By Jacqueline A. MacDonald
There's no such thing as a good running injury--only a good sportsmed specialist to cure it.
© 1999 42K(+) Press, Inc.
Most runners know the withdrawal symptoms that come with being injured: moodiness,
jitters, excess undirected energy, guilt. When injured you'd give almost any material
possession for a cure. And yet too often runners rely on self-diagnosis rather than
consulting with a specialist. We fear being told not to run, which is often the typical
prescription from a family doctor. But if you find the right specialist before your minor
ache becomes a full-blown injury, you might be able to keep training and speed the healing
process. Shouldn't finding a good sports medicine specialist be more important than
finding a good auto mechanic? We're dealing with your body here, and with your passion.
Yet many runners wait too long to find a specialist they trust.
I recently learned the hard way that any ol' doctor will not do when it comes to treating
running injuries. My odyssey in search for a cure began when my trusted sports podiatrist
died. This podiatrist had kept me running injury-free in a pair of custom-made orthotics
for five years. I had begun to believe I was invincible. But when I let my orthotics wear
down before going in for a tune-up, all my old injuries began to flare at once: runner's
knee, Achilles tendinitis, plantar fasciitis.
In a rush for a cure, I made an appointment with the first doctor I could find—not a
running specialist. To make a long story short, I continued training without proper
treatment; my injuries got worse and set off a string of new inflammations that sidelined
me for the entire spring racing season. As the injuries progressed, I consulted with other
specialists who lacked experience with runners—a chiropractor who prescribed more cooked
vegetables, a podiatrist who worked primarily with diabetics and could not figure out how
to adjust my orthotics properly—further delaying the healing. I am now on the verge of a
cure with help from a sports podiatrist, orthopedic surgeon, and physical therapist
experienced in helping runners, but I could have saved months of down time and hundreds
of dollars had I consulted with these experts in the first place.
How can you avoid making a similar mistake if you're injured? How can you figure out which
type of specialist you should see to treat your specific injury? How do you find one near
you who is qualified to work with runners?
A variety of medical and related professionals can help you with your injury: podiatrists,
orthopedists, sports medicine physicians, physical therapists, athletic trainers, massage
therapists, sports chiropractors. Which type of specialist you should see will depend on
the nature of your injury, but there's a large overlap among some of the professions. In some cases, a team involving more than one type of specialist may be necessary. The information that follows tells you which injuries different professionals can treat and what special expertise and treatment methods they can offer.
Keep in mind that regardless of the type of specialist you see, you'll want to find one
with considerable experience in treating running injuries. Not all specialists are created
equal in this regard, as I learned the hard way. Some of these professions have national
governing bodies that can supply lists of qualified specialists in your area, while others
do not. In any case, word of mouth is the best way to find a specialist who works
specifically with runners. Talk to other runners you know, your local running club,
or your local running-shoe store.
Doctors of podiatric medicine (DPMs) specialize in medical and surgical management of
foot and ankle disorders. Poor foot biomechanics can be the underlying cause of many common
running injuries, not only in the foot but also in the legs. According to Perry Julien, a
sports podiatrist who has served as medical director for the national indoor track and
field championships, podiatrists are your best bet for correcting biomechanical problems.
"Podiatrists tend to be much more biomechanically oriented" than other types of specialists,
says Julien. If you need orthotics, consult with a podiatrist, but podiatrists can provide
other types of treatment as well.
Like MDs, podiatrists can prescribe medication and perform surgery. To be licensed as a
DPM, podiatrists must complete four years of podiatric medical school. The first two years
are similar to medical school, and the second two years focus on the lower extremities.
Most podiatrists complete a one- to three-year residency, focusing on surgery.
At your first visit, you'll give a sports podiatrist a thorough history of your training
program and your injury. He or she will assess the injured area, sometimes using X-rays
and other testing methods. Together, you will then discuss and establish a treatment plan,
which may or may not include making orthotics to control foot biomechanics and prevent
future recurrence of the injury. You may also be referred to physical therapists, massage
therapists, or other specialists.
The American Academy of Podiatric Sports Medicine can provide a list of qualified sports
podiatrists in your area. Contact the podiatric academy at 800/ 438-3355, or visit the Web
site at http://www.aapsm.org.
Orthopedists are MDs who specialize in musculoskeletal problems of the upper and lower
extremities and the spine. An orthopedist who specializes in sports medicine will be
qualified to treat essentially any running injury to the foot, knee, hip, or back. They
are often the last stop for treatment after all conservative measures have failed and
surgery is required. Raj Pandya, an orthopedist who works with ultrarunners and collegiate
athletes, says he often receives referrals from other specialists who have unsuccessfully
tried treatments such as ice, anti-inflammatories, orthotics, and physical therapy.
Orthopedists have MD degrees and complete five years of residency in orthopedic surgery.
Orthopedists such as Pandya who focus on sports injuries may also complete an additional
year of residency in sports medicine.
Word of mouth is the best way to find an orthopedist who treats runners. Once you've identified possible orthopedists, make sure they are board certified by the American Board of Orthopedic Surgery.
Internal Medicine/Sports Medicine Physician
Sports medicine physicians (SMP)—doctors in internal medicine with a specialty in treating
athletes—can assess everything from stress fractures, knee problems, and tendinitis to
other medical disorders associated with running. They are the best choice, though, for
treating systemic illnesses related to running. "The SMP will frequently diagnose and
treat anemias (low blood count), gastrointestinal symptoms, nutritional concerns, eating
disorders, and cardiac issues such as palpitations and chest pain," says sports medicine
physician Kimball Johnson. Sports medicine physicians also can treat exercise-induced
asthma and diagnose the symptoms of overtraining. While sports medicine physicians can
diagnose orthopedic injuries, if these do not respond to initial treatments such as
cortisone injections, ice, and strengthening exercises, the physician may refer you to
a podiatrist or orthopedist. Or, if a podiatrist or orthopedist is not recommended to you,
you may need to seek one out for yourself.
Sports medicine physicians have MD degrees, three years of residency in primary care or
internal medicine, and often two to three years of additional training in a sports medicine
fellowship program. While some sports medicine physicians work exclusively with athletes,
this is rare; most also continue their general practice in internal medicine.
Sports medicine physicians should be members of the American College of Sports Medicine, but this organization does not keep referral lists.
For running injuries, look for a physical therapist who specializes in assessment and
treatment of athletic injuries. Physical therapists (licensed as PTs) can help speed the
recovery of lower back pain and soft tissue injuries such as muscle pulls, tendinitis,
plantar fasciitis, runner's knee, and ankle sprains. "PTs help to restore their patients'
functional levels and train patients to perform activities of daily living in ways to
prevent injury," says physical therapist Robert Medcalf.
Physical therapists usually work in conjunction with a doctor or podiatrist, and many
states require physician referrals for physical therapy. Even in states that do not require
referrals, insurance companies typically will not cover
the costs without one. Generally, then, consulting with a podiatrist, orthopedist, or
sports medicine physician is necessary prior to seeing a physical therapist.
If you visit a physical therapist, expect to be treated with a variety of methods to
relieve pain and restore function. Pain relief techniques include ultrasound, electrical
stimulation, and hot/cold treatments. The therapist may use massage to relieve pain and
restore function. Typically, the therapist will prescribe a range of stretching,
strengthening, and posture exercises that gradually allow you to resume normal activities.
At your first visit, a physical therapist will ask about the nature and causes of your
injury. He or she will then do a variety of tests to determine your range of motion and
strength in the injured area and to assess the integrity of your joints, muscles, tendons,
and ligaments. You will then be recommended a treatment plan, based on your rehabilitation
Following the initial visit, you'll begin a rehabilitation program that typically requires at least two to three visits per week to the physical therapist over several weeks. If caught early, soft tissue injuries may need four weeks of physical therapy, but more advanced injuries will need more time. Sessions generally last an hour to an hour and a half. A typical session might begin with a 10-minute warm-up on a stationary bike, followed by a series of stretching exercises, followed by strengthening exercises using weight equipment or isometrics focused specifically on the injured area. The session might end with ultrasound, massage, and ice treatments. Of course, the specifics of the treatment plan vary with the injury.
Qualified physical therapists have, at minimum, a four-year college degree in physical
therapy from an accredited program. Most programs now also offer a master's degree, and
some offer doctoral degrees. After graduation, candidates must pass a national licensing
exam; states may impose additional requirements.
Many private physical therapy clinics (listed in the Yellow Pages) advertise sports
medicine services. You can ask whether the therapists have postgraduate certifications
in orthopedics and/or sports medicine, and whether any are runners themselves. The
American Physical Therapy Association (APTA) can provide you with information about
certified orthopedic or sports phys-ical therapy specialists. Reach the APTA at
800/999-2782 or via the Web at http://www.apta.org.
Once your injury is diagnosed, athletic trainers can help you design a treatment
program to rehabilitate your injury, resume training, and prevent the injury from
recurring. Athletic trainers are licensed as ATCs (athletic trainer, certified). They have
qualifications similar to those of physical therapists, but their training focuses
specifically on rehabilitation of sports-related injuries, while physical therapists are
broadly trained to treat physical ailments brought on by a range of causes (including auto
accidents or occupational activities). As with physical therapists, in some states,
physician referrals are necessary before an ATC can begin treatment.
Your typical first visit with an athletic trainer begins with a thorough history of your
training program and injury history. The trainer then discusses and suggests a
rehabilitation program tailored to your injury. According to athletic trainer Bud Cooper,
himself a lifelong runner, programs will vary depending on the individual's physique, age,
motivation, and training goals. "Getting the individual to buy into the program is key,"
Your program may involve stretching and strengthening exercises similar to what a
physical therapist would prescribe, as well as special treatments to reduce inflammation.
Athletic trainers are schooled in helping injured athletes cope with the psychological
stress of being away from the sport—a familiar problem to any runner who as ever been
injured—and can help you design a program to maintain your cardiovascular fitness and
relieve stress while your injury heals.
Athletic trainers start their training with two years of college at a four-year
institution and then complete two years focused on management of sports injuries.
Their training covers five basic areas: injury prevention, injury recognition and
evaluation, injury rehabilitation, health care administration, and counseling.
The National Athletic Trainers' Association (NATA), the accrediting group that sets
guidelines for education of athletic trainers, has presidents in every state who may be
able to help identify qualified trainers in your area. Contact NATA at 800/879-6282 or
via the Web at http://nata.org for a list of state presidents.
Massage therapists work the soft tissues of the body—muscles, tendons, and
ligaments—to alleviate pain or stress symptoms. According to massage therapist Nan Webb,
who specializes in working with runners, the types of injuries that respond best to
massage treatment are tendinitis and chronic muscle tightness. Massage works for
tendinitis because releasing muscle stress can alleviate the pull on the tendon.
"Tight muscles demand more tendon flexibility, and tendons are not by nature very
flexible," says Webb. "Massage is also a good choice to work out areas of chronic
tightness, to help to increase flexibility, and to alleviate those little nagging
aches and pains."
Runners can benefit from massage both to help with recovery from injury and as part
of a regular maintenance program to prevent injuries. Massages received after a hard
workout or race can reduce the build-up of metabolic by-products in muscle tissues and
speed the athlete's recovery. Sometimes competitive runners may have a massage before or
during competition (such as between events on the track) to prevent injury and help loosen
During your first massage session, the massage therapist will ask about specific areas
of tightness or irritation. You'll undress to your underwear (or running shorts) and lay
under a sheet on a massage table. A typical full-body massage lasts an hour and costs $50
to $70; many massage therapists also offer the option of working on specific body parts
for less time.
Finding a qualified massage therapist is especially important, because improperly
applied massage can aggravate some injuries, such as muscle tears and herniated disks.
Massage will not alleviate the symptoms of nerve and joint pain.
Though there are several hundred massage schools around the country, only about half of
the states have laws requiring massage therapists to be licensed. In states with license
laws, basic educational requirements for receiving the license range from 300 to 1,000
hours of study; the therapist can then receive a license as an LMT (licensed massage
therapist). If your state does not license massage therapists, look for membership in the
American Massage Therapy Association (AMTA) and/or certification by the National
Certification Board for Therapeutic Massage and Bodywork. The latter organization's
certification exam is now also the accepted licensing exam in many states.
Therapists who have passed the exam hold the credential of CMT (certified massage
therapist). The AMTA offers a certification in sports massage, but according to Webb,
many qualified sports massage therapists have not taken the certification exam.
The AMTA (847/864-0123 or email@example.com) can provide lists of qualified
massage therapists in your area.
Doctors of chiropractic (DCs) specialize in assessing the alignment of the
musculoskeletal system, so they are best suited for helping with injuries that may have
been caused by a musculoskeletal imbalance. Examples of running injuries most commonly
treated by sports chiropractors include those of the pelvis and lower back, as well as
any injury of a muscle group or tendon that originates in the pelvis or lower back. Hank
Glass, a sports chiropractor who works with several world-class runners and with track
athletes from Georgia Tech and the University of Georgia, says the injuries he treats
most frequently in runners include iliotibial band friction syndrome (an injury with
symptoms felt in the knee), piriformis syndrome (with symptoms in the thigh and buttock),
and hamstring strains.
Chiropractors cannot treat fractures or lacerations. They also cannot prescribe
medication. Conditions requiring use of anti-inflammatories or other drugs will require
that you consult with a physician.
At your first visit to a sports chiropractor, expect him or her to analyze the motion of
your body during running, in some cases with the help of X-rays, and to test the strength
and flexibility of key muscle groups. The chiropractor will then assess whether a
biomechanical problem led to your injury and determine the underlying cause of the
biomechanical problem. Next, the chiropractor will manipulate your body to readjust your
spine, pelvis, and extremities as necessary. Some chiropractors perform these manipulations
by hand; others use special instruments. The chiropractor then should prescribe a program
of strengthening and stretching exercises to maintain the new alignment.
General training for a chiropractor usually is a four-year undergraduate program similar
to that of a premed student, followed by four years of graduate training in chiropractic
medicine. Chiropractors also must pass national and state licensing exams.
If you believe that your injury could benefit from chiropractic treatment, be sure to find
a chiropractor who specializes in working with runners. According to Glass, the
chiropractor "must understand the stress biomechanics of running." Many types of
chiropractors lack experience with runners, so it's important to choose carefully.
Certifications in sports chiropractic are possible, but clinical experience with
athletes is more important in determining whether a chiropractor is qualified to treat
running injuries, according to Glass.
State chiropractic licensing boards can provide listings of chiropractors with
different specialties. The American Chiropractors Association (800/986-4636 or
http://www.amerchiro.org) and International Chiropractic Association also can provide
information (800/423-4690 or http://www.chiropractic.org). As usual, though, the best
sources for referrals in your area are other runners.
As you sort through the list of specialists to figure out where to start,
remember that it's critical to find someone who understands running.
"Finding a specialist who understands running injuries is more important than
what type of specialist you see," says Pandya. Also, when you make that first
appointment, be sure to ask lots of questions. "Runners need to take responsibility for
their care," says Julien. And be aware that the first stop may not be your last.
Your specialist may need to refer you elsewhere for part of your treatment.
But be patient, and you will run again. It might take effort and patience to find a
specialist who is a great match for you, but once you find one who can keep you running
injury free for years to come, I think you'll agree it's worth it.