Injuries
Runner injuries are always an important point of discussion between athletes and plantar fasciitis is an usual injury. Every athlete will have been through an injury period and it is always a tough mental time. Looking at the statistics, the majority of the injuries are between the knee and the foot. The top five injuries with runners are:
1 – Patellofemoral Pain Syndrome (PFPS) – Runner’s Knee
2 – Achilles Tendon injury
3 – Plantar Fasciitis
4 – Shin splints
5 – IT band
Another common injury is the hamstring injury.
The main causes of injuries are the increase in the training load too quickly and a previous injury. To avoid injuries, ensure you increase the load very progressively and if you get injured, get the physio to improve the situation and work on your rehabilitation up to the end of the treatment.
To lower risks of injuries, apart from the running, you should work on the drills before the speed sessions and add the following sessions: plyometric, hills reps, Strength and Conditioning.
Disclaimer concerning this article: I give general advice based on my knowledge gained during my sport massage therapy course and readings. This article is not replacing the judgement of a doctor or a physiotherapist. Ensure you visit your local doctor or therapist for a detail analysis of your injury.
What to do when you get an injury:
First, the most important is to stop your run / session. Do not run on an injury. Take a taxi, ask a drive back home or walk back. However, do not continue your run.
Secondly, when you are at home, you need to follow the PRICE treatment for the next 48 hours to 72 hours until the inflammation is gone:
– Protect the area.
– Rest: avoid walking too much, do not do any sport. If the pain is very acute, use crutches.
– Ice: This is a bony area, then you should ice only for 5 minutes at a time. Ice three to five times per day. Use a cloth to avoid the ice to be in direct contact with the skin. If you have access to the sea, a cold river, you can use the natural water to cool down your full legs. Using ice cubes in a bathtub is an alternative.
– Compress: If there is inflammation of the knee, compress the area.
– Elevate: Ensure the knee is slightly bent. An advice is to put a cushion under the mattress and not directly under to feet.
Third, get an appointment with your physio. The physio will be able to start the treatment after the inflammation.
Fourth, if the physio cannot fully treat and the injury is very serious you need to go to your doctor or specialist. If the injury is serious, go straight to the doctor or to the emergency room of your local hospital.
Reminder
The physio will be able to improve the injury during your visit, but remember that the main improvements are going to come from you. Ensure you do all the exercises given by the physio.
Do not overdo because it can be counter-productive and bring further inflammation, but ensure you do not wait until next appointment to get the physio to improve the situation.
Plantar Fasciitis:
The Plantar fasciitis is the third most common injury with athletes. The tendons on the sole of the foot are getting inflammed. The Plantar Fascia ligament is between the heel and the toes.
Most of the time, the pain is close to the heel, and is very painful, like a stabbing pain. The pain is more common in the morning, when you put your foot on the floor after a night in bed. Or if your injury is more mild, then you may feel pain only when running of walking.
This injury may take some time (roughly a couple of months) to heal, because we can not rest the foot easily and because it is a ligament injury.
The plantar fascia is very important in the foot position. It is holding the foot arch in place.
It is the last soft tissue before the propulsion, during the strides.
Plantar Fasciitis is a common condition that occurs when the large ligament runs under your foot becomes irritated and inflamed. It connects your your heel bone to your toes and is used when you walk, run, climb stairs, jump, and stand on your tip toes.
Let’s see the bones and ligament involved:
What is happening exactly: The Plantar Fascia ligament are used in each stride during the walk, run, jumps or climbing. They are even used when we are standing. This ligament is very important in the height of your foot arch. It is common that the ligament gets irritated or inflamed. It is then an Plantar Fasciitis injury for the athlete.
symptoms and cause:
The plantar fascia is getting painful after a run or sport activities. Generally, the pain appears after the run or the following morning, when the tendon is getting colder. The pain is under the foot, close to the heel. The pain, tenderness is more important in the morning, and improve with light activity.
Plantar Fasciitis are caused by repetitive or intense strain on the plantar fascia ligament. This ligament is used in each stride. Usually, the cause for this injury are:
– Overuse (increase the mileage of the intensity too fast).
– Old running shoes which are loosing their support or foot protection.
– Poor running form.
It is important to work on your form by doing drills before the speed session, strength and conditioning, warm-up correctly before each important session and increase the intensity or the mileage of your training progressivelly to allow the body to get stronger. The foot is certainly the last to get taken care during the different exercises.
Tip: Removing the shoes and running slowly on a grass pitch is a great way to improve the fascia (start with only one loop of the pitch and increase slowly). When we were kids, we had this natural stride and ability, but years of wearing shoes made our feet lazy.
Diagnosis:
The pain is localized under the foot just in front of the heel. The pain is more important when the tendon is cold. Just by pushing with the tumb, you can feel pain in the ligament.
If the inflammation is important, you can even see that the skin is red and you may feel heat in the area.
The doctor may ask to get a Magnetic Resonance Imaging (MRI) in order to see better the damages on the ligament.
Treatment:
First, reduce the inflammation using ice three to five times per day. After 48 to 72 hours, the inflammation should reduce.
A good way to reduce the pain is to insert a heel sole in your shoes. This extra layer will reduce the extension of the ligament itself during the strides. It will help to reduce the inflammation.
It is at this point that the physio will be able to start the treatment of the plantar fascia injury in a very specific way.
The first treatment will be on the fascia directly with cross fiber deep massage. It will not be a very pleasant massage with some pain. The use of needles may help to accelerate the healing.
The therapist should then work on both the calves, the achilles tendons and the quads. Both may be tight, and have scare tissues to improve. A tight or shorter calf/Achilles will mainly be the cause of the plantar fascia to be put in tension.
The therapist can apply kinesiology tape under the foot to support the ligament. The tape is applied from the toes to the heel bone, along the ligament itself and be extended to the Achilles tendon. Then a second tape can start on the top of the foot and wrap the foot / the arch / the first tape and back up to the top of the foor.
When going back home, the therapist will give you exercises and then ensure you spend time improving the situation by doing the exercises as specified. The use of ice after the exercises may avoid further inflammation.
Massages:
It is important to massage the ligament. It is good to put a small bottle (25 centilliters) in the freezer. Use a coke bottle with shapes to improve the massage depth. Then roll the bottle on the foot arch, adding pressure on the tender area:
Once the pain is reduce, use a tenis ball, then a more rigid massage ball in order to put more pressure:
The main stretch will be on the plantar fascia itself. You should increase the level of stretching depending of the pain. You may finish by icing the ligament to reduce inflammation and pain. First on your knees, bend the toes as much as possible to stretch the foot arch. Then with your fingers, stretch the toes:
Fold a towel or a tshirt and put it under your toes, then lift your heel from the floor. To increase the movement, use a step and drop/raise the heel:
Stretch the Achilles tendon with an excentric movement, similar to the Stanish protocol (see the article about the Achilles tendinitis):
Another area to stretch is the calves. With the foot on the floor, put your hands on the wall and bend forward to stretch the calf and the Achilles tendon. You should feel the back of the legs stretching.
Then and use a roller on your calves and quadriceps to improve the muscle suppleness.
Other Therapies:
Other therapies may involve using shock waves, injections of corticosteroid directly in the ligament or a surgical treatment.
To lower the risk of the plantar fasciitis to happen, work on your strength and add the following to your training:
– 10 to 15 minutes of drills before each speed training session
– One session of plyometric per week
– hills repetitions (at the end of your easy days, 5 to 10 hills repetitions)
– Strength and conditioning (2 sessions per week)
– Remove your shoes and start to run on a grass field to strengthen the foot.
– Increase the training volume gradually, especially for master athletes
– Choose your shoes carefully