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Over half a million people participate in marathons each year, and millions more enjoy running in shorter races and at their leisure. Aaron Keil, DPT, is a physical therapist and the Johns Hopkins Outpatient Rehabilitation Manager at The Johns Hopkins Hospital. He is a long-time runner, and is an expert in treating the foot and ankle, ranging from casual runners to professional runners. Dr. Keil recently spoke about preparation, pain, treatment and other common concerns among runners. Have you run in a marathon? Share your photos.

Q: What is the most common injury faced by runners?
A: Knee injuries are the most common, including IT band tendonitis and lateral knee pain as well as issues with the knee caps. The second most common injury is foot and ankle injuries, such as plantar fasciitis.

Q: Do more experienced runners face different types of injuries than new runners?
A: The main cause of injury for runners is related to abnormal stress on the body, so whether you are just starting out with running and are increasing your distance too quickly, or are already running 50 miles a week and increasing that by a few extra miles, the body can only handle so much stress over a certain period of time, and trying to accommodate this stress too quickly is what often causes injury.

Q: When should someone seek medical attention?
A: The length of time a person has had an injury plays very largely into how long it will take for them to get better. The longer the pain has been going on the more difficult it is to undo. It is often difficult for runners to realize when there is a problem, because running as a sport can be inherently painful. In general, if a runner has pain that is sharp and localized and happens repeatedly you should probably see someone. General muscle soreness is common after runs, but should not last more than a few days. If discomfort lasts more than a week it is important to see someone before the problem gets worse.

Q: Are there more holistic approaches to treating pain?
A: While often there is a short-term fix, pain can be a reflection of many other things happening. for instance, sometimes it is an issue with the hip that is causing someone’s knee pain, and while we can temporarily help the person feel better, the problem will return unless we address the larger issue causing the abnormal tissue stress.

Q: What kind of exercises to you recommend for runners?
A: The core area is very important — and is more than just the abdominal area that people think of. The mid-section of the body, from the mid back to the knees, are all part of the core and need to be addressed. I think that it’s also important to focus on endurance and how these muscles can function over time. When Muscles fatigue is when bad things can happen to runners, so it is important to make sure specific muscles can last over time.

Q: What is the best way to avoid injury?
A: One of the most important is avoiding too much too soon. Whether you are a seasoned runner or new to the sport, pushing your body too hard too quickly may result in injuries. A general rule is the body will react to too much stress over a short period of time (in the form of pain and injury) but will respond to stress by getting stronger if that stress is applied over a longer period of time.

Q: What do you think of the barefoot running and minimalist shoe trend that has risen in the past few years?
A: At first, I had been hesitant to believe there was any good science behind this trend. I used to tell my patients that each foot type should be matched with a certain shoe type for an optimal outcome. However, study after study has shown that this does not matter as much as we previously thought, Essentially, we’re starting to see that those runners that transition into a minimalist shoe over the right period of time, almost always change their running style to more effectively absorb the impact forces of running. This ultimately may lead to a significant reduction in injury risk.

Q: How does one begin running with minimalist shoes?
A: There is a risk of getting injured when changing shoe type, and Achilles tendonitis is higher with forefoot runners, so it is important to gradually change your shoes to build up tolerance. The arch muscles in your feet are not used to flat running, but for most people this will get stronger over time. The best way to start is to spend more time barefoot or in thin sandals, not just running but also walking around the house to prepare your feet. After a few weeks of that you can start running with a minimalist shoe for 25 percent of your run, and after a few weeks of that increase to 50 percent, and gradually work your way to running only in minimalist shoes.

Q: Do you ever suggest people give up running?
A: Barring a severe medical problem, there’s no reason that someone cannot return to running or become a runner. Many people say they have a bad knee or some other problem that prevents them, but my belief is that with the right treatment most of these issues can be resolved.

Q. What’s the latest research related to running and foot and ankle injuries?
A: Running related injuries of the foot and ankle are oftentimes the result of overtraining (too much stress, too soon). The overall health benefits of running far outweigh the risks that may be involved.

Q. What kind of treatment does Physical Medicine and Rehabilitation offer?
A: We can usually help runners get out of pain fairly quickly with a variety of treatment options: deep tissue mobilization, focus on restoration of appropriate flexibility and strength, the use of real-time ultrasound technology to more accurately assess muscle function in real-time and finally, we have some amazing technology that allows us to measure specific force data while someone runs in real-time, coupled with slow motion video.

Q. Are there any health risks for runners?
A: The only one I can think of is doing too much too soon. However, if you do have a specific medical condition (osteoporosis, neuropathy, etc.) consulting a medical professional before running may result in a more successful and rewarding experience.

Where can people find more information?

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