Common Conditions & Repetitive/Overuse Injuries For Runners
By Linda Craig, LMT, NMT *
FOOT & ANKLE AND LOWER LEG CONDITIONS
1. Pes Planus (Fallen arch/flat feet): leads to over-pronation, and if not corrected can cause shin splints and stress fractures. Treatment options include orthotics and/or arch supports such as Super Feet; strengthening tissue with exercises and massage techniques. An easy exercise to strengthen the arch is to “scrunch” & pick up a wash cloth with toes.
2. Pes Cavus (High Arch): increases tensile stress & shortens the plantar fascia and may cause plantar fascitis and/or bone spurs. Treatment may include loosen plantar muscles to lengthen tissues on the bottom of foot via foot massage roller, tennis ball or massage; ice & stretch calf muscles and plantar (bottom) surface of foot.
3. Morton’s Foot (shortened great toe relative to 2nd toe); 20% of population has this condition; effects foot mechanics and push-off of stride and may cause plantar fascitis or shin splints. Treatment protocols include orthotics, massage and wider toe box in running shoes.
4. Plantar Fascitis; overuse condition causing pain and inflammation, especially at the heel attachment of the fascia. Left untreated and continued overuse may develop in to a bone spur at the attachment. Treatment includes rest, cryotherapy (ice), stretching of the Achilles tendon and foot; deep friction massage to break up adhesions and stripping of calf and foot flexors.
5. Achilles Tendinitis; intense shock absorption combined with poor blood supply at the base of the Achilles make this tendon vulnerable to overuse injury; may cause distal pain in the tendon, tight, inflexible calf muscles, and swelling of tendon. Treatment includes rest, cryotherapy combined with stretching & massage, especially to calf muscles (lengthens and releases the tendon).
6. Tibial Stress Syndrome (Shin Splints); overuse condition; Lateral/outer shin splints occur due to running long distances downhill or on sidewalks with uneven camber or running track. Causes of Medial/inner shin splints include flat feet, inadequate footwear, overpronation, running on poor surfaces or poor body mechanics of foot or leg. Treatment includes modification of activities, change of shoes, and rest. Friction massage along with active & passive stretch will benefit
7. Muscle cramping/spasm; common in calves but can occur in quads, hamstrings. Causes include inadequate stretching, poor muscle metabolism, salt deprivation, potassium imbalance and commonly dehydration at the tissue level. Treatment includes hydration (water, electrolytes), stretching – especially PNF, and contraction of antagonistic muscle to disrupt the pain-spasm-pain cycle causing the cramp. [i.e. if quads in front leg spasm, contract the hamstrings to release the quads]. Dehydration is a primary cause of muscle cramps & spasms - DRINK MORE WATER!
KNEE & THIGH CONDITIONS
Knee injuries – Meniscus & ligament (ACL, PCL, MCL, LCL) sprains & tears; depending on severity require braces, P.T. or orthopedic surgery. Massage techniques along with P.T. used more in rehab (post-surgical) to avoid scar tissue and increase flexibility, and enhance mobility of surrounding muscles
Hamstrings & Quadriceps pull/tear; as with knee, depending on severity may require medical treatment; massage techniques can be used to loosen and release the muscle belly, but deep tissue pressure should not be applied to the muscle attachments
Adductor/groin pull; pain and tightness in front inner pelvis down the inner thigh; massage & stretch adductor group, stretches to release and lengthen inner thigh muscles
IT Band Syndrome; IT band stabilizes the knee and allows it to track properly. Often IT Band Syndrome affects the knee on one side; left untreated muscular imbalances occur on the opposite side (including tight leg muscles & hip flexors, shortened psoas); felt in lateral knee but involves thigh & hip due to increased tensile stress. Treatment is to stretch IT band to reduce tension; ice and massage especially to gluteal region and hip muscles; also release upper leg muscles (hip flexors & hamstrings)
HIP, PELVIS & CORE CONDITIONS
Sacroiliac (SI) Joint Dysfunction; posterior junction of the sacrum and pelvic bones create a wedge; compressive forces common in runners can stretch or weaken the ligament structures which support the SI joint. Depending on cause, treatment may include chiropractic adjustment and massage of soft tissue in hip & low back
Piriformis Syndrome; nerve compression syndrome in which the sciatic nerve is impinged by the primary lateral rotator of the hip (piriformis muscle). Pain begins in glutes, then migrates into the hamstrings, and eventually down the back-leg. Massage of gluteal region and deep hip muscles aids in healing.
Shortened Psoas; tightening of the largest and strongest hip flexor; mimics low back pain; common in runners and dancers. Massage, stretches and exercises to extend and strengthen the core (such as pilates) help treat this condition.
Pelvic Tilt; caused by structural/postural deviations and/or poor body mechanics; Anterior tilt (may be caused by shortening/tightness in the psoas muscle); Posterior tilt (may be due to weak lumbar and abdominal muscles and tight hamstrings; and Lateral tilt (muscular imbalances in pelvis/hip). All respond well to massage and stretching techniques.
*Based on 13 years experience working as a massage therapist on a wide variety of recreational & professional athletes. Compiled based on personal knowledge and information in Functional Assessment in Massage Therapy by Whitney Lowe (forward by Benny Vaughn). Whitney is a graduate of Atlanta School of Massage and now heads up the Orthopedic Massage Education & Research Institute (OMERI) in Bend, Oregon.