Chapter 17 "Running Life" - 16 Injury Treatment

16 If something goes wrong despite great care A paradoxical phenomenon in medicine and its countermeasures Running is a strangely paradoxical exercise in medical terms.Running strengthens the heart and lungs, keeping us free from heart attacks, cerebral hemorrhages, and other ailments common to our time.But running also brings its own set of sicknesses—what Dr. Sheehan calls health sicknesses.The main form of this disease is foot pain and leg pain, but sometimes other problems are also included.Another oddity is that most doctors aren't very helpful when it comes to this kind of injury.

Not long ago, at a cocktail party in Manhattan, there was a brief but telling scene.A doctor who is new to running chats with a manager who has been running for ten years.The doctor had been suffering from pain in his Achilles tendon for weeks, but none of the treatments he had tried had worked.The manager told the doctor that he had had the same problem.Encouraged by the manager, the doctor took off his shoes and socks and asked the manager to examine his injured Achilles tendon.The manager gently pressed the Achilles tendon and kept asking if it hurt. After the examination, he presented his diagnosis to the doctor, who recommended the following treatment options: heat, light taps, and less running.Within a few days, the doctor reported that the pain in his Achilles tendon, which had been lingering for weeks, was gone with the treatment recommended by his manager.

This story may sound a little weird, but it's actually not weird at all.Most doctors are trained to treat diseases, not to keep them healthy.They often feel comfortable treating patients with obvious symptoms—broken bones, coughs, headaches, or conditions that can be identified as genuine medical problems.When they meet people who want to improve their health, they often feel that they don't know what to do.Dr. Gabe Mirkin of Silver Spring, Maryland, who writes for The Washington Post's Sports Medicine column, also teaches the course at the University of Maryland.He recently wrote to me:

My feeling is that doctors are overdoing athletes with overuse of cortisone and lendocaine.After all, doctors have to give money to see a doctor.That's why most runners expect their doctor to do something about it when they get injured.In reality, however, there is very little that doctors can do when a runner is injured.The main job of a doctor is to prevent injury. For example, he can examine and treat a runner's deficiencies—lack of flexibility, muscle balance, and physical deformities—that make him or her prone to injury.By asking the right questions, he can determine whether the injury was caused by overexercising.Finally, he can advise runners on whether they need a break.

Mirkin's observations about a doctor's professional interest in surgery were borne out when I myself went to see an orthopedic surgeon on Park Avenue for an infection in my foot.After examining me, the doctor said that he could prescribe some pills to clear up the infection, but those pills did nothing to clear up the underlying cause of the infection. I asked him what he could do to eliminate the root cause, if possible.He answered very simply: "Cut it off." I took the medicine and the infection went away and I was running again two weeks later.I've run it for a few years since then with no issues.

Of course, the disease may come back one day, and surgery may actually be required.Even then, I've had a good few years. Mirkin recounts a similar experience: "I was advised by an orthopedic surgeon to have knee surgery. I didn't do it out of fear. As Benjamin Franklin - who must have known overconfident doctors well - said, 'God heals disease, the doctor billed, 'My knee finally healed.' Interestingly, and perhaps remarkably, doctors themselves are skeptical of the role their colleagues play in the lives of runners.If this is just an internal dispute, then we don't have to deal with it.

But this is not an internal dispute.Instead, it speaks to a medical phenomenon that affects almost every runner sooner or later.Simply put, it can be difficult to find a physician who is familiar with the situation to treat sports-related injuries.With the exception of a few team doctors and specialists, most doctors don't know much about this injury.Notice what happens to the doctor himself when he is injured in running; he may be as clueless as the most ignorant layman.This is not surprising at all.Recently, I reviewed the standard medical textbooks used by some of the best medical schools in our country.The textbooks say little about physical activity beyond simply mentioning that long-term exercise slows the heart rate.One doctor I met while running testified that of the entire time he spent in medical school, he recalled spending less than a day learning to heal a common ailment that athletes suffer from.

Of course, there are doctors who are knowledgeable about sports-related injuries, but such doctors are few and far between and not always available when they are most needed.Because of this, the typical runner ends up being his or her own doctor, patiently exploring various medical treatments through trial and error and absorbing the accumulated experience of other runners. The following categories talk about the most common problems of runners and some treatment methods. Knee joint problems that runners are prone to The more correct term is osteochondromalacia of the knee, a compound word derived from the Greek words "cartilage" and "soft" and the Latin word "patella" (also known as the kneecap).This is the most common ailment among runners.

While the exact cause of the condition is unknown, it is related to excessive wear and tear between the kneecap and the lower end of the femur. When the two bones fit together well, the kneecap moves freely in the depression at the lower end of the femur.However, sometimes it is misaligned, and the kneecap does not stay in the depression where it should be, but squeezes a slope of the friction depression.If you squeeze and rub for a long time, part of the cartilage of the kneecap will be worn out.The result is knee pain, stiffness, and swelling.To treat chondromalacia, many doctors recommend stopping running. (Injury-prone runners who can't find a doctor who sympathizes with their problems will often come across this one-of-a-kind advice.

Tom Talbot, a runner in his forties, saw a doctor with a back injury.In response to a doctor's question, he said the injured area hurt the most after running.Not surprisingly, the doctor advised him to stop running.Talbot, who has been running—and racing—for twenty-five years, replied, "You don't understand me. I think not being able to run is not good." The doctor replied, "It's a completely different Consider it from the perspective of the patient.” So he set out to find an alternative that the patient could accept. ) However, in the usual case this is unnecessary.For example, simply shortening your running distance temporarily, doing quadriceps-strengthening exercises, and running on a surface that slopes toward the injured side—such as a road with a high bump in the middle—can often stretch a runner's kneecap. cure. (Right knee chondromalacia runs in the direction of traffic, left knee chondromalacia runs against the direction of traffic.) Many doctors believe that although it is called runner's knee, it is not a knee problem at all. Rather, it is a problem with the foot, caused by incorrect load-bearing characteristics.This is evidenced by the fact that after runners start wearing orthopedic shoes, chondromalacia often disappears therewith.Wearing orthopedic shoes alters the weight distribution of the foot, thereby altering the relative position of the kneecap and femur.So if you have persistent knee problems, you should see a podiatrist—preferably one who sees athletes regularly. (According to some physicians, one of the causes of softening of the cartilage is Morton's toe. In 1935 Dr. Dudley Morton published a paper entitled "The Human Foot: Its Evolution, Physiology, and Morton's toe, named after Dr. Dudley Morton, is nothing more than a phenomenon in which the first toe is shorter than the second. (Although if the first toe The same effect will occur when the toe is overactive) Under normal circumstances, the pressure shared by the first toe is twice the total pressure carried by the remaining four toes. If the first toe cannot share as much pressure, then , heels, thighs, knees, and even the back can go wrong. Regardless of the role Morton's toes play in cartilage softening and other diseases, there is no necessary causal relationship between them. Many people with Morton's toes never Nothing went wrong.)

foot problems Since the feet have 214 ligaments, 38 muscles, and 52 bones (one quarter of the bones in the body), it is not surprising that there is something wrong with the feet.Runners' foot problems can generally be divided into the following five types. blister As stated in the previous chapter, prevention is the best cure.However, if a blister does develop, there are several remedies.If it is a small blister, just use the method mentioned above to deal with it.However, if the blister is so large that it is painful, the blister should be pierced with a sterile needle, the fluid squeezed out, and then the blister should be covered with petroleum jelly and covered with gauze.If it's a little more elegant, put a piece of one-eighth-inch foam rubber--like the kind of foam rubber that goes in the mountaineering ambulance kit for blisters.In general, you will find that after this treatment, you can continue to run without any problems.The only time you need to see a doctor is if you develop an infection. compression fracture Compression fractures are slight changes in bone structure caused by excessive force or jolts.Generally speaking, this kind of fracture does not need plaster fixation or dressing, but can disappear on its own after rest.But such fractures are often misdiagnosed as coeloid osteophytes or foot bruises. (Diagnosis is difficult, even for doctors who know how to do it, because not all such fractures can be detected on x-rays.) Compression fractures occur most often in the longest phalanx (foot phalanx). bone) and two bones in the lower leg (tibia and fibula).Some authorities say that because of the current trend toward long-distance running, stress fractures are more common than ever.Compression fractures almost always go away on their own within six weeks, if you reduce your exercise activity to the point where you don't feel any discomfort after your run.Running on soft, bouncy surfaces can also help fractures heal. bone injury The average person hears the medical term for a bone injury—heel periostitis—and thinks it's some kind of terrible disease.It's actually nothing more than inflammation of the heel from repeated bouncing.Heel pads—available at sporting goods stores that sell running supplies—can relieve pain and allow the injury to heal over time. plantar fasciitis Plantar fasciitis is an inflammation that occurs at the junction of the plantar ligament and the heel, and its cardinal symptom is heel pain. Like bone injuries, plantar fasciitis often heals with heel pads or other cushioning. heel bone spur It can be difficult to distinguish heel spurs -- bony growths on the heel bone -- from plantar fasciitis without an X-ray.In general, there is no need to distinguish between the two diseases, because heel spurs can often be cured with heel pads.Only when the heel bone spur becomes a persistent disease, the doctor will recommend surgical removal of the growth of the heel bone. ankle problems Sometimes ankles ache from grinding too hard or from running too long on uneven surfaces.As I write this section, my friend Charles Steinmetz has been suffering from ankle pain for two weeks from running too hard in the Philadelphia Marathon to break his own record.But Steinmetz -- the preventive medicine expert -- says he's not discouraged.Because he knows that a little injury is sometimes the price that must be paid to create sports performance.Besides, his ankle joint is getting better day by day.The disease is easy to bear and easy to treat. The most grueling ankle injury that runners don't tolerate, and certainly isn't easy to treat, is Achilles tendinitis, an inflammation of the Achilles tendon sheath at the back of the ankle (in which the Achilles tendon slides). When inflamed, the Achilles sheath swells, causing Too much compression between the tendon and sheath, causing friction and pain.Much has been written about the treatment of Achilles tendinitis, and treatments are offered by doctors and non-medical professionals alike, recommending everything from physical exercise to surgical intervention.But there are a few points that everyone agrees on. Since a tight Achilles tendon can make Achilles tendinitis worse, shoes with well-fitting heels (with the heel removed if necessary) can often reduce pain.Some authorities also recommend soaking the injured foot several times in hot water after a run, then applying ice to the sore Achilles tendon.Wearing elastic straps can also sometimes help. Never go for a fast run until the inflammation is gone.Limiting physical activity to flat, firm ground (where your heels don't bounce or sink in) can also help.Running uphill can strain the Achilles tendon, so avoiding it can also help. If you have Achilles tendinitis, you're likely to conclude that the trouble is worth it if it prevents a recurrence.As mentioned in the previous chapter, the main preventive measure is to do some calf muscle and tendon stretching activities before and after running. (Another precaution that some runners say can sometimes be taken is to wear a pair of shoes with a lower heel than the forefoot. I bought a pair a few years ago when those shoes were all the rage. Although I Found it almost impossible to walk in these shoes, but I wear them a lot after running to get the calf muscles stretched.) Never treat Achilles tendonitis lightly.Don't be a hero when you have Achilles tendonitis.If you then run too far or too fast, then it can develop into a partial or complete tear in the Achilles tendon.If this happens, you're in real trouble. tibial osteophyte Coeloid osteophytes are inflammations of the coeloid muscle and embryonic tendon.Although this phenomenon mostly occurs in people who are new to running, it can sometimes occur in long-term runners after increasing their physical activity.Osteoarthritis can vary in severity, sometimes causing little more than a dull ache, and other times preventing a person from running.The main causes of coeloid osteophytes are jolts, running too hard on toes, and exercising in shoes that are too tight.Wearing padded, lightweight shoes and running with your heels on the ground can often help. muscle soreness It is impossible or even advisable to completely avoid muscle soreness because physical exercise inevitably overworks the muscles.But you can minimize the pain.Muscle soreness is caused by metabolic waste products excreted during physical activity, as well as minor tears in the muscles.Soreness can be relieved by continuing to do light exercise for a few minutes after running, because light activity can excrete waste products from the muscles.It can also help to gradually increase your activity over a period of several weeks, rather than all at once.When you have muscle soreness, there's nothing to do but take a steam bath and wait for the pain to go away on its own.If you can find someone to give you a good massage on the sore area, you will feel better.You might still be sore, but you'll at least get some psychological relief. cramps When you decide to contract a voluntary muscle—say, your calf—your brain sends a message through the network of nerves in your body.When the information reaches the end of the nerve, it releases a conductive chemical that produces the electrical impulses that cause the muscles to contract.When the contraction is complete, the brain sends a second message, releasing another chemical that counteracts the first message, interrupting the electrical impulse that causes the muscle to contract.One theory is that when the brain is not sending out messages and the first chemical—the medical name is acetylcholine—reaches the muscle, or when the muscle contraction is over and the second chemical—cholinesterase— — Failure to reach the muscle in time, both of which can cause cramping.A simpler—though not to say contradictory—theory holds that cramps are caused by deficiencies in salt, calcium, potassium, magnesium, or B vitamins.Some authorities even say that cramps are entirely due to fatigue, of course, this is a hypothetical argument to talk about the biochemical mechanism of the spasm.Anyway, stretching the muscles, massaging, and walking usually resolve the cramps. (If you sit down, the cramps may return right away.) Runners with frequent cramps should first try to increase salt in their diet, and then increase the calcium, potassium, magnesium and other chemicals on a case-by-case basis. Sudden severe pain in the flank When you run hard and take long, deep breaths, you almost always have a sudden, sharp pain in the flank that goes away quickly when you slow down.Some runners are more prone to flank pain than others.But people are trained.In fact, flank pain rarely occurs when your body is in good shape.Therefore, strengthening the body can reduce the symptoms of pain, and may be able to eliminate the symptoms.In the event of flank pain symptoms, use your abs to take a deep breath and slow down your run.If you're running a race, it's not a good idea to slow down and it depends on how much pain you're willing to endure.Anyway, so far no one has died from hypochondriac pain. hematuria Blood is sometimes found in the urine after an exhausting run, especially in elite athletes who compete in competitive running (such as Frank Short).There are many reasons for this - a small amount of muscle damage can cause blood in the urine, for example - and usually nothing is wrong.Of course, if you have recurring blood in your urine, it's also a good idea to see a doctor—preferably one who sees athletes regularly. Runner's Emotions Sometimes, for no apparent reason.Runners can feel sluggish, depressed, and disinterested in their surroundings.This is almost always due to overexercising—running too hard, too often, to give you time to fully recover.The treatment is to reduce the amount of running exercise and ensure adequate sleep time.