Five warning signs for runners
that painful decisions may lay ahead
by Joe Siple Bob Ivnik knew he should stop running. The Mayo Clinic neuropsychologist's training program had only prepared him to run half of the Twin Cities Marathon.
Yet he had reached the mile marker that read 13.1 and continued running. As he approached the 16th mile, a pain in
his foot cried out for him to stop. But by this time, he was motivated to reach the finish line. So he pressed on.
Ivnik made it four more miles 20 in all before the pain in his foot became excruciating. He was forced to stop just six miles short of the finish line. What's worse, the damage had already been done. Ivnik had strained the tissue of the arch in his left foot.
"When I stand, it looks like I have a flat foot," Ivnik says now. "It's the result of that day."
Despite the injury, Ivnik continued running after just two weeks of rest. Amazingly, he went on to finish 17 marathons one under three hours before the ultimate consequence of his decision took place several years later.
"I was getting coffee at a Holiday Inn during one of my daughter's basketball tournaments," Ivnik recalls. "I turned around with
the coffee and all of the sudden, my knee hurt like hell."
Ivnik had torn his meniscus the culmination, he believes, of his poor decision years before. "I think it was because the biomechanics of that leg were altered and over the years, there was a lot of wear and tear because of it."
Ivnik will never run another marathon, but his running shoes didn't need to be hung so prematurely. All runners can prolong their running careers and the enjoyment they get from
running by paying attention to five warning signs that differentiate acceptable pain from serious implications.
Sign No. 1: Localized pain
Dr. Edward Laskowski, a rehabilitation specialist at the Mayo Clinic in Rochester, Minnesota, and co-director of Mayo's Sports Medicine Center, says localized pain is a dead giveaway for an injury that needs professional evaluation.
"If someone comes in complaining that his whole leg hurts, or his whole calf hurts, it could just be
overuse or (the result of) new training depths," Laskowski says. "But if he comes in saying his lower leg bone hurts right in this spot, then we think about injuries like a stress fracture."
The same theory applies when someone is training. If during a run a large portion of your leg becomes uncomfortable, it shouldn't necessarily be dismissed. A more acute, localized pain, however, usually represents a more serious threat.
Laskowski, who served as a doctor to
athletes of all countries at the Olympic Polyclinic during the 2002 Salt Lake City games, says ITB syndrome (Ilio-tibial band syndrome) is a common injury that is distinguished by localized pain on the outside of the knee. Flat feet or flat arches can be a predisposing factor.
"Flat arches sometimes causes a little bit of rotation of the tibia which pulls on the insertion of the ITB," he says. In other words, it results in localized pain.
Sign No. 2: Persistent pain
"If you have pain or soreness that persists well into the next day, that would suggest you overdid it that day," says Dr. Jay Smith, another rehabilitation specialist at Mayo Clinic's Sports Medicine Center.
Soreness itself doesn't necessitate worry. Smith admits that all athletes experience various aches and pains. It's lasting pain that causes concern.
Often, soreness that stretches on for days is the result of what Smith calls the "terrible too's":
"Too hard, too long, too fast, too soon," he says. "People decide to run a marathon and they basically ramp up their mileage or their time too quickly. The No. 1 injury risk factor for all runners is an error in training." Ignoring persistent pain is one of those errors.
Sign No. 3: Compensation
When pain afflicts runners, the natural reaction is to change his or her gait. Often this is manifested in the form of a limp, but not always. It certainly changed the
way Ivnik ran after his initial foot injury.
Laskowski agrees that if an injury causes a change in form, it needs to be checked out.
"Sometimes your friends will even say, 'Hey, why are you limping?'" Laskowski says. "You may not even realize it. But if it causes any compensation or changes your gait mechanics or your running stride, we should take a look at it."
Sign No. 4: Pain or swelling
Just as all pains are not created equal, neither are the
body parts in which runners feel them. With most of the pounding being absorbed below the waist, many marathon-related sports medicine visits involve lower body injuries. Some of these injuries should be taken more seriously.
Dr. Smith asserts that lower back pain is not usually natural and may suggest the runner isn't absorbing shock very efficiently. "If you're feeling the effects of running in your spine then you're either overtraining or your running mechanics are not
optimal," he says.
Another red flag is pain or swelling surrounding a joint or tendon. Although Smith recognizes that pain in a hamstring or the quadriceps should not be ignored, it doesn't have the same implications as pain near a joint or tendon.
"That's primarily because if you start having joint pain or tendon pain and injure those structures, they take a lot longer to heal," Smith says. "If you pull a quad or your hamstring, we know we can get you going
pretty fast because muscle heals at a faster rate."
Sign No. 5: Ignoring past injury
Laskowski says one of the most common predictors of a future injury is a past injury. The reason is fairly obvious: many people haven't done the proper rehabilitation to restore strength, flexibility and stability to their bodies, putting themselves at greater risk for another injury.
As a way to educate runners on the dangers associated with old injuries, Laskowski gives a lecture for
a marathon training class called "Preventing and coping with running injuries."
"We try to inform our participants on exactly what we're talking about: what pain is significant, what to watch out for, and how to have an appropriate flexibility and strength program integrated into your marathon training."
If a runner doesn't focus on these aspects of training, Smith says there is an answer for that as well, albeit less attractive. "You can clean up the
mess afterward," he warns.
Cleaning up the mess
Sometimes runners get away with pushing through injuries. Some even get away with ignoring the five signs explained above. But many don't, and it's not always a risk worth taking.
Ivnik is strictly a cyclist these days. He looks forward to his weekend treks, which routinely reach the 70-mile mark. Still, he admits feeling regret about his running mistakes and wishes he would have treated his injury before it ended his
running career.
"It hurt a lot," Ivnik says about his initial foot injury. "It wasn't just an ache or pain. I was just stupid."
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