Northside Hospital - Run, or Rest?

Run, or Rest?

By Dr. Joseph Powers

Injuries aren’t inevitable, but the cards are stacked against runners: Up to 50 percent will experience an injury on an annual basis, and novice runners are even more at risk. Still, the benefits of running far outweigh the occasional problem. So what can we do to keep you running and out of my office?

First, forget the old mantra, “no pain, no gain.” Pain is an important signal that something is wrong. Don’t run through it: Not listening to your body can worsen an injury, cause other injuries and prolong recovery. I prefer to see you in my office at the onset of an injury, when I might recommend physical therapy, cross training or a slight modification to your training routine. Runners should always let their bodies set the pace.

Novice runners face a much higher injury rate than experienced runners, often because in their eagerness to improve they add on the miles or intensity too quickly. Avoid excessive or very rapid increases in training; rather, gradually push yourself harder to help stave off injury.

When I see an athlete, it’s important to assess not only their injury but also what may have led to it. From intrinsic issues such as anatomy, gender and age to extrinsic issues like training, strength, mechanics, nutrition and shoe wear, there are countless variables. Trying to determine whether they can “work through” an injury versus significantly modifying their training can be difficult. It depends on the athlete’s goals, the timing of their next race and the severity of the injury.

Some tips for the most common running injuries I see in my office:

Iliotibial band syndrome (ITBS): An aching, burning pain over the lateral (outer) knee that occasionally radiates up the thigh toward the hip. Usually, runners will complain of pain primarily when running, but also sometimes when using the stairs and standing from a seated position. Acutely, resting and ice can be helpful, and oral anti-inflammatories (NSAIDs) may be of benefit. (Always contact your physician before taking these medications.) If running still hurts, consider swimming or cycling using a lower crank resistance. Runners who have pain only at certain paces, or very mild symptoms, may continue to run. If you are limping, stop. Ultimately, to fix the underlying issue we need to correct strength and mobility deficits, possibly by working with a physical therapist.

With runners knee, also called patellofemoral pain syndrome (PFPS), most runners will complain of pain around the patella (kneecap) that worsens with running, squatting or while going up or down stairs. Much like with ITBS, modifying training and therapy to address muscular imbalances are typically quite helpful. X-rays and MRIs are not typically required to make the diagnosis. We can often determine if your pain is from PFPS based upon history and physical exam alone.

For runners with shin pain, it is important to distinguish between shin splints, also called medial tibial stress syndrome (MTSS), and stress fractures. These conditions can feel similar, with pain along the shin when running, but the prognosis is very different. Runners with pain along the shin that persists after runs, especially if there is a point tender area, should see their physician to investigate for a potential stress fracture – which requires rest from impact activities until it is fully healed. Although runners dread this diagnosis, we can often find alternative lower-impact activities, like swimming or cycling, to help you stay active while you recover.

Plantar fasciitis is the most common cause of rear foot pain in runners. Pain typically presents over the heel, worse with first step in the morning and with push-off while walking and running. Stretching exercises, done either at home or with a physical therapist ,can help. If the pain doesn’t lessen with home exercises and stretching, consult your physician.

Dr. Joseph Powers is a board-certified physician with the Northside Hospital Sports Medicine Network. He specializes in non-operative orthopedics and sports medicine. For more information, visit:


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