Emma, from Lower Earley Osteopaths, talks about her experience training and running the Reading half marathon and treating patients who were injured during their training.
Half marathon season is upon us! Having just run my first Half Marathon last weekend in Reading, alongside over 12,000 people, I could not believe the number of supporters who turned out to cheer us on and the incredible atmosphere and sense of community! Whether it was your first time (like me), a yearly tradition, one of the many half marathons or training for upcoming full marathons, they are hard work and include plenty of ups and downs.
If you, like me, ran the Reading Half Marathon then you may have undergone the teasing from love ones as you hobbled down the stairs Monday morning! Personally my hip is a little sore following the run and my knees a little stiff…….luckily I work in the right job (with a great boss) and had a little TLC treatment to get me back up and running, not before a few patients laughed at me hobbling around the treatment room!
The last few months have been hard work, I personally over came some injuries and had a number of patients come in desperate for me to answer the question….. “Can you fix this before the race?!” One patient in particular I managed to get back into training and he beat me across the line by 3 minutes!
So how can Lower Earley Osteopaths help you? Let me tell you a little about my training and injury, and one of the patients I treated.
I have always wanted to run a half (and a full) marathon, whilst away travelling I thought it was time for a new challenge so I signed up as something to work towards when I returned. My training started in December, road and treadmill running, not long after Christmas I had my first knockback……medial tibial stress syndrome aka shin splints. The inside part of my left shin started to hurt, every time I ran or walked long distances it would become painful. I decided it was time to talk to Marcus (The Boss) about treatment and to look into why it was happening. We decided to work together to resolve my injury with treatment and exercises. The more we looked into the problem the more it related to a patient I was treating for the same injury!
Firstly Marcus and I discussed my history, I had broken my left ankle 5 years previously and 4 years ago underwent re-constructive ligament surgery, I rehabilitated the ankle but this was the first time I had done such intensive road running.
Marcus carried out a physical examination; my left foot arch had dropped, potentially as a result of altered foot mechanics following my ankle surgery. That meant less shock absorption was occurring in the foot placing extra strain on my shin bone called the tibia. As I was walking my arches were flattening and my foot was rolling inwards or ‘overpronating’. Each time the arch flattened with walking or running it was over-stretching my posterior tibial tendon, which attaches the posterior tibial muscle to the bone. The muscle runs from the back and inside of the tibial bone, wraps around the inside of the ankle and attaches to the bottom of the foot. The over-stretching was causing a repeated tugging on the muscle’s attachment to the tibial bone. This leads to pain, inflammation and small areas of swelling along the inside of the tibia.
However this pain can also be caused by stress fractures as they have similar symptoms. Stresses from continual running on hard surfaces and heavy strain from the tibialis muscles can weaken and fracture the tibia; if you continue to train through shin splints you can develop stress fractures.
We agreed I was suffering from medial tibial stress syndrome, in particular posterior shin splints. Shin splints is the name given to pain over the front of the tibial bone, it is often worse after weight bearing exercise and periods of being stationary such as sleeping. This is because the muscle shortens and therefore is sore when you first place pressure on it, until the muscle has stretched. Often other muscles tighten in response, frequently, and in my cause, this includes the calf muscles which exuberates the problem and prevents it resolving itself.
Shin splints are caused by overuse and sudden increase in duration or intensity of weight bearing activities such as running. The pain can be due to an imbalance in muscles, foot mechanics or the attachment of the muscle to the bone, most commonly caused by foot overpronation. There are a few types of shin splints; I suffered from posterior shin splints however there is also anterior shin splints.
Anterior shin splints is caused by over straining the anterior tibialis tendon and muscle. This is often brought on from start/stop sprinting, running downhill or people who run on the balls of their feet. When you run on the balls of you feet less absorption is dissipated by the foot arch, this forces the excess stress to be taken up by the anterior tibialis muscle leading to inflammation and pain on the outer part of the tibia, where it attaches.
Treatment of shin splints:
Firstly ice over the inside tibia to reduce the inflammatory pain. Secondly I brought a pair of trainers that corrected my overpronation by providing more arch support when I ran or walked. This reduced the irritation of the posterior tibialis muscle and the trainers provided extra shock absorption.
I created a stretching regime to stretch the tight calf muscles and exercises to change my gait mechanics, learning to run heel to toe, and heel raises to strengthen the weakened muscles. I then did the hardest thing: rest. I took 3 weeks off running and replaced it with non weight bearing activities such as yoga, tai chi, pilates, swimming and aqua aerobics. This meant I was still maintaining my aerobic levels, strengthening my core and stretching any tight muscles but allowing the tendon and bone to repair and preventing the risk of a stress fracture. After those weeks I continued to do more non-weight bearing activities to create a healthy balance.
Treatment in the clinic involved acupuncture, low dose lazer treatment to encourage healing and soft tissue techniques to stretch tight muscles.
As a result I ran my first half marathon in 2 hours 10 minutes……I can’t wait to try to beat it next year!
My patient John*:
My patient came in with left calf pain. This first started after running the half marathon last year and reoccurred after a 10 mile run a few days previous. John was running 25 miles a week in preparation for the Wokingham half (in a week’s time) and the Reading half (5 weeks time).
Examination showed a left dropped foot arch causing a bowing in the calcaneal (Achilles) tendon. His left superior tibial/fibular joint was locked and his anterior tibialis muscle was tight. I diagnosed a calcaneal tendonitis due to an over-pronated arch. I recommended that John replaced his running shoes as they were a little over worn to provide more arch support. I gave him a couple of exercises such as calf raises and stretches and to relax into the running to shift his centre of gravity backwards slightly to prevent the overloading of the anterior tibialis muscle. Treatment included mobilising the locked joint, soft tissue techniques to the tight muscles, stretching the calcaneal ligament and freeing the compaction in the left foot. He appeared fit and ready for the Wokingham half, so I booked John in the Monday after the race to loosen any tight muscles and check any problems post race.
Monday came and John hobbled into the clinic, two days before the race he had lifted a tumble dryer and injured the lower right hand side of his back, therefore he was unable to run the Wokingham half. We diagnosed a right sided sacro-iliac joint lock with hypertonia of his buttock muscles, which were mildly compressing a nerve down the back of the leg. We manipulated the lock joint and used soft tissue and stretching techniques to release the spasmed muscles. I gave John some stretches to continue loosening the tight muscles and advised ice to reduce any inflammation around the joint.
I saw John a week later, he was much better and had returned to his usual training, I treated the residual tightness, told John to continue his stretches and advised no more tumble dryer lifting! The next time I saw John was at the Reading half as he beat me across the finishing line by 3 minutes!
*name changed to anonymise the patient.