Running Injuries with Dr. Jason Tarno

Running has been a popular sport since the 1970’s. Because of the climate in Las Vegas, many people enjoy running year round. What are some common injuries that runners sustain?

Most of the injuries that runners sustain are due to the chronic impact of the lower extremities, ie: the feet, shins, and knees. The common injuries to the feet involve fractures, stress fractures, tendonitis, and plantar fasciitis. The common injuries to the shins involve shin splints and tibial stress fractures. The knees can present with pain to the kneecap or to the actual joint itself.

What is the difference between a fracture and a break?

The term fracture is the medical term for a broken bone. The meaning is the same, and the words are used interchangeably.

What is the difference between a fracture and a stress fracture?

A fracture is caused when a bone is overloaded by some outside stress. Usually this outside stress is an acute twist or impact of the bone. A stress fracture occurs when the bone is overloaded over time. Initially, the bone tries to adapt to increases in stress by laying down more bone. However, if the impact, or stress is more than what the bone can keep up with, eventually the bone starts to develop microfractures. This causes pain. Pain is a signal to the body to stop or back off from the activity that is being performed. If the athlete does not listen to their body and continues to impact the bone, eventually the bone can completely fracture.

What is plantar fasciitis?

The plantar fascia is a band of tissue that is on the plantar aspect (or bottom) of the foot. It begins at the heel bone (calcaneus) and attaches to the toes. It acts to support the tendons and the arch of the foot. With overuse, the tissue can become inflamed and tight. This disorder is very common in runners and can be tough to treat in active people.

You mention the arch of the foot. Are people affected differently if they have flat feet vs. a high arch?

If the arch of the foot has flattened out (flat foot), the impact of running is increased in the foot because the shock absorption that the arch provides is not present. The foot becomes floppy, and without the shock absorption that the arch provides, the first and second toes take on a lot more of the impact load. This can lead to stress fractures in the toes. If the arch of the foot is too high, the foot becomes rigid. The impact load then travels up the leg to the shins (tibia), knees, or hips. Occasionally, even the low back takes on some of the load.

What is the difference between shin splints and a stress fracture?

The term shin splints is also known as medial tibial stress syndrome. As the name implies, there is stress to the medial or inside aspect of the tibia (shin bone). The stress does not refer to the bone itself; however, but to the muscles that attach to the tibia. A stress fracture, as detailed above, is an actual defect in the bone itself.

You mentioned above that runners could injure their knees. Can you expound on that?

Runners do not often twist or hyperextend their knees during their activity like football or soccer players do. Running is a straight ahead, impact type of sport. Most of the problems; therefore, have to do with degenerative disorders. The shock absorbers in the knee called the meniscus can become thinned and lead to degenerative tears. This can lead to swelling in the knees. Occasionally, the undersurface of the kneecap, or patella, can become inflamed as well. Exercises for the quadriceps can help pain in this area.

It seems like there are a lot of disorders that can happen with running. Do you recommend against running as an activity?

No. Many people love to run, and simply, cannot function without their daily run. I think that if someone is having constant pain with their activity, they should see their sports physician, because it could be the start of something significant, as described above. There is another population of people that run because they think that they have to run in order to “get in shape” or lose weight. Those people need to know that there are other activities that can provide aerobic benefits without the constant impact to the lower extremities.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com

Frozen Shoulder with Dr. Jason Tarno

Las Vegas is a place where people of all ages tend to be very active. Tennis, racquetball, and golf are activities that many people enjoy even in their later years. In these sports the shoulder can become injured, and these athletes can wind up with a stiff shoulder. What is this stiffness and why does it occur?

Stiffness of the shoulder is known medically by the term adhesive capsulitis. This term refers to a tightening of the shoulder capsule that covers the shoulder joint. It was first described in the late 1800's, and is defined as a condition of the shoulder that is characterized by painful restriction of motion of the shoulder. It tends to affect women more commonly than men, and is seen most often in the fifth, sixth, and seventh decades of life. It can occur in either the dominant or non-dominant shoulder.

How is this different from “frozen shoulder?”

There is no difference. Both terms refer to the same disease process and are used interchangeably in the medical literature.

What are the causes of this type of shoulder stiffness?

Causes of adhesive capsulitis can be broken down into primary causes and secondary causes. In primary causes, the individual cannot identify a specific injury. Researchers are still attempting to identify the cause in these cases. Secondary causes stem from injuries such as fractures or rotator cuff injury. Other secondary causes stem from diseases such as thyroid disorder or diabetes.

Do x-rays show anything?

The diagnosis of adhesive capsulitis is really made on clinical exam. Painful range of motion with restriction of motion is the real key to diagnosis.

What is the treatment for this disorder?

Treatment consists of range of motion exercises. Physicians write a prescription for physical therapy, and the patient works closely with a therapist to increase their shoulder motion. The patient is monitored every four to six weeks for progress on their motion. If improvement is measured, then therapy is continued. If the patient seems to plateau or decrease their range of motion, a procedure called manipulation under anesthesia is performed.

What is manipulation under anesthesia?

The patient is taken to the operating room and given anesthesia to allow them to relax and to go to sleep. Once the patient is asleep, the orthopedic surgeon takes the arm and moves the shoulder through its range of motion to break down scar tissue. Once the patient awakens they are placed on medication for pain and they resume their physical therapy routine.

Are medications helpful?

Occasionally a steroid injection is offered to help with pain and inflammation. This also can aid in the progress of physical therapy. If the patient has diabetes, care must be taken in monitoring glucose levels, because steroid injections can elevate sugar levels.

How long does this problem usually last?

This disease process can last for as short as 6 months to as long as 2 years, and sometimes even longer. The key is to find a good physical therapist, to keep a positive attitude, and not to give up. Most patients do well with treatment.

- Jason M. Tarno, D.O., is Board Certified and Fellowship trained in Sports Medicine. Dr. Tarno is an associate of Crovetti Orthopaedics and Sports Medicine.

For further information call: 990-2290.

Or visit us at: www.CrovettiOrtho.com