Archive for the 'Bones and Joints' Category

Q: I’m training for a marathon right now—my first! I know that I’ll have to push my body during training, but I’m terrified of getting injured. What’s the best way to tell the difference between tired legs and muscles on the brink of injury? –Carla

This is a great question, and one that every runner should consider! The ability to listen to your body is the single greatest tool you can possess in order to successfully navigate the demands of marathon training. In the simplest terms: The better you understand your body, the better runner you can become.

The key is to learn when your body is telling you “I’m tired,” and when it’s screaming “Stop!” First, understand that fatigue is a necessary component of training. Running puts stress on muscles, causing the body initially to break down and later to repair itself. This is how you get stronger and faster.

“Good pain” is when you push just beyond your comfort zone—if you run a little farther or a little more quickly than your body is used to. If you finish a tempo run and your legs feel a bit heavy, this is normal and safe. Good pain goes bad when you become so tired that your form breaks down. If you have to compensate or alter your stride in order to finish a workout, you’ve just crossed over to the dark side.

To prevent bad pain from turning worse, watch for your body’s “yellow flag” alerts. Reconsider the tempo run scenario: One mile into your workout your right hamstring is hurting so badly that it creates a hitch in your stride. This is your body telling you to stop the run, walk home and take a few days off to let your leg recover.

In most cases, if you heed your body’s yellow flags immediately, you will only need a small amount of time to heal. Too often, a marathon runner is so nervous about finishing every single workout in her plan that she runs right through the yellow alerts into the red zone. When this happens, serious injuries occur—the recovery process may last weeks versus days, and can force withdrawal from a planned race.

Allow your body to be your guide and never ignore your yellow flags. Follow these simple tips to ensure you stay on the streets rather than the sidelines. . .

#1 Build a base before you start training.

If the first week of your training program includes a long run of eight miles, but the farthest you’ve run recently is only five miles—hold off. Start from your current fitness level rather than where the training program begins, and allow yourself enough time to build an adequate foundation. The stronger you come into the training season, the more likely you are to withstand the demands of training, recover optimally and succeed without aches, pains and injuries.

#2 Change up your pace.

Many runners fall into the trap of maintaining the same pace for every workout. In reality, your pace needs to ebb and flow. An easy run should always be completed at an easy pace, which will vary depending on how you feel on a given day. This may be a 10-minute-per-mile pace on Monday, but an 11-minute pace on Friday after you’ve had a stressful week at work. Base your pace on effort rather than your watch.

#3 Slow down for long runs.

Increasing your mileage puts stress on your body. You don’t want to burn the candle at both ends by running fast as well. Keep your long runs at a pace at which you can talk in complete sentences. Remember, this pace will vary based on the day and the elements. Train from within.

#4 Be wary of localized pain.

Sore legs are one thing, but a sore lower calf is another. Pay extra attention to pin-pointed discomforts, as these can often cause poor running form due to compensation.

#5 Never push through aches to stay on schedule.

Sure, your knee has a niggling ache, but you need to get in your speed workout this week. One more run won’t hurt it, right? Wrong! It’s a tough pill to swallow, but skipping the workout to allow your muscles to heal can be the difference between making it to the starting line and applying for a deferral. Cross train with a low-impact activity, stretch and self-massage until the bad pain goes away.

In the United States, approximately 7,000 total shoulder replacements were performed each year from 1996 through 2002. Generally, shoulder damage can be treated without surgery. However, if the pain continues to be severe and the shoulder does not respond to treatment over a period of three to six months, surgery may be advised. One of the most common surgeries is to the rotator cuff. This area refers to the muscles and tendons that cover the shoulder joint and hold the ball and socket joint in place. Usually, problems with the rotator cuff are the result of torn tendons, which can occur from overuse or injury.

Other specific conditions that sometimes require shoulder surgery are damage to the joint lining, usually as a result of arthritis, as well as torn ligaments or a loose shoulder joint. A surgeon will take a close look at the cartilage, bones, tendons and ligaments of the shoulder to assess damage before repairing damaged tissues.

In shoulder surgery, damaged tissue around the rotator cuff is replaced. Recovery time after surgery varies, usually from one to six months, during which time physical therapy is important to ensure the full range of movement is regained. Individuals who have had shoulder surgery can return to physical activity and playing sports after a period of time.

According to the American Academy of Orthopedic Surgeons, over 250,000 knee replacement surgeries, or arthroplasties, are performed in the United States each year. Most of these surgeries are for individuals over the age of 65. However, more and more surgeries are being performed on younger patients. The first knee replacement was performed in 1968. Since then, advances in surgical technique as well as replacement knees have changed the field of knee replacement surgeries.

The complexity of knee replacement surgery depends on whether one knee or both knees are being replaced. In cases of those afflicted with arthritis (who usually have pain in both knees) both knees are often replaced at one time, rather than having two separate surgeries. In other cases, doctors recommend operating on one knee at a time so that the unaffected leg can aid movement while the leg that was operated on heals itself. Replacing both knees is known as bilateral total knee replacement, or bilateral knee arthroplasty.

During knee surgery, the damage part of the joint is removed and the surface of the bone is replaced so that an artificial joint can be attached. A period of four to five months of physical therapy is required after knee surgery, a process which begins when the patient is still in the hospital after surgery. Individuals who have had surgery can engage in low-impact physical activity, such as swimming or waling, and can eventually select high-impact sports.

According to the American Academy of Orthopedic Surgeons, more than 231,000 total hip replacements are performed each year in the United States. About 85% of artificial hip joints last 20 years before the components begin to break down and the joint needs to be replaced. In a hip replacement surgery, an artificial hip joint is implanted. Currently, there are two ways to perform hip replacement surgery: either traditionally, or using a minimally invasive procedure.

During standard hip replacement surgery, the “ball” and “socket” of the joint is removed and replaced with new, artificial joints. After surgery, the patient stays in the hospital for four to six days, where weeks-long physical therapy begins. It should be noted that the replacement hip joint is meant only to aid with day-to-day movement; those with artificial hips should avoid sports or heavy activity.

It is estimated that, in 2010, about 4,400 surgeries will be performed to replace arthritic or injured ankles with artificial joints. The two most common types of surgery involving the ankle are ankle fusion, also known as ankle arthrodesis, and ankle replacement. Either surgery may be performed after all other options have been exhausted. Individuals who often have ankle surgery are those would have arthritis or a worn-out and painful ankle caused by serious injury or fracture.

In an ankle fusion surgery, cartilage is removed from both sides of the joint so that bone will fuse onto bone. The ankle is kept in place during healing using a metal frame placed outside the body. It usually takes about 12-15 weeks for the bones to fuse. In ankle replacement surgery, the ankle joint surface is replaced with an artificial implant. A bone graft is often used to encourage the bones to fuse.

Today, many doctors practice a procedure called arthroscopy to help diagnose joint problems, repair joints during surgery, and monitor healing after surgery. In an arthroscopy, the surgeon is able to view joints and the surrounding soft tissues by inserting a small viewing instrument into the area near the affected joint. Arthroscopy is a very common procedure when examining or operating on the knees, shoulders, and ankles.

If all other forms of treatment fail to address joint pain, surgery may be necessary. Each year, more than 770,000 hip and knee replacements are performed in the United States. Although surgeries are common, a doctor should work carefully with a patient to determine if surgery is the only option. Physical exams and thorough diagnostic testing, as well as further tests to closely examine the bones, include:

A radiograph or x-ray, which is useful for revealing fractures or other damage to the bone.

A computed tomography, or CAT scan, which generates three-dimensional images of the joints

Magnetic resonance imaging (MRI), which uses a large magnet, radio waves, and a computer to generate a picture of the joint. MRI’s can revel ligament injuries, as well as damage to the tendons and bones.