Urban Myths and Running Injuries

from Sports Performance International

MYTH:  Taking an anti-inflammatory will cure my plantar fasciitis and/or Achilles tendinitis. –> MOSTLY FALSE

Achilles tendinitis and plantar fasciitis refer to the inflammatory phase of these conditions only. This phase is short lived and abrupt in onset. Endurance athletes and runners are much more likely to develop pain as a result of repetitive micro-traumas to these soft tissue structures due to strength deficits and biomechanical faults. This condition evolves over a period of weeks and is more correctly termed Achilles tendinopathy or plantar fasciopathy.

It is important to note that this is the reason why treatment aimed at decreasing inflammation (NSAIDs, ice, steroid injections, RICE) are ineffective, but rather correcting the biomechanical faults and/or training errors contributing to the repetitive micro-trauma is the effective solution.

FACT:  Actively correcting strength deficits and restoring normal biomechanical movement patterns is the key to effective recovery strategies.

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MYTH:  My arch hurts, so I must have plantar fasciitis… A bone spur is causing pain in my heel. –> FALSE

Pharmaceutical marketing coupled with cognitive intransigence of both medical providers and runners has effectively perpetuated the “-itis” or inflammatory misassumption.  Current basic science refutes inflammation as the basis of this painful injury, as it has in other related running injuries like Achilles tendinopathy discussed above.  Micro-tears within injured tissues represent the fundamental basis of this spectrum of injuries, which are the result of sustained biomechanical overload.

FACT:  Plantar fasciopathy typically presents as pain in the bottom of the heel or arch with the first step in the a.m.  Heel spurs can be present on x-rays but are RARELY the cause of pain, micro-tears within the plantar fascia cause pain.

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MYTH:  Runner’s knee, which is classified as pain around the kneecap (patella), is caused by muscular tightness or weakness of the quadriceps. –> MOSTLY FALSE

The expression “runner’s knee” is a non-specific term that conceptually lumps together different causes of pain about the kneecap.  These include Patellofemoral Pain Syndrome (PFA) and Patellar Tendinopathy.  PFA presents as pain about the kneecap and surrounding area typically worsened with running, stairs, squatting, and often affects both knees.  Patellar tendinopathy is a focused pain where the patellar tendon joins the kneecap.  The most common source of weakness is not isolated in the quadriceps but rather in the body’s core musculature surrounding the pelvis and neighboring the gluteus maximus.

FACT:  The causes and treatment of both PFA and patellar tendinopathy are distinctly different and require specific solutions for each, NOT general attempts incorrectly focused on isolated tightness or weakness of the quadriceps.

MYTH:  Iliotibial (IT) band syndrome is caused by tightness on the outside of the knee and can be fixed by NSAIDs, stretching, rolling or massage. –> FALSE

The IT band is a dense tendon-like structure that originates in the core gluteal muscles about the pelvis, crosses over the outside of the hip and extends down to the outside of the lateral leg and knee.  It is speculative that the tissue will “lengthen” or with rolling, stretching or massage.  A sudden ramp in mileage and/or hill work can evoke pain over either the outside of the hip or knee.  Intense pain over the outside of the knee with walking downstairs or running downhill is the classic complaint.

FACT:  The effective solution for IT band problems is functional strengthening of the core (glut, hip, and pelvic stabilizers).

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MYTH:  I recently began using new running shoes, and I think they caused my shin splints. –> MOSTLY FALSE

The expression “shin splints” is another non-specific term to describe pain in different parts of the lower leg or tibia.  Like the term “runner’s knee” it conceptually lumps together various distinct and different sources of painful injury in the leg.  While shoe wear and supports (orthotics, corrective insoles) can influence the expression of pain, shoes or supports are not the sole cause NOR solution for the symptoms.  The fundamental causes of pain relate to biomechanical faults which result in abnormal movement patterns of the foot beyond the limited control of shoe wear or supports.

The most common complaint of lower leg pain described as “shin splints”, is a specific injury over the inside border of the tibia, which is more correctly termed Medial Tibial Stress Syndrome (MTSS).  While an intrinsic biomechanical fault (within the body) is predictably present, the development of MTSS almost always includes an increase in training load that converges to cause increasing stress within the soft tissues attaching to the medial border of the lower leg bone (tibia) causing the area of tenderness.  It is important to note that continuing to increase the training load without correction of the biomechanical fault can progress the injury from an initial soft tissue injury to a focal bone stress injury, i.e. a stress fracture of bone.

FACT:  The effective solution for MTSS is modification of the training load and correction of the contributing biomechanical fault, which commonly requires optimization of arcs of motion about the ankle joint and/or restoration of core control with strengthening of the pelvic gluteal muscles.  The purchase of different shoe wear is unlikely to resolve the injury if the measures above are not achieved.

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Sports Performance International provides the same services for both the recreational and the elite athlete. Their goal is to do more than just treat symptoms – or merely tell you to cease exercising. Instead, recognizing the often complex nature of most injuries, they combine all of the services available to lay out a systematic plan to correct the cause of your injury – educating and directing you with a program to preserve your conditioning while your injury heals.

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