Fall is here, cross-country running season has begun and the 26^th Steamtown Marathon is only a few weeks away! With that in mind, running injuries, some very specific to women, are on the increase…

While driving to or from work have you noticed more local running enthusiasts in the past few years? Moreover, have your noticed that most of the runners are women? Scranton Running Company has contributed to NEPA’s participation in a national trend; more women are engaged in running than men! Female runners account for 9.7 million runners (57%) while 7 million males run on a national level.

With this surge, the female runner has been subjected to a host of related injuries, including shin splints, which often lead to stress fractures. New research has found that stress fractures may be related to the loss of weight and body mass associated with the sport.

A recent study from Ohio State University found that female runners with a Body Mass Index (BMI) below 19 may have a higher risk of developing stress fractures than women with a BMI of 19 or above. Furthermore, the study also found that these women took longer to recover from these injuries.

According to Timothy Miller, MD, “When body mass index is very low and muscle mass is depleted, there is nowhere for the shock of running to be absorbed other than directly into the bones. Until some muscle mass is developed and BMI is optimized, runners remain at increased risk of developing a stress fracture,”

The study also found that female runners with a BMI of 19 or higher with severe stress fractures required 13 weeks to recover from their injuries and return to running. Runners with a BMI lower than 19, however, took more than 17 weeks to recover.

They concluded that women should know their BMI and consult with a medical professional to maintain a healthy number. Additionally, women should cross-train and include resistance training to improve the strength and muscle mass of the lower extremities to prevent injury.

The current BMI wisdom, according to the National Institutes of Health, is 19.8 for men and 24 for women, however, strong and competitive women tend to have a BMI of 26. A BMI of 18 is considered malnourished.

What is BMI?

Body mass index (BMI) is a measure of body fat based on height and weight of adult men and women over 20 years of age, according to the National Institutes of Health.

BMI = (weight in pounds / height in inches squared) X 703)

Example 1: a person who weighs150 pounds and is 68 inches (5 feet 8 inches) tall has a BMI of 22.8

Example 2: a person who weighs 110 pounds and is 66 inches (5 feet 5 inches) tall has a BMI of 17.7

Underweight      < 18.5%

Normal weight      18.5 to 24.9%

Overweight      25 to 29.9%

Obesity            30 and over

What is a stress fracture?

A stress fracture is fatigue damage to bone with partial or complete disruption of the cortex of the bone from repetitive loading. While standard x-rays may not reveal the problem, a bone scan, and MRI will. It usually occurs in the long bones of the leg, mostly the tibia (shin bone) but also the femur (thigh) and foot. Occasionally, it occurs in the arm.

Who is at risk for stress fractures?

FEMALE RUNNERS WITH BMI LOWER THAN 19 – is a primary risk factor.

10-21% of all competitive athletes are at risk for stress fractures. Track, cross country and military recruits are at greatest risk. Females are twice as likely as males to have a stress fracture. Other athletes at risk are: sprinters, soccer and basketball players, jumpers, ballet dancers are at risk in the leg and foot. Gymnasts are also vulnerable in the spine while rowers, baseball pitchers, golfers and tennis players can experience the fracture with much less frequency in the ribs & arm.           

The problem is much more prevalent in weight bearing repetitive, loading sports in which leanness is emphasized (ballet, cheerleading) or provides an advantage (distance running, gymnastics).

Stress fractures usually begin with a manageable, poorly localized pain with or immediately after activity such as a shin splint. Over time, pain becomes more localized and tender during activity and then progresses to pain with daily activity and at rest.

Other Causes of Stress Fractures

• Overuse, Overload, Over training – is the number one cause. Running too many miles with too much intensity with too much frequency is the perfect formula.
• Inadequate Fitness Level – or activity level prior to the stress fracture. For example, the high school runner takes the summer off and then quickly accelerates his/her program to quickly for cross-country in August/September.
• Poor Biomechanics – when your feet hit the ground the forces are absorbed and transferred to the rest of the body. If the biomechanics of feet are not perfect, then the forces are not absorbed and another body part bears too much force. For example, flat or pronated feet poorly absorb the shock and pull the tendons of the foot and shin.
• Recent Change in Training Schedule – sudden increased intensity or speed
• Recent Change in Running Surface – sudden change to a hard or soft surface
• Recent Change in Footwear – shoes too hard or too soft, too much control or too little control, too much pronation or too much supination
• Overweight – running with an extra 10 pounds and attempting to return to running as a method of weight loss
• Underweight – the underweight female athlete is at high risk for stress fractures. If underweight and have a history of menstral irregularities or and eating disorder, the risk of stress fracture increases significantly
• History of Stress Fractures – makes the athlete two times as likely to have another

Prevention & Treatment

• Maintain Ideal BMI – 24 for female runners
• If Overweight – gradual exercise with diet, not too much too quickly - Mix run & walk every 10 minutes
• If Underweight – improve diet maintain healthy body fat%
• Alternate Training – cross train with non-weight bearing activities: bike, swim, elliptical
• Perform lower body weight training – to strengthen the muscles of the lower body, thighs, knees, ankles, feet.
• Gradually Build Up Fitness Level – wean into activity 1-2 miles, then add ½ mile at a time
• Correct Biomechanics - Orthotics, Running shoes, see a Podiatrist
• Gradual Change in Training Schedule
• Gradual Change in Surfaces – ½ run on soft surface, ½ run on hard surface
• Gradual Change in Foot ware – walk in new shoes first, then run 1-2 miles
• Consult Family Physician/Orthopedic Physical Therapist/Nutritionist

Source: Ohio State University, Science Daily

Visit your doctor regularly and listen to your body.     

EVERY MONDAY – Read Dr. Paul J. Mackarey “Health & Exercise Forum!” via Blog

EVERY SUNDAY in "The Sunday Times - Read Dr. Paul J. Mackarey “Health & Exercise Forum!” in hard copy!

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. For all of Dr. Paul's Articles, visit our exercise forum!

Part I of II

Patients frequently ask me about the purpose of colorful tape worn by athletes on their shoulders, elbows, knees and other areas during the competition. It turns out that this look is more than “just a fashion statement!” Medical researchers have studied and published on this topic to assess its value. 

The tape worn by competitive athletes is called Kinesio Tape (KT). It has become very popular in athletes using repeated overhead use of their shoulder as in volleyball, basketball and tennis. It is also used for other joints and muscles such as  elbow, wrist, knee, calf and ankle. It is a special flexible tape designed to mimic the qualities of human skin. KT is very different that other forms of athletic tape. It is latex free with acrylic adhesive that is heat activated. It can be worn in the shower or pool. The cotton fibers allow for quick drying and evaporation and can be worn for 3-4 days. KT is approximately the same thickness as skin and can be stretched 30% to 40% of its length at rest.

Some reports propose that the tape has several benefits. It provides stimulation of the muscles and tissues that support the shoulder, improves space in the joint to limit pain and inflammation from impingement, and improves sensory stimulation to improve coordinated movement of the arm.  Studies have found that those athletes using KT on the shoulder reported significantly less pain with overhead activities as compared to a sham tape application. No differences were reported in range of motion or ability to perform daily activities.

Terms used for Conditions Using KT:

Impingement – when one or more of the rotator cuff muscles gets pinched between two bones.  This is very common and very painful especially when you attempt to raise your hand over your head. 

Rotator Cuff Tear – the rotator cuff is made up of muscles which hold the joint together.  A rotator cuff can become torn (partially or fully) due to trauma such as falling on the shoulder or following wear and tear from years of overhead activities.  Rotator cuff tears are common both in athletes and in the older population.

Rotator Cuff Tendonitis – inflammation of one or more of the rotator cuff tendons is often caused by overuse. Repetitive overhead activities can cause this problem.

Bursitis – inflammation of a fluid filled sack that tries to lubricate and protect the shoulder from impingement.

This is just a partial list of some of the more common problems, which can result in shoulder pain from impingement. All of these conditions are uniquely different and need to be treated differently.   Some of these conditions respond well to oral medications, others to injection, others to physical therapy and still others may need surgery. If you have shoulder pain that lasts for more than three days or you notice that you cannot raise your hand over your head, you need to see either your family doctor or an orthopedic surgeon. 

The four things you can do while you are waiting for your appointment?

1. ICE: The best thing to do is to put an ice pack on the sore shoulder.  While many people may be tempted to reach for a heating pad, ice usually works much better.  One should put ice on the shoulder for no longer than 20 minutes at a time. 
2. PROTECT: Try to avoid movement or actions that cause shoulder pain.  You might have to give up vacuuming, washing the car, painting the bedroom ceiling or throwing the ball from third base to first for a while.  You may want to get help bringing in the groceries and even putting on your coat.  Pain is the body’s way of telling you that you are causing damage to yourself.
3. POSITION: Try to sleep on your back with pillows under your elbow to cushion or support your arm.  This may help those individuals who can not sleep at night due to shoulder pain.
4. MEDICATION: Ask your family physician if you can take an anti-inflammatory medication such as Advil, Aleve, or even aspirin.  This may help alleviate swelling and pain in the shoulder.

Read Dr. Mackarey’s Health & Exercise Forum – every Monday next week “Frozen Shoulder”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

To read all of Dr. Mackarey's articles visit: https://mackareyphysicaltherapy.com/forum/

Paul J. Mackarey PT, DHSc, OCS is a Doctor  in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an associate professor of clinical medicine at GCSOM.