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Monday, April 2, 2012
David Nolan, PT, DPT, MS, OCS, CSCS, and a clinical specialist with the MGH Sports Physical Therapy Service, answers questions about preventing injuries while training for the Boston Marathon. Nolan also filmed videos illustrating key exercises designed to help avoid common injuries.
Q: When training for the Boston Marathon aches and pains are to be expected. What are the warning signs for pains that could indicate a more significant injury?
Any pain that comes on as more of an ache and stops as you stop running or gets better fairly quickly is typically not too much to worry about; especially as runners are getting into their bigger mileage. For a lot of people it's a big transition from running 10 or 15 miles a week to training where you're running 30 or maybe 40 miles a week. You're using joints and muscles in more vigorous ways so some of that's going to come with some discomfort, but it should come down pretty quickly. When it starts to become painful enough that it's changing your mechanics when you run or it's lingering after you run and impacting your day to day function, then that's usually a sign that things aren't going to disappear on their own. It's time to see a doctor or a physical therapist.
Q: What are the most common marathon-training related injuries?
The most common things that we see in runners are typically in and around the knee. So patellar tendon problems and patellafemoral problems, in which there's abnormal tracking in the kneecap causing pain in the front of the knee. We'll probably also see some problems in and around the foot, such as Achilles tendon, arch pain, or plantar fascia problems.
Q: Is there a time in training when runners are more prone to injuries?
A lot of times it'll happen as people start to get into their bigger mileage. I see a lot of long-term runners get injured after they've increase their individual runs and weekly mileage. They may have had some very subtle strength differences or flexibility issues that didn't prohibit them in the past, but now that they're doing things at a higher level it's taxing the body enough that something breaks down.
You need a certain amount of flexibility, a certain amount of strength, a certain amount of endurance to be successful with the demands you're putting with your body. So if those things aren't there, those are usually the people that start breaking down or having injury.
Q: So simply running isn't enough?
No, one of the biggest problems we see is that runners spend the bulk of their time running. It's a huge part of their training program, which is purely straight ahead function and we have two other body planes. We have a rotational plane and then sort of a side to side. There's often an imbalance between muscles they use all the time with running and the other muscles that aren't used as often within their training.
In runners, as well as other athletes, there's frequently weakness in the hip and gluteal region. Weakness in these areas changes the mechanics of your legs when you're landing and when you're running. It ultimately tends to overload the structures around the knee and foot. This issue is actually more common among female athletes.
The problem is so prevalent that we often focus our injury prevention programs and rehab programs on this region.
Q: What's your best piece of advice for runners?
Listen to your body. If you're getting discomfort or pain, talk to somebody who works with runners sooner rather than later whether it's a physical therapist like me or a physician. Very often we see folks that wait and wait and wait and then its two weeks before the marathon and we get these frantic calls from people that can barely walk. Just because you're running bigger miles doesn't mean you should have lots of pain doing it. And if you do, something's probably not right. The sooner you work with somebody to address it, the sooner you get back to running pain free and happily.
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