FROM RUNNING INJURY

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A guide from RUNNINGINJURY.co.uk

HOW TO RECOVER

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Achilles injuries

Three quarters of runners experience a moderate or severe injury each year.

We review a few of the most common.

What is Achilles tendonitis?

The Achillles tendon, which connects the two major calf muscles (the gastrocnemius and soleus muscles) to the heel bone, is strong. But the tendon lacks flexibility. It is particularly susceptible to injury.

Achilles tendonitis - sometimes referred to as Achilles tendonosis – is characterised by soreness above the back of the heel. Given its well-developed nerve supply, it can be very painful.

The pain is often felt in the morning. It can also be aggravated by exercise – with particular pain felt

the day after exercise.

Different forms of Achilles injury The condition can take many forms. The pain may be felt in the lower portion of the heel, where the tendon attaches to the heel bone. Alternatively, and more commonly among the young and active, it may be felt a few centimetres higher in the mid-portion of the tendon.

In the worst cases, runners can suffer a rupture of the Achilles tendon (typically associated with a sudden snap or pop in the back of the calf or heel).

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...runners can be particularly susceptible

when unsuitable running shoes are worn....

Source of the pain There is some uncertainty about the source of the pain. It may be related to new blood vessels growing into the damaged tendon. The central nervous system may also be important in Achilles pain.

Achilles tendonitis and Achilles tendinosis The terms Achilles tendonitis and Achilles tendinosis are often used to refer to Achilles pain, reflecting an ongoing debate as to whether Achilles pain is an inflammatory condition (referred to as tendonitis) or a degenerative condition (referred to as tendinosis).

Tendonitis was traditionally used to refer to Achilles conditions. But with analysis of supposedly inflamed tendons revealing an absence of inflammation, use of the term tendinosis has become increasingly common and is considered by some to be the medically correct term.

What causes Achilles tendonitis?

Research has highlighted a range of factors that could contribute to Achilles injuries, though the precise cause of Achilles tendon injuries remains open to debate.

Unsurprisingly, some studies have highlighted overuse as a key factor. During running, the Achilles tendon is estimated to transmit forces equivalent to seven times body weight.

The type of running may also be important. In addition to sudden increases in distances run, contributory factors to injury could be an increase in running pace or an increase in the frequency of hill running.

Those who overpronate, with their running characterised by excessive inward rolling of the foot and ankle, may also be at particular risk. And runners can be particularly susceptible to Achilles injuries when unsuitable running shoes are worn.

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... An alternative view is that to stop walking or running can actually be detrimental

to long-term recovery...

More generally, those with tight or weak calf muscles – which can increase stress on the Achilles tendon – may be particularly susceptible to Achilles injuries. The wearing of high heels, which shorten tendon and calf muscles, can also contribute to the condition.

Finally, some studies have also suggested that genetic factors may play a significant role.

How can I speed my recovery from Achilles tendonitis?

You'll find a full range of products to aid your rehabilitation in our dedicated Achilles-injury store.

In addition, the following recovery methods may be of use.

1. Rest. A key area of debate is the merits of rest versus continued activity.

Some argue that Achilles pain should be treated with immediate rest from running. An alternative view is that to stop walking or

running can actually be detrimental to long-term recovery. Over the past few years, scientific evidence has supported the idea running should continue during the recovery process – provided that this results in no greater than moderate pain.

There is general agreement, though, that some forms of running – most notably, hill running - are best avoided when Achilles pain is present.

More generally, a cautious approach is typically advised. Although there may be no need to refrain from other sporting activities, it may be necessary to scale back where such activities result in soreness.

2. Stretching. Simple leg heel raises form the core of standard recovery programmes, helping to strengthen calf muscles. As noted in the excellent ‘Running Anatomy’ guide by Joe Puleo and Patrick Mulroy, such stretches “should be a staple of every runners’ strength training programme” - though the authors also note that they should

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... a change to more suitable running shoes may improve

the condition...

be avoided if you are still suffering the initial effects of the injury.

It is typically recommended to incorporate in the stretch an eccentric component (whereby muscles and tendons are lengthened, in contrast with concentric stretches). Some studies have suggested that this may help speed recovery.

We’ve pulled together some of the best stretching videos for runners at our YouTube channel.

3. Footwear (men's; women's). As with many injuries, a change to more suitable running shoes may improve the condition. That may involve more effective motion control running shoes that are designed to limit excessive inward rolling of the foot and ankle. Heel raises, for example from Sorbothane, or orthotics, such as in the Footmedics range, can also be effective, acting to reduce tension on the Achilles tendon.

4. Surgery. For a rupture of the tendon, surgery is normally necessary. In general, most

patients make a good recovery.

Note that steroid injections are rarely recommended as they can cause the Achilles tendon to rupture.

When will I recover from my Achilles injury?

Overall, recovery from Achilles tendonitis can be relatively slow, reflecting the poor blood flow in this area. Severe cases may take several months to resolve.

In general, though, full recovery is typical. As a recent review in the American Journal of Sports Medicine concluded, there is little agreement on the best way to treat Achilles tendon disorders. But research appears to provide compelling evidence of positive results where eccentric calf muscle strengthening programmes have been followed.

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Ankle injuries

where the ankle rolls in the other direction, such that the sole of the foot faces in an outward direction, resulting in damage to the ligaments on the inside of the ankle.

The damage sustained in a sprained ankle is typically to the anterior talofibular ligament, which connects the ankle bone (the talus) with the smaller of the two bones in the lower leg (the fibula). In severe cases, the sprain might also damage the calcaneofibular ligament, connecting the heel bone to the fibula nearer the heel.

What causes ankle injuries?

In most cases, ankle pain during physical exertion is caused by a sprain - a stretching or tearing of ligaments. Sometimes, it is related to other injuries, such as Achilles tendinitis.

The standard ankle sprain is an inversion sprain (or lateral ligament sprain). This is where the ankle turns over such that the sole of the foot faces inwards, damaging the ligaments on the outside of the ankle.

While an eversion ankle sprain is less common, it sometimes occurs, particularly with a fracture. This is

“ You must listen to your body. Run through annoyance but not through pain.”

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…Gentle stretches of the calf muscles can also support

ankle movement…

1. Rest. A first step is to rest the injury to reduce pain and prevent further damage. But partial weight bearing is thought to speed recovery and is usually recommended as soon as pain will allow. It may also be possible to follow a reduced training programme, though running on an inflamed or infected joint may lead to longer-term damage.

2. Ice or cold therapy. This can ease the pain, reduce swelling and limit bleeding (as well as stimulate blood flow when applied at a later stage). The standard approach is to apply the cold therapy treatment for 15 minutes as soon as possible after the injury takes place and then repeat every couple of hours.

3. Compression. This approach helps to reduce both bleeding and swelling. Both bandaging and ankle supports can work well, providing support and compression to the injured ankle.

Ankle sprains are typically placed in one of three categories. A Grade I ankle sprain is where there is stretching of the ligament, accompanied by pain and swelling. Running, let alone jogging, may be impossible.

In the case of a Grade II ankle sprain, the injury is more severe, with partial tearing of the ligament. This is typically accompanied by greater swelling and bruising (reflecting bleeding under the skin) and walking is painful.

Finally, for a Grade III ankle sprain, a complete tear of the ligament is experienced. This will be painful, with walking a challenge, and you are likely to feel quite unstable.

How can I speed my recovery from ankle injury?

Take a look at our dedicated ankle injury recovery store for the full RUNNING INJURY range of rehabilitation products. In addition, the following recovery methods may be of use.

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…bandaging and ankle supports can work well, providing support and

compression to the injured ankle…

6. Medical treatment. While it does not usually come to this, there can in some instances be a need for medical treatment, including potentially anti-inflammatory drugs and antibiotics. But, in cases of overuse injuries, the approaches above (often as part of a programme of physio treatment) are often enough to resolve the symptoms and lead to a full recovery.

When will I recover from ankle injury?

How long you take to recover from ankle sprains can vary widely. But, with a little work and an active approach to rehabilitation, full recovery is common within three months and in some cases takes as little as a week.

4. Elevation. The final part of the so-called 'RICE' approach (Rest, Ice, Compression, Elevation) involves the use of gravity to reduce bleeding and swelling. This allows fluids to flow away from where the injury is located.

Following the initial painful stage, there are other treatments that can help the ankle return to normal as soon as possible.

5. Stretching. A small number of stretching exercises are generally thought to be particularly effective. For example, ankle circles can aid ankle movement and, when performed with the leg elevated, can also reduce swelling.

Gentle stretches of the calf muscles can also support ankle movement. This is important as, following a sprained ankle, the calf muscles commonly tighten to protect the joint.

You’ll find some of the best stretching videos for runners at our YouTube channel.

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Plantar fasciitis

For many, the pain associated with plantar fasciitis prevents any running at all. Some find that the pain is reduced as they warm-up for a session and then during the session itself – before increasing again, sometimes quite sharply, as soon as they cool down.

What causes plantar fasciitis?

Plantar fasciitis is astoundingly common in the population at large. An estimated 10% of the US population will suffer from plantar fasciitis during their life. Each year, it is thought to account for more than one million medical visits.

What is plantar fasciitis?

Plantar fasciitis is an injury that's hard to ignore.

The injury is characterised by pain on the sole of the foot and near the heel, reflecting inflammation of the plantar fascia. This is the connective tissue that extends from the heel bone to the base of each toe - and it is at its thinnest, and most, vulnerable, near the heel.

The pain is often most acute with the first steps each morning upon waking. Even a light touch to the underside of the heel can be painful.

“I learned, for example, that running injuries can be caused by being female, being male, being old, being young…”

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…In a study in the mid-1990s, 1 in 7 patients found a

change of shoes to be the most effective treatment…

typically ascribed to repetitive pounding on the heel during running.

How can I speed my recovery from plantar fasciitis?

Take a look at our dedicated plantar fasciitis store for the full RUNNING INJURY range of recovery products. In addition, the following recovery methods may be of use.

1. Rest. It may not be the most attractive option for keen runners, but there’s a lot to be said for simple rest. In one study, a quarter of patients reported rest as the most effective treatment.

2. Stretching. There’s a wide array of different stretching programmes you could undertake to help speed your recovery. One study found that more than four in five patients undertaking stretching programmes were successfully treated.

There’s little hard evidence to

In the vast majority of cases, the origins of the injury are unknown. But a variety of factors are thought to increase the likelihood of suffering plantar fasciitis. In addition to the pregnant and obese, those with low foot arches, and indeed those with high arches, are at increased risk. That’s also the case for people with different leg lengths, as well as those with inflexible calves.

The problem also appears to be especially prevalent among runners. One estimate, from the early 1990s, suggests that around 1 in 10 runners are affected. Other evidence suggests that long-distance runners account for a disproportionate proportion of serious cases that result in surgery. And those who overpronate, with their running characterised by excessive inward rolling of the foot and ankle, might also be particularly susceptible to plantar fasciitis.

Consistent with this finding, one review concluded that the most common cause of plantar fasciitis is overuse rather than anatomy. More generally, the condition is

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…more than four in five patients undertaking

stretching programmes were successfully treated…

the plantar fascia. And, in one study, a third of patients reported that nights splints provided the best treatment for plantar fasciitis.

5. Orthotics. More than a quarter of patients reported orthotics as the most effective form of treatment in one study.

6. Steroid injection. Given the uncertainty around the effectiveness of the treatments discussed above, it’s striking that there’s a clear consensus on use of steroid injections. A range of studies have found that, in the short term, steroid injections can provide pain relief. But, over the longer term, steroid injections do not appear to alleviate pain to any greater extent than a placebo.

It’s also important to note that in the case of a rupture of the plantar fascia, where the ligament is actually torn rather than inflamed, steroids can actually hinder recovery.

7. Surgery. Surgery to resolve plantar fasciitis problems is rarely necessary. Indeed, it is only

favour one programme over another — or indeed how frequently stretches should be performed and for how many repetitions. Whatever the stretching programme, however, it’s important to have a clear idea of proper form when performing the stretch. Poorly performed stretches could do more harm than good.

On our YouTube channel, you’ll find a number of videos demonstrating stretches that often form a core part of successful recovery programmes.

3. Running shoes (men's; women's). In a study in the mid-1990s, 1 in 7 patients found a change of shoes to be the most effective treatment. For those with relatively flat feet, motion control shoes (designed to limit excessive inward rolling of the foot and ankle) can be effective.

4. Night splints. Night splints may also help recovery from plantar pain. They can avoid the shortening of the fascia that typically occurs during sleep and so maintain the proper length of

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…in around 80% of cases, plantar fasciitis problems clear up within a year…

undertaken in around 5% of cases.

Nonetheless, studies have found extremely high success rates from plantar fascia release surgery. This involves cutting part of the fascia to release tension and relieve inflammation. In more than three out of every four cases, patients report reduced pain levels after the surgery, though complications can arise.

When will I recover from plantar fasciitis?

Described by Danny Dreyer, author of Chi Running, as an injury to be avoided at all costs, plantar fasciitis can be a tremendously frustrating injury. And the length of time that it takes to recover can vary significantly from case to case.

The good news, though, is that, for reasons not yet well understood, runners can typically expect a full recovery from plantar fasciitis. And, in around 80% of cases, plantar fasciitis problems clear up within a year.

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Shin splints

What causes shin splints?

While the immediate cause of such pain is not entirely clear, a range of factors are thought to contribute to shin splints.

Overuse may be important, with sufferers often having sharply increased mileage, changed to running on hard surfaces or excessively stepped up their hill running programme.

The injury may be related to overpronation, where there is an excessive inward roll of the foot after the runner lands.

Beginners and overpronators may

What is shin splints?

The term shin splints does not precisely describe a specific running injury. Instead, it covers a range of pains relating to the shin, the large lower leg bone called the tibia.

Shin splints most commonly refers to what is medically known as medial tibial stress syndrome (MTSS). The pain is generally, but not always, felt on the medial side – the inside of the leg, facing the other leg.

“Pain insists upon being attended to. God whispers to us in our pleasures, speaks in our consciences, but shouts in our pains…”

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application of ice, compression (for example through use of compression bandages) and elevation of the injured area.

To maintain fitness, cross-training – in the form of other non-weight bearing exercise - can take the place of running during this period.

The return to running needs to be gradual. If pain is felt during or following a run, it is advised to stop the workout.

In addition to a slow step up in mileage back to previous levels, it is typically advised to make changes to the types of workout undertaken – avoiding hill running and speedwork during the recovery phase.

2. Stretching. This is typically a key part of the recovery programme. Where calf muscles are tight, for example, simple calf stretches can be particularly important.

3. Running shoes (men's; women's). As with many other injuries, where runners are wearing inappropriate or worn out shoes, that can

also be particularly susceptible, as well as those with tight, inflexible Achilles, calves and plantar muscles. Weak core muscles may also add to the risk of suffering from the condition, as with many other running injuries. This can be exacerbated by a lack of or (unsuitable) warm-up and stretching.

Finally, inappropriate or worn out running shoes can play an important role. As we discuss below, this can also contribute to an additional risk factor: a poor running style, with for example overstriding.

How can I accelerate my rehabilitation?

You'll find the leading shin splints recovery products in our dedicated online store. The following rehabilitation tips may also be of use.

1. RICE. In general, treatment of shin splints initially revolves around the RICE approach that is used for many running injuries. The first element is resting from running,

…A survey found that shin splints accounted for roughly one in seven

running-related injuries…

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… where runners are wearing inappropriate or worn out shoes, that can increase the risk of shin

splints.…

How long will it take to recover from shin splints?

In general, with care and rest, runners can recover fully from shin splints. The recovery time varies widely, though in most cases an expectation of recovery within 3-6 months is not unreasonable.

increase the risk of shin splints. It can also contribute to runners developing a poor running gait, further raising the risk of injury.

An obvious way to tackle a shin splints problem is therefore to switch to more appropriate running shoes.

4. Improve running style. Danny Dreyer, the man behind the Chi Running approach, argues that the condition will simply reoccur if you keep the same running form that generated shin splints in the first place. He advocates the Chi Running style and suggests that this barely uses the shin muscles. Chi Running involves runners picking up their feet with each stride - rather than pushing off with their toes, which Dreyer suggests can lie behind shin splints.

5. Surgery. Finally, in cases where these conservative treaments are unsuccessful, it may be necessary to consider surgery.

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About us 1) We are a small team of running enthusiasts. We are passionate about avoiding injury. And we are dedicated to supporting your recovery.

2) You can stay up-to-date with the latest RUNNING INJURY news, tips and offers - including occasional flash sales with reductions of up to 85% on running gear from the latest brands. Sign up for free here.

3) You can also stay on top of the latest running news and special offers on Twitter, Facebook and Google+.

Please note 1) “Three quarters of runners…” Is based on ‘Foot strike and injury rates in endurance runners: a retrospective study’ (Harvard University, 2012).

2) “You must listen to your body…” is a quote from Dr George Sheehan.

3) “I learned, for example…” is a quote from Amby Burfoot.

4) “Pain insists…” is a quote from C S Lewis.

5) 'Track HDR2' image is by kind permission of Sonyalphashooter; check out the portfolio at www.sinkphotography.com.

6) Running and injury information provided here is for educational purposes only, and is not a substitute for advice from a physician. We strongly recommend any reader to consult a physician before undertaking any exercise or recovery programme.

Resources 1) There are very few comprehensive recovery programmes dedicated to these and other common injuries. Below we list a few that are available:

- Ankle injuries

- Back injuries

- Hamstring injuries

- Knee injuries

- Plantar fasciitis

- Shoulder injuries

- Shin splints

A guide from RUNNINGINJURY.co.uk