RUNNING INJURY PREVENTION

Running is a great form of exercise, recreation, and sport participation for adults, adolescents, and children. Whether alone or in a team environment, running, when done properly, can enhance physical fitness, coordination, sense of accomplishment and physical and emotional development. However, running under adverse conditions or with inadequate clothing and equipment can cause a variety of injuries and physical stress.
 

WHAT ARE THE SIGNS THAT I MIGHT HAVE A RUNNING INJURY?

Signs that you may be injured or need to alter or stop your running include:

•  Pain or discomfort while running
•  Pain at rest
•  Inability to sleep
•  Limping
•  Easily experiencing shortness of breath (exercise asthma)
•  Stiffness
•  Headaches during or after running
•  Dizziness or lightheaded feeling any time
   

WHAT ARE SOME COMMON RUNNING INJURIES?

Running injuries in kids are relatively common and may include:

•  Knee injuries — kneecap pain, tendonitis
•  Lower leg pain — shin splints, stress fractures, calf problems
•  Foot and ankle injuries — ankle sprain, heel pain, plantar fasciitis (bottom of foot pain), toe injuries
•  Pelvic and hip injuries — muscle pulls, growth plate stress injuries, tendonitis, groin pain, buttock pain
•  Heat injuries — sunburn, dehydration, heat exhaustion, stroke
•  Skin injuries — blisters or heat rash
   

WHY IS IT IMPORTANT TO STOP RUNNING IF I'M HURT?

Pushing through pain just makes the problem worse, which will keep you from running for a long time. Stopping when there is a problem and correcting it gets you back running again in the shortest, safest amount of time. Whenever there is a problem, contact your doctor immediately for proper diagnosis and treatment. Most of the time, problems are easily fixed if attended to quickly.
 

HOW CAN I PREVENT RUNNING INJURIES?

Planning Goals

• Talk about running with a coach, athletic trainer, knowledgeable adult runner, or running organization
• Children and parents should consistently discuss the goals of the running program
• Determine the reason (goal) you are running (e.g., fitness, recreation, training, competition)
• Develop a running plan and strategy that is compatible with your goal and your current level of fitness
• Set safe, achieveable goals and advance slowly and cautiously
   

  Preparing to Run

• Hydrate (drink water) well in advance
• Stretch for five minutes before beginning
• Speed up slowly
• Proper Running Attire
  
  The local running store is a good place to start and ask questions. It's important to remember the following:
   
• Lightweight, breathable clothing prevents perspiration buildup and allows for better body heat regulation
• Running hats, head covers, and ear covers shield the sun but allow temperature regulation — they are also excellent for cold weather to avoid frostbite
• Proper fitting and proper thickness of socks help avoid blisters and irritation
• Proper shoes with good support arches should fit well and be comfortable
• Inspect your shoes before running: if they have worn thin or are angled, purchase new shoes
• Orthotic shoe inserts (commercial off-the-shelf or custom-made) are especially valuable for people with flat feet, high-arched feet, unstable ankles, or foot problems
   

  Safe Locations and Times to Run



• Flat ground is more gentle on the body than hills
• Avoid steep hills
• All-purpose track surfaces (high school track) are ideal — especially for beginners
• Stay in well-lit areas (e.g., schools, public streets).
• Always run with a partner (preferably a teen or parent)
• A parent should always know:
   - where you are running
   - when you are running
   - how far you are running
   - with whom you are running
   - when you expect to be back
   - when you are finished
• Use a bag to carry a cell phone with you
• Avoid using headphones, especially if you are running on the street, so you can hear traffic and warning sounds
   

  Safe Weather Conditions

  
  Children and adolescents cannot tolerate the weather extremes that adults can, making them more susceptible to heat and cold injuries. Prevent heat illnesses (e.g., sunburn, dehydration, exhaustion) or cold injuries (frostbite) by monitoring the weather conditions.
  
  Avoid running if:
   
• Temperatures are over 90 degrees
• Humidity levels are high
• Temperatures are cold or freezing
  
   

  CONTRIBUTING EXPERTS

  
  The following expert consultants contributed to the tip sheet:
  Robert Burger, MD

FOOTBALL INJURY PREVENTION

Football is one of the most popular sports played by young athletes, and it leads all other sports in the number of injuries sustained. In 2007, more than 920,000 athletes under the age of 18 were treated in emergency rooms, doctors' offices, and clinics for football-related injuries, according to the U.S. Consumer Product Safety Commission.
 

WHAT TYPES OF INJURIES ARE MOST COMMON IN FOOTBALL?

Injuries occur during football games and practice due to the combination of high speeds and full contact. While overuse injuries can occur, traumatic injuries such as concussions are most common. The force applied to either bringing an opponent to the ground or resisting being brought to the ground makes football players prone to injury anywhere on their bodies, regardless of protective equipment. 
 

COMMON INJURIES IN FOOTBALL PLAYERS

Traumatic Injuries

Knee injuries in football are the most common, especially those to the anterior or posterior cruciate ligament (ACL/PCL) and to the menisci (cartilage of the knee). These knee injuries can adversely affect a player's longterm involvement in the sport. Football players also have a higher chance of ankle sprains due to the surfaces played on and cutting motions.

Shoulder injuries are also quite common and the labrum (cartilage bumper surrounding the socket part of the shoulder) is particularly susceptible to injury, especially in offensive and defensive linemen. In addition, injuries to the acromioclavicular joint (ACJ) or shoulder are seen in football players.

Concussions

Football players are very susceptible to concussions. A concussion is a change in mental state due to a traumatic impact. Not all those who suffer a concussion will lose consciousness. Some signs that a concussion has been sustained are headache, dizziness, nausea, loss of balance, drowsiness, numbness/tingling, difficulty concentrating, and blurry vision. The athlete should return to play only when clearance is granted by a health care professional.

Overuse Injuries

Low-back pain, or back pain in general, is a fairly common complaint in football players due to overuse. Overuse can also lead to overtraining syndrome, when a player trains beyond the ability for the body to recover. Patellar tendinitis (knee pain) is a common problem that football players develop and can usually be treated by a quadriceps strengthening program.

Heat Injuries

Heat injuries are a major concern for youth football players, especially at the start of training camp. This usually occurs in August when some of the highest temperatures and humidity of the year occur. Intense physical activity can result in excessive sweating that depletes the body of salt and water.

The earliest symptoms are painful cramping of major muscle groups. However, if not treated with body cooling and fluid replacement, this can progress to heat exhaustion and heat stroke — which can even result in death. It is important for football players to be aware of the need for fluid replacement and to inform medical staff of symptoms of heat injury.
 

HOW CAN FOOTBALL INJURIES BE PREVENTED?

• Have a pre-season health and wellness evaluation
• Perform proper warm-up and cool-down routines
• Consistently incorporate strength training and stretching
• Hydrate adequately to maintain health and minimize cramps
• Stay active during summer break to prepare for return to sports in the fall
• Wear properly fitted protective equipment, such as a helmet, pads, and mouthguard
• Tackle with the head up and do not lead with the helmet
• Speak with a sports medicine professional or athletic trainer if you have any concerns about football injuries or football injury prevention strategies

 
The following expert consultants contributed to the tip sheet:
William N. Levine, MD
Brett D. Owens, MD

SWIMMING INJURY PREVENTION

Swimming is among the most popular low-impact fitness activities, with more than a million competitive and recreational swimmers in the United States. More than one-third of these athletes practice and compete year-round. Elite swimmers may train more than five miles a day, putting joints through extreme repetitive motion. Most swimming injuries affect the shoulders, knees, hips, or back, depending on stroke.
 

WHAT CAUSES SWIMMING INJURIES?

With overuse comes fatigue and failure to adhere to proper stroke techniques. Often swimmers demonstrate tremendous flexibility or joint laxity, which can be normal. Slight injuries and micro-trauma can cause shoulders to become unstable and lead to shoulder pain and tendinitis. Other repetitive injuries include inner knee problems and hip problems from breaststroke kicking, and back injuries from dolphin kicks or dry-land cross-training.
 

WHAT ARE THE MOST COMMON SWIMMING INJURIES?

Swimmer's Shoulder

The shoulder is the joint most commonly affected by swimming injuries or overuse. Shoulder injuries may include rotator cuff impingement — pressure on the rotator cuff from part of the shoulder blade or scapula as the arm is lifted. Biceps tendinitis (painful inflammation of the bicep tendon) and shoulder instability, in which structures that surround the shoulder joint do not work to maintain the ball within its socket, all can result from fatigue and weakness of the rotator cuff and muscles surrounding the shoulder blade.

Lower Body Injuries

Knee injuries that involve the tendons and ligaments (breaststrokers' knee) are common. Breaststrokers may also experience hip pain from inflammation of the hip tendons. Back problems, including lower back disk problems or another problem at the junction between the spine and pelvis, termed spondylolisis, may be increased by the dolphin kick often used in competitive swimming.
 

HOW CAN SWIMMING INJURIES BE PREVENTED AND TREATED?

• Communication among athlete, parent, coach, and medical professional is critical to both swimming injury prevention and successful recovery
• Use good stroke technique
• Lessen repetitive strokes that are causing the overuse injury
• Perform core strengthening and cross-training exercises as part of pre and early season routines
• Consider alternative training techniques rather than training through an injury
• Use periods of rest to recover
• Focus rehabilitation efforts on rotator cuff and scapular strengthening for most shoulder injuries and pelvic and hip strengthening exercises for hip and knee injuries
• Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or prevention strategies

The following expert consultants contributed to the tip sheet:
Daniel J. Solomon, MD

SOCCER INJURY PREVENTION

Soccer is one of the most popular sports in the world and the fastestgrowing team sport in the United States. Although soccer provides an enjoyable form of aerobic exercise and helps develop balance, agility, coordination, and a sense of teamwork, soccer players must be aware of the risks for injury. Injury prevention, early detection, and treatment can keep kids and adults on the field long-term.

Injuries to the lower extremities are the most common in soccer. These injuries may be traumatic, such as a kick to the leg or a twist to the knee, or result from overuse of a muscle, tendon, or bone.
 

WHAT ARE SOME COMMON SOCCER INJURIES?

Lower Extremity Injuries

Sprains and strains are the most common lower extremity injuries. The severity of these injuries varies. Cartilage tears and anterior cruciate ligament (ACL) sprains in the knee are some of the more common injuries that may require surgery. Other injuries include fractures and contusions from direct blows to the body.

Overuse Lower Extremity Injuries

Shin splints (soreness in the calf), patellar tendinitis (pain in the knee), and Achilles tendinitis (pain in the back of the ankle) are some of the more common soccer overuse conditions. Soccer players are also prone to groin pulls and thigh and calf muscle strains.

Stress fractures occur when the bone becomes weak from overuse. It is often difficult to distinguish stress fractures from soft tissue injury.

If pain develops in any part of your lower extremity and does not clearly improve after a few days of rest, a physician should be consulted to determine whether a stress fracture is present.

Upper Extremity Injuries

Injuries to the upper extremities usually occur from falling on an outstretched arm or from player-to-player contact. These conditions include wrist sprains, wrist fractures, and shoulder dislocations.

Head, Neck, and Face Injuries

Injuries to the head, neck, and face include cuts and bruises, fractures, neck sprains, and concussions. A concussion is any alteration in an athlete's mental state due to head trauma and should always be evaluated by a physician. Not all those who experience a concussion lose consciousness.

HOW ARE SOCCER INJURIES TREATED?

Participation should be stopped immediately until any injury is evaluated and treated properly. Most injuries are minor and can be treated by a short period of rest, ice, and elevation. If a trained health care professional such as a sports medicine physician or athletic trainer is available to evaluate an injury, often a decision can be made to allow an athlete to continue playing immediately. The athlete should return to play only when clearance is granted by a health care professional.

Overuse injuries can be treated with a short period of rest, which means that the athlete can continue to perform or practice some activities with modifications. In many cases, pushing through pain can be harmful, especially for stress fractures, knee ligament injuries, and any injury to the head or neck. Contact your doctor for proper diagnosis and treatment of any injury that does not improve after a few days of rest.

You should return to play only when clearance is granted by a health care professional.

HOW CAN SOCCER INJURIES BE PREVENTED?

• Have a pre-season physical examination and follow your doctor's recommendations
• Use well-fitting cleats and shin guards — there is some evidence that molded and multi-studded cleats are safer than screw-in cleats
• Be aware of poor field conditions that can increase injury rates
• Use properly sized synthetic balls — leather balls that can become waterlogged and heavy are more dangerous, especially when heading
• Watch out for mobile goals that can fall on players and request fixed goals whenever possible
• Hydrate adequately — waiting until you are thirsty is often too late to hydrate properly
• Pay attention to environmental recommendations, especially in relation to excessively hot and humid weather, to help avoid heat illness
• Maintain proper fitness — injury rates are higher in athletes who have not adequately prepared physically.
• After a period of inactivity, progress gradually back to full-contact soccer through activities such as aerobic conditioning, strength training, and agility training.
• Avoid overuse injuries — more is not always better! Many sports medicine specialists believe that it is beneficial to take at least one season off each year. Try to avoid the pressure that is now exerted on many young athletes to over-train. Listen to your body and decrease training time and intensity if pain or discomfort develops. This will reduce the risk of injury and help avoid "burn-out"
• Speak with a sports medicine professional or athletic trainer if you have any concerns about injuries or soccer injury prevention strategies
  
   

  CONTRIBUTING EXPERTS

  
  The following expert consultants contributed to the tip sheet:
  Rob Burger, MD
  Kenneth Fine, MD

TWO-A-DAY SEASON

As our "boys of fall" begin practices again before those friday night lights turn back on, it's crucial that their bodies be as prepared as possible for the affects associated with such a strenuous routine.

1. Eat 

Carbs and proteins are going to be essential to rebuild the tissues that inevitably break down from exercise. Two-a-days are meant to maximize the time spent prior to the start of the season, meaning coaches are trying to improve your strength, speed, and confidence as much as possible to start off the season on a good note. The only way to build tissue is to break it down, first - meaning workouts will be difficult. It's crucial that you increase the calorie count when the workout routine increases, as well - by as many as an extra 1,500 calories (on average) per day, depending upon the workout and the athlete's body type. Make sure to get proteins and carbs in your system within 2 hours of finishing a workout, but your body is most efficient at allowing proteins and carbs into your cells within the first 45 minutes. Not only will your body recover faster when you're well-fed, but keeping the energy stores in your body plentiful helps to improve the duration you can withstand a workout at such a high level. 

2. Drink - and don't drink

Athletes of all ages: staying hydrated is so important. Keeping electrolytes in your system by means of gatorade or pedialyte (for quick replenishment), and drinking plenty of water throughout the day will help you to stay hydrated during those long days out on the practice field and in the weight room. It's hard to hold a practice and manage thirst in full padding in 100+ degree heat for coaches; to keep athletes properly hydrated, they'd need to allow water breaks every 10 minutes or less. This turns into an extremely inefficient practice, which is why it helps to seriously manage hydration when not in practice.

Collegiate athletes, on the other hand, also need to limit their alcohol consumption during, and leading up to the start of two-a-day practices to help keep them hydrated and firing on all cylinders. One episode of binge drinking just about wipes out all progress made in 2 weeks worth of workouts, physically, and the aftermath of a binge drinking makes maintaining mental focus very difficult. 

3. Rest

Get plenty of rest. Adjusting to such an extreme amount of high level physical activity will wipe you out - and it's crucial that athletes accommodate their sleep schedule to help reduce fatigue in the days following. Sleep is when your body does most of it's healing - and you will need time to heal and recover to be able to make it through the next day, let alone the next couple of weeks. 

4. Take Advantage of Breaks

Any breaks you're given during a workout - take them. Instead of having to run to drink out of a fountain, keep a large water bottle with you to help you minimize time spent running to get to and from the drinking fountain. 

5. Know Your Body

When you realize you're beginning to severely overheat, back off of a workout. It's imperative that you listen to your body. We understand that most coaches are tough on their players, and therefore, expect them to finish the workouts and only take breaks when allotted with the entire team. The best thing you can do in these situations is back off whatever you're doing; whether it be running, burpees, lifting, etc. by slowing down your pace, lifting a little bit less weight, or taking more time to recover between sets. 

6.  Talk to the Coach

Need an excuse for a break? Go talk to your athletic trainer about a stretch for an "old injury" or a "cramp" or go talk to a coach about something he may want you to do. This will give you some time to recover while still being productive. 

TENNIS INJURY PREVENTION

Tennis, played worldwide, is one of the most popular racket sports. A high number of tournaments for competitive tennis players may lead to overuse injuries, such as "tennis elbow" or wrist injuries. For noncompetitive tennis players, improper or inadequate physical and technique training may be the cause of overuse injuries. Although overuse injuries make up a large chunk of tennis injuries, the good news is that such injuries can be prevented with some changes to technique and training routines.
 

WHAT TYPES OF INJURIES ARE MOST COMMON IN TENNIS?

Two-thirds of tennis injuries are due to overuse and the other one-third is due to a traumatic injury or acute event. Overuse injuries most often affect the shoulders, wrists, and elbows.
 

WHAT ARE COMMON INJURIES AND TREATMENTS?
 

Tennis Elbow

The injury most heard about is "tennis elbow," which is an overuse of the muscles that extend the wrist or bend it backwards. It is also the muscle most used when the tennis ball impacts the racquet. Proper strengthening of this muscle and other muscles around it, along with a regular warm-up routine, will help decrease the likelihood of experiencing tennis elbow. Paying attention to technical components such as grip size and proper technique can also help prevent this condition.

Shoulder Injuries

Shoulder overuse injuries are usually due to poor conditioning and strength of the rotator cuff muscles. The rotator cuff helps to position the shoulder properly in the shoulder socket. When it is fatigued or weak, there is some increased "play" of the ball in the socket, irritating the tissues. The tendon or the bursa can become inflamed and hurt. This usually produces pain with overhead motions such as serving. If the pain persists, it can interfere with sleep and other daily activities.

Flexing and extending the wrist against light resistance with an exercise band three to four times a week may help lessen pain and decrease injuries.

Stress Fractures

Twenty percent of junior players suffer stress fractures, compared to just 7.5 percent of professional players. Stress fractures are the result of increasing training too rapidly. When the muscles tire, more stress is placed on the bone.

If this occurs too quickly, the bone cannot adjust rapidly enough to accommodate the stress and it breaks. These "breaks" are usually cracks in the bone that cause pain rather than an actual break or displacement of the bone. Stress fractures can occur in the leg (tibia or fibula) or in the foot (the navicular or the metatarsals).

These injuries are preventable with proper strength and endurance training prior to extensive tennis playing. Appropriate footwear is also critical to preventing stress fractures.

Muscle Strains

Muscle strains usually occur from quick, sudden moves. A good warm-up followed by proper stretching can help diminish muscle strains. The warm-up should include a slow jog, jumping jacks, or riding a bike at low intensity.

Proper stretching should be slow and deliberate. Do not bounce to stretch; hold the stretch 30 seconds or more. The best stretches are moving stretches, such as swinging your leg as far forward and backward or swinging your arms in circles and across your body. Proper stretching should last at least five minutes.

If you have any concerns about an injury or how to prevent future injuries speak with a sports medicine professional or athletic trainer. The athlete should return to play only when clearance is granted by a health care professional.

British Journal of Sports Medicine. 40(5), 454-459, 2006.

CONTRIBUTING EXPERTS

The following expert consultants contributed to the tip sheet:
Patricia Kolowich, MD