home » cascading injuries? reboot!

This article was inspired by an athlete I coach who was caught in a downward spiral of injuries. He's an accomplished, experienced athlete who has done well at all distances, but over a period of several months nearly had to stop running. He had no single injury that could stop you like a muscle tear or stress fracture, just a series of related problems that together made running misery; even walking was a problem at times.

Unlike a traumatic injury where you instantly know something is wrong, and exactly what it is, diagnosing his problem took a while.

Unbeknownst to this athlete his problems began with a subtle foot issue. A benign cyst of his plantar fascia caused a change in stride, favoring a sensitive area of his foot. Anytime you change the way you move there can be consequences; the effects can be cumulative and not show up until later when the stressed area finally says 'no more!' The compensatory change in stride caused a chain reaction of problems traveling from his foot upwards, it was enough to slow him down but not stop him. My advice was to take some complete time off from running, which he did in short bits of a few days, but not long enough to heal. A runner who feared he'd lose hard-earned fitness by missing a few run days, imagine that!

Eventually his injuries manifested as limited range of movement at his hip flexors, and this slowed him to a walk by the end of several races. The good news is that when the original foot problem was addressed, along with diligent stretching and some PT work, his run training is back on track.

My own recent case of cascading injuries required nearly two months completely off from running to heal. It started with a minor blow to my heal that bruised my Achilles. Instead of taking a few days off from running I kept going. I found that if I toed-in with my foot there was less stress on the sensitive part of the afflicted Achilles, and unfortunately this became my new form. Rotating my foot inwards created new stress at the lateral (outside) of my knee. Some runners naturally toe-in and there's nothing wrong with that, but for me it was a change.

One day I went for a run, felt a sharp pain at 20-minutes and limped back. It felt as if I pinched something within my knee joint or strained my IT band, but in fact that was not the problem. Toeing-in put my biceps-femoris (hamstring) tendon in a constant state of tension where it connects to top of tibia; eventually it could no longer assume the task and strained. In addition, the peroneal nerve behind my knee was pinched and in a constant irritated state. Walking was a challenge; getting up and down stairs was brutal.

If I had taken a few days off from running when I first bruised my Achilles, I wouldn't have needed two months off later. Any runners out there who don't know when to back off? With swimming and cycling to fall back on we don't have to lose any cardio fitness while we wait to get our run legs back.