RUNNERS AND THE “TERRIBLE TOOS” —
Did you ever wonder why runners suffer from so many injuries to their feet, legs and knees? Well, unlike walking, where a portion of both feet is on the ground at all times, running is a “one-legged” sport. This puts double the stress on all of the lower extremity joints and tendons. The most common running injuries are knee pain, calf pain, stress fractures, shin splints and plantar fasciitis.
Many injuries in runners have more to do with improper and inadequate training than with any other factor. These are called the “terrible toos” and include: too much, too soon, too fast, too often and with too little rest. With some modification of training regimens BEFORE the ½ marathon or marathon, there may be less injuries. For new runners, at least 6 months to a year of training BEFORE marathon training is required to acclimate tendons and ligaments to the sport.
Different shoes can cause different areas of injury. While minimalist shoes may be lighter and more flexible than traditional shoes, more forefoot stress fractures and calf pain have been seen to occur in these shoes. With traditional padded shoes, iliotibial band pain (outside of thigh) may be more common due to increased cushioning in shoes causing a change in the forces as the heel strikes the ground. As shoes are worn down, changes in running gait can create sources for injury.
Another source of injuries in runners is in concomitant training such as weight training. Slow and steady increases in weights are best in preventing “terrible toos”.
There are, of course, individual risk factors for injury. These include ligamentous laxity, abnormal knee position, foot pronation, weak hip abductors, being female (wider hips with increased pelvic angulation), tight Achilles tendon, training on canted surfaces, and overtraining.
Once injured, runners must deal with the annoyance of rest, NSAID’s and possibly a PT program designed to strengthen quadriceps, hip and core muscles, and calf muscles, as well as stretch hamstrings and calf muscles. Upon return to running, it is best to avoid hills, graduall y build up speed and distance, use proper shoes, and possibly add prescription orthotics to shoes to improve foot and lower extremity function.
In sum, avoid the pitfalls of overuse. Start slowly, train gradually, and use the correct shoes for your needs, possibly with prescription orthotics. There will always be another marathon to train for so take your time. You are in this for the long haul.