John Cianca, M.D.
Medical Director, Chevron Houston Marathon
Training for a marathon will expose you to injury. Injuries in running, particularly distance running, are almost always the result of a process not an event. It means that the way you run is the most influential factor. Also, where you are in your training will influence what type of injury develops.
In all cases, it is the underlying process that needs to be corrected in order to eliminate the injury and prevent additional problems. Treating only the symptoms is frequently not enough to eradicate the injury. This is where many people underestimate their injuries and many healthcare providers miss the mark.
Stay True to Form
It is often said that running injuries are the result of too much, too often and too fast training. This is true; but it is not the only axiom for injury. Your running form (biomechanics) dictates much of your vulnerability to injury; and results in some runners being more likely to be affected by how they train.
Simply said, some people are built to run and others, not so much. The structurally gifted runner can endure longer more intense training better than a runner who is not so gifted. And, because they are faster, they have less exposure time (both in duration and actual impacts) than the slower runner. That being said, the less gifted runner must make accommodations and modifications in their training in order to avoid injury.
Injury types vary during the marathon training program. In the first weeks of training, particularly in new runners, pain and inflammation around the foot and Achilles tendon, inside of the shins and at the front of the knee are very common. These can simply be part of the process of your body adjusting to training; but this should not be taken to mean that they are normal or acceptable. And if they are persistent they need to be treated.
As training progresses, there are other injuries that become prevalent. Hip pain and pain along the outside of the thigh and knee (Iliotibial band) are most common. Additionally, as you start to accumulate more mileage and longer runs, stress fractures become more likely. Stress fractures are the most serious common injury and require time off from running.
Stress fractures can occur in any bone but are most common in the lower inner shin and the second metatarsal (forefoot) in runners. These fractures will heal in four to six weeks with rest from weight bearing. However, stress fractures in the hip or pelvis are not unusual and can take 12-16 weeks to heal.
What’s Your Mechanism?
Perhaps the most important information in this article regards the mechanism of any injury. Almost all running injuries are caused by mechanical strain brought about by muscular imbalance, weakness, or tightness, which makes running form less efficient and more stressful. More times than not this occurs during the landing phase of running.
Specifically, as you advance one leg to make contact or as you are bearing weight on the leg, forces cause overload to a given tissue if your mechanics are not optimal. Over many miles of training this exacts a toll on the tissue that is overloaded and injury develops. It is most important to figure these errors out in order to eliminate the injury. The duration of marathon training is enough to expose even the smallest of mechanical errors.
There are a few very common errors in running mechanics that cause most of the injuries. Not controlling pronation is the most common error. This occurs throughout the lower extremity, with the hip being the most common area for deficiency.
Weakness in the abductors of the hip is a frequent cause of inability to stabilize the lower extremity during stance phase of running. This leads to several different compensations, all of which can result in injuries. These injuries may include ITB pain, hamstring and adductor strains, femoral neck stress fractures and patellofemoral pain, among others.
So, if you find that you are injured, think beyond your symptoms. Look at how you train and, most importantly, examine how you run. These two parameters are the root of most injuries.
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John Cianca, M.D., Physical Medicine & Rehabilitation
Medical Director, Chevron Houston Marathon
Dr. Cianca is a board certified specialist in Physical Medicine & Rehabilitation (PM&R). He was born in Rochester, N.Y. Upon graduating in 1988 from Albany Medical College, he completed a transitional internship at Mary Imogene Bassett Hospital in Cooperstown, N.Y., and then returned to Rochester to do his residency in PM&R at Strong Memorial Hospital at the University of Rochester.
In 1992 he moved to Houston, to do a musculoskeletal fellowship in the Department of PM&R at Baylor College of Medicine. Dr. Cianca began a private practice in July 2004, but continues as an adjunct associate professor with the Department of Physical Medicine & Rehabilitation at Baylor College of Medicine.
Dr. Cianca’s clinical interests are in musculoskeletal injury, acupuncture, viscosupplementation and biomechanics. His practice is based upon the principles of sports medicine, but he sees patients of all ages and levels of activity. His goal is to help people undertake their recreational and vocational pursuits with better understanding of their particular biomechanics. In 2005 he added musculoskeletal ultrasound to his practice. He uses ultrasound for both diagnosis and procedures.
Dr. Cianca teaches fellows, residents and medical students as part of his medical practice. He also is very involved in community-based education as part of the mission of the Human Performance Center which he founded in January 1994.
Dr. Cianca is a founding member of the American Road Race Medical Society. He has served as medical director for the Houston Marathon since 1998. Finally, Dr. Cianca is active in developing research in the areas of human performance and musculoskeletal medicine.