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Doctor’s Note: Common running injuries



By Dr. Jeff Daniels EBS Medical Columnist

Now that the weather is cooperative and the days are long, I’ve been able to get back into my jogging groove. I hesitate to use the term “running,” since at my age, a fast walker could outpace me.

Many of my patients are runners and it’s estimated that 20-30 percent of Americans participate in some form of running exercise. Two of my patients just completed half-marathons—one in Jackson, Wyo., the other in West Yellowstone—and both did very well in their age groups.

Some of us were made to be runners, but many others don’t have the knees or the stamina for a daily jog or a long distance run. There are many ways that running can take a toll on the body.

The average age of participants in road races is 40 years old and when I talk to people who have tried running but had to quit, it usually revolves around problems with the knee joint. For many people over 40, this involves osteoarthritis of the knee joint, due to wear and tear of the menisci and articular cartilage deep inside the joint.

But the most common cause of runner knee pain is patellofemoral pain syndrome, or PFPS. It results from the cartilage-covered back of the kneecap (patella) rubbing against the cartilage-covered notch at the end of the femur.

The pain starts insidiously around and under the patella, and examination can elicit a grinding feeling and pain when the patella is compressed as the knee is extended. Activity modification, strengthening of the quads and hamstrings, using a brace, and taping the patella are used to alleviate this condition.

The iliotibial band syndrome results in pain on the outside of the knee, which is tender when pressed, and is often associated with downhill running. It can take up to six weeks, but activity modification, stretching and hip strengthening are all utilized to get back to being pain free.

Stress fractures are estimated to occur in up to 15 percent of runners, and 50 percent of these occur in the lower leg bone (tibia). In the foot, the thick tarsal bones account for 25 percent of all stress fractures. Even the pelvis and femurs of runners can be affected by these small cracks in bone due to overuse.

Stress fractures in certain bones are more likely to be complicated by poor healing, nonunion of the bone fragments, or even avascular necrosis—the death of bone tissue due to a lack of blood supply. Luckily, tibial stress fractures are a low risk for complications.

X-rays are not very reliable for finding stress fractures—it’s estimated that they pick up only one in six of these injuries. An MRI has the best chance of finding a stress fracture, or disproving that one exists. Limited weight bearing helps most of these heal, but occasionally surgery is necessary.

The term “shin splints” refers to a stress reaction of the tibial bone, and occurs in up to 20 percent of runners. Other leg problems that occur in runners include plantar fasciitis, Achilles tendinosis, hamstring strain, and compartment syndrome.

After reading this article you might want to throw away your running shoes or never get into this great exercise in the first place. However, I believe the musculoskeletal, cardiac, and psychological benefits far outweigh the hazards.

And it really is a great feeling when you cross the finish line!

Dr. Jeff Daniels has been practicing medicine in Big Sky since 1994, when he and his family moved here from New York City. A unique program he implements has attracted more than 700 medical students and young doctors to train with the Medical Clinic of Big Sky.

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