All middle-distance athletes desire a pain-free road to the top. Unfortunately, that scenario is very unlikely, as humans do not have it in their genome to either run far or fast without structural breakdown. With this in mind, a track coach should be well-versed in two aspects of the team members’ musculo-skeletal health: common running injuries that are likely to occur and causes of these injuries. It should be made clear from the outset that a coach is not a physician, and while it is fine to voice a diagnostic opinion based on coaching experience, it is not acceptable for a coach to evaluate moderate to serious musculo-skeletal injuries and prescribe therapeutic treatment.
A list of common running injuries would include problems with the skin and toenails, connective tissue manifestations of the ligaments and tendons, stress fractures of the bones of the foot or leg, striated muscle contraction limitations, bone growth plate irregularities, and plantar fascitis.
Skin and toenail problems can usually be handled by the athlete with assistance from the school athletic trainer. Blisters are usually treated by cleaning it with alcohol and puncturing with a sterile needle. A light coating of Neosporin and a compression bandage should then be applied. A subungual hematoma is a blood blister under the toenail caused by poorly sized shoes. Many times these are not painful and should just be left alone. The nail will eventually fall off. If it is painful, then an athletic trainer will need to drill a small hole to relieve the pressure. Fungus toenails are very common with distance runners due to constant micro-trauma to the nail plate. Fungal toenails are rarely painful and do not cause problems to the foot. A serious long distance runner seldom has ten healthy toenails and even if treated with oral medications the fungus returns.
There are many tendons in the leg and foot as they connect muscle to bone. The most common tendon injury is to the Achilles tendon. The other two common problems are shin splints, which is tendon related, and inflammation to the posterior tibial tendon. The term tendonitis refers to pain and inflammation of a tendon. The treatment for tendon injuries include: relative rest/cross training, physical therapy, oral medications, and orthotics. More aggressive treatment involves stimulation with ultra-sound. Shin splints are very common running injuries. The term medial tibial stress syndrome (TSS) is a better name since it is a combination of bone and tendon that causes the manifestations. TSS presents with diffuse but sometimes localized pain along the medial tibia. Swelling is limited. Fasciculations or ridges may be felt in chronic cases of TSS. Treatment involves strengthening the posterior muscle, physical therapy, proper shoes, arch supports or orthotics and limited use of over the counter pain medications.
Statistics show the most common season ending injury for high school and collegiate runners is a stress fracture. Treatment for a stress fracture depends on the bone and the diagnostic used to identify the fracture. Most stress fractures are not detected in x-rays but are seen in most MRI images. There are five metatarsals in the forefoot and this is a problem area. Most often the stress fracture is in the middle set of metatarsals. Diagnosis of a metatarsal stress fracture is easy. There is localized pain and swelling on the top of the foot. Pain increases with palpation. X-rays may be negative up to one month from onset of pain. Tibial stress fractures are also negative on x-rays at first but do show up after four weeks. These fractures are more prevalent than commonly thought. They may suddenly appear after one session of hard work, and this is in contrast with fractures of the foot that seem to get progressively worse. Treatment involves 2-3 weeks in a boot and running should not resume for 5-6 weeks. The pain is acute and localized and seldom radiates to the medial side.
Plantar fascitis is one of the most common injuries found in runners, but it is not too prevalent in high school or collegiate middle-distance runners. The injury is chronic inflammation of the fasci fat pad under the heel and could lead to a bone spur. Padding in the shoe generally helps the problem. 24 hour treatment is required for this stubborn injury. When an athlete gets out of bed in the morning sandals should be worn. Barefoot walking on hard surfaces is strictly forbidden at any time. Rolling around a golf ball with the bottom of your foot while seated has had positive effects.
Growth plate running injuries are common in boys as young high school runners. Osgood-Schlater and Sever’s disease are the two most common problems. With Osgood-Schlaters disease the tibial tuberosty has not yet fused with the tibia. With Sever’s disease, the back of the calcaneous has not yet fused with the heel bone. Pain usually occurs around the time of a growth spurt. The bone grows a little faster than the muscle and the muscle pulls on the growth plate causing pain. Treatment depends on the degree of pain and appearance of swelling. Unfortunately, anywhere from a lessoning of running to a period of time in a cast may be necessary. Stretching when the area is not swollen is helpful, as are shoe modifications and taping of the area.
Many running injuries of the leg can be traced to inflexibility in the pelvis and hip of the athlete. Prior to the year 2000, most running injuries were thought to be related to problems in the foot that manifested themselves in upper leg injuries. It was the bottom-up theory. Now most running injury diagnosis seems to follow the top-down theory that points to the pelvis and hip as the root of most leg injuries. A well thought out and habitually done stretching protocol of the muscles of the hip and pelvis is a great injury prevention routine. Muscles located in the pelvis and butt are among the largest muscles of the body and are neglected by most athletes because they are so durable.
Please remember that every athlete is different and manifestations are unique to the individual. When you do encounter problems, ice is almost always safe to use on any overuse type injury. Oral medications such as ibuprofen should be used with caution. Studies have shown that high school students are showing early stomach ulcerations due to overuse of non-steroidal anti-inflammatory medications.
Middle Distance Coaches, read this before winter break: Middle Distance Winter Training
Scott Christensen is the head track coach at Stillwater Area High School in Oak Park Heights, MN.