The West Coast, particularly West Los Angeles where I practice, is a hub for endurance training. Even though I stay clear of anything longer than a 5K, I’m submerged deep into the track and field, marathon, and triathlon worlds because of a huge subgroup of my patients.
For this article I will be discussing all those that are 800m or longer distance runners. Sprinters, jumpers, and throwers are an even more distinct subgroup. Those middle-distance and above runners and triathletes really log the miles. A fifty plus mile a week is not uncommon, and unfortunately, with this high mileage comes a few common injuries. Due to the athlete’s ability to push through pain, the injuries may not apparent until they cause severe pain. Here are the three most common problems I see, and the treatment I recommend:
1. Stress Fractures
Injuries that affect the foot bones, including the calcaneus, are the most common. Swelling, pain, and tenderness in a distinct are all symptoms but are also not limited to stress fractures. If I even suspect a competitive runner of having a stress fracture, then I send them for an MRI to confirm the source of the problem. If the images reveal stress reaction or fracture, then I sideline the athlete for a minimum of six weeks, but more likely eight. At the six-week mark, if they are itching to get back out there, I take another MRI. If the images reveal anything resembling a stress reaction, then the athlete sits out two more weeks. All too often I’ve seen athletes try to run too soon, only to miss an entire season.
2. Ankle Sprain/Strains and Peroneal Tendonitis
Most of the time ankle sprains are traumatic at the onset, but then the severity varies. A proper chiropractic adjustment immediately after the ankle sprain and icing for ten minutes can significantly decrease healing time. Icing, soft tissue care, and chiropractic adjustments would be my treatment protocol. Before running again, there needs to be special attention focused on proprioceptive rehab training and even proper biomechanics. Pose running drills are definitely one of my go-to rehab choices. If proper rehab is not addressed, then the athlete will most likely return to my office within three months of the original injury, complaining of the same injury or of peroneal tendonitis.
3. Achilles Tendonitis
This one has to be the bugger of all buggers. In the last two years I’ve seen three completely severed achilles tendons and numerous athletes with achilles tendonitis. Those with a detached achilles who are still competitive will be referred for a surgical consult. Those with tendonitis have usually had it for years. When I encounter this situation, I hit it hard (similar to tennis or golfer’s elbow tendonitis). Besides treatment with me, initially for three times a week, the patient’s homework is to ice in an ice bucket 4-5 times a day for seven minutes, roll calves and quads out daily, and mobilize talus anterior to posterior. Once the tendonitis is under control, the patient will continue to return once a month for maintenance and do specific mobility exercises.
These are my top three injury players for mid- to long-distance runners. Here’s my general advice to all runners: use ice, since that seems to help every injury associated with the foot, go to a chiropractor to get your foot and pelvis adjusted, and respect the time your doctor or specialist has told you to take off. Nothing is worse than jumping the gun to return, only to be out of the game for months instead of weeks.
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