Getting back to a fitness routine? Don't over-do it

As the nice weather approaches, we all make plans to restart our exercise programs like walking, running and biking. Our bodies are capable of adapting to increasing load, but if we push hard too quickly, this can cause injury. If we typically train for 12 weeks to prepare for a half marathon and we try to do it in eight weeks, this may overload the body's ability to adapt, leading to overuse injury.

A common overuse injury for runners is leg pain. In this case, leg pain refers to pain in the leg somewhere between the knee and ankle.  Often, that pain is called "shin splints." This is a lay term for many types of exercise-induced leg pain, but doesn't really identify the cause. The pain could be something as simple as a strain or as serious as a stress fracture. It's important to know the warning signs of serious injury.  

Pain that persists for several minutes to several hours after exercise, throbbing pain at rest, or pain at night after going to bed all can be warning signs of something serious. And running through the pain is not the answer.

Medial tibial stress syndrome (MTSS) is an inflammation of the periosteum (membrane lining the bone).  This is the most common leg injury and most often labeled as shin splints.  There is pain along the mid to distal third of the inner tibia, pain with running and tender to the touch. This can occur when runners increase their training more than 10 percent per week. 
The initial treatment is rest until you are pain free. Cross-training with water jogging or cycling are usually tolerated and ice massage can be helpful as well.

Another common injury that occurs is muscle strain of the anterior tibialis muscle. This is the muscle in the front of the leg along the tibia (shin bone). Progressing too quickly, speed walking and chronic downhill running are frequent causes.  Stretch and massage the area after a light warm up and modify or vary your training.

Tendinopathies are troublesome and can end a running season if not addressed early. The common tendons involved are the posterior tibialis that runs along the inner ankle and foot and the Achilles tendon that attaches to the back of the heel. Tendinopathies are micro tears in the tendon that lead to inflammation and swelling. They can be related to overtraining, poor footwear, inadequate warm up and lack of adequate arch support. This injury is one that requires some continued activity to help the healing.  Intensity must be decreased significantly. Try longer warm ups, cross training and consider arch supports.

Finally, there is a diagnosis that is very serious and must be addressed as early as possible–a tibial stress fracture. If left unattended, this injury can lead to serious consequences. A tibial stress fracture is a crack that occurs in the tibia as a result of repetitive overload. If the runner pushes the miles or the pace too quickly, the bone weakens and these cracks can progress to full breaks in the bone which would be devastating and require surgery. 
The warning signs are profound pain with running or hopping, pain at rest and pain at night. If a tibial stress fracture is suspected, start complete rest and see your physician.

As spring approaches, enjoy the chance to get outside and be active. But be smart, listen to your body, and don't think you can just run through it.

-Robert Cabry, M.D.