2. Pain during exercise as well.
3. Pain limits exercise.
4. Pain limits anything more than walking.

This injury will progress through to grade 4 if training continues without treatment.

To make a correct diagnosis your physical therapist must rule out chronic tears of the tibialis anterior and tibialis posterior muscles. Localized tenderness is always felt at the area of injury where the bone is affected.

Causes of this bone strain are overpronation or poor adaptation to the excessive shock of running. Anteriorly, overstriding causes the muscles on the front of your leg to work harder eccentrically. This overworking of the muscle creates pain and injury to where these muscles attach to the tibia. Posteriorly, this pain is thought to develop due to twisting of the tibia and fibula due to excessive pronation  leading to minute bone cracks that are painful.
Risk factors associated with this type of injury:

• Problematic training techniques.
• Hard training surfaces.
• Inappropriate shoes.
• Leg length discrepancies.
• Calf tightness.
• Overpronation.
• Poor bone density or bone strength.
• Muscle imbalances.

Treatment of this injury will depend on identifying causal factors. If you suffer from this type of pain be sure to consult your family doctor or physical therapist.

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Achilles tendonitis is an acute inflammatory condition affecting the achilles tendon. There is degeneration of the tendon, microtearing with an inflammatory response. Paratenonitis is inflammation of the paratenon and may or may not me accompanied by tendon degenerative changes.

Achilles tendinosis is not accompanied by an inflammatory response and doesn't respond to antiinflammatories. This is one of the most debilitating injuries a runner can sustain and becomes more commonly found amongst older runners.
These injuries can be graded as follows:

1. Pain only upon rising in the morning that doesn't last.
2. Pain is also experienced after exercise.
3. Pain during exercise that hinders performance.
4. Pain prevents exercising.

Achilles tendinosis can be caused by excessive pronation. This abnormal foot motion essentially wrings the tendon creating excess strain to the tendon, and its matrix where it has a poor blood supply.
Also, age and minor degenerative changes reduce the tendons ability to absorb shock, causing further degeneration of the tendon.
Contributing factors:

• Sudden increase in training distances.
• Sudden return to training after a break.
• Stiffness of the calf due to inadequate stretching.
• Shoes that old or worn.
• Inappropriate shoes.
• Shoes that are too hard.
• Shoes with a heel less than 12-15 mm.
• Hypermobile feet.
• High arches.
• Age.

Treatment of achilles tendinosis requires addressing the causal factors above. See your physical therapist for the appropriate exercises, modalities, and manual therapy.

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Tears of the achilles tendon occur usually after a history of chronic achilles tendinosis. There may or may not be a history of pain prior to the rupture. The treatment for this is immediate surgery. The torn tendon begins to degenerate soon after the injury, making any surgery difficult if there is a delay.