THE THERAPY CORNER

Watch Your Step!

Virtually all the entries in this series on running injuries have had one thing in common: the cause(s) can be traced back to some form of overuse, or repetitive stress, pattern. Certainly, these are the overwhelming majority of injuries suffered by runners that I see in clinical practice.

Once in a while, however, I am visited by a runner who has sustained a traumatic injury while running. The most of common of these involve ankle sprains and/or fractures, as well as injuries to other body parts due to falls.

We usually don't associate traumatic ankle injuries with distance running, as we do with sports such as football, basketball, soccer, lacrosse; essentially, those activities that require lateral and cutting movements, as opposed to the straight-ahead nature of running. And while this fact may justly indicate a lower risk for such injuries, there are factors that can increase this risk that all runners should be aware of and pay attention to.

First and foremost is the heightened susceptibility to ankle sprains that runners incur when running on uneven terrain. Soft, grassy fields or golf courses may be appealing in terms of perhaps decreasing ground reaction stress to the body, but most have irregular, even sometimes jagged, surfaces that make it much more risky that an unexpected foot fall will result in a turned ankle. Trails, such as the popular running routes in Green Lakes State Park, are even more perilous due to hidden tree roots and fallen branches, rocks, or ruts in the ground.

Falls caused by such hazardous environments can also cause injuries to other body parts. One runner I know has fallen numerous times on icy surfaces and even once fell while running in the early morning and darkness, unexpectedly encountering a recently-departed woodchuck on the shoulder of the road. (The runner was wearing a reflective vest so as to be visible to cars; the groundhog – not so much.) The subsequent sudden descent caused a severe wrist and finger sprain, while the winter falls most often lead to elbow, hip and knee scrapes.

The objective here is not to review treatment of such injuries, but rather what to do to prevent them.

The following may seem like common sense, but it doesn't hurt to be more conscious of measures you can take to reduce your risk for these types of injuries.

• When running on trails or other uneven surfaces, watch your step. We love running in parks and around lakes for the scenic vistas, but the ground in front of you is where your eyes should be. Stop and take a break if you want to take in the view.
• Training with friends in such settings can be part of the pleasure of running, but don't let conversation distract you from paying attention to the ground. This is especially true if you are running behind others who may be blocking your view of upcoming hazards.
• If you run in the dark, I strongly recommend you look into one of the new "Coal-miner" headlamps now on the market. They are light-weight, comfortable, and surprisingly bright and effective in helping you see the road (and dead or alive hazards) ahead.
• Snow, ice, and darkness are a recipe for ruin. If you cannot wear clamp-on devices for traction because part of your route in on clear roads, at least look for shoes that have a "nub" or irregular sole for better grip on the slippery surface. In any case, run slowly if you're not feeling secure, especially when on the downhills.

Lastly, I want to emphasize that any traumatic injury that results in significant pain, swelling, bruising, and especially, inability to bear weight or pressure on the injured part should be x-rayed to rule out a bone fracture. What may seem like a simple sprain often turns out to be something more severe. Better to be safe than sorry.

Gabe Yankowitz, DPT

Gabe is a physical therapist and long-time runner practicing in LaFayette and in the outpatient physical therapy clinic at St. Camillus Health and Rehabilitation Center in Syracuse. While he treats all orthopedic conditions, running injuries are his special interest.