A runner I know fairly well just recently resumed his training after a six week lay-off due to injury. I couldn’t really perform a full, objective examination on him, so I’m only guessing that his injury involved a sprain of the left sacroiliac [SI] joint ligaments that left him unable to bear weight on that side – most particularly during the increased forces imparted during running – without severe pain. As the injury progressed and worsened with continued efforts to run, adjacent muscles became irritated and inflamed, adding to his woes. Eventually, he was forced to accept the inevitable and, after the necessary rest and healing period, has been able to gradually work his way back.
While I cannot diagnosis the nature of his injury with 100% certainty, I’m pretty sure I know the “how and why” of it. Stated simply, this runner, who should definitely know better, violated one of the cardinal rules of the sport: Thou shalt not wear new shoes for the first time for a long run!
The great majority (80-90% by most studies) of running injuries are due to training errors. Most of these can be placed in the too-many-miles-too-soon, overaggressive speedwork, steep hills category. Some training errors, though, are related to improper footwear. This may involve the wrong shape or cushioning characteristics of the shoe for an individual athlete, leading to biomechanical abnormalities. Knowing the particulars of running shoe construction can be a difficult thing for the average runner to know, however.
What isn’t difficult to know is the basic rule against wearing new shoes the first time for a distance greater than an average daily run. This holds true even when – as was the case with our runner – the shoes are the same model that have been worn for years without problems. Despite the stellar quality-control efforts by shoe manufacturers, the possibility of minor variations or imperfections always exists. Such variances may be enough to throw off a runner’s gait mechanics over the course of 15-20 miles, leading to increased stress on a joint or tendon.
In our present case, the problem was simply the result of tying one shoe improperly which, in combination with the stiffness of the new shoe, caused irritation to the tendons on the top of the right foot. Our runner, not wanting to ask his partner to stop so he could make the necessary adjustments, waited until the 5-mile water stop to do so. Although the shoe was fine afterwards, the damage had already been done: the left SI joint took an inordinate amount of jarring due to the limp our runner employed to compensate for the foot pain. The next 11 miles, while now mechanically sound, still added stress to already injured ligaments, further inflaming them.
This runner obviously could have avoided this, his first serious injury in 18 years, by heeding that first commandment, but the more important moral of this story comes from the knowledge that he still may have kept this injury at bay if he had just immediately heeded what his foot was telling him at the start of the run. A simple, 30-second adjustment of the laces in the first quarter-mile may well have made all the difference. Hopefully, the appropriate lesson has been learned and a recurrence will be averted.
But, just in case, I’ll be sure to remind him every morning when I see him in the mirror.
