Ask the Sports Doctor: Running Injury Q&A

Joshua Blomgren, DO, a sports medicine physician with Rush University Medical Center and Midwest Orthopaedics at Rush, recently took part in an online chat about treatment and prevention of common running injuries. In case you missed it, here are some highlights from the discussion.

I started running for the Chicago Half Marathon and started to have anterior knee pain and instability. I also started to have lots of grinding in both knees. Will I need time to rest? Would a knee brace help? 

Joshua Blomgren, DO: Anterior knee pain is a common complaint in runners. Very commonly the patellofemoral, or “knee cap” joint, is the culprit. The knee cap glides in a groove in the thigh bone with walking, running and activity. There is a complex interplay of leg alignment and muscular activity that contribute to the activity of the joint. If the joint is slightly out of alignment it can become painful. A lot of runners will experience it as they progress in their training. This is the likely cause, considering the pain and grinding sensation. There are some braces that can help improve the “knee cap” alignment, but most often a physical therapy program to strengthen the quadriceps and gluteus medius muscle can help alleviate your pain and help you to continue your training.

How important is post-run stretching in preventing injury? Any guidance on ideal length of time to spend stretching post-run?

Blomgren: Stretching has been shown in multiple studies to aid in injury prevention. There are two types of stretching — static and dynamic. Static is the more commonly known type as this is the commonly thought of “reach, stretch and hold.” Dynamic stretching is stretching the muscles as you are using them. Dynamic stretching has been shown to be most beneficial as part of the warm-up, and static stretching is done as part of a cool-down. Make sure to focus on the major muscle groups of the legs.

Some of my toes/toenails bruise after running. Is there a way to prevent that from happening?

Blomgren: Many times this is due to trauma from the foot sliding slightly in your shoe. Making sure that you have appropriately fitted shoe ware is one helpful tool. Toenail length should also be taken into consideration. Keeping the toenails somewhat short can help prevent this as well. Wearing a synthetic or sweat-wicking sock can help prevent the foot from sliding in the shoe as well.

I see a lot of people running on the lakefront in the so-called “minimalist” or “barefoot” shoes. What do you think of them? 

Blomgren: These types of shoes promote a mid-foot or fore-foot strike during the running cycle. This has some advantages in that it enhances and utilizes the natural elasticity of the muscles and tendons. This can be beneficial from the standpoint of injury prevention. A runner wanting to adopt this style of running or these types of shoes should make a slow and gradual transition to running in these. You should transition and increase the mileage over a two- to three-month time period to avoid overuse injuries as these will change the way your foot and muscles and tendons work.

I often hear running friends complain about aches or nagging problems — sometimes they are running with some degree of pain. Any rule of thumb? How do you know when its time to consult a physician?

Blomgren: Aches and pains are common, especially during marathon training. Most commonly the injuries that occur fall into the overuse category. These types of injuries fall on a spectrum: pain after activity –> pain during activity, without restricting activity –> pain during activity, with restricting activities –> pain at rest. The goal would be to have something evaluated or treated/managed before it starts to restrict activity. When a person is approaching the time when it is restricting activities, it is time to have it looked at by a certified professional.

Joshua Blomgren, DO, is a team physician for the Chicago White Sox and the Chicago Red Stars women’s soccer team and a medical provider for the Bank of America Chicago Marathon.  Follow him on Twitter.

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