Hamstring Tear

Long-time runners suffer from injuries in the hamstring, hip, and buttock area more than beginners. Many of us have seen sprinters pull up suddenly with a hamstring tear. That doesn’t happen very often to distance runners. Our hamstring problems are low-grade, chronic microtears that accumulate over time and usually because of neglect. Most of these injuries are the result of poor flexibility in these areas, and veteran runners who don’t have good stretching habits are notoriously tight from knee to butt. But beware of hamstring problems if your job involves long periods of sitting. Sitting for long periods can shorten your hamstrings and the surrounding muscles and tendons. Try not to sit for more than an hour at a time. In your runs, ease into your normal pace to give the large muscles along the back of your legs a chance to warm up.

The Knee Bone’s Injury

The fear that most people have of runners’ knees—crippling arthritis—is largely unfounded. That doesn’t mean that runners don’t get knee injuries, though. In fact, in one survey of runners, injuries to the knee were more common than injuries to any other body part.
Let’s face it: The knee is one of the most poorly “designed” parts of our body. This tiny little shifting piece of bone acts as the brace between our feet crashing into the ground and almost the entire rest of our body. Add to that the stress of running on asphalt, overpronation, and, for some, being overweight, and it’s a wonder that there aren’t more knee injuries!
The two most common knee injuries for runners are iliotibial band syndrome and, appropriately enough, runner’s knee (what the professionals call chondromalacia patella). The iliotibial band is a thick cord that runs from the pelvis to the outside of the thigh and connects just below the knee. It helps to stabilize your thigh muscles and knee when you run. Usually, you’ll feel pain on the outside of your knee, but you might also feel it along the outside of your hip. The pain can be sporadic from day to day, but it usually comes on after you’ve run a set distance. Bowlegged runners are susceptible to this injury. They should concentrate on regularly stretching the iliotibial band to make sure that it can work through a wide enough range of motion when running. And anyone can get it if they regularly run on uneven surfaces, especially the same side of an overly slanted road.
In the short term, you’re best to limit your mileage to just below the level at which you usually start to feel pain. In the long term, be smart—work on increasing the band’s flexibility, and run on level surfaces. If you have no option but to run on slanted roads, regularly switch directions so that one leg isn’t always made to run as if it were longer. In runner’s knee, repeated stress on the knee causes inflammation and softening of the cartilage under the kneecap. This prevents the kneecap from tracking normally over the end of the thigh bone. You’ll usually feel pain around or behind the kneecap; it might get worse when you climb stairs.
Overpronators are especially susceptible to runner’s knee because the knee has to compensate for the extra inward rotation of the lower leg. Among relatively new runners, weak thigh muscles are often a leading cause of this injury. Your thigh muscles help to align your knee and keep it straight. If they’re not as strong as they should be, they may not be able to help the knee guide itself along its proper course.

Shin splints or tibial stress syndrome

Shin splints—or what the running doctors call tibial stress syndrome—are one of the most common injuries for new runners. That’s because they’re usually caused by muscle and tendon weakness in the front or inside of the lower leg. With more running, these areas become strong enough to handle the increased stress they’re being subjected to. Weak arches can also lead to shin splints by making the shin muscles work extra hard to raise your arches when you run. Shin splints can lead to stress fractures, so you want to beat them before they beat you.
Shin splints are tiny tears of the front lower leg muscles away from the shin bone (or tibia). At first, you might notice a pulling or vague aching sensation in the area after you run. The pain can become sharp, usually after you’ve run for a certain amount of time. The area around the shin may become inflamed, or lumps may form where the muscle tries to reattach itself.
I don’t mean to sound like a broken record here, but the best immediate treatment for shin splints is the standard: ice, anti-inflammatories, and cutting back on your mileage. And another thing I keep harping on: Run on soft surfaces whenever possible. Shin splints are one of those injuries that people sensitive to running’s pounding get; that’s why beginners, who haven’t built up as much resistance to pounding, get them much more frequently than long-timers. So reduce that pounding by running on more forgiving ground.

Achilles Tendon Injuries

The Achilles’ heel for some runners is the Achilles tendon. That’s because the Achilles tendon—a cord-like structure that connects the heel to the calf muscles—has a fairly limited range of motion. It can get overworked pretty easily. To make matters worse, blood flow to the area is poor, so it takes a while to get loosened up. If you have Achilles tendinitis, you’ll know it because nothing else causes sharp pain in that area. The pain, which can also be a burning sensation, will be anywhere from an inch above your heel to the bottom of your calf. In bad cases, you’ll be able to see how inflamed the tendon is, because it will be visibly swollen compared to your healthy Achilles tendon.
Achilles tendinitis is often caused by many of the same things that lead to plantar fasciitis, including tight calf muscles and overpronation. Sometimes it can be caused when the back of your shoe sits too high against your heel. (This is why you’ll see many running shoes with notches at the top of the heel counter.) In addition to the standards of icing, anti-inflammatories, and cutting back on your running if your normal form is altered, here’s another trick for beating Achilles tendinitis:
Wear heel lifts in your street and running shoes until the problem goes away. The lifts will take some of the pressure off your inflamed tendon by elevating it. A simple, at-home method is to cut a half-circle that fits your heel from corrugated cardboard. Be sure to put a new one in at least once a day as the cardboard gets compressed. In the long term, be extra careful about stretching, and get out of the habit of wearing high-heeled shoes, which can shorten and tighten your calves and Achilles tendons.

Bone stress fractures in your feet

Stress fractures are tiny, incomplete breaks or cracks in a bone. They can occur many places in the body, but runners most often get them in the feet. They’re caused by too much repetitive stress to bones that are overworked. That’s why stress fractures occur gradually—over time, the bones are asked to do just a little bit more than they’re ready for, and the shock is great enough to cause a slight crack. Stress fractures are different from a standard broken bone because with a stress fracture, there’s not a sudden, obvious incident when the bone breaks. Rather, the pain begins gradually, usually as a slight twinge, and only intensifies as you continue to run on it. Trust me, though—if you get a full-blown stress fracture, there will be no mistaking that you’re hurt. With every step, sharp pain will shoot from your foot up your leg, and it will get worse the longer you run on it.
Stress fractures are almost always caused by some of the errors that I outlined earlier in this chapter—increasing mileage and intensity too quickly, wearing shoes without enough cushioning, and doing too much of your running on hard surfaces. Runners who don’t include enough calcium in their diets are also susceptible.
Unfortunately, when you have a stress fracture, you need to stop running. Otherwise, you’re just asking for it. The bone will continue to rupture, and you could develop a complete break, which will add considerably to your downtime. So if you feel the beginnings of a stress fracture, take a few days off and ice the area (which will probably be a little tender and swollen, and maybe even a bit warm to the touch at first). If you definitely have a stress fracture, you’re best off not running for at least two weeks, as well as avoiding other weight-bearing activity during this time. If it’s still bad when you restart, stop again, and see a doctor.

Healing Your Heels

The most common running injury to the heel area is called plantar fasciitis. This condition is an inflammation of the plantar fascia, a fibrous band of tissue that runs from the heel to the toes. You’ll feel pain along the inside bottom of your foot anywhere from the heel through the arch. Many times, the pain is worst when you step out of bed in the morning or when you’ve been sitting for a long time, and then it improves during the day as the plantar fascia has a chance to loosen up.
The plantar fascia most often becomes inflamed because it has to work through more of a range of motion than it’s designed to. When your heel strikes the ground, the pressure on the heel pulls on the plantar fascia. If your calf muscles are too tight, or if you overpronate but don’t wear shoes with enough motion control, then you’re most likely to develop plantar fasciitis. Also, high-arched, rigid feet can predispose you to this injury because when your heel lands, your foot doesn’t move enough, so the plantar fascia has to absorb more shock.
The best treatment for plantar fasciitis is icing. Ice the bottom of your foot from heel to ball. One good trick is to ice your foot with a frozen cola bottle (if you can still find the glass ones). The cold of the bottle does the work of the ice, and rolling your foot over the contours of the bottle gives the plantar fascia a nice little massage. (It’s pretty hard to stretch it otherwise.)
Most people with plantar fasciitis can run on the injury. Cut back if the pain gets worse, not better, as you run. Preventative steps include increasing the flexibility of your calves and Achilles tendons, and making sure that your shoes have the proper combination of motion control and cushioning.

Tending your Toes

Most toe problems you’re going to get as a runner are cosmetic rather than serious. The most frequent visitors will be black toenails, which are so linked with the sport that the condition is also known as runner’s toe. Runner’s toe happens when the nail is either pressed down too much on the bed that underlies it or the nail separates from the bed. In either case, blood pools between the nail and the bed. Eventually, the nail turns black. When this condition is caused by the nail being pressed into the bed, it’s almost never painful. The nail gets very hard, and it looks like hell, but it won’t bother you. After a few months, the nail will grow out or fall off. In the meantime, you’ve got yourself a nice little memento from your miles that will instantly identify you as a runner to any knowledgeable person who happens to see your feet. Sometimes, the nail loosens rather than hardens, and this is usually uncomfortable. New runners whose toenails aren’t used to much wear and tear will get these more than longtime runners.
If your black toenail is wobbly, sterilize a needle, and then use it to drain the blood from under the nail, as you would drain a blister. Runner’s toe is usually caused by ill-fitting shoes. If your shoes aren’t long enough, your longest toe (which in some people is the second toe) will slam against the front of the shoe. You might also irritate your nails by running on a course that has a lot more downhills than you’re used to, because your toes are going to rise up a bit more than usual on the downhills to help you brake. Wet shoes, either from sweat or rain, are also a leading cause of runner’s toe.
Poorly fitting shoes may also cause blisters, “hot spots,” and other irritations on the tops of your toes. When a pair of shoes causes blisters during your first few runs, then you’ve probably bought shoes that are too small. Cover these irritated spots with one of the many second-skin products on the market, and you’ll usually be fine.

Ice or heat to cure your pain?

Ice should always be your first line of defense against injury. If I notice the slightest little ache, I like to ice it after my run and a couple of other times during the day, too, if possible. A few minutes of preventative care can work wonders in keeping a little nagging pain from developing into a disruptive injury.
Why ice instead of heat? The reason is that most running injuries are a result of soft body tissues (muscles, tendons, ligaments) that have become inflamed. Blood vessels get damaged and swell; the greater the swelling, the worse the injury, and the longer recovery is going to take. Icing the inflamed area causes the blood vessels to constrict. This reduces the swelling because less blood flows to the injured area and the damaged tissue relaxes.
This not only reduces the pain you feel, but also speeds healing, because as the tissue’s metabolism is slowed, there’s less tissue breakdown. Heating an inflamed area worsens, rather than improves things. Heat has the opposite effect of ice, so the blood vessels of the injured area become that much more swollen. Heat is helpful when your inflammation has reduced, however. This reduction usually won’t occur for at least 72 hours. At this point, the increased blood flow that heating stimulates will speed delivery of nutrients to the damaged tissue, thereby speeding healing. Heat is also good if you have overall stiffness in an area. The general rule is to use ice on small, acute body aches because they are signs of damage to a specific body part and to use heat for more widespread stiffness. Always ice an injury for at least 5, but no more than 20 minutes. The area should become red and numb, not white and numb. After running is the best time to ice, because the tissues will be the most swollen, but you’ll speed recovery if you can find a few other times during the day to ice. Rub the ice in circular motions on the injured body part.
The best method of icing I’ve found is to fill a few paper cups with water and keep them in your freezer. When you need to ice an injury, just tear down the top of the cup until the ice is exposed and hold the cup from the bottom while icing. This method keeps your hands warm while you ice, so you’re more likely to stick with it for the proper amount of time. When you’re done icing your injury, just put the cup back in the freezer until you need it again. These cups can last for months and will ensure that you always have one handy.