By Scott G. Morris, M.D., OrthoAlabama Spine & Sports
Cross-country is not only a race that challenges runners physically but also psychologically through diverse landscapes. It takes planning and quick thinking to maneuver around unpredictable obstacles. Because of the unpredictability, runners can get injured, especially without the proper preparation. We see a range of orthopedic injuries in these athletes that can keep them off the trail.
Ankle Sprains
Ankle sprains occur when the ankle is rolled, twisted or turned in an awkward way. The ligaments that hold the ankle bones are stretched beyond the normal range of motion and, in some cases, tear. Most instances of this type of injury occur on the outer ankle.
Depending on the severity of the sprain, the symptoms and signs vary. A common symptom is pain, especially when weight is put on the affected foot. Other symptoms include bruising, swelling, limited range of motion, ankle instability, tenderness when the ankle is touched and a popping sensation or sound at the time of injury.
Preventing this injury is quite simple. Stretch each day to keep the muscles and tendons flexible. It is also good to note that it is essential to put aside time to warm up before any activity and time to cool down afterward. Wear the right shoes that are not too snug or loose, and tuck in shoelaces to avoid tripping over them. Make sure you hydrate and eat a well-balanced diet so your body can have the energy it needs to perform at your best.
If you do get injured, most cases of ankle sprains can be treated in the first 24-48 hours of injury using the PRICE method: protect your injury using crutches or applying a splint or brace, rest and take a break from physical activities, ice the ankle in 20-minute increments to reduce swelling, compress with an elastic bandage, and elevate or raise your ankle above your heart while sitting or lying down. Another way to treat a sprained ankle is by reducing pain and swelling with anti-inflammatory medication. Ankle sprains are not the only injuries affecting cross-country runners.
Plantar Fasciitis
Plantar fasciitis is inflammation of the plantar fascia, which is a tough, fibrous band of tissue that connects to the heel and base of the toes. The function of the plantar fascia is to hold the arch of the foot in place to help with its mechanics when walking. Plantar fasciitis occurs when tension or stress is put on this band of tissue and increases when pushing off on the ball of the foot and toes. This pushing-off motion regularly occurs while walking and running, but over time, the plantar fascia loses its elasticity and becomes irritated.
The main symptom of plantar fasciitis is heel pain. The pain can vary, ranging from gradually increasing to sudden pain, especially after missing a step or jumping from a great height. It can also worsen after a time of inactivity such as waking up in the morning. It may reduce when doing light activity, but it gets worse with vigorous activity. You may also experience heel pain when barefoot or in shoes with minimal support.
To prevent this injury, it is key to balance your activity and rest. Keep a healthy weight by exercising and stretching regularly. If you stand often, take frequent breaks, especially if you wear heels. You might also try wearing orthotics for better support.
Common treatments include specified stretches, physical therapy, icing, anti-inflammatory medication, rest and activity modification, orthotics, shock wave therapy, steroid injections and surgical treatment, including gastrocnemius release. This procedure lengthens the gastric tendon, which is a part of the Achilles tendon, to decrease irritation. Another overuse injury that is common for runners is shin splints.
Shin Splints
Shin splints occur when too much stress is put on the shin bone (tibia), muscles and connective tissues. It develops when a new exercise is started, or someone does not ease into adding more activity or exercises.
Symptoms include pain or tenderness on the inner or outer part of the shin, and the pain can be dull or sharp. It can start when the heel touches the ground during running and becomes worse over time, becoming painful to the touch. Pain can also be felt on the inside of the lower leg just above the ankle and get worse when standing on the toes or rolling the ankle inward.
Shin splints can be prevented by wearing well-fitted athletic shoes and gradually increasing the intensity, duration and frequency of your workout. Alternating between high-impact activities and low-impact activities, like swimming or cycling, can also benefit you and prevent this issue. Though cross-country includes running in unpredictable natural environments, try limiting or taking a break from running on hard, uneven or hilly surfaces.
If you are experiencing symptoms of shin splints, try stretching and strengthening exercises to relieve some tension. Icing with cold packs and anti-inflammatory medication will help reduce potential swelling. It might also be time to get new shoes that have a stiff heel and special arch support. Shin splints that are not treated right away can develop into a more critical injury—stress fractures.
Stress Fractures
A stress fracture is a crack in a bone or severe bruising within a bone. This injury is typically caused by overuse and repetitive activities, and for runners, it is commonly experienced in the foot or lower leg. It can happen when people change activities or increase the intensity or duration of their activities.
Like shin splints, the main symptoms are pain and tenderness, but they can be accompanied by swelling. This pain gets worse with physical activity and does not subside after activity. In fact, it becomes more noticeable when resting or standing and walking.
Some of the best ways to prevent fractures is to stop exercising or training as soon as you feel pain. Take the time to warm up before physical activity and cool down when you finish. It is also important to use the right equipment. For runners, that means wearing the right kind of shoes and orthotics if necessary. Plan a diet and exercise regimen that works for you.
Based on the location and severity of your fracture, the best treatment option for your situation may vary. The most common treatments are rest, ice, over-the-counter pain medication, compression, immobilization with a cast or boot, elevating your injury and using crutches to reduce pressure. Stress fractures can put a pause on your activities and so can Achilles tendonitis.
Achilles Tendonitis
The Achilles tendon is a band of tissue that connects the calf muscles to the heel bone. When this band is under a lot of stress, it is referred to as Achilles tendonitis. Like the previously mentioned injuries, this is an overuse injury that is caused by increased duration or intensity of an activity, be it running, jumping or otherwise.
It can be identified by a mild ache in the back of the leg located above the heel after activity. More severe pain may be noticed after prolonged running, climbing stairs or sprinting. Aside from pain, you may also experience tenderness or stiffness, especially after periods of long rest. Mild activity can alleviate these symptoms.
If you want to prevent this injury, start new physical activities gradually, especially advanced intensity level activities. You should also invest in proper footwear, stretch often, do lower leg strengthening exercises and take a break from activities that put stress on the Achilles tendon.
If you experience swelling, rest, ice the area and take non-steroidal anti-inflammatory medication. Other treatments your doctor may recommend include physical therapy, cortisone injections, splinting at night, changing or improving your footwear and shockwave therapy. For more severe cases of Achilles tendonitis, surgical treatments may be the best option, including debridement and minimally invasive surgery, both of which involve the removal and “cleaning up” of tissue. Alternatively, gastrocnemius recession, or calf lengthening, is an option.
Cross-country has its many benefits and its many challenges. By planning ahead, taking preventative measures and seeking a professional if you do get injured, you can stay in prime running shape to run stronger and compete longer.