Injuries, Ask Dr. Ray

Contact John Loeschhorn
mtnrnr@pacbell.net

Ray Menzies, MD

"The Walking/Running Doctor"

Office Address: 19582 Beach Blvd., #307

Huntington Beach, 92648

phone (714) 378-2404

e-mail: willray@pacbell.net

Fred Cowles (left) thanks Dr. Ray for saving his life.

John Loeschhorn says, "He's my personal physician."

Dr. Ray says, "I will plan to be at Heritage Park by 7:00 am each Saturday to answer questions and give advice to runners. I would like to run at 7:30 and will talk to those who want to run with me, but I don't want to sacrifice my training run either. I will make as many coffee clatches as I can."

John Loeschhorn says, "He's a volunteer, he can choose his own work schedule."

Dr. Ray says, "I will respond by e-mail to those who prefer it. I won't give out my home number and I won't plan on taking calls at home except when I'm on call for those who have established themselves as patients."

He is a member of the American College of Sports Medicine; he is up to date on the latest medical treatment protocols.

Those who want to see me in the office, are welcome to make an appointment. My staff will be prepared for their call. Patients will be asked to bring their shoes and training log.

Insurance may cover all or part of your visit. I will check with my office manager as to the cost of the visit, but it will likely be around $80.00, although it might be less.

Click Below For More Information:

First Aid For Runner’s Knee
First Aid For Achilles Tendinitis

Causes of Walking/Running Injuries

Walking and running are wonderful forms of exercise because when they go well, everything goes well and when they go badly, the problems can almost always be fixed. This is not true of many other sports injuries which often involve permanent damage to body tissues.

Fitness is achieved through the adaptations of the body to the stress of physical activity. This means if there is no stress, there is no adaptation. Most of the adaptation to training takes place during recovery between training sessions. Adequate rest, therefore, is essential.

Among walkers/runners, short-lived minor pain is common and insignificant. The occurrence of persistent pain, however, means failure of some aspect of the walking/running tissues (bone, ligament, tendon, muscle) to recover from the stress of training. Except in cases of prior trauma, the most common cause of athletic injuries is training error. This often involves overuse which, as Warren Scott MD has said is “too much, too soon, too hard, too often”. Other factors include anatomical problems (misalignments, muscle imbalance or foot mobility problems) or inappropriate running shoes. In short, persistent pain is usually caused by bad body mechanics, bad shoes or bad training.

Summary of Causes of Walking/Running Injuries

Training errors

Increasing mileage too fast
Too many miles at high speed
Too many miles on hills
Too many miles on difficult surfaces

Biomechanical factors:

Over pronation/hypermobile foot
Under pronation/inflexible foot
Short leg
Ligament laxity
Misalignment of bones and joints
Muscle imbalance

Inappropriate shoes

Ill fitting shoes
Inadequate foot motion control
Inadequate cushioning
Worn out shoes

Of course, everybody in pain prefers to have a name to attach to it so I have listed the common diagnoses that we make for walking/running related injuries.

runner’s knee
iliotibial band syndrome
plantar fasciitis
shin splints
stress fractures
delayed muscle soreness
acute muscle tear
chronic muscle tears
muscle cramps
Achilles tendinitis
trochanteric bursitis

Severity of Walking/Running Related Injuries

Tim Noakes has classified athletic injuries by severity from Grade I through Grade IV based on the observation that such injuries if they get worse do so in predictable stages. This classification is helpful in deciding on appropriate treatment and modification of shoes and training.

Grade I injuries cause pain after exercise, often only several hours after exercise has ceased.

Grade II injuries cause discomfort during exercise but insufficient to reduce training and racing performance.

Grade III cause pain of such a degree that training and racing performance are interfered with. (That is, a Grade II that has gotten worse.)

Grade IV injuries prevent any attempts at walking/running.

Virtually every athlete will experience pain or discomfort after work outs at some time since it is difficult to stress the body enough to produce a training effect without occasionally over doing it. As long as it does not progress, no special medical attention or modification of training is necessary for this degree of injury. In addition, most walkers/runners can treat Grade II injuries themselves by assessing their shoes for excessive wear or loss of cushioning and analyzing their training for errors and making the necessary changes. If the injury does not respond, then medical attention is required.

First Aid for Walking/Running Injuries

Many pain syndromes are self limited and require no specific treatment. Pain that you don’t want to put up with will usually respond to RICE, the time-honored regimen of rest, ice, compression and elevation. Sufficient time to permit recovery is of course the most important. This usually involves “active rest” meaning a temporary reduction in training volume (mileage) and speed sometimes to the point of walking large parts of the session at a slow pace. The application of a bag of ice to the painful area for 10 to 15 minutes after a workout and repeated 2 to 4 times a day often provides dramatic relief. Non-steroidal anti-inflammatory medications such as aspirin, ibuprofen (Advil) and naproxen (Aleve) also can give significant relief of pain.

Odd as it sounds, there are athletes who think they can increase mileage and speed at the same time they are treating a painful injury. This approach leads to worsening of the injury and ultimately more time away from productive training. The intelligent athlete will make adjustments early so he can recover quickly and then gradually increase his training load.

Injections and surgery are to be avoided.

References:

Noakes, Timothy. The Lore of Running. Leisure Press. 1991
Birrer, Richard B. Sports Medicine for the Primary Care Physician. CRC Press. 1994
Allen, Murray E. et al. Sports Medicine Review. Mosby. 1997