Running Medicine: Benefits & Pitfalls
Ellen Casey, MD
Assistant Professor
Sports Medicine
Drexel University College of Medicine
Objectives
1)
What are the benefits of running? Is there such a thing as too much running?
2)
Why is knee pain so common in runners?
3)
Which anti‐inflammatory is best for tendonitis?
4)
What about footwear?
5)
When should I seek medical attention?
Why should I run?
Physical Benefits of Running
 Maintain healthy weight
 Lowers cholesterol
 Decreases risk of heart disease
 Decreases risk of cancer
 Stronger bones
Psychological Benefits of Running
 Lower stress
 Decreased depression
 Improved self‐esteem
 Better sleep
Is there such a thing as too much running?
Problems with too much running
 Arthritis
 Stress fractures  Tendon pain
 Impaired immune system
 Elevated cholesterol
Epidemiology of Running Injuries
 Annual incidence is 67%
Fredericson, Sports Med, 2007
Epidemiology of Running Injuries
 90% sustain an injury during marathon training
 Novice runners are at highest risk
Fredericson, Sports Med, 2007
Risk Factors for Running Injuries  High training mileage
 Cut‐off around 20 miles per week
 Previous injury
 Prior 12 months
 Inadequate rehabilitation
 Abrupt change in training
 Frequency
 Intensity
 Surface
 Cross‐training
Running & Osteoarthritis (OA)
 Lack of conclusive evidence
 No increase in 60 yo runners (180 min/w x 12 years)
 Increased hip OA in runners (>65 m/w)
 No increase in complaints of joint pain in runners vs. non‐runners
 Runners with OA may have faster progression compared to non‐runners
McDermott 1983 ; Lane 1993; Kujala 1995; Ding 2007
Why are knee injuries most common?
Knee Injuries in Runners
 Patellofemoral Pain Syndrome
 Iliotibial Band Friction Syndrome
 Osteoarthritis
 Meniscal tears
Patellofemoral Pain Syndrome (PFPS)
 Runner’s knee
 Pain around/behind the knee cap
 Increased pressure/motion between the femur and the knee cap
 More common in females
 Multiple causes
Causes of Runner’s Knee
① Hip/pelvis

Weak hip muscles
② Knee

Tight IT band

Asymmetric pull of quads
③ Foot/ankle

Excessive pronation/flat foot
Causes of Runner’s Knee
 Knee is the victim of poor hip or foot mechanics
Treatment of Runner’s Knee
 Hip and lower leg strengthening
 Functional movements
Treatment of PFPS
 Taping
 Bracing
 Orthotics
 Improve running technique
 No injections!!!
What anti‐
inflammatories are best for Achilles tendonitis?
Achilles Tendon Pain
 True inflammation is rare
 Not tendonitis!!!
 Overuse  thickened, irregular tendon
 “Tendonopathy”
 “Tendonosis”
Ultrasound of Tendonopathy
Treatment of Achilles Tendonopathy
 Pain control
 Ice
 Heel lift/CAM walker
 Tylenol
 Activity modification – as tolerated; alter running mechanics
 Rehabilitation
 Injections
 Surgery
Rehabilitation
3x15
Twice a day
7d/week
Total 12 weeks
93% symptom‐free after 5yrs
Alfredson 2005
Injections
 NO STEROIDS
 Bioinjectibles
 Tenotomy
 Autologous blood
 Platelet‐rich plasma (PRP)
What about footwear?
What about footwear?
Rear Foot Strike without shoes
Lieberman 2010
Loading Rate = 600 BW/s
Peak = 2 x BW
Rear Foot Strike with shoes
Lieberman 2010
Loading Rate = 100 BW/s
Peak = 0.2 x BW
Midfoot or Forefoot Strike without shoes
Decreased peak Decreased loading rate
What about footwear?
 Your mechanics are far more important than what you wear on your feet!
When to seek
medical attention?
Reasons to see a medical provider
 Inability to bear weight or limping
 Red, warm joint
 Night pain
 Pain that is getting progressively worse
 Unable to meet goals due to pain/injury
Questions?
References

1.
Barton CJ, Menz HB, Crossley KM. Clinical predictors of foot orthoses efficacy in individuals with patellofemoral pain. Med Sci Sports Exerc. 2011;43(9):1603‐10. doi: 10.1249/MSS.0b013e318211c45d. PubMed PMID: 21311359.

2.
Bokhari AR, Murrell GA. The role of nitric oxide in tendon healing. J Shoulder Elbow Surg. 2012;21(2):238‐44. Epub
2012/01/17. doi: 10.1016/j.jse.2011.11.001. PubMed PMID: 22244067.

3.
Fukuda TY, Rossetto FM, Magalhaes E, Bryk FF, Lucareli PR, de Almeida Aparecida Carvalho N. Short‐term effects of hip abductors and lateral rotators strengthening in females with patellofemoral pain syndrome: a randomized controlled clinical trial. J Orthop Sports Phys Ther. 2010;40(11):736‐42. doi: 10.2519/jospt.2010.3246. PubMed PMID: 21041965.

4.
Heiderscheit BC, Chumanov ES, Michalski MP, Wille CM, Ryan MB. Effects of step rate manipulation on joint mechanics during running. Med Sci Sports Exerc. 2011;43(2):296‐302. doi: 10.1249/MSS.0b013e3181ebedf4. PubMed PMID: 20581720; PubMed
Central PMCID: PMC3022995.

5.
Lieberman DE, Venkadesan M, Werbel WA, Daoud AI, D'Andrea S, Davis IS, et al. Foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature. 2010;463(7280):531‐5. doi: 10.1038/nature08723. PubMed PMID: 20111000.

6.
Mahieu NN, Witvrouw E, Stevens V, Van Tiggelen D, Roget P. Intrinsic risk factors for the development of achilles tendon overuse injury: a prospective study. Am J Sports Med. 2006;34(2):226‐35. doi: 10.1177/0363546505279918. PubMed PMID: 16260469.

7.
Mascal CL, Landel R, Powers C. Management of patellofemoral pain targeting hip, pelvis, and trunk muscle function: 2 case reports. J Orthop Sports Phys Ther. 2003;33(11):647‐60. Epub 2003/12/13. PubMed PMID: 14669960.
References

8.
Nakagawa TH, Muniz TB, Baldon Rde M, Dias Maciel C, de Menezes Reiff RB, Serrao FV. The effect of additional strengthening of hip abductor and lateral rotator muscles in patellofemoral pain syndrome: a randomized controlled pilot study. Clin Rehabil. 2008;22(12):1051‐60. doi: 10.1177/0269215508095357. PubMed
PMID: 19052244.

9.
Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. The Australian journal of physiotherapy. 2009;55(1):9‐15. Epub 2009/02/20. PubMed PMID: 19226237.

10.
Rutten MJ, Collins JM, Maresch BJ, Smeets JH, Janssen CM, Kiemeney LA, et al. Glenohumeral joint injection: a comparative study of ultrasound and fluoroscopically guided techniques before MR arthrography. Eur
Radiol. 2009;19(3):722‐30. doi: 10.1007/s00330‐008‐1200‐x. PubMed PMID: 18958474; PubMed Central PMCID: PMC2816243.

11.
Satterthwaite P, Norton R, Larmer P, Robinson E. Risk factors for injuries and other health problems sustained in a marathon. Br J Sports Med. 1999;33(1):22‐6. Epub 1999/02/23. PubMed PMID: 10027053; PubMed
Central PMCID: PMCPMC1756136.

12.
ThijsY, Pattyn E, Van Tiggelen D, Rombaut L, Witvrouw E. Is hip muscle weakness a predisposing factor for patellofemoral pain in female novice runners? A prospective study. Am J Sports Med. 2011;39(9):1877‐82. doi: 10.1177/0363546511407617. PubMed PMID: 21632979.