Tuesday, May 27, 2008

Running Injuries

Running occupies several hours of my time each week.

Running is exercise, the sport of the solitary, the challenge of the self, and meditations on the go. Running is life.

But this isn't a post on the pleasures of running. It's a post on one of the most practical aspects of running: injuries, their antecedents and solutions. This post should only be of interest to other runners and triathletes. Skip it if you find that it's boring.

After about 4 years of running and as many marathons, I've experienced several different types of running injuries. And it hasn't been pleasant, I can tell you that, not one bit.

Magazines like Runner's World routinely carry articles on injuries (just like they cycle regularly through diets, race tips, inspirational stories, interviews with Deena Kastor etc), but much of it is of little value, just like the magazine itself. I swear, periodicals that are non-news (Newsweek, FEER etc) are pretty much some of the most useless literature that you will ever read.

I've done extensive literature research on running injuries (it helps to have access to journal articles) and tried out some remedies. Here's my not-so-commonly found collected wisdom on the injuries that have afflicted me before in the past.

Delayed-onset muscle soreness
Not really an injury, but everyone experiences soreness at some point. Wikipedia has an article here. The lactic acid theory we all learnt about in school is toast, and actually has been for about the last 10 years. Now, the reigning hypothesis is microscopic muscle tears. The jury is still out on stretching too.

But one thing always works, and that's a good massage by a skilled therapist. An indulgence that's always a pleasure if I might add.

Catch-all term for pain in the shins. Sometimes properly called medial tibial stress syndrome. I've experienced a variant of this that I'm convinced is periostitis (tenderness while palpating the tibia one third of the way up from the ankle), but that could be just me playing doctor (which I'm not).

The cause of this is usually overtraining. Lay off the running completely, or run less so that pain never surfaces during training. Increment mileage very gradually, the 10% rule is a good rule of thumb to follow.

Plantar Fascitis
You know you have this when you wake up in the morning, get up and feel pain in your soles or Achilles Tendon when you take your first steps in the morning. Lots of stuff written out there about this injury, so I won't repeat it.

The plantar fascitis stretch is great for this (easily found by googling).
Other than that, when you're standing around and have nothing to do, or watching TV, do the reverse of the stretch. Scrunch up your toes, flex hard then relax, The aim is to strengthen the foot and its associated muscles.

Patellar Chondromalacia
AKA knee pain. Again, lots written about this. The usual advice helps. One important caveat, be sure not to mistake iliotibial band syndrome (ITBS) for this. I made that mistake myself. More on that later. In addition to the usual advice on knee pain, I would add that laying off the training to allow time to rest, not overtraining, and knee strengthening exercises like squats or knee bends (after the pain is gone, *obviously*) help. But don't overdo it.

Personally, taking glucosamine sulfate licked this problem for me permanently. But apparently it doesn't work for everyone. Forget the chondroitin, it's horribly expensive, is typically derived from shark cartilage, and some studies indicate that for it to be useful, it has to be taken in conjunction with glucosamine. You don't have to be a scientist to appreciate the difficulty in attributing beneficial effects to either solely glucosamine or chondroitin in studies like this. Read the literature with a healthy dose of skepticism.

More about glucosamine: take only glucosamine sulfate, not hydrochloride. The sulfate is apparently absorbed more easily. The so-called optimal dose is 1500 mg per day, usually 3 capsules, but the cumulative dose matters. So don't expect effects to kick in until at least 6 weeks after. Being a sugar, there's been speculation that taking glucosamine decreases insulin sensitivity, hence increasing the risk of diabetes. I hedge against that by taking only 1000 mg each time, and only right after a run (that's right, not everyday), when I figure my body is starved for sugar anyway. Absorption might be quicker too. But that's just me thinking aloud.

There's a topical application for glucosamine, developed by a Singapore company (surprise surprise!), but I've personally never tried it.

Iliotibial Band Syndrome
Ah, the biggie injury. The one that has plagued me many times before and continues to plague me when I'm not disciplined with my mileage.

Again, lots of information written out there. But not all of it clear. I'll have my own two cents to add to that in the next post.

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