Transcription:

Melanie Cole (Host):  Runners are a determined lot and often adopt that mantra, “I can push through this” which is fine when you hit that mental wall during a race that you’ve prepared for, but not when it comes to ignoring your body’s warning signs and addressing those aches early and often. My guest is Shannon Barie. She’s a RunSmart physical therapist at the Courage Kenny Rehabilitation Institute in New Ulm. Welcome to the show, Shannon. So, tell us about the most common running injuries that you see as a physical therapist.

Shannon Barie (Guest):   Yes. Hello. We see Achilles tendonitis, iliotibial band syndrome, plantar fasciitis, runner’s knee and shin splints very frequently.

Melanie:   So, there’s a difference between the acute injuries and these chronic, overuse injuries. So, I’d like to start with plantar fasciitis because it’s pretty common, it’s really painful and it can keep you from being able to even walk, much less run. What do you tell people about avoiding these overuse injuries?

Shannon:   Well, some of the best advice I can give them is about proper training. We see too much too soon come from most runners. They want to get out and really tackle the mileage but what would be a better plan would be to increase, say no more than 10%, per week of mileage or intensity. So, if I’m running 10 miles this week, I should not run more than 11 miles next week. Those numbers have kind of proven to keep our body able to adapt to all of those stresses we’re putting on it with running.

Melanie:   How important are shoes to the whole runner thing and what goes on with them and the pains and aches that they feel?

Shannon:   Running shoes are our best piece of equipment we can put on. They have to be comfortable. I can’t specify a brand that would work the best. Are they comfortable? Are they doing what they need to do? Runners nee to replace them often, too—every 400 miles or so—and they are very important. It’s what’s going to hit the ground first. I suggest different types of shoes for different reasons. If someone is coming in with plantar fasciitis or Achilles tendonitis and it’s an immediate or an acute problem, I might actually suggest more stability or a stable running shoe compared to someone who has been running longer and isn’t having any problems getting them into a minimalist or a cushion shoe works great. You know, the runners that are treated with the plantar fasciitis and such, I’m suggesting a bit more stable shoe. I’m actually trying to get those runners back into their running trainers and things, too.

Melanie:   I’m glad you mentioned the 400 mile shoe thing because people tend to say, “Oh, I’ve had these shoes a long time. They’re very comfortable.” So, that’s why they wear them. And yet, they’ve got Achilles tendonitis or plantar fasciitis. Do you ever recommend orthotics like a Spenco or one of these products be added into the shoe?

Shannon:   I first like them to replace the shoe. You know, if the soles are running down after just 125 miles already. So, replacing the shoes is the smartest way to go. If they love their shoe, just buy the same make and model every time because if it’s working for them, I don’t switch them. As far as orthotics, often over the counter ones, yes. They work really well. It doesn’t need to be a custom one and we use them, maybe more temporarily, to help them through an injury—maybe 6 weeks, 10 weeks—and then try to wean them out of them unless there’s something severely  wrong with their foot.

Melanie:   Tell us a little bit about iliotibial band syndrome, ITB, and what causes that and how can it be prevented?

Shannon:   The person often says, “I have got pain and burning down that outside of my knee” and it’s caused, a lot of times, by too much downhill running or  running on one side of a track or a street where the ground is angled or even just really increasing your mileage one week. Then, we’ve noticed, too, that weak side hip muscles, called the hip abductors or gluteus medius and maximus muscles, those contribute and we PTs find that these runners might even do better running faster or sprinting workouts while they’re trying to recover. It just doesn’t put that knee in that same angle that jogging does. That can help them get by sometimes.

Melanie:   What about runner’s knee?

Shannon:   The most common pain that a runner is going to feel at the knee is also called patellofemoral pain—that pain around the kneecap—and the muscle imbalances that control the kneecap can contribute; weak outside hip muscles and, again,  overuse, and form mechanics. Yes, I treat it a lot. We see it every week in here and one of the best ways that we can help people with runner’s knee is to watch their training regimen. I suggest keeping a training log so they can track what they’re doing and their body’s responses and also, there’s something called cadence manipulation. So, a lot of times, people who have pain at the front of their knees are probably those same runners who are pounding every time they hit the pavement. You know, that really bowed runner and they probably are running a rather low number of steps per minute and that’s called cadence. We see maybe 140-150 steps per minute compared to our more efficient runner who is running 170-180. Then, those forces from that heavy heel striking have to come up somehow and they often kind of hit the knee and so we work a lot with people with changing their cadence, kind of a gradual approach to help them run more comfortably.

Melanie:   One of the first things that new runners experience is shin splints. Are there stretches or anything that can prevent shin splints before they happen?

Shannon:   Well, shin splints are often caused as well, by a runner who’s running too many downhills or that’s running too much volume, too many runs, at high mileage. They might even be doing too much speed work and these runners also might not be switching their shoes enough. So, the old shoe phenomenon is what it’s called. As far as stretches and that sort of thing, I’d first change their overtraining that they’re doing to their body. I’d make that switch first and then I’d even look at that cadence manipulation we were just talking about with the front of the knee pain and try to get them to decrease their hill work and decrease the amount of pounding they’re going to do. Sure, it’s important that the ankle and the calf have mobility and that they have proper strength and that sort of thing. But, often that’s, again, those people that just pound too much when they run or, even if they’re playing sports like basketball and they’re stopping and starting all the time, that can contribute, too.

Melanie:   Is there any way to convince runners to cross train to avoid some of these chronic overuse injuries and get them, because they are that determined lot and running is their focus, but can you get them to swim or, God forbid, walk sometimes? Or do they feel that that just takes down their running ability?

Shannon:   That is a hot topic with runners. You know, as a running physical therapist, I never want to take them  out of their sport, but we do have to make modifications and if I can reduce their running a little bit, we still have to keep up their cardiovascular fitness by trying things like you just suggested:  bicycling, running in the water. That is a great activities for runners. They have that compulsion to run. We can get them in the pool and they can still run and not increase their injuries. Cross training is a wonderful thing to do and it just decreases the stress on the body during that time. I like also trying to fit in some strengthening programs with these runners and stretching for the people who need it. Definitely a piece of the puzzle to the rehabilitation of a runner.

Melanie:   We don’t have a lot of time left but where do icing and bracing play a role in some of these chronic injuries?

Shannon:   All injuries, in their first week, can be partly managed with ice a bunch of times a day. If it’s a chronic injury, ice isn’t going to be as helpful any more. So, it’s really essential, in the first few weeks with an injury. With bracing, it’s the same kind of the same thing. In the beginning, when you want some support for the injury, if you put a brace on it, the body part won’t have to do as much work; won’t have to feel as many forces but since that probably isn’t going to be something that you keep as a permanent fix, we want to wean off of the braces over time as well.

Melanie:   So, in just the last minute here, give us your best advice for preventing running injuries before they start for these runners that. This is just so important for them.

Shannon:   I would say be gradual. Integrate these changes--whether it be new shoes, mileage, intensity, hills, terrain; whatever -- slowly. Runners returning from an injury or even beginning runners, novice runners, might do very well also with a walk/jog interval program. I love those. That’s how I get a lot of my runners back is to use a gradual return to running. But, my first and foremost suggestion is be gradual with your training.

Melanie:   That’s great advice. You’re listening to The WELLcast with Allina Health. For more information, you can go to AllinaHealth.org. That’s AllinaHealth.org. This is Melanie Cole. Thanks so much for listening.