Clinical Sports Medicine for the Runner

Scott Daniels      Physical Therapist      Wellington Orthopaedic and Sports Medicine

With the repetitive nature of running, musculoskeletal injury is an inevitable occurrence for the running athlete.  As a matter of fact, it has been estimated that 65% of all runners will experience an injury that will require treatment in a sports-medicine clinic at some point in their career.  With this incidence, it is important for runners to have a good understanding of the environment of a sports-medicine clinic in order to take advantage of the various types of treatment available.  The following paragraphs describe some important aspects of sports medicine provided in a clinical setting.

Sports-medicine provided in a clinical setting should be care that is provided by means of a team approach.  This team approach should include, at a minimum, an Athletic Trainer, Physical Therapist, and a Physician who all have training in sports-related injuries.  In addition, sports medicine clinics may have a massage therapist and/or an exercise physiologist with expertise in sport-specific massage and exercise.  Ideally, this team approach is carried out under the same roof in order to facilitate and encourage collaboration among all of these health-care professionals.  Frequent communication among health- care professionals in a sports-medicine environment allows a patient to take full advantage of the expertise of each of these health-care providers and leads to a more comprehensive approach to dealing with injury.

Sports-medicine in a clinical setting should be care that separates rehabilitation from training.  Sports-medicine clinicians are often asked (especially by runners); how will exercise help me if I already exercise in the form of running many miles per week?  The exercise that a sports-medicine professional prescribes is therapeutic in nature and part of a rehabilitation process.  This is much different than the exercise that is part of training.  Therapeutic exercise is geared toward a painful condition such as tendonitis, instability, or overuse.  The purpose of these activities is to provide an environment conducive to allowing the problem area to heal.  Instead of focusing on strength and endurance, these therapeutic exercises provide re-education of the nerve and muscle components of a joint.  These activities are focused on utilizing the bodies own built in pumping mechanism to decongest or flush the injured area of impurities and inflammation.

Another example of separating rehabilitation from training occurs in the form of stretching.  Most athletes who present to Physical Therapy with a painful condition will indicate that they stretch.  They will then also agree that they stretch before activity and after. While it is beneficial to stretch before and after training, it is not enough when dealing with a sports-related injury.  When recovering from injury, more frequent stretching is necessary to improve the elasticity of the injured area which in turn will improve the area’s shock absorbing capacity.  As we age, our tendons that attach muscle to bone have a tendency to lose their water-holding capacity and become less-hydrated and more susceptible to injury.  This dehydrated and brittle state of our tissues may not result in measurable loss of range of motion to a joint.  Given this, one should not rely on a measurement or test to determine whether or not you should stretch.  Instead, stretch frequently throughout the day in order to re-hydrate the tissues and improve their shock absorbing capacity rather than attempting to increase range of motion.

Finally, sports-medicine in a clinical setting should be care that includes a heavy dose of re-education exercises away from the site of injury so that these areas can help to absorb some of the forces of running.  Typically, these areas are referred to as our core and include muscles that are located on the front and back of our body between the bottom of our ribs and our mid thigh. More specifically, it includes the deep muscles of our spine that help to minimize movement between vertebrae during high-shock sporting activities such as running.  This area also includes the abdominal muscles and muscles of the low back.  Finally, this area includes the large muscles of the hip to include the gluteals, hip abductors and hip flexors.  Proper education of all of these “core” muscles can help to dissipate the ground reaction forces experienced during repetitive running.  Dissipation of these forces can lead to improved healing of injured areas, prevention of future injury and possibly improved performance.

If and when injury strikes, keep these concepts in mind when seeking advice from a health-care professional.  Doing so may help to minimize the time you will spend away from running.

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