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Health & Exercise Forum

Steamtown Marathon I of III: Prevention of Running Injuries

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Sep 28, 2009

Dr. Paul MackareyIt is two weeks away from the 14th Steamtown Marathon. This is the first of three columns dedicated to those dedicated runners preparing for the big day, Sunday, October 11, 2009.

I would like to take this time to congratulate and thank Bill King, race director, and his band of brothers, for their tireless efforts organizing and sustaining a great race that instills pride for all people of NEPA. It has inspired many people, myself included, to transfer the discipline and determination required to complete a marathon, to improving the quality of each day by conquering life’s challenges one mile at a time.

Therefore, I thought it fitting to share information regarding the prevention of running injuries for the marathon and recreational runner:

How to Prevent Running Injuries


Find the right surface to reduce stress on muscles and joints

  • Shock absorbency
    • Avoid concrete as much as possible
      • 10x as hard as asphalt
    • Consider dirt trails
      • Especially for higher mileage runs
  • Consistency
    • Sudden change in running surface may produce injury
    • Therefore, change surfaces gradually
  • Avoid tight turns
    • Indoor tracks
      • Shins stressed because of tight turns and hard surface
    • Slow curves and straight paths are better
  • Soft surfaces – Caution (sand and grass)
    • While the shock absorption is good, use caution if too soft, inconsistent and uneven
    • Increase risk of injury (sprain, strain, tendonitis, fractures) because if surface is uneven and inconsistent
    • Sand – can lead to achilles tendon overuse
      • Heel sinks and foot slides on push-off
  • Softer surfaces do reduce impact – soft but firm and even
    • For example: hard, wet sand on beach is good after tide goes out
    • Smooth, soft surfaces are less stressful than concrete/pavement
  • Trails, running tracks, dirt roads, smooth fields
    • To minimize injury risk:
      • Pay attention to the variability of the terrain
      • Holes, rocks, uneven areas
      • Build up slowly
      • Wear appropriate footwear
  • Running on one side of the road – Caution
    • Slopes create dangerous off-center forces on the ankles and feet
    • Roads typically slant 7° to 9°
    • Causes biomechanical problems
  • Uphill running
    • Can stress Achilles especially in people with tight calves
    • Hill running should be gradual
  • Downhill running
    • Increases stress on knees
      • Anterior or lateral knee pain

Body weight

  • The heavier the runner, the more stress on the joints and soft tissues
    • Lose excess weight
    • Wear proper running shoes for your weight

Running technique

  • Heavy heel strike
    • Excess force
  • Landing hard in midfoot or ball of foot
    • Stresses Achilles
      • Especially in sprinters
      • Stretch calves to prevent injury

Stay hydrated

  • Prevents heart injury
  • Drink water and sports drinks – before, during, after

Stay loose

  • Be diligent with a regular stretching program

Keep your muscle balance

  • Running strengthens the hamstrings
  • If the quadriceps are neglected, patellar pain can result
  • Add core and LE strengthening to routine
    • Quads, hams, hips
  • A high level of conditioning prior to an injury
    • Reduces risk of injury
    • Lessens the severity of the injury
    • Reduces recovery time
  • Consult with a medical professional to assess the posture and alignment of the lower limb
    • Develop specific stretching and strengthening exercises to address potential problems
    • May recommend specific footwear or shoe inserts depending on foot type and alignment issues identified

Make use of recovery techniques

  • Post-run ice
    • Reduces inflammation
    • Relieves soreness
    • Speeds recovery
  • Massage
  • Warm water whirlpool
    • Wait two hours after race or long run
  • Walking
  • Easy bike ride

Make sure you are ready to return

  • To prevent re-injury, gradually return to training with cross training (running in water with floatation belt, cycling or an elliptical trainer)
    • May re-injure if return too soon
      • Chronic problem may develop
  • Guidelines for safe return to running
  • Painfree
  • No swelling
  • Full range of motion
  • Full or close to full (90%) strength
  • For lower body injuries
    • Ability to bear full weight on hip, knee and ankle without limping

Visit your doctor regularly and listen to your body.

Next week read Part II of III on the Steamtown Marathon.