Treating Overuse Injuries As Springtime Beckons Runners

As I look out my window at my backyard in the Midwest, we are still covered in over a foot of snow and only tall patches of grass scattered about hint at the underlying ground. Spring is fortunately just around the corner and along with it, clear roads and access to our many running trails.

A large percent of Iowa residents are on the verge of finally venturing outside to enjoy nicer weather. For a substantial number of my patients, and myself included, spring is a time to begin running and training. An increase in activity leads to an increase in overuse injuries of the lower extremity. There is no such thing as one-size-fits-all training or a standard treatment regimen. However, keeping current on emerging concepts makes for a prepared patient educator.

While knee injuries tend to be the most common running-related injuries, I more routinely encounter tibial stress syndrome, Achilles tendonitis, metatarsal stress fractures, metatarsophalangeal joint (MPJ) capsulitis and plantar fasciitis when seeing runners in my practice. Within the next month, I will see a drastic spike of aspiring runners with complaints leading to these diagnoses.

The tried-and-true treatments such as activity modification, immobilization, physical therapy and non-steroidal anti-inflammatory drugs prove valuable in relieving pain and allowing healing. Emerging training techniques and popular culture, however, offer some evolving topics to consider and understand if you treat sports medicine injuries.

Patients routinely ask me about barefoot or minimalist running/training. I educate the patient that we as physicians do not have a vast knowledge base on barefoot or minimalist shoe running to the point where we can make evidence-based medicine recommendations. My statement has validation from a 2014 systematic review by Perkins and colleagues on the “Risks of Running Barefoot or in Minimalist Shoes.”¹ The authors offered the following conclusion: “Because of lack of high-quality evidence, no definitive conclusions can be drawn regarding specific risks or benefits to running barefoot, shod, or in minimalist shoes.”

That does not mean that one should not recommend minimalist or barefoot running. In fact, I recommend that if the patient is interested, he or she should spend some time with online searches and approach our local running stores for support and information. Additionally, local running clubs are usually very welcoming and can be an invaluable resource for my patients. Oftentimes, the physical therapists we are already utilizing for these patients serve as great resources for the latest training regimen. Spend time getting to know your local physical therapists who have an interest in treating runners so you can best refer your patients.

In addition, I do mention to my interested patients the Pose Method® of running technique. This running style incorporates a forward lean, allowing gravity to work for the runner instead of against him or her. This technique encourages a more forward landing position on the foot, thus lowering impact up the kinetic chain. “Pose, fall, pull” is the official language of this technique. I have experienced success personally and professionally recommending this low-impact running style.

If you have a sports medicine practice and live in a colder climate, consider some light reading during these last few days of cold to stay up to date on trending training styles. I encourage you to visit the website (https://posemethod.com/ ) for more information.

Reference

1. Perkins KP, Hanney WJ, Rothschild CE. Risks of running barefoot or in minimalist shoes. Sports Health. 2014; 6(6):475-80.