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Running injuries that crop up during marathon training are a real bummer!

Here’s part two of our Q and A with physical therapy doctor Ben Shatto.

In this episode you will hear about injury recurrence, plantar fasciitis, knee pain, ITBS and more. My favorite quote from this episode is, “Injury is never normal”.

[Part 2] Running Injuries Q and A

Disclaimer: This blog post and podcast are not meant to replace the advice of your doctor/health care provider, or speak to the condition of one particular person but rather give general advice.

Questions Featured in this Episode:

1. Is there any risk of damaging yourself if you continue to train hard while having PF (other than the pain progressing)? -Lee

The short answer is YES. There is a significant risk. You don’t want to tear the plantar fascia. The surgery is a very long recovery. As the pain worsens, you are likely experiencing more and more micro tearing (which can eventually tear the plantar fascia completely and sideline you for a very long time). Recovery includes possibly a cast and/or a rigid walking boot. Based on the severity, weight bearing can also be completely limited. The longer you take to address this, the longer it will take to treat and heal. For more information, please refer to this page.

2. I’ve recently changed my form from predominantly heel striking to a forefoot strike. Any input on whether changing form is ever a good idea, and if so, how to make that type of transition during training might be helpful. -Jon

In general, there is no real reason to change running form unless there is a repeated injury or a significant issue with the technique that is likely to cause an injury. There isn’t any conclusive proof that a heel strike is better or worse than a mid foot strike or that a certain running method is better than another. Transition is always longer than expected. The older you are, then the harder on the body the transition can be. A fast transition would be 3 months, but it’s common to take a full year to fully adapt. The body needs time to adjust to the new stresses placed on it with the new technique so you have to rebuild a base. Be sure to work very hard on recovery during the transition to limit the risk of further aches, pains, and injury.

3. Feet! The ball of my left foot, but more medial and even to the top has bothered me for a couple years! If I back WAY off running, it’ll subside, but one run does me in! I don’t know if what I have is metatarsalgia or not, but it has given me the blues. Second, deep muscle tightness. I carry weight in my “backside” and thighs, and I have a hard time really working on knots with a stick or foam roller. I feel like I need a left leg transplant, from waist down!!!! It’s tight, knotted, twisted and pained…all the way to my toes! -Julie

Fascia does not remodel easily. It takes 6-12 months of diligent work to remodel fascia. Don’t expect a quick fix, and don’t give up! Use your body weight and a harder ball, such as a softball, to self-mobilize areas with dense tissue.
May need assistance from a masseuse or body worker. For some, fatty tissue can have many knots and nodules. Don’t worry about them. They can be painful, but are not serious.
Look into a run/walk protocol to help increase running distance. Please refer to MTA’s fantastic interview with Jeff Galloway. Work through the plantar fasciitis protocol (see links below). If you’re still aren’t experiencing any relief, ask for help.

4. I would love to hear what to do about metatarsalgia. I understand it is a normal injury for runners. -Judith

Injury is never normal. This term is used for many different kinds of pain that is located in the ball of the foot. It could be a neuroma, a stress fracture, pain at the metatarsophalangeal joints, arthritis, and gout. Typically associated with overtraining and/or poor foot mechanics. Risk factors include: poor fitting shoes; high heel shoes; being female; being overweight; hard running surfaces; and tight Achilles tendon. Treatment is similar to plantar fasciitis in many case: (1) Begin foot intrinsic muscle strengthening (see linked article below). (2) Address footwear and/or possibly add an orthotic. (3) Shorten stride length and quicken cadence. (4) Look up the kinetic chain for possible imbalances. For more information, please refer to this article.

5. This isn’t so much an injury, but perhaps a preventive question. I hear crunching in both knees when I do squats and lunges. Zero pain, but just curious if that’s a precursor to a possible issue down the road. Thanks guys!! Looking forward to the interview. -Lou from Germany

This is often referred to as chondromalacia, in which the cartilage under the knee cap can become soft or irregular and can lead to grinding and popping.
Typically this is due to patellar femoral pain syndrome (PFPS) or poor patellar tracking. It can also be related to arthritis in a more middle-aged population. It occurs often in both youth and middle-aged people. It’s more common in women and those with flat feet. Constant grinding can lead to early deterioration, so it should be addressed. Focus on hip strength and correcting imbalances in the lower extremity. Address the pelvis clear down to the feet as there are many potential causes. Start a quality glucosamine supplement in order to help preserve cartilage tissue.

6. Long term solutions for ITBS?! All I do right now is foam rolling post run (when I can fit it in) and symptomatic foam rolling. -Kelly and Ruth

Look at your running form. If you run with a narrow base, then you risk more strain on the IT band and may also be prone to shin splints. You can increase cadence time and work on hip strength, particularly the hip rotators. It’s important to be dedicated to improvement and not just to foam rolling as needed. Recovery and injury prevention are critical and should be performed regularly. Set aside the time to work on recovery and cross training in addition to your regular training runs. If you do not take proper care of your body, then you are likely to get injured at some point. This can lead to missing valuable training time and can ruin a racing season.

7. We would love to hear some thoughts on prevention of injury recurrence for nagging stubborn injuries. (Hip flexors for me!) Is it all in the strength/core training and yoga or what else can we do to prevent being side-lined? –Naomi, Joellen, and Tricia

Rule #1 is recovery work should be as programmed into your training cycle as your actual training runs. Set up a long term plan to spot train and address known areas of weakness. If you on choose to work on one area, choose core strengthening. Focus more on the posterior chain (not just the abs). If your hip flexors are chronically an issue, than you are likely sitting too much. The second most likely cause is that you have a lumbar vertebral segment that is hypermobile. The best treatment is core strengthening. For more information see this article.

8. What are some keys to injury prevention for masters’ runners? -Steve

Be consistent with a recovery protocol. Warm up longer, and take more time for a cool down. Focus on body work by utilizing a foam roller or lacrosse ball or by working with a masseuse. Focus on strength training. Muscle mass slowly diminishes with age (particularly, Type II muscle fibers). Regular strength training is important. Focus on a clean lifestyle of proper eating and hydration. Supplement as needed (particularly with a quality glucosamine supplement like Mt. Capra CapraFlex). Work toward limiting inflammation with your food and supplement choices.

Also Mentioned in This Episode

The Runner’s Toolbox – free resource to help combat injuries.

Jabra’s February give-away. Be sure to sign up for their newsletter in order to be entered in the drawing.

Exercises for IT band, knees and feet

• One leg squat AKA pistol squat
• Reverse lunge with knee lift
• One leg balance with knee raise- 60 seconds/side
• Negative calf raise- heels hang down off step

Read and listen to Part 1 here which focusses on glutes, hamstrings, muscle imbalances and more