Q&A: How can I prevent and identify stress injuries during running season?
The Chicago Marathon has welcomed more than 900,000 runners since the event was founded in 1977. With the upcoming race scheduled for October 11, 2020, both new and seasoned runners are working through their respective training programs. Many seek treatment during this time to prevent injury or recover from an injury sustained while training.
Dr. Jorge Chahla is a renowned orthopaedic surgeon who partnered with prominent primary care sports medicine specialist, Dr. Jeremy Alland, to answer your questions about pain while running and when to see a doctor.
Q: What are some of the most common injuries you evaluate leading up to the marathon?
A: Anytime athletes increase the intensity and frequency of their training, we see a lot of soft tissue injuries, such as hamstring strains and calf strains. Specific to running, there are a lot of overuse injuries secondary to the increased load. Most commonly plantar fasciitis, patellofemoral syndrome, and stress injuries.
Q: Are there certain people who are at increased risk of developing and overuse injury?
A: There are some predisposing conditions such as osteopenia/osteoporosis, malnutrition, chronic medical conditions (diabetes, cardiovascular disease), and chronic use of medications (such as prednisone) which all affect the body’s ability to recover from load. For the relatively healthy individual, the highest risk are those with history of prior injuries, and those with the least experience training for marathons.
Q: There are times when orthopaedic injuries can be managed at home. Can you describe symptoms that should bring a runner to the doctor sooner rather than later?
A: Pain that affects everyday weightbearing, such as pain with every step, is concerning and should be evaluated. Especially if pain is in the hip area, as this can be a femoral neck stress fracture. Any acute injury in which there is concern for tendon rupture, which would include a “pop,” bruising, and/or a deformity in the area, should also be seen. Most other conditions can be observed with rest and seen if not improving.
Q: What’s the difference between stress reaction and stress fracture? Are they treated any differently?
A: Stress injuries occur along a spectrum. The early part of stress injuries are called stress reactions and signify swelling within the bone. These usually present with generalized pain the area, worse with activity, but often do not affect everyday activities. If continued stress is placed on the bone with a stress reaction, it progresses to a stress fracture. These have more pinpoint pain the area of the fracture and generally hurt with everyday activities including every step while walking.
We often use the single leg hop test to determine if there is concern for stress injury. This can easily be done at home by a runner and if positive, rest is highly recommended. It is not perfect, but generally allows for appropriate caution.
Q: What are your recommendations for endurance athletes who are looking for strategies to stay healthy while training?
A: Make sure to give yourself enough time to gradually increase your mileage. Use a training plan, especially one that is designed with injury prevention in mind by reputable sources. Remember that training does not mean just running a lot. You need to cross-train, such as biking, swimming, plyometrics or weightlifting. By changing the type of activity, you can improve your cardiovascular fitness while decreasing your chances for an overuse injury. Recovery is also as important as training. Make sure you have recovery days planned and follow them. Do not fill your recovery days with a list of activities that leads to miles of walking and thus, not recovery. Find a good stretching program to dedicate at least 15-20 minutes to everyday. Nutrition is crucial. Calories are fuel and if you are increasing your load, you need more calories for recovery. There are nutrition plans available online as well. Listen to your body. Resting a few days if your feel something is not right can save you from having to take off weeks with an injury. Consultations with a sports medicine physician before pain progresses is always advised.