Below the Belt: Common Athletic Injuries

In Canada, John Hooper, BEd, CPed(C), CPed, sees the same athletic injuries constantly. As owner/operator of Foot Health Centre-The Shoe Fits in Hampton, New Brunswick, Canada, and department head for pedorthic services at Metro Health Services in the Saint John Regional Hospital in Saint John, New Brunswick, he has plenty of patients with good intentions to exercise.

“For instance, every spring is plantar fasciitis season,” Hooper said.

Canada’s harsh winters force most people to exercise inside, and few maintain the intensity of their warm weather workouts.

“Everyone who has been relatively sedentary for 4 months … spring arrives and they are going to start running,” he said. “They hurt themselves, and it takes some time to get back.”

Common injuries and causes

Among the most common injuries for athletes are foot and ankle pains — plantar fasciitis, metatarsalgia and Achilles tendonitis — “shin splints” or medial tibial stress syndrome, and “runner’s knee” or patellofemoral stress syndrome. Although each of these has a slightly different cause, each develops from overuse of the muscle where the patient feels pain.

Plantar fasciitis

With this overuse injury, patients experience pain in the sole of the foot brought on by inflammation of heel tissue. This condition has no standard cause, but several factors can contribute. For some, plantar fasciitis develops as a result of repetitive strain or excessive mileage.

Hooper completes a thorough athletic history for the patient to determine specific trauma points.

“The ones that I see most commonly [are that] they came down on a heel too hard, and bruised or damaged the insertion point of the plantar fascia, which causes swelling and inflammation,” he said.


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Metatarsalgia encompasses any pain that occurs in the forefoot, between the arch and toes. This type of pain can be initiated by some sort of trauma or, more commonly, by ill-fitting shoes.

Achilles tendonitis

Inflammation of the tendon can develop from any number of activities, such as increasing distance or intensity too quickly, running up hills, and overpronation of the foot. Athletes with this condition notice gradual pain in the tendon during prolonged exercise that lessens with rest.

Medial tibial stress syndrome

Also known as “shin splints,” this syndrome causes tibial pain usually brought on by an overload on the shinbone and the surrounding tissue.

According to the Mayo Clinic, specific activities can trigger this pain, such as running down a slanted surface or participating in sports requiring running with quick stops, like basketball, soccer or tennis.

Patellofemoral stress syndrome

“Runner’s knee” causes pain surrounding the front of the kneecap when participating in activities that stress athletes’ knees, such as running, bicycling and skiing.

Hooper tends to see this syndrome in patients as a compensatory problem.

“They may have had a foot or ankle injury, compensated for that, and therefore the knee becomes strained,” he said.

Clearing up the initial problem often will help eliminate the knee pain.

Serious athletes

Hooper advises against what he calls the “terrible toos”: athletes pushing themselves too hard, too fast, too far and too often. Most of the athletes he works with fall into all those categories.

Cathy Simon, BSc, PT, physiotherapist/clinic owner of Active Physiotherapy Clinic in Saint John, New Brunswick, sees many patients who commit these common training errors.

People fail to realize that “one of the most important things is a proper training program,” she said.

Athletes in all sports are affected by these types of injuries. In soccer, basketball and hockey players, and others involved in aggressive sports, the most common injuries are traumatic. Players slam into each other, or get hit with a ball or puck, causing bruises and breaks on impact.

Runners, on the other hand, experience more microtrauma and repetitive strains, Hooper said. The frequency of these injuries, however, depends on the athletes’ experience levels.

The serious athletes who are involved in intense programs actually suffer from fewer injuries because they properly train. They find professional mentors to sculpt their routines for correct form and intensity. This group’s injuries tend to be chronic and flare up as the athletes increase their mileage over the years.

Affected athletes

“The groups I see that are more likely [to hurt themselves] are the new athletes, people who are just getting started in a running program,” Hooper told O&P Business News. “Or kids who are playing sports that they haven’t played much before.”

These young athletes need the most guidance because their habits will follow them throughout their lives. Those who develop poor training habits — lack of preparation, failure to stretch properly and low overall body strength, for example — will develop more injuries as a result.

Additionally, the older group experiences similar problems when starting an exercise program. People reaching their 40s and older find themselves needing to exercise for perhaps the first time in their lives, and may increase the intensity of their workouts too rapidly. The older group also may rely on training habits from their teen years that, as with those used by younger athletes, were not necessarily correct.

Many athletes of all ages who suffer from these injuries fail to seek treatment immediately. Hooper estimates that most of the patients he sees have had this problem for 2 to 3 months or longer.

“Pain is the best motivator,” he said. “They will reach a point where they either have to get [treatment] or stop what they are doing. If they are fairly serious athletes, they are not going to stop.”

By the time these patients see him for treatment, they are experiencing a fair amount of pain and Hooper and a team of physiotherapists, occupational therapists and other paramedical professionals set out to aid in recovery. At that point, an orthotic or a custom shoe often is not enough.

Multidisciplinary treatment

Hooper believes that prevention is the ideal treatment. To accomplish this, he recommends that athletes first create a training plan. This plan should take into consideration their current activity levels and gradually build in intensity until they reach their goals, which should be realistic and personalized.

Simon suggests supplementing any running program with a variety of other activities, such as flexibility work, core exercises, yoga, Pilates and weight training.

“Balancing out the running definitely can help prevent injuries,” she said.

Another critical factor in any sport is equipment, which encompasses anything from skates to sneakers to padding. Athletes must ensure their shoes not only fit well, but are appropriate for their gait and activity.

When assessing injuries, Hooper tries the simplest cure first. For example, he begins by examining the patient’s footwear to determine if it is appropriate. If a 2-week trial with new shoes fails to fix the problem, he then moves to an orthotic treatment like metatarsal pads or heel pads to correct any mechanical fault.

If these efforts are unsuccessful, Hooper refers the patient to a physiotherapist or another allied health professional to aid with interventions such as proper stretching and strength-building techniques.

“I happen to work in a hospital and in a clinic setting where I have [physiotherapists and athletic trainers] right next door to me, and that is extremely advantageous,” he said.

This multidisciplinary approach, he said, offers the patient a more thorough treatment than he could provide alone.

“We all have our areas of expertise,” Simon said. “Working as a team to treat and follow up with the patient is important.”

Athletic education

No amount of pedorthic or orthotic intervention can replace proper education, which is perhaps the most critical component of any athletic program. Hooper practices his advice, spending time outside the clinics educating athletes and patients with diabetes and arthritis.

Simon concurs with this approach, and works with each of her patients to customize a program based on their current needs. Even in patients who have the same goals or conditions, she ensures individual attention.

“Five people who have Achilles tendonitis, [should not do] the exact same exercise because everyone’s body mechanics are different, and how they run is different,” she said.

Group situations often prove invaluable for this instruction. Committed athletes should consider finding an experienced coach or group to help them condition their bodies and learn the sport. Running groups help new and experienced runners with form, preparation and motivation.

“Ideally new runners get in with a group that has a leader,” Hooper said. “Someone who can educate them and get them started, without them going out on their own and getting themselves injured.”

Even top-level athletes can neglect these preventative steps, despite knowing the consequences.

“I would encourage anyone who wants to get involved in vigorous physical activity to do a little planning and [research] before they begin in order to avoid injury and create a pleasurable experience rather than a painful one.”

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Stephanie Z. Pavlou is a staff writer for O&P Business News.

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