Sports Injuries Are Weekend Warrior Woes

Ah yes, spring in Colorado when the lowlands are warm enough for a bike ride and the mountains just harvested freshies fit for a king. Whats a working athlete to do? Bike and ski in the same weekend, of course.

But, while we may have (or think we have) the energy to do it all after logging in 40 hours at the office, sometimes being a weekend warrior catches up to us. And when it does, it’s usually in the form of nagging knee pain, an aching back or some other ignored-it-another-weekend injury. Even if you’re not a weekend warrior and put in more hours training than the average Joe, you can end up in physical therapy with similar injuries, too.

Most of these aches and pains stem from a combination of overuse injuries and poor flexibility, not direct accidents. Avoiding these injuries requires intelligent prevention. If you have enough energy to scale a rock face, put in 50 miles on the road bike and carve up black diamonds in a single weekend, then you should have the guts to at least stretch before and after each adventure.

However, that’s easier said than done. Weekend warrior types tend to ignore reoccurring symptoms. The best thing you can do once you have an injury is to seek help when the injury is new. “We really advocate getting in early when you sense something’s wrong,” says Boulder Center for Sports Medicine’s Stephanie Somes, PT, ATC. “We can deal with it so much easier then.”

The most important thing to remember is that every person, and injury, therefore, is different. One runner’s knee pain could be the result of severe overpronation and improper shoe fit; another’s could stem from a tight thigh or calf muscle. So, while the injuries below are common in endurance athletes, their causes vary widely. On that note, here’s what physical therapists suggest you watch out for.

Warrior Woe: IT band syndromes

What It Is: The iliotibial band, better know as your IT band, is a thick, stubborn, hard-to-stretch muscle-tendon band that runs along the outside of the thigh from hip to knee. Inflammation of the band where it rubs against the outer knee can cause a burning or stinging sensation during running or similar repetitive, high-impact sports.

Causes: IT band tightness can result from numerous intrinsic problems or overtraining issues. For example, I visited Bernard Condevaux, PT, CSCS at Health South, complaining of significant pain in the front of my left knee. After several tests, Condevaux determined that my left leg was slightly longer than my right leg, which was causing tightness in the left IT band. That, coupled with my overdeveloped runners quads and underdeveloped inner quads, was pulling my kneecap out of whack and causing the tenderness.

Other intrinsic causes of tight IT bands can include muscle imbalances, foot pronation or bow legs. Sometimes training mistakes are to blame. Running regularly on imbalanced surfaces, ignoring poor shoe fit, neglecting stretching, or performing workouts that are too frequent or intense can also lead to tightness.

Solutions: Because its not really a muscle but a band of tendons, the IT band is difficult to stretch. Health Souths Brad Cooper, MSPT, ATC, MTC, sometimes recommends severe pronators wear a wedge in the shoe to lift up the appropriate part of the foot. Orthotics are also an option. In addition, soft tissue procedures like massage or rolling on Styrofoam tubes can break up the tightness.

Strengthening support muscles is another key solution. Practicing subtle side-angled leg lifts helps build up the gluteus medius (the side panel of the butt) that supports the IT band. Creativity works, too. Erika Jacob, a physical therapist at Denver Physical Therapy, touts a weird technique that involves baby oil and a plunger. Don’t ask, but apparently it’s less painful than the Styrofoam roller.

Prevention: Stretching, stretching, stretching. Build an extra 10 minutes into your scheduled workout to stretch. Condevaux recommends holding stretches for 60 seconds or more. And dont neglect your glutes and inner quad muscles at the gymbuilding a balanced lower body can help fend off IT band issues.

Warrior Woe: Patello-femoral syndromes

What It Is: Activity-related pain at the patello-femoral joint space where the kneecap connects to the thigh bone. Often felt in both knees, this syndrome typically ignites during exercise. Pain can be spread out or localize at the inner or outer kneecap. Pain increases during exercise and subsides during rest. However, the pain may return when you’ve been sitting for periods with bent knees. Sometimes you’ll hear a “crunching” sound when you move the knee or it may feel like it’s “giving out.”

Causes: Whats important to remember, says Colorado Rehabilitations Dr. Scott Primack, is that its really one big chain of pulleys and levers. That is, often patello-femoral pain is associated with other issues such as a tight IT band or foot pronation.

Solutions: Physical therapists become scientists when diagnosing this injury. With so many unique causes, its up to the doctor to decide if you need to strengthen your inner quad muscles, for example, get better shoes or work on loosening your hamstrings. Prevention: Buy shoes from a qualified sports store such as Boulder Running Company. Watch yourself on the treadmill, learn about your pronation issues, and choose a shoe by its fit, not by its fashion statement. Since patello-femoral syndromes are typically brought on by overuse, cut back or, even better, cross-train. Sometimes experienced runners adapt to the pain and end up with another problem, Somes says. Dont do that either.

Warrior Woe: Lower back pain

What It Is: Most commonly an aching low back pain is associated with endurance sports such as biking. Typically the iliopsoas, near the lumbar spine, tightens with each upstroke on the bike pedal, for example. The shorter and tighter the muscle becomes, the more trouble it can cause.

Causes: Anytime you are bringing your knee to your chest, you are shortening that muscle, says Condevaux, who, in addition to working at Health South, is the physical therapist for the U.S. National Mountain Bike Team. We also see lower back pain a lot in triathletes who are in their aerobars for extended periods of time, says Condevaux, adding that for many athletes time is a limiting factor and for those looking to get in a ride, stretching beforehand and warming up is often overlooked.

Solutions: Condevaux tests for flexibility to help create customized solutions. In addition, hell do some soft tissue work on the area. He recommends building up the abs to take pressure off the hip flexor and the iliopsoas.

Somes says her staff looks very closely at bike fit. “We adjust bike heights or use a cleat shim which lifts up the front of the foot.”

Prevention: First, get a qualified bike fit. Make sure youre not creating the problem with your equipment. Learn how to do a set of back strengthening exercises properly; dont cheat. Somes also highly recommends cross-training, working on your posture, and stretching through yoga or Pilates.

Warrior Woe: Plantar fasciitis

What It Is: The plantar fascia is the thick ligament band in the bottom of the foot that attaches to the heel and runs to the ball of the foot. The plantar fascia offers little give, and unless your feet are perfectly aligned, can begin to pull on the heel. Inflammation of the band where it attaches to the heel causes pain in the bottom of the heel or arch when you first stand up, but may let up once you start walking. However, the inflammation usually returns with repetitive walking or heel-thumping running. Its easy to imaine why this happens: Each time we step, all of our body weight rests on the heel of one foot, then moves through the entire foot as we flatten our step.

Causes: Often this syndrome is caused by intrinsic issues such as high arches, flat feet or inward pronation. Tight calf muscles or a tight Achilles tendon will also add to the potential for developing this painful injury. In addition to overtraining, shoes with little arch support or stiff soles can add to the problem.

Solutions: This one is especially hard to heal and is very painful because it doesnt get any rest, Jacob says. Youre always walking on that same foot. And when you begin to favor your forefoot or opposite foot, you add new stress and potentially new injuries. A physical therapist will first look at orthotics. Pronation issues can be alleviated with several adjustments, from custom-made footbed inserts to more stable shoes, which will essentially re-train the intrinsic muscles in the foot.

Prevention: Obviously, this one involves learning your foot motion and finding the best shoes for your running and walking styles. Jacob suggests a lot of calf stretching, changing shoes on regular basis and listening to your body.

Learn to love your shoes, Cooper adds. “Once you find a type that you like, buy two pairs because it’s the moisture from sweat that breaks the shoe down.” Also remember to wear running shoes for running, not shopping or lifting weights, and to change them every 500 miles regardless of visible wear.

Now that you know what to watch out for, train smart.

Amateur triathlete Julie Moyers has found yoga and cross-training to be the best solutions for her IT band woes.