Quick brief on medical aspects of running

1. MEDICAL PERSPECTIVE ON
RUNNING AND HIKING INJURIES

2. COMMON HIKING INJURIES
• Patellofemoral pain syndrome (Runner’s knee)
• Iliotibial Band Syndrome
• Sprains
• Meniscal injuries
• Blisters
• Patellar tendonitis (Jumper’s knee)

3. Anatomy of the Knee

4. Anatomy of the Knee
• Bones: Femur, Tibia, patella
• Ligaments: Anterior and posterior collaterals
ligaments. Medial and lateral cruciate
ligaments.
• Mensici: Distributes weight over the surface of
the joint and functions as a shock absorber or
cushion. Two menisci, lateral and medial.

5. Patellofemoral Pain Syndrome
• Pain behind the kneecap.
• How does it occur?
-Can occur from overuse of the knee in sports
activities as running, walking, jumping, bicycling,
or hiking. With repeated bending and
straightening of the knee, irritation of the inside
surface of the patella can occur due to the
articulation of the patella in the knee joint.
• Pain is typically worse when participating in the
aggravating activities listed above.

6. Iliotibial Band Syndrome
• Pain on the outer side of the knee.
• How does it occur?
-Occurs when the iliotibial band rubs over the bump of the
femur (thigh bone) near the knee, causing irritation. Most
commonly occurs in running.
• Factors include:
1. Having a tight iliotibial band
2. Having tight muscles in your hip, pelvis, or leg
3. Your legs not being the same length
4. Running on sloped surfaces
5. Running in shoes with a lot of wear on the outside of the
heel.

7. Sprains
• A sprain is an injury that causes a stretch or a
tear in a ligament. Ligaments are strong bands
of tissue that connect bones at a joint.
• How does it occur?
-Twisting or severe stretching of the joint.
Sudden stopping (ACL).

8. Meniscal Injuries
• Cartilage is tough, rubbery, smooth tissue that
lines and cushions the surface of the joints. If a
meniscus tear occurs, it can cause knee pain and
can limit motion. Clicking is a sign, in some cases,
of a meniscal tear during examination tests.
• How does it occur?
-A meniscal tear or injury can occur when the
knee is forcefully twisted or sometimes with or
no trauma, such as when squatting.

9. Blisters
• A blister is a bubble of fluid under the outer layer of skin.
The fluid may be clear or red with blood, or pus.
• How does it occur?
-Blisters are caused by your skin rubbing against something
are called friction blisters. These are the most common.
-You may get blisters on your feet if your shoes or socks
don’t fit well and rub uncomfortably. Athletes and hikers
(MARINES) are highly susceptible.
• Smaller blisters should be left to drain naturally. Larger
blisters should NOT be drained in an environment where
infection can occur. See a corpsman or medical provider for
guidance and/or assistance with drainage, or dressing.

10. Patellar Tendinopathy (Jumper’s Knee)
• Tendons are strong bands of connective tissue
that attach muscle to bone. Tendinopathy,
opposed to tendonitis (inflammation) or
tendinosis (micro-tears), refers to both
inflammation AND micro-tears.
• How does it occur?
-Most commonly, jumping. Other activities
such as running, walking, bicycling, or hiking
may also lead to patellar tendinopathy.

11. Prevention
• Prevention is the responsibility of all Marines up and
down the chain of command as well as the medical
personnel accountable for the health and well-being of
their motivated, hard-charging, war-fighters.
• But Doc, how on earth can I ever prevent injuries? Of
course your knees hurt, you just walked 12 miles with
80 pounds on your back. It’s probably just a case of
vaginitis.
• Not true gentlemen, your unit corpsmen have
preventative measures and medical knowledge entirely
at your disposal! Follow me on this journey.

12. Proper Footwear
• Running shoes, boots.
1. Foot Type
-Most people do not walk perfectly. They tend to put more of their body
weight on either the inside of the outside of the foot. If your foot leans
too far to the outside its called over-supination, and vice-versa to the
inside, is called over-pronation.
I. Over-supination factors:
a. You have a high arch.
b. The bottom of your shoe is worn more on the outside.
I. Over-pronation factors:
a. You have a low arch.
b. Your ankle rolls inward when you walk.
c. You have calluses under the big toe or the ball of your foot.
d. The sole of your shoe is worn out on the inside.

13. Proper Footwear
• What is the right shoe for me?
-Once you’ve identified your foot type, you can start looking for
proper running shoes.
I. Over-pronator
 You need a shoe that will provide some degree of motion control
and stability. Buy hard insoles that support the arches (i.e.
Sofsole)
I. Over-supinator
 A shoe with good cushioning is important.
o It is important to realize, however, that cushioning is important in
both over-supinator and over-pronators. Good shoe cushioning
and form fitting shoes will correct your technique and take less
pressure and strain off of hotspots for pain.

14. When should I replace my footwear?
• It is recommended by most athletes to replace
footwear every 500 miles.
• Midsoles of shoes (the middle of the sole near
the arch) tend to lose their effectiveness after
600 miles of use, depending on weight, and
material used.

15. Over-pronators (Flat Footed)

16. Over-supinator (High arches)

17. Worn Cushioning on Sole of Footwear

18. How to Treat Injuries
• By and large the treatment will be the same
for most injuries.
• RICE – Rest, Ice, Compression, Elevation
• NSAIDS – Non-Steroidal Anti-Inflammatory
Drugs (Motrin, Naproxen)
• Ice Therapy-Place and ice pack on your knee
for 20-30 minutes every 3 to 4 hours for the
first 2 to 3 days.

19. Red Flags for Injuries
• Shooting pain
• Severe 7/10+ pain
• Deformity
• Fever, chills, night sweats, malaise associated with joint
pain.
• Loss of sensation or pulse lower than the injury.
• Knees giving out or locking
• Evidence of trauma, bruising and open wounds.
• Tingling, numbness, swelling, decreased range of motion,
weakness.
Please report to medical personnel if any of the symptoms are
present.