Runners May Be In Great Shape, But They Are Prone To Injuries

By most estimates, nearly 70 percent of runners will become injured. While many of their injuries will appear minor, they can become more serious over time if not properly treated.

Running injuries may impact other areas of the body as well. Because I am an extremity expert as well as a chiropractor, I am trained to look at the body.   I want to identify the true source of the problem treat any malfunction in the body and develop a training or rehabilitation program to solve it.

Among the most common running-elated injuries are:

  • Runner’s Knee – This is the most common running-related injury. Known as patello-femoral pain, and sometimes diagnosed as chondromalacia of the patella, runner’s knee is essentially irritation of the cartilage of the kneecap. The condition results in pitting or fissuring of the cartilage to varying degrees. While running, various mechanical conditions may predispose runners to a poorly tracking kneecap. This can result in irritation and/or damage to the kneecap. Runners will notice pain near the kneecap, especially after sitting for extended periods of time with knees bent or while walking down stairs or downhill. Appropriate treatment involves eliminating or modifying activities that cause the pain; correcting improper biomechanics that allow the injury to arise; and avoiding positions that further irritate the condition, such as sitting for prolonged periods of time.
  • Iliotibial Band Syndrome – Symptoms of this syndrome include pain or aching on the outside of the knee, usually occurring in the middle or at the end of a run. When you flex and extend your knee, the iliotibial band, which runs along the outside of the thigh, can become irritated from repetitive rubbing over the outside of the knee. There are several causes of this syndrome, including weak gluteal muscles, bowed legs, over-pronation of the foot, leg length discrepancy, and running on uneven surfaces. Running on a circular track may also contribute to the problem. As with other running injuries, athletes should decrease their training regimen. In addition, they should also add stretches for the ouside of their thigh to their warm-up program, avoid running on uneven or circular track surfaces, and some should wear motion control running shoes.
  • Shin Splints – Also called medial tibial stress syndrome, “shin splints” refers to pain occurring in either the front or inside portions of the lower leg. Tenderness extends along the length of the lower leg at either of the surfaces. Those most at risk for shin splints are beginning runners who are not yet used to the stresses of running or who have not stretched or strengthened properly. To care for shin splints, runners should decrease their training, and begin with ice and rest, later adding strengthening of their lower leg muscles. They may use swimming and biking as alternative forms of exercise. If symptoms persist, runners should consult their physicians.
  • Achilles Tendinitis – The Achilles tendon is the connection between the heel and the muscles of the lower leg. Several factors contribute to the development of Achilles tendinitis, including excessive hill running, sudden increases in training, and improper shoes. One of the major factors is excessive tightness of the posterior muscles of the leg, including the calf muscles and the hamstrings. Runners with this condition should reduce their running. They can use ice and gentle stretching to reduce pain and tightness. If not treated properly, Achilles tendinitis can develop into a chronic problem.
  • Heel Pain (Heel Spurs and Plantar Fasciitis) – The most common heel problems are caused by strain of the plantar fascia, which extends from the heel to the toes. Strain in this tissue can become very painful, especially with the first steps of the day. The condition can cause swelling at the origin of the plantar fascia at the heel. The pain is most noticeable when the foot flattens during weightbearing or when pushing off with the toes during walking or running, and it is usually located near the heel. The problems tend to occur in flat, flexible feet and in high arched, stiff feet. Left untreated, the pain can spread around the heel. Treatment should include a decrease in the intensity and duration of running workouts. Runners should also evaluate their running shoes for excessive wear and for proper fit. The wrong shoe for a foot type can worsen biomechanical flaws and cause plantar fasciitis.

Runners can take several precautions to prevent being sidelined because of an injury. While some of these steps might seem time-consuming or expensive, they are a good way to keep you on the right track.

  • Prepare for exercise/activities – Understand what muscle groups will be used and slowly start conditioning them by strengthening them. Talk with a PM&R physician to determine the appropriate type of exercises.
  • Properly stretch muscles before running – Muscles and joints need to warm up before beginning a run. Also be sure to allow for a “cooling down” period afterward.
  • Use an appropriate running shoe – There are several brands and models of running shoes. Make sure you are using the type best suited for your feet and your running style. Running shoes should also be replaced regularly. Consult a specialty running store to choose an appropriate shoe.
  • Incorporate hard days and easy days into your training program – Mileage should only be increased approximately 10 percent each week. Runners should make sure to decrease their mileage slightly every third week as a way to allow for recovery prior to additional mileage increases. Runners should also be patient with their development, being careful not to push themselves too far or too fast.
Some information provided by the 2012 American Academy of Physical Medicine and Rehabilitation: http://www.aapmr.org/patients/conditions/msk/Pages/runfact.aspx

Is Jumper’s Knee (AKA: Patellar Tendonitis) Serious?

This problem occurs when there is an inflammation or injury of the patellar tendon, right underneath the kneecap. Jumper’s knee is an overuse or repetitive injury that occurs over time.

This injury can happen with any sport that requires constant jumping, landing, and changing direction.  This can cause strains, tears, and damage to the patellar tendon.

Jumper’s knee can seem like a minor injury and a lot of people ignore it until they can’t stand it anymore. Because of this, many athletes keep training and competing and tend to ignore the injury or attempt to treat it themselves. However, this strain can lead to a serious condition.

Bones, joints and muscles in the knee work together to flex and extend the knee.  When the knee is extended, the quadriceps muscle pulls on the quadriceps tendon, which in turn pulls on the patella. Then, the patella pulls on the patellar tendon and the tibia and allows the knee to straighten. In contrast, when bending the knee, the hamstring muscle pulls on the tibia, which causes the knee to flex.

In jumper’s knee, the patellar tendon is damaged. Since this tendon is crucial to straightening the knee, damage to it causes the patella to lose any support or anchoring. This causes pain and weakness in the knee, and leads to difficulty in straightening the leg.

Symptoms:

1. Pain directly over the patellar tendon (or below the kneecap)

2. Stiffness of the knee, particularly while jumping, kneeling, squatting, sitting, or climbing stairs

3. Pain when bending the knee

4. Pain in the quadriceps muscle

5. Leg or calf weakness

6.Warmth, tenderness, or swelling around the lower knee

7. Balance problems

For mild to moderate jumper’s knee, treatment includes:

1. Resting from activity or adapting a training regimen that greatly reduces any jumping or impact

2. Icing the knee to reduce pain and inflammation

3. Wearing a knee support or strap (called an intrapatellar strap or a Chopat strap) to help support the knee and patella. The strap is worn over the patellar tendon, just beneath the kneecap. A knee support or strap can help minimize pain and relieve strain on the patellar tendon.

4. Elevating the knee when it hurts (for example, placing a pillow under the leg)

5. Anti-inflammatory medications, like ibuprofen, to minimize pain and swelling

6. Massage therapy

7. Minimum-impact exercises to help strengthen the knee

8. Rehabilitation programs that include muscle strengthening, concentrating on weight-bearing muscle groups like the quadriceps and calf muscles.

How long does it take to recover?

Recovery can take a few weeks to several months. It’s best to stay away from any sport or activity that can aggravate the knee and make conditions worse. However, recovering from jumper’s knee doesn’t mean that someone can’t participate in any sports or activities. Depending on the extent of the injury, you can still play the sport you love, you just need to maintain stretching and maintenance to the joint.

How can we prevent Jumper’s Knee?

The most important factor in preventing jumper’s knee is stretching. A good warm-up regimen that involves stretching the quadriceps, hamstring, and calf muscles can help prevent jumper’s knee. Sometimes applying heat to the area helps as well before a work out.  It’s always a good idea to stretch after exercising, too.

Kneecap (Patella) Pain And Instability, What Can Be Done?

Proper movement of the hip and leg are essential for walking, jumping, running. During any leg movement, your kneecap (patella) moves up and down because of contraction and relaxation of the quadriceps muscles. Bending your leg pulls the kneecap down and straightening your leg brings it up.

There is an indention or groove in the front of your leg that allows the kneecap to glide smoothly up and down and not rub directly onto the bone. Sometimes the indention is not deep enough, muscles are not working properly or your bone is out of place.  This can cause your kneecap to move improperly and slide outside of the groove. In time, this promotes arthritis, pain and long term bad body mechanics. This can lead to painful surgery and long periods of rehabilitation.

Here are some symptoms of kneecap instability and incorrect body mechanics:

    • 1. Knee buckles and can no longer support your weight

2. Kneecap slips off to the side

3. Knee catches during movement

4. Pain in the front of the knee that increases with activity (especially while running)

5. Pain when sitting, standing or bending

6. Stiffness

7. Cracking sounds during movement

8. Swelling and pain

Treatment:

If the kneecap has been completely dislocated out of the indention or groove, it must be put back. This is not as painful as it sounds. Sometimes it can happen when you are bending or moving. The kneecap just pops back into place. Other times, it is gently placed back in the groove with an adjustment.
During an examination, I can normally figure out if one of your quadriceps muscles is either too strong or too weak. This can lead an improper pull of the kneecap during movement. Stretches or exercises can even out the force in the area and keep your kneecap moving properly.

Allowing the kneecap to move properly in the groove will keep the risk of arthritis, tendonitis and knee replacement at low risk.  It will also allow you to keep the active life style that you need to stay fit and healthy.

Chondromalacia (Patellofemoral Pain Syndrome)

Your knee is responsible for absorbing a lot of stress when you walk, jump or run.  Cartilage located underneath the surface of your kneecap (patella) can sometimes be scraped or damaged during overuse, leg malposition, injury or tightness of surrounding muscles.   When the under surface is irritated, Chondromalacia of the patella occurs.  It is also called “Patellofemoral Pain Syndrome”.  Basically, the tissues underneath your kneecap have become inflammed.

Symptoms: Usually a dull, aching pain in the front of your knee especially when walking uphill or downhill, kneeling, squatting or sitting for long periods of time with your legs bent.  You may also experience a grating or grinding sensation when you straighten your leg.

When there is a flare-up, ice can help with the pain and inflammation.   I have found in my practice that a common reason why Chondromalacia occurs is because of tightness of either the Vastis-medialis or Vasits-Lateralis muscle.  This leads to a bio-mechanical problem where the knee does not move efficiently.  Finding out which muscle needs to be strengthened and which one needs to be stretched is key.  When there is an imbalance in the thigh, one muscle begins to pull your kneecap and rub against the tibia (leg).  This results in cartilage damage.

Proper stretching and strengthening exercises can prevent incidence of pain and prevent further damage to the tissues.

So, who commonly gets Chondromalacia?  Surprisingly, adolescents and young adults!  Most likely athletes who participate in running or jumping sports like soccer, basketball, volleyball.  Running can add 3-5x pounds of body weight force to the joints and Jumping can add 5 to 7x pounds.   This means if you weight 200lbs, running can add 1,000 pounds of forc and jumping can add up to 1,400 pounds.  That is a lot of strain to the joint and body.  Over time, squatting or or climbing stairs can become quite painful and sometimes even unbearable.

Proper body mechanics is important for taking the stress out of our bodies and allowing our joints to move the way they should.  Make sure you understand that this can be a repetitive injury which may take some time to heal but you can certainly get through it and even continue participating in the sport of your choice.  Specific exercises along with chiropractic alignments can greatly reduce flare-ups and chronic problems.

If you are experiencing knee pain, we can help!

Tips For Preventing Bicycling Injuries

Sometimes people who come into my office complaining of neck, low back, knee pain or hand/foot numbness don’t take notice that their posture at work, home or school may be having negative effects on their nerves. Often times they are oblivious to the fact that the sport they do to stay in shape may have bad effects too.

Neck, low back, knee or hand/foot pain during or after biking may mean you don’t have proper bike ergonomics. Buying the right bike for you is imperative. Here are some tips to avoid injuries and keep riding.

The proper saddle:

Your seat should be at a level that supports the full weight of your body while allowing you to re-adjust your position. If the front of your seat is tilted up, you will slide backward and it will be hard to reach the peddles and force you to push your back forward adding stress to the low back. If the seat is tilted downward, you slide forward putting more pressure on your arms, wrists, hands and knees.

To make sure your seat is the right height. Wear the appropriate biking shoes and put your heels on the pedals. Start to pedal backwards and make sure your knees fully extend without reaching. If you notice that you have to move your hips from side to side to pedal, then your seat is too high. Now when it is time to start pedaling forward you will notice that the balls of your feet are over the pedal and a slight bend in the knees occur with each push.

Proper handlebar height:

Miscalculation of handle bar height can lead to neck, shoulder back, hand/wrist pain.
Proper ergonomics of the handlebars will allow you to bend your elbows while using all of the positions of the handlebars and gears.

Knee pain occurs when the seat is too high or low or tilted improperly. Also, the improper bike shoe position can cause knee problems: Here are some cause and effects of improper seat or pedal ergonomics.

  1. Seat too high will result in pain in the back of the knee or hip pain.
  2. A low seat or forward seat will cause pain in the front of the knee.
  3. Improper foot position will cause pain on the outside of your knee.

Differences in leg length may lead to twisting on the bike, stretching of one leg which pulls on the hips. Shoe orthotics and hip adjustments to keep the hips even can alleviate this problem.

Neck Pain:

Neck pain happens commonly with cycling. Usually this is a problem of having the handlebars too low or having a bike that is too long for the cyclist. Not stretching the hamstrings or muscles in the front of the thigh can cause neck problems because it will force the spine to arch which will force your head to extend backward while riding.

Foot numbness or pain:

Wearing the proper shoe is necessary with someone who bikes regularly. Bike shoes are made to evenly distribute the pressure on each pedal. Also, if you are riding in a gear that is too high for you, it will put more pressure on the feet causing a disruption of the nerves and tissues of the feet.

Hand Pain or Numbness:

Wear padded gloves while riding to provide a cushion and not push on the median nerve. Allow the shock of the ground to be put on the elbows which can bounce and absorb the pressure from the bumps during the ride.

Remember to always stretch and relax before and after riding. This will prevent tightness and reduce the chance of pulling a muscle.

Pain in back of knee may be a Baker’s Cyst

Q: What is a Baker’s Cyst?

A: A Bakers Cyst is a fluid growth that occurs on the back of the knee. It can become hard and very painful.  A Baker’s Cyst can occur in children and adults.

Q: How does it happen?

A: A cyst starts to grow when there is a biomechanical problem adding stress to the joint such as with walking, running, standing and/or posture. It is also called a Popliteal Cyst.  Pulling of the muscles, tendons and ligaments can form swelling and then the cyst will start to form.

Q: What are the symptoms of Baker’s Cysts?

A: Symptoms of Baker’s Cysts can include:

  1. swelling behind the knee which can get to to size of a golf ball
  2. Difficulty and pressure on the joint when bending the knee. This pressure can go all the way down the calf muscle.
  3. Pain and tenderness after exercising

Q: What can be done to help alleviate a baker’s cyst?

A: Rest is the number one way of relieving problems with the cyst. Inflammation will go down and the fluid in the cyst will start to alleviate. Braces can also be worn to reduce the stress on the joint and prevent bad body mechanics which start to build the cyst back up again.

If given time to heal and stress is taken off of the joint, the cyst will get rid of its fluid and disappear.  Did you know that there is a 40% chance that a cyst removed by surgery will reoccur. That is a pretty high percentage!  So, if you can bear it, give it some time to take care of itself instead of opting for invasive surgery.  Once your tissues are cut open, there will be scar tissue left over and it may be hard to recuperate.

It is also important to alleviate the bio-mechanical problem.  It can be caused by uneven leg length, foot problems, tight muscles which add stress to the knee joint, trauma to the knee joint.  Taking care of the cause the cyst occurrence is key.   This will avoid a lot of unnecessary pain and irritation.

Bursitis: Our Joint Lubricator. What it does and how it flares up!

What is Bursitis?
Bursitis is inflammation of a bursa.   The bursa is an area of fluid around a joint which functions like grease on a machine.  It helps our joints glide properly and protects us from unnecessary friction causing injury. Technically, there are 160 different bursa in our body.  Most common areas where bursitis occurs is by large joints such as the shoulder, elbow, hips and knees.  These are complex areas that are commonly flared up by most athletes who train hard.

Over the years there may be flare ups of the bursa because of added joint pressure, crystal accumulation or degeneration in the joint space. Infection affiliated with Rheumatoid Arthritis can also cause Bursitis.

Symptoms of Bursitis is pain, swelling and tenderness in the joint space. It feels very deep in the body when there is a flare up.

How can this be treated?
In the case of an infection, a visit to your primary care physician may be necessary for inflammatory medication.  In the majority of cases, rest, ice and making sure the joint is moving properly to prevent unnecessary friction is recommended.  Once your body is moving correctly, the bursae can now go back to functioning normally.

We take great pride in helping people through this debilitating problem.  Proper treatment and rehabilitation can prevent future flare-ups and we can help you at our Redwood City facility.

Knee “Baker’s Cyst” Does Not Require Surgery

Q: What is a Baker’s Cyst?

A: A Bakers Cyst is a fluid growth that occurs on the back of the knee. It can become hard and very painful.

Q: How does it happen?

A: This cyst starts to grow when there is a biomechanical problem adding stress to the joint such as with walking, running, standing and/or posture. It is also called a Popliteal Cyst.

Q: What are the symptoms of Baker’s Cysts?

A: Symptoms of Baker’s Cysts can include:

  1. swelling behind the knee which can get to to size of a golf ball
  2. Difficulty and pressure on the joint when bending the knee. This pressure can go all the way down the calf muscle.
  3. Pain and tenderness after exercising

Q: What can be done to help alleviate a baker’s cyst?

A: Rest is the number one way of relieving problems with the cyst. Inflammation will go down and the fluid in the cyst will start to alleviate. Braces can also be worn to reduce the stress on the joint and prevent bad body mechanics which start to build the cyst back up again.

If given time to heal and stress is taken off of the joint, the cyst will get rid of its fluid and disappear.

Did you know that there is a 40% chance that a cyst removed by surgery will reoccur. That is a pretty high percentage!

Q: So, what can chiropractic do?

A: Chiropractors are trained to find abnormal movement in the body and re-align your joints to get rid of bad posture and extra stress on your joints. Understanding proper body mechanics and training your body to move properly will help alleviate any additional cysts in the future!

Call 650.353.1133 for an appointment today to have an exam. We are located in the peninsula and are easy accessible via car and caltrain.

During your exam, I will not only look at your spinal issues but will also check your extremities and soft tissue concerns. I can help you with a wide array of problems that occur in the whole body!

Athletes: I can increase your mobility, results and prevent injuries!