Saturday, February 11, 2012

Common Running Injuries

Run long, eat plants!

I want to say right upfront that I don't have any formal 'western' medical training or education.  The things I have learned were acquired through my experiences as an ultrarunner, pacer, crew chief, and injured athlete.  If you're hurt and you need assistance with something, I would suggest a qualified running injury specialist. If you're in Southern California, I would highly recommend Dr. Victor Runco of the San Diego Running Institute (SDRI). SDRI helped me early in my running career and Dr. Runco taught me a great deal about running shoes and how to select the right equipment to work with a specific body type.

With running injuries, if you walk in an urgent care or other general medical facility, you will likely not get the attention you need...because running injuries are unique and only those that are athletes and also work in the medical profession can provide the guidance we need as athletes.

In this post, I would simply like to share the way I mitigate common running injuries, at home, with a tight budget, so I can continue training and working toward my personal goals in mountain ultramarathon racing. I hope you find some of this useful and, if so, leave a comment so I know my efforts to share are reaching someone in need. Thank you.

1. IT Band Syndrome (ITBS)

The Iliotibial band connects your outer hip to the outside of your knee.  With repetitive training, like distance running, you gradually tighten the IT band so much that pain begins to develop in the outer knee or outer hip area.  This is one of the most common running "injuries".  You can google ITBS if you want to learn more... These are the things I do to mitigate ITBS, which reveals itself during heavier training periods of my year...or after 100 mile races....or if I try to run from San Francisco to San Diego like I did in 2010.

My buddy Kurt doing massage to my left IT band during a 100 miler last October.
 Jerry Mitigation Technique for ITBS:

Stop Running for 1 week: Because I experience ITBS after several weeks of heavy training (150+ mi weeks or back to back ultramarathons), I first stop running for at least a week.  In my experience, taking a week off has little to no negative impact on my fitness.  And, if I continue running with IT band pain, it will only get worse.

Take Ibruprofen or Advil: During that week off, I take ibruprofen or Advil at the recommended dose on the bottle.  It takes several days of taking ibruprofen to get the anti-inflammatory properties to trigger a response in the body.  If I'm trying to reverse the inflammation and recover, I will combine the ibruprofen with the days off...and try my best to do this before it develops to the point I cannot run at all.

Eat Dark Berries:In keeping with the anti-inflammatory effort, I also consume a great deal of foods that help with healing. These foods help the body's effort to fight the inflammation and pain.  For me, those foods are smoothies with dark blue/purple berries, Jamba Juice acai toppers, dark chocolate, and fresh vegetable/fruit juice.

Stretch: The best stretch for ITBS is the last one in the 26 postures of the Bikram yoga series called, "spine twist." So, if you practice yoga...or can get to a Bikram studio, that is the best way to get the stretches you need.  Many of the other yoga postures, especially through Bikram's series, can help you tackle ITBS very quickly. Making Bikram yoga a part of your regular routine would probably help you avoid ITBS all does for me.  The other stretches include several that you might not realize help the IT band.  The stretches commonly done for quads, for example. Also, sitting "Indian style" helps me if I do it a few times per week.  As with any stretch, you get the benefits after some do the stretches many times per day...not just once.

IT Strap while NOT running: The IT strap is an over-the-counter strap commonly found at running stores.  It is worn above the knee, about 4-6". Unfortunately, most people wear it incorrectly. The best way to use the IT strap to help mitigate IT band, in my opinion, is to wear the strap in between runs. That is, under your clothing, for 2-3 days. If you can tolerate it, wear it while sleeping. Then, take the strap off for your run.  The idea of the IT strap is to slowly stretch your IT band so it is more flexible, therefore, allowing you to run with less pain. The IT band is inherently working and tense while running, so the IT strap is just going to aggravate the pain.

2. Runner's Knee (Patellofemoral Pain)

The knee is quite complex.  The truth is, this elusive "runners knee" can be many different things. So, this is one of those things you don't want to mess around with. You should really consult a professional when it comes to knees.

Patella Straps visible post-race from this 2007 50k (lowered to my shins after the race)
Since this was taken, I have learned to mitigate the problem much better.
In ultramarathons, I often experienced inflammation in my knees. It primarily occurred in the later stages of my race and I have been able to mitigate the problem in this way:

Plant-Based Diet: About 3 years ago, I "went vegan". As a result, I experienced many great benefits. Directly related to this post, I enjoyed lower inflammation in my body during and after training or races.  This happens day to day...and also during 100k and 100 milers. One of the main reasons I don't experience this inflammatory pain anymore is because I don't eat animal products.

Back off: Most everyone is guilty of the "too much, too fast" training regimen. It takes the body quite a while...(like 3 years) to become accustomed to new types of training or sports.  If you are, admittedly, new to ultrarunning or marathoning (less than 2 years), you are mostly likely running too far, too often, too fast.  If you don't want to be forced into several months off...back off and identify the problem with the help of a sports medical professional.

Patella Strap: The patella strap is another mitigation tool sold at running stores. The strap is worn under the need cap, spreading the soft patella tissue, which allows a bit more room for the kneecap to slide and flex. This strap is a Mueller brand patella strap commonly sold at running stores and similar places:

Mueller Knee Strap

The problem with this strap is the least for me.  It makes the effort to place tension on the patella, but with running, you will likely have a problem because the knee cap starts to hit the strap. Or, the strap moves out of position.  This strap costs about $20 if my memory serves me right.

A much more effective strap is one you make out of a pair of panty hose socks.  The material used in panty hose socks is very elastic.  If you cut the 'foot' off the sock, and create an approximately 10" tube of panty hose, you then can roll up the hose to the desired tension. This material, when rolled up, will not slip from your patella. You can easily adjust it up or down...while running if you like. Black panty hose rolled up looks like this:

Panty Hose Patella Strap

3. Plantar Fasciitis (PF)

This is the one running injury that I get contacted about more than any other.  "PF" is a pain to many people. Unfortunately, there is a lot of bad info out there.  There are many shoe and product companies trying to make a buck off of this common injury.  Here is what I know about it......and how I have helped 50-100 people work back to their training.

PF is a pain in the heel of the foot or on the bottom. You may experience the greatest amount of pain in the morning as you wake up.  The pain is felt in the connective tissue on the bottom of your foot...or as that tissue wraps up around the heel of your foot.

Stop Running for about a week: You have to give your body a chance to start healing itself. So, 'rest' just means stop running. Cycling and swimming wont aggravate PF so you can definitely put some time on the bike...cycling shoes, for instance, don't flex, so you wont set yourself back at all if you ride a trainer in cycling shoes.

Strassburg Sock: The Strassburg Sock is a soft night splint. You wear it while you are sleeping. The foot is held in a position, with the sock, that allows your foot to heal in a stretched position. This allows for greater flexibility the next day. With the greater flexibility, you will experience less pain. The sock is worn at night and then you take it off in the morning. (see next step)

Roll the ball: Keep a baseball or golfball under your bed. When you awake, take off the Strassburg sock and roll your foot on the ball for 1-2 minutes.  You will warm the soft tissue (now stretched from the use of the Strassburg sock) and you will, through friction, prepare the tissue to be flexible when you stand up.  Once you stand up, you can slowly walk and warm up your foot. This should be a daily routine for mitigating PF.

Rolling on the ball before standing up from bed in the morning.
Black toenails? Damn straight! I earned those.

New Shoes: We could talk for days about shoe selection, seriously. But, very often, the plantar fasciitis is aggravated by your foots inability to flex and move.  The more flexible your shoes, the less prone you will be to the PF.  Cheap running shoes, or those that are built like a tank, with plastic structures, springs, black tar rubber, or some other crap, are probably creating your problem.  Go to a reputable running store and look for a more flexible, lighter, running shoe. Perhaps, you might even consider those in the new "minimalist" line.  The barefooters are correct in saying that the shoes are a big part of our modern running 'injury' problem..but, in consideration of modern society, the urban environment, and the fact that you may have not gone barefoot for the past 40 years...I highly suggest wearing a shoe...but just modifying your selection to be "less shoe." In other words, train your body....and find a shoe that protects your foot but doesn't comfort you like a fetus in the womb.

Final thoughts:

These are just three types of common running injuries. There are many other...don't guess about what might be wrong with your body. The mitigation techniques I've suggested are for people that know they have these issues and might consider these techniques to help an already-existing issue. Good luck! Run long, eat plants!



  1. So... I guess you don't subscribe to the "my leg is nearly severed and dangling by a tendon, so I'm just going to run 10 miles today" school. Good. lol.

    I don't really run ultras (I think 27+ is my longest), but I've had my share of these injuries (minus ITBS), and what you describe pretty much works for me also.

    I currently have PF but it's manageable, and if the symptoms get bad I just wear shoes with a bit of arch for a day or two and the symptoms go away.

    My worst problem has probably been patellar tendonitis, and what worked for me best is dropping the high shoes and upping my cadence. For whatever reason, minimalist shoes get my knees tracking straight and a faster cadence doesn't give me time to think too much about where to put my feet, and I don't do dumb things like land on one part of my foot too hard, etc. It just works. Since resting and adopting these practices my knees only show about 5-10% of the symptoms they did last summer. It's basically the difference between me running, and not running.

  2. Sounds good friend... after any length of time in this sport, these things creep up. I'm happy you've found techniques to overcome. Thanks for sharing :) Jerry


Thanks for your comments to Rise Over Run...I read all the comments and appreciate your time in sharing your thoughts. Run long, eat plants........Jerry