If I hear, “It really hurts when I start to run.” or “I have to limp for the first couple of steps when I wake up, but the symptoms get better the more I walk.” Then we are dealing with a soft tissue injury or overuse syndrome.
If you are one of the many walkers, runners, or CrossFit athletes in our Greater Indianapolis community, and you participate in a highly intense workout program, there may be times when you experience this type of problem in your feet, ankles, or lower legs. This flavor of pain will take you on a roller coaster ride that will decrease with rest and come back once you return and increase the duration or intensity of activity. Once it becomes chronic, the distress will be persistent or severe enough to keep you from enjoying and having fun with your selected activity!
There’s always a certain degree of injury risk when you exercise. Training IS controlled injury. Muscle will not change, aerobic threshold will not increase, and blood flow will not improve if the body is not stressed. This doesn’t mean you should avoid it, though! On the contrary, it is essential for your overall health and wellness.
What you need to do is be aware of warning signs of common overuse injuries in your feet, ankles, and lower legs. As you’ll see, this is important for providing the appropriate treatment for optimal healing. If you address these issues the right way, you can get back to your normal workout program in the shortest possible time. If you are proactive, experienced, and can read your body’s warning signs, you may avoid this entirely.
Overuse Injury Signs and Symptoms
One of the symptoms that tends to be common for many overuse injuries is post-kinetic dyskinesia. This is one of my favorite 50-cent terms that means “pain after rest.” This may not make sense at first because rest should make an injury better. What happens is the soft tissue (muscles, ligaments, and tendons) cool down with rest and lose their elasticity/flexibility and become stiff. The damage occurs while running, jumping, and walking but doesn’t show up until the cooldown. This is after sleep, during the drive home, or while watching TV.
We’ve discussed this elsewhere, but pain is a good thing. Without it, you are unable to know that a problem exists. You can think of this as a “check engine light” for your body. Would you drive with this warning light on as long as you would suffer with an overuse injury?
Pain is certainly a prominent symptom—and keep in mind that even though it’s actually a good thing you’re able to feel pain, it still needs to be addressed! But there are other signs as well. Localized swelling and temperature are certainly common signs of overuse injuries. Another that is actually rather concerning is when you experience a “crunching” or crepitace in a tendon. That is a sign that you need to come in and see Dr. Leibovitz pronto.
Types of Common Overuse Injuries
As a general rule, injuries can be placed into one of two different camps – acute and chronic. Acute injuries are those sustained in a single traumatic event, such as an ankle sprain. Another example is the start of symptoms like pain in the Achilles tendon.
Overuse injuries can easily become a chronic condition. They develop over time in response to an accumulation of physical forces. View inflammation as a fire: the longer it is around and the bigger it gets, the more difficult it is to put out. Tendons will change over time with such damage and become very resistant or impossible to regain a normal appearance.
Now, the body has a remarkable ability to withstand tremendous force loads, but only when it is properly prepared. If bones and soft tissues are properly acclimated, you might develop issues such as:
- Plantar Fasciitis – This condition is the most common source of heel pain and develops when your plantar fascia—a tough, fibrous band of tissue—becomes irritated and inflamed. The plantar fascia is an important structure for your foot. It helps maintain your foot arch and stretches slightly when you walk, which assists the entire foot in absorbing the tremendous physical forces that come from each step.
Absorbing all those physical forces, especially over time, can take a toll on the fascia. Overuse aggravates this connective tissue and eventually causes inflammation. Biomechanical issues like over- and under-pronation due to flat feet or abnormally high arches (cavus foot) can also place excessive stress on it. Your plantar fascia then begins to swell, thicken, and become inflamed, all of which results in pain in your heel.
- Achilles Tendinitis – This common overuse injury develops when your Achilles tendon is subjected to repetitive or intense strain during physical activity. Subjecting the Achilles to sudden increases in workload or having tight calf muscles increase the risk of this injury.
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Achilles tendinitis or irritation at its attachment into the heel bone can be particularly concerning when it becomes a chronic condition because the actual structure of your Achilles tendon can change. This lessens its ability to function normally and means increased risk of future injury and surgery.
- Posterior Tibial Tendonitis – Like with Achilles tendinitis, this is an overuse injury affecting the tendons passing through the inside of the ankle to the arch. They have the important responsibilities of holding up your foot arch when you walk. The tendon can become injured in response to overuse, especially from high-impact sports and activities when mild to moderate pronation is present. This can lead to a collapsed foot if it stretches or tears.
Come in and see Dr. Leibovitz so he can properly diagnose it and create a treatment plan for you.
- Stress Fractures – Instead of the bone fractures sustained as result of a single incident, stress fractures are hairline surface cracks that develop in response to an accumulation of forces from high-impact activities. This pain will escalate with the duration of activity. If you take a metal coat hanger and start to bend it, it will become weaker and more flexible with each bend. This is a stress fracture.
Whereas plantar fasciitis is the most prevalent source of heel pain, it tends to be more of a nuisance in comparison to tendonitis in the Achilles and posterior tibial tendons. Those injuries are “show stoppers.”
Another injury to be mindful of is a plantaris tendon rupture. Although this is not an overuse injury it occurs with running, jumping, or rapid change in direction. It is common to feel a “pop” in conjunction with this kind of rupture. This occurs in the upper back of the calf and can be mistaken as an Achilles’ rupture
Overuse Injury Risk Factors and Prevention
This might be surprising, but a particular group that has a high risk for overuse injuries are people who participate in a bariatric program.
You might expect that when someone goes from 400 lbs. to 200 lbs., there would be fewer problems from walking around. What isn’t obvious is that even walking places excessive force on the lower limbs. We have gone from 800 lbs. of force per step to 400 lbs. per step, but every step adds up. In all likelihood, there was minimal activity before the weight loss and a significant level of activity is required to maintain the program. The body was simply unprepared to face those kinds of forces. (As we’ll discuss in a moment, preparing your body makes a huge impact in injury prevention.)
Another obvious group that has a heightened risk for injury are those who participate in CrossFit and other intense workout programs. Now, not everyone who does CrossFit is going to get hurt, but it is important to know that intense exercise regimens can put the body—and especially your lower limbs—under tremendous physical force loads.
The best way to prevent overuse injuries from developing in the first place is to load your body over time. You have a remarkable ability to grow and strengthen, but your body needs to adapt.
If you are going to lead an active lifestyle—and you absolutely, 100% should—keep in mind the fact that variety is good – that is why CrossFit was developed. Doing the same thing over and over and over is not only monotonous and can lead to boredom, it also places strain and pressure on the same body parts repeatedly. Running can be a wonderful exercise, but consider mixing in a couple of sessions of cycling or swimming every week as well. Cycling is especially good because there is very little harsh impact on your lower limbs.
Recovering from Overuse Injuries
Staying active IS the big picture and is important to maintain, so we advocate modifying your physical activities as part of the treatment plan instead of outright stopping. Running and doing a CrossFit “WOD” (workout of the day) can place excessive force on the injury site, while lower-impact activities like swimming, cycling, yoga, and perhaps even walking can help you maintain conditioning.
The good news with recovering from an overuse injury is that as long as you are compliant with the treatment plan created for you, surgery tends to be rare.
Of course, you need to come in and see your go-to foot doc here at our Indianapolis, IN office to have that customized treatment plan prepared to address your injury. Either contact us online right now for more information or give us a call at (317) 545-0505 to request your appointment today!