Avoiding Running Injuries

By Andrew Getzin, M.D.

When warm weather approaches, runners take to the streets and local outdoor tracks. Running provides people with many health benefits, camaraderie, and a temporary escape from their day-to-day lives. Unfortunately approximately 45 to 70 percent of runners are injured each year. I am frequently asked questions about running injuries by my patients and running partners.

How can I increase my mileage and avoid injury?

There are few limitations to the distances people are able to safely run. I know of seventy-year-olds who complete marathons. Most experienced runners can safely increase their training by up to ten percent per week. However, runners often forget that there are two ways to increase: either an increase in training mileage or in training intensity.

What are the most common injuries and how are they treated?

Most injuries in runners are not from acute trauma but from repetitive ground forces over time. Three common running injuries are patella femoral syndrome, iliotibial band syndrome, and medial tibial stress syndrome. I urge runners to pay attention to the onset of pain and to seek medical advice early, because injuries are most responsive to treatment before they become serious or chronic.

Patella femoral syndrome (PFS) or "runner's knee," typically appears as pain behind the kneecap that increases with prolonged sitting or walking downstairs. People with PFS often report having noisy knees that pop or crack and sometimes experience episodes of the knee buckling. PFS occurs when the muscles are fatigued, which allows the kneecap to move out of its normal tracking. It is treated by activity modification, icing, stretching, formal physical therapy, and using a knee sleeve to maintain the patella in its normal position.

Iliotibial band syndrome (ITBS) is a common injury in Tompkins County because of the hilly terrain. The iliotibial band is a fibrous band that runs along the outside of the thigh from the hip to the knee. It can become inflamed with increased downhill running, running in the same direction on a track, or with running on roads with steep shoulders. Pain over the outside of the hip and knee may be an indication of iliotibial band syndrome. Treatment includes icing, flexibility exercises, strengthening of the hip muscles, and in some cases, steroid injections.

Medial tibial stress syndrome (MTSS), sometimes referred to as shin splints, is caused when overworked muscles inside the lower leg tighten and pull at the bone. Pain initially occurs after running. If this injury is ignored, it progresses to cause pain during running and ultimately all the time. Activity modification, calf-strengthening exercises, ice massage, and sometimes shoe orthotics can effectively treat this injury.

What other steps can I take to prevent injuries?

Most importantly, listen to your body. If you notice pain during running that lasts for a few days or recurs during future runs, see your doctor. Consider cross training. Biking, swimming, cross-country skiing, and pool running are very good alternate activities for runners that can help improve fitness and decrease the number of miles of actual running needed to adequately train for long races. All runners should feel comfortable with some form of cross training so they do not try to "run through" injuries. Running shoes should be replaced approximately every 300-500 miles depending on the individual runner. Keep a daily record of your training to avoid increasing your mileage too rapidly. Finally, consider adding strength training.

Injured runners are often reluctant to see a doctor for fear that they will be told not to run. Physicians who understand the runners' mentality prescribe active rest, where activity is maintained but in a way that diminishes harmful forces on the injury and allows healing. Good communication between the runner and the treating physician is important, especially about training goals and upcoming races. This understanding will allow a timely return to an appropriate running schedule.

Dr. Getzin is board certified in family practice with a Certificate of Added Qualification (CAQ) in sports medicine. He is on the medical staff of Cayuga Medical Center and in practice at Cayuga Sports Medicine. He is head team physician at Ithaca College and founder of the Ithaca Triathlon Club. Dr. Getzin is medical director at Island Health and Fitness in Ithaca.