SCMS: Running Injuries by Tim Maiden

Recently, podiatrist Tim Maiden shared some tips with runners on how to prevent and manage running injuries – at a clinic held in preparation for the Standard Chartered Marathon Singapore (SCMS).

Currently working as a Senior Podiatrist at the Foot Practice clinic, Maiden has been based in Singapore since 2011. Prior to that, he had been working in Cambridge and London.

Tim Maiden shared some tips with runners at a recent SCMS clinic.

Introduction to running injuries

Said Tim Maiden, “Injuries are either intrinsic (caused by factors that can be controlled) or extrinsic (caused by factors that cannot be controlled). While age may sometimes be a factor, it should not hold runners back. Instead it is deficiencies in running form or gait that need to be addressed.”

Maiden also pointed out that if a recent injury is ignored and not given a chance to heal fully, it will remain there, even developing into a chronic pain. Said Maiden, “We always see people with chronic conditions in our clinic.”

What causes injuries?

According to Maiden the two key factors that may cause running injuries to occur, are:

Changes in loading – If your training regime goes up, say from 400 metres per week to one 800m run, then this may have massive implications and your body may not be able to cope with the sudden increase.
Repetitive loading – Doing too much running without taking sufficient rest, will cause injury, because running cause wear and tear and if the body is not allowed to heal, then that is where injuries happen.

Types of injuries

Plantar Fasciitis is a common cause of heel pain in runners.

Plantar Fasciitis – A common cause of heel pain that happens when the plantar fascia – a flat band of ligaments connecting the heel bone to the toes, gets inflamed.

Added Maiden, “This is a compressional injury and is linked to the compression of the heel bone. It will happen when you change your running shoes for example from heavy padded ones to minimalist ones, or when your running shoes become worn out but you continue to run in them. These happen because the shoes are unable to help the body absorb the shock any longer. We see this on a daily basis in our Singapore clinic.”

According to Maiden, about 50 per cent of runners will get this.

To treat this, Maiden recommends 3×12 sets of full heel raises, in order to stretch and strengthen the plantar fascia.

Achilles Tendonitis – When the achilles tendon – a band of tissue that connects calf muscles at the back of the lower leg to your heel bone – gets ruptured.

Said Maiden, “The achilles tendon is thought to be the strongest tendon in the body. It is actually not the strongest but it can still cope with a ton of tension before it ruptures. It gets torn because of repetitive tissue loading on a daily basis.”

He continued, “For example if you have an instability in your body or you are running with the wrong techniques then it will tear. Often something innocuous may cause it to tear.” Having weak glutes or knees may predispose runners to this condition.

To treat this, Maiden suggests that runners can do heel raises, but instead of complete heel raises, they only need to go up halfway till they are standing on their tiptoes. Says Maiden, “This loads the achilles tendon tissues and strengthens them.”

Medial Tibial Stress Syndrome – This is commonly known as shin splints and is caused by repetitive loading at the shin area.

Added Maiden, “Shin splints is actually a blanket term for all shin pain; this makes it hard to treat as there are actually more than 31 different diagnoses relating to shin pain and they are all different – some are bone related, whereby others are nerve related. There is no one fix all recipe for shin pain.”

To determine types of shin pain, in the clinic, Maiden will do a simple one legged hop test. He says, “If you can hop on one leg, chances are that it is not a bone fracture.”

He added, “With most shin pain you can carry on running, with a slight dip in performance, and the pain should go away; but if it does not disappear then you need to find out what the issue is.”

In the short term, using shock absorbing insoles, which Maiden can customise in his clinic, will work, but in the long term, strength and conditioning exercises are still the best solutions though.

Knee Pains – Said the podiatrist, “The knee is the most isolated joint in the body. It is away from the hips; at the same time away from the feet.”

As such if the pain is in the knee, this could mean that the issue could be caused by the hips/glutes or it could be an ankle instability problem. So this makes it hard to treat knee issues.

However there are tests to determine where the instability is being caused by, when it comes to knee pains. These include the single legged squat or the deep squat.

A blister that has just been ‘popped.’

Blisters – These are small bubbles on the skin filled with liquid.

Says Maiden, “Rubbing does not cause blisters. But if you press down on the blister, the finger is moving but the skin is not. Blisters are actually caused by bones moving under the skin.”

Maiden also added that Vaseline does not help with toe blisters – contrary to popular belief. He said, “Some of the requirements for causing blisters are high friction and pressure, moving bone and repetitive movements.”

Runners Nail – This is typically black or broken toenails in runners.

According to Maiden this is often caused by repetitive rubbing of the toes backwards and forwards inside the shoes. It also happens when the shoe is not the right size.

Says Maiden, “The most common thing to do is to pierce the nail to get the blood out; but sometimes it may be best to leave the nail alone or get a professional to do it properly.”

Choosing running shoes and shoe lacing techniques

Running shoes often come in pre-made sizes. Depending on your foot size it may sometimes be difficult to buy the perfect pair of shoes, as a result.

So Maiden suggests that modifying your shoe laces can make the shoe fit the foot, and thus lessening your chance of sustaining injuries as a result.

Says Maiden, “Orthotics and inserts are no way as effective as changing your lacing technique. Vaseline and rub-on gels are only effective for the first hour upon application.”

Ultimately, Maiden recommends that runners choose whatever shoe they are comfortable in – rather than buying into the hype about minimalist shoes, or the latest cushioned shoes and so on, though.

Running techniques

According to Maiden, if “it ain’t broken, then there’s no need to fix it” in terms of changing and adapting your natural running techniques.

He added, “Everyone will want you to run a new form or running technique in order to reduce your risk of injury; but regardless of what running technique you adopt, there is still stress coming to your body in some way or other. I think that you are best running what feels natural to you; the only time when I suggest that you should transition and change your running technique, is if you are having a chronic injury or pain that you are trying to prevent.”

Running Socks

Different types of socks cater to different runners.

For runners in humid climates such as Singapore, the podiatrist feels that using absorbent wicking socks are good, as these absorb the moisture, thus preventing the feet from becoming sticky and wet.

For preventing blisters, Maiden suggests that using two layered socks are good. He says, “They are really effective; these reduces sheer on the body.” As well, toe socks also go some way to reducing the chance of blisters according to Maiden.

While compression socks do have their place in the running world, Maiden admits that he is currently on the fence about their usage because he has not seen too much studies on them that prove their effectiveness. He says “They are nice to wear though and they do somewhat seem to help with blood circulation.”