Dr. Feel Good
Injured runners need special treatment.
Here's how to get the help you deserve.
By Jennifer Pirtle
Wade Smith was no stranger to
physical activity when he took up running four years ago. After
all, he'd raced motorcycles, ridden mountain bikes, and cycled
in road races all his adult life. But eight months into his new
sport, he developed a sharp pain on the outside of his right knee.
The pain, which kicked in after a mile or two of running, would
steadily worsen until he couldn't continue. When he asked his
family practitioner for a referral to a sports-medicine specialist,
the doctor was less than sympathetic. "He told me that if
it hurt to run, then I should stop running," says Smith,
35, a financial reports manager for a Pittsburgh-based chemicals
company.
Smith pressed for the referral
and eventually got it. "The specialist wanted to know about
any training changes I'd made and what surfaces I ran on,"Smith
says. "He took X-rays, examined my running shoes, measured
my
muscles and my leg length, and inspected my posture."
The diagnosis? Illiotibial band
syndrome, a common overuse injury involving the ligament that
runs down the outside of the thigh. Smith did have to reduce his
mileage and cross-train. But after two months of physical therapy,
which included active stretching and weight training to strengthen
his hip and quad muscles, Smith was pain-free and back to his
usual distance and intensity. As Smith discovered, just as it
makes sense to buy your running shoes from a salesperson who knows
the difference between motion-control and cushioning shoes, it's
also smart to seek out a sports-medicine specialist who understands
an athlete's body.
Active Training
To become a sports-medicine specialist, doctors and orthopedic
surgeons choose a voluntary one- or two-year specialized sports-medicine
fellowship following their medical school and residency requirements.
This extra training focuses on musculoskeletal structure, sports-related
injuries, and rehab techniques. Direct exposure to active people,
such as high school, college, and pro athletes, gives the doctors
a hands-on knowledge of the type of clientele they'll treat. "A
sports-medicine specialist knows what an athlete is going through
and what he or she is trying to accomplish,"says Andrew Tucker,
M.D., medical director of Union Memorial Hospital of Sports Medicine
in Baltimore and the head team physician for the NFL's Baltimore
Ravens. "We're both on the same page in terms of the ultimate
goal. Even if getting back to a certain level of one activity
is not appropriate, we can help them get that 'runner's high'
in other ways, such as through cross-training."
Tailored Rehab
As part of an initial consultation, a sports-medicine specialist
will try to identify how the injury developed. For example, is
it a result of a training error (too much, too soon)? Are shoes
or running surfaces to blame? Is it a
biomechanical problem, such as a muscle imbalance? Once the cause
is discovered, the specialist will design a tailored program to
prevent the injury from recurring. Movements that stretch, strengthen,
and balance muscles are key, as is allowing the runner to rest
without experiencing loss of conditioning. "Instead of running,
we might substitute other forms of activity rather than having
them cut out exercise altogether,"says James Irrgang, Ph.D.,
vice chairman of clinical services in the department of physical
therapy at the University of Pittsburgh's School of Health and
Rehabilitation Sciences.
Cool Tools
It's not necessary for a sports-medicine expert to be affiliated
with a university, but the competitiveness of collegiate and pro
sports means that these doctors are likely to have the most up-to-date
tools at their fingertips. While costly high-tech machines can't
replace knowledge and experience, first-rate equipment can enable
sports-medicine doctors to treat patients more quickly and effectively.
Videotaping your stride in an on-site running clinic could help
a specialist better understand your pattern of motion and how
it ties in to your injury. Or he might put you on a variable-speed
underwater treadmill to duplicate dry-land running while avoiding
wear and tear on your joints, as doctors at the University of
Pittsburgh do. John Xerogeanes, M.D., chief of sports medicine
at Emory University Orthopedics and team physician at Georgia
Tech in Atlanta, uses the Dornier device, a high-pulse ultrasound
used in hospitals to break up kidney stones, to loosen tight Achilles
tendons.
Finding a Specialist
Although many sports-medicine experts work with high-profile athletes,
you don't have to be an Olympic marathoner to benefit from their
knowledge and experience. "Only about 12 percent of our patients
are collegiate or
professional athletes,"says Dr. Xerogeanes. The American
Osteopathic Academy of Sports Medicine (aoasm.org) is a good place
to look. Also, ask your running peers--word of mouth can lead
you to a good doctor. If someone says they're a sports specialist,
ask if he is fellowship-trained and if he cares for athletes?
"Some might have the training,"says Dr. Xerogeanes,
"but might never treat athletes in their day-to-day practice."
Sports-medicine specialists are typically covered by insurance
plans. Even so, most runners would agree that a good sports doc
who respects--and doesn't simply dismiss--their commitment to
running is priceless.
Strong Medicine
Runners don't take injuries lying down. Here, John Xerogeanes,
M.D., chief of sports medicine at Emory University Orthopedics
in Atlanta, gives recommendations on how to fight four common
injuries.
1) Illiotibial Band Syndrome
Where It Hurts: Pain and swelling at the outside of the
knee.
Treatment: Fewer miles, or no running at all (cross-training
instead), stretching, ice, anti-inflammatory drugs.
2) Patellofemoral Pain Syndrome
Where It Hurts: Tenderness behind or around the kneecap,
toward its center. Often worsened by squatting or descending stairs.
Treatment: Cut mileage; avoid knee-bending activities;
stretch and strengthen the muscles around the kneecap.
3) Shin Splints
Where It Hurts: A general pain along the shin.
Treatment: Rest, rest, rest. Cross-train instead of running,
then resume running gradually for short distances and
cross-train between runs. Also ice and stretch.
4). Plantar Fasciitis
Where It Hurts: A sharp pain in the arch or on the heel,
usually worst in the morning.
Treatment: Stretch the calf muscle, massage the bottom
of the foot using a golf ball, ice after running, take antiinflammatories,
wear inserts, orthotics, or night splints.
