Don't Run Into Trouble

The right shoes and a slow start are key to an injury-free running regimen

SUNDAY, Oct. 21, 2001 (HealthDayNews) -- Running regularly for exercise and to relieve stress is a great workout. But like any physical activity, it requires the right equipment and the right preparation to get the maximum benefit and to avoid injuries.

The American Academy of Orthopaedic Surgeons reports that almost 175,000 running-related injuries are treated every year in doctors' offices and emergency rooms. Of those, says Dr. Letha Griffin, the athletic team physician at Georgia State University, the most common involve overuse injuries, which can cause shin splints, heel spurs and plantar fasciitis.

Plantar what?

The plantar fascia is a thick, fibrous ligament that runs from the heel to the base of the toes. When you walk, the ligament pulls on the heel bone, raising the arch of your foot as it pushes off the ground. If your foot moves incorrectly, it can become strained, swell and begin to fray the fibers of the ligament where it attaches to the heel. The characteristic symptom of plantar fasciitis is getting up in the morning and hardly being able to walk.

"Sometimes people did too much too fast instead of going slowly," Griffin says. "They try to join in too quickly. The injuries can linger for quite awhile and are difficult to resolve."

The tell-tale symptoms of an injury are pain and swelling. If it doesn't go away on its own after some ice, over-the-counter pain relievers and a few days of rest, or if it's getting worse instead of better, go see the doctor.

"You could have a stress fracture, which are micro-cracks," Griffin says. "That could lead to a true fracture."

The best way to avoid injuries, Griffin says, is to always stretch out, warm up and cool down. Also, take it easy at first.

"Start slow," she says. "Go from walking to running."

It all really begins, though, with the right pair of shoes. Anyone who's ever been to a sporting goods store knows that can be a daunting experience.

"You go in, and you're overwhelmed," says Dr. Howard Palamarchuk, director of sports medicine at the Temple University School of Podiatric Medicine in Philadelphia. "You look at prices and colors and Nike and all these names. A lot of these shoes are engineered extremely well these days. They have a lot of features built into them to make them safe for you. We don't just measure people -- we send them in with a prescription."

Although the purchase may seem a bit involved for many recreational runners, it's still important to buy a shoe that's built for running.

"We find a lot of people get hurt because they wear a running shoe to play basketball and [other sports] on," Palamarchuk says. "People are doing treadmill running in tennis shoes, and there's no padding in them."

That's because tennis shoes are made for moving side to side, not for the constant pounding of forward motion.

The other critical aspect of finding the right shoes is proper fit. There should be at least a thumb's width between the toe and the end of the shoe, and it's better to go a little larger than smaller because feet swell a lot during running.

You also need to pay close attention to your arch, because a high arch requires extra support. If you're not sure whether you have a high arch, do the concrete test.

"If your foot's wet and you're standing on concrete, is everything flat or is there a tunnel under your arch?" Palamarchuk says. "In a high arch, you're looking for more cushioning."

Also, take a close look at the tread. The most durable material, Palamarchuk says, is carbonized rubber, which is the same material used to make race car tires. And if you're planning to do most of your running on trails, you want a studded tread.

"You're better off to have shoes like that for wet surfaces for grip and grab," Palamarchuk says. "Shoes that are too smooth will slip."

What to Do: For tips on developing a safe running program, visit the American Academy of Orthopaedic Surgeons. For details on overuse injuries, visit the Web site of the American Academy of Family Physicians.

SOURCES: Interviews with Letha Griffin, M.D., athletic team physician, Georgia State University, Atlanta; Howard Palamarchuk, M.D., director of sports medicine, and assistant professor, Department of Podiatric Orthopedics, Temple University School of Podiatric Medicine, Philadelphia
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