There are basically two types of injuries: acute traumatic injuries and chronic overuse injuries. Acute injuries are usually the result of a single, traumatic event such as a fall or a collision. Overuse injuries are subtle and usually occur over time. This makes them challenging to diagnose and to treat. Overuse injuries are more common in sports than acute injuries and are the result of repetitive microtrauma to the tendons, bones, and joints. The common injuries seen with many sports include: tennis elbow, swimmer’s shoulder, plantar fasciitis, runner’s knee, jumper’s knee, Achilles tendinitis, and shin splints.
The human body has a tremendous capacity to adapt to physical stress. We tend to think of “stress” mostly in the context of its negative effect on our emotional wellbeing. Physical stress can include exercise and activity, and is beneficial for our bones, muscles, tendons, and ligaments, making them stronger and more functional. This happens because of an internal process called remodeling. The remodeling process involves both the breakdown and buildup of tissue. There is a fine balance between the two, and if breakdown occurs more rapidly than buildup, an overuse injury occurs.
Are you at risk for a repetitive running injury? We have narrowed down the best predictors of who is at risk for a running injury to help you stay on your feet. We want to celebrate with you this season as you conquer your goals.
#1- Previous Injury
The most proven predictor of a future repetitive injury is a previous repetitive injury. 70% of injured runners will re-injure themselves within 12 months. (Beresini. New York Times. October 24, 2010) What causes these re-injuries? Training errors are the most common cause of overuse injuries. These errors involve rapid acceleration of the intensity, duration, or frequency of the training activity. Properly planning your training during the season and preparing your body in the off-season is key to preventing these overuse injuries. When you have been injured, let us know and we can advise you on your recovery strategy.
Overuse injuries frequently happen with people who are returning to a sport or activity after injury. Athletes often re-injure themselves when they try to make up for lost time by pushing themselves to achieve the level of participation they were at before injury. The injury most often occurs as the rapid increase in training load overwhelms the stabilization of the injured joint. Therefore, proper stabilization of the joints being used during the training is critical in avoiding overuse injuries.
#2- Genetics
Genetic or acquired imbalances between strength and flexibility around certain joints predispose individuals to injury. Body alignment, such as knock-knees, bowlegs, unequal leg lengths, and flat or high arched feet, will impact overuse injuries. Many people also have weakness due to old injuries, incompletely rehabilitated injuries, or because of repetitive postures like prolonged sitting and bending.
Foot Arches and Injury
One example of those predisposed to a repetitive overuse injury are those with high or flat arches in their feet. People with high and low arches have impaired balance when compared to people with neutral arches (Tsai L, J Orthop Sports Phys Ther. 2006;36:942-953). This creates an instability of the kinetic chain of the lower extremity which leads to compensation and injury with increased training or load.
In one study, 927 novice runners were followed for 1 year:
- – 33% of very low arch runners became injured
- – 25% of very high arch runners became injured
- – 18% slightly high arches or neutral arch runners became injured
- – Those with extremely low arches were unable to finish the study as they could not run more than 186 miles a year! That is fewer than 4 miles a week.
The height of the arch can even predict what injuries will most likely occur. It has been shown that low–arched runners will exhibit more soft tissue injuries and a greater prevalence of injuries along the inside of their leg, especially at the knee and ankle. This overloading mechanism also occurs at the feet, predisposing these athletes to a greater risk for inner foot injuries such as plantar fasciitis and sesamoid problems under the big toe. High-arched runners are also at risk, with twice the probability for stress fractures. They are also more likely to have more injuries along their outer leg such as, IT band syndrome, ankle sprains, and stress fractures of the 5th metatarsal. (Williams. Clin Biomechanics. 2001; 16, 341-347)
#3- Balance and Stability
Prediction of overuse injuries has been shown with the use of a few simple balance and stability tests. Here are a few of the best:
Star Excursion balance test:
Begin this test by standing on one foot and try reaching backwards. Reach from your weight-bearing foot on a diagonal while balancing on your stance leg. Measure from your front foot to the point where your back foot and toe touch the ground without losing your balance. Do this on both sides and compare. Runners with a reach difference greater than 4 cm are 2.5X more likely to sustain an injury.
Single leg squat test:
Perform this simple test by simply standing on one leg with a slight bend in your stance leg. Perform a shallow one legged squat and observe the posture of the stance leg and the position of the knee over the foot. Does the knee turn inward? Does the leg shake? Do the hips slide to either side? If any of these are a yes, then you have identified a hip instability weakness. This has been linked to a high predictability of knee injuries with jumping and soccer athletes and hip injuries with weight lifting and running. (Crossley K, Am J Sports Med. 2011; 39: 866.)
The Squat Test:
Observing a full squat can tell you a lot about proper ankle, knee, hip, and spinal stability.
Individuals who maintain proper loading (shoulders over knees, knees over big toe, well balanced, maintain arches in the foot, and symmetrical hip movement) will most likely experience fewer repetitive injuries. Watch out for shifts to one side over the other during the squat, falling backwards during the lower end of the squat or knees that move inward during the squatting motion. All of these are signs that joints of the lower extremity are not moving properly and that stability is not being maintained. These movement dysfunctions can cause excessive load and stress which can lead to an injury.
#4- Improper Breathing Patterns
Breathing and stability functions are codependent. Both breathing and joint stability must be maintained during any dynamic functional activity or exercise. When push comes to shove, the body will always breathe at the expense of stability. When training becomes difficult, only the best athletes can do both. For example, when a runner becomes fatigued, they will prioritize breathing instead of maintaining core stabilization. This alternative compensation pattern will often result in low back pain and/or less hip stability. This can become a learned pattern that is repeated more frequently and hastens the onset of a repetitive injury.
Diaphragmatic Stability Test:
In a seated position, place your fingers into the spaces of your lower rib cage. With a normal breath in, do you feel your lower ribs expand and widen or suck in and elevate? Proper breathing technique involves the lower ribs expanding, widening, and the inhalation involving the whole lower quadrant and pelvis. Failure to be able to do this at rest is predictable for a lack of diaphragmatic stabilization during activity. This can lead to compensation and injury.
How to treat overuse injuries:
Some tips for treating an overuse injury include:
- Cut back the intensity, duration, and frequency of an activity are often advised but rarely is it recommended to stop the activity.
- Adopt a hard/easy workout schedule and cross training with other activities to maintain fitness levels.
- Perform proper warm-up activities before and after.
- Use ice after an activity for minor aches and pains.
If symptoms persist past a few days, a more detailed treatment plan may be needed for your specific condition. This may include a thorough review of your training program and an evaluation for any predisposing factors. In our office, we love to discuss these topics with our patients and when needed, we can apply some powerful tools to speed up recovery. Everyday we employ the use of Active Release Technique, Acupuncture/Dry Needling, and Chiropractic adjustments to facilitate healing. For more on these techniques, check out a few of our articles on our Blog for more information.
Prevent Overuse Injuries
Most overuse injuries can be prevented with proper training and common sense. Learn to listen to your body. Remember that “no pain, no gain” does not apply here. The 10 percent rule is very helpful in determining how to take things to the “next level.” In general, you should not increase your training program or activity more than 10 percent per week. This allows your body adequate time for recovery and response. This rule also applies to increasing pace or mileage for walkers and runners, as well as to the amount of weight added in strength training programs.
Your rehabilitation program can also be modified to maintain overall fitness levels in a safe manner while you recover from your injury. You should return to play only when clearance is granted by a healthcare professional. If you are in need of a specialist like this, please contact our office. It is a great joy of mine as a Chiropractic Physician and Certified Strength and Conditioning Specialist to provide treatment, training advice, and more to our amateur and professional athletes.
If you are struggling to overcome a repetitive injury, reach out to our office and let us help you become healthier than you have ever been.
Daryl C. Rich, D.C., C.S.C.S.
