Achilles tendonitis is a painful and often debilitating inflammation of the Achilles tendon, also called the heel cord. The Achilles tendon is the largest and strongest tendon in the body. It is located in the back of the lower leg, attaches to the heel bone (calcaneus), and connects the leg muscles to the foot. The Achilles tendon gives us the ability to rise up on our toes, facilitating the act of walking, and Achilles tendonitis can make walking almost impossible.


Side View of Foot Back View of Foot
& Calf Muscles

Click on the images to view a larger version.

There are three stages of tendon inflammation:

Peritenonitis
Tendinosis
Peritenonitis with tendinosis
Peritenonitis is characterized by localized pain during or following activity. As this condition progresses, pain often develops earlier on during activity, with decreased activity, or while at rest.
Tendinosis is a degenerative condition that usually does not produce symptoms (i.e., is asymptomatic). It may cause swelling or a hard knot of tissue (nodule) on the back of the leg.

Peritenonitis with tendinosis results in pain and swelling with activity. As this condition progresses, partial or complete tendon rupture may occur.

Incidence and Prevalence
Achilles tendonitis is more common in athletes and overall incidence of the condition is unknown. It occurs in approximately 6–18% of runners.

Risk Factors and Causes

Poorly conditioned athletes are at the highest risk for developing Achilles tendonitis. Participating in activities that involve sudden stops and starts and repetitive jumping (e.g., baseball, basketball, football, tennis, running, dancing) increases the risk for the condition. It often develops following sudden changes in activity level, training on poor surfaces, or wearing inappropriate footwear.

Achilles tendonitis may be caused by a single incident of overstressing the tendon, or it may result from a series of stresses that produce small tears over time.

The condition also develops in people who exercise infrequently and those who are just beginning an exercise program, because inactive muscles and tendons have little flexibility because of inactivity. It is important for people who are just starting to exercise to stretch properly, start slowly, and increase gradually.

In some cases, a congenital (i.e., present at birth) condition causes Achilles tendonitis. Typically, this is due to abnormal rotation of the foot and leg (pronation), which causes the arch of the foot to flatten and the leg to twist more than normal.

This condition causes the lower leg muscles (e.g., gastrocnemius, soleus) to stretch more than normal. Like a rubber band, the further the muscles stretch, the tighter they become. The force on the Achilles tendon and the heel bone increases, resulting in Achilles tendonitis. Because the arch of the foot naturally flattens over time, especially in athletes, Achilles tendonitis often develops later in life.

Women who wear high-heeled shoes often and switch to sneakers for exercise also can develop Achilles tendonitis. The Achilles tendon and lower leg muscles gradually adapt to a shortened position because the shoes prevent the heel from stretching all the way to the ground. When this occurs, wearing sneakers or flat shoes forces the Achilles tendon to stretch further than it is accustomed to, causing inflammation. If high heels are worn everyday, stretching should be done every morning and night to keep the Achilles tendon lengthened.

Signs and Symptoms

In most cases, symptoms of Achilles tendonitis develop gradually. Pain may be mild at first and worsen with continued activity. Repeated or continued stress on the Achilles tendon increases inflammation and may cause it to rupture. Partial or complete rupture results in traumatic damage and severe pain, making walking virtually impossible and requiring a long recovery period.

Patients with tendinosis may experience a sensation of fullness in the back of the lower leg or develop a hard knot of tissue (nodule).

Treatment for Achilles tendonitis depends on the severity of the injury. If heel pain, tenderness, swelling, or discomfort in the back of the lower leg occurs, physical activity that produces the symptoms should be discontinued.

If the problem returns or persists, a medical professional should be consulted. If pain develops even with proper stretching and training techniques, the patient should consult a podiatrist to check for hyperpronation and adequate arch support. The addition of an orthotic may be enough to maintain good arch and foot alignment and eliminate pain.

If damage to the tendon is minor, the injury may respond to a simple course of treatment known as RICE (rest, ice, compression, elevation). Patients are advised to:

rest the tendon by keeping off their feet as much as possible;
apply ice packs for 20 minutes at a time every hour for a day or two to reduce swelling;
compress the ankle and foot with a firmly (not tightly) wrapped elastic bandage; and
elevate the foot whenever possible to minimize swelling.
A nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen may be used to reduce pain, swelling, and inflammation.
Additional treatment may be required if injury to the tendon is severe, if mild Achilles tendonitis does not respond to basic treatment, or if symptoms return with the resumption of physical activity.

A flexible cast may be used to immobilize the foot and reduce swelling, and crutches may be used to keep weight off the foot. This treatment may be necessary for up to 8 weeks.

If the injury responds to this treatment, the patient may then be advised to wear low-heeled shoes and perform rehabilitation exercises (e.g., physical therapy) to gradually stretch the tendon before full activity is resumed.

Severe Achilles tendonitis, tendon rupture, or tearing away from the heel bone may require surgery and lengthy rehabilitation. Surgery involves removing the tendon's inflamed outer covering and reattaching the torn tissues.

Following surgery, patients undergo passive range of motion physical therapy and progressive strengthening exercises for 2–3 weeks. Most activities can be resumed in 6–10 weeks and competitive sports usually can be resumed after 3–6 months.

Prevention

Proper conditioning and appropriate footwear are the best defense against Achilles tendonitis. People who engage in physical activity should always warm up (e.g., jumping jacks, light jogging) and stretch properly before beginning the activity. Cold muscles are inflexible and working them hard without stretching causes excessive stress to the muscles and tendons.

If discomfort occurs, the activity should be discontinued immediately and ice should be applied to the affected area to relieve inflammation. If the problem persists or recurs, medical evaluation is necessary. It may be advisable to consult a physical trainer to determine whether a flaw in technique is contributing to the problem.

Iliotibial band syndrome (ITBS) is a common cause of pain in the outer (lateral) side of the knee. ITBS is also a common overuse injury in runners. The iliotibial band is a belt-like band of tissue that runs from a muscle on the outer side of the hip, the tensor fascia lata, down the outer side of the thigh and attaches to the outer side of the patella and the tibia. Other muscles of the hip also attach to the iliotibial band and together with the tensor fascia lata control outward hip movement (abduction). The iliotibial band also provides stability to the lateral side of the knee.

ITBS is usually the result of overuse or over training. ITBS is found predominantly in runners and is often associated with changes in training such as a sudden increase in distance or intensity. Running on uneven surfaces such as the shoulder of the road may also cause ITBS, most commonly in the "downhill" leg. Other predisposing factors include prominent lateral femoral condyles or tight iliotibial bands.

As mentioned above, the pain from ITBS is felt on the lateral aspect of the knee. The pain may also radiate up the lateral aspect of the thigh or around to the front of the knee. The pain is usually made worse by repetitive flexion and extension movements of the knee. Initially, the pain may only be felt during a run. If training continues, pain may be felt even at rest.

On examination of the knee the iliotibial band is usually tight. There is often tenderness of the iliotibial band where it passes over the lateral femoral condyle. When pressure is applied to the lateral femoral condyle and the knee is repetitively flexed and extended the pain that is felt during training can often be reproduced. X-rays are usually normal.

Treatment of ITBS may include relative rest, icing, medications to reduce inflammation and pain, stretching, and strengthening exercises. Doctors and physiotherapists

Proper sports nutrition is often the most neglected part of a runners training. The entire message here is as follows:

Eat right and you'll perform better.

It's that simple.

Your body functions best, and you perform better, when your diet includes the right kinds of foods in the right amounts at the right times. The following sports nutrition information will enable you to put together your ideal diet, one that will help you achieve your ideal body weight, and get the most out of your running. You'll learn the basics of good sports nutrition. Finally, you'll learn how to hydrate and fuel your body before, during and after your workouts.

Listed below are the sports nutrition topics we will be discussing in this section:

Carbohydrates
Fats
Protein
Water
Vitamins/Minerals/Supplements
Eating Before, During, and After a Run
General Nutrition Tips for Runners
Top Running Nutrition Recommendations

Carbohydrates
Why are carbohydrates so important?

Here's the easy one-word answer: Energy!

Carbs (as they're sometimes referred to), are your body's main source of energy for aerobic exercise. Your body coverts the carbohydrates you eat into glucose (a simple sugar). Glucose is then immediately used by your body for energy or is stored in the muscles as glycogen. Glycogen stores are utilized by runners and help keep you from "bonking" or "hitting the wall". You've run out of carbohydrates if you have to slow dramatically to continue running.

So, how do you keep from "hitting the wall" or running out of glycogen stores?

The trick is to store energy by eating carbs on a continuous basis. Experienced runners focused on meeting their nutrition needs eat the right carbs in the right amounts at the right times! Experts recommend that your diet should consist of 60 to 65% carbohydrates. This amount will keep your muscles well-fueled so that you can meet both your nutrition and training goals.

Carbohydrates are broken down into two basic categories:

Simple carbohydrates
Simple carbohydrates are the most basic form of sugar. Examples of foods containing simple carbohydrates are candy, fruit and sodas. These foods can provide a quick burst of energy-but it's only temporary. For this reason, you should keep simple carbohydrate snacks to a minimum. But feel free to enjoy a treat every now and then, especially after a good run.

Complex carbohydrates
Complex carbohydrates provide energy on a more consistent, long-term basis. That's why experts recommend that the majority of the calories you get from carbohydrates be in the form of complex carbohydrates. Foods that are high in complex carbohydrates include cereals, pasta, breads, rice, potatoes, and vegetables. It's important that you maintain a diet high in complex carbohydrates to support your running program and meet your sports nutrition needs.

Fats
Fats, in many cases, get a bad rap. The confusion lies in how much fat is healthy in your diet as well as the type of fat you should be eating.

So what's the bottom line?

Your body needs fat but not all fats are created equal!

Each type of fat is okay in limited amounts, but some fats better meet your running nutrition needs than others. Fats are classified as:

Saturated
Poly-Unsaturated
Mono-Unsaturated

Saturated fats
Saturated fats are easy to spot. They remain solid at room temperature. Common examples include red meat and dairy products. These fats are required by the body in small amounts and should make up just 10% of your overall caloric intake.

Poly-unsaturated fat
These fats stay semi-solid at room temperature. Many margarine and butter alternatives as well as vegetable oils are made with poly-unsaturated fats. Poly-unsaturated fats are a step closer to the "good" fat you should make a staple of your diet. However, you can go one step farther.

Mono-unsaturated fat
Mono-unsaturated fats are liquid at room temperature. Examples include olive oil and most other natural oils. Recent studies have shown that diets with a higher proportion of mono-unsaturates seem to reduce the risk of heart disease and better meet your sports nutrition needs. As a result, you should obtain 20 to 25% of your daily calories from fats with the majority of those coming from mono-unsaturated fats.

Protein
As you exercise and eat right, you'll feel your body getting stronger.
Why?

Proteins absorbed during consumption.

Protein helps to build muscle and tendons, repair broken down muscles, and regulate hormones. Meats, eggs, beans and nuts are common examples of foods that contain significant amounts of protein. Experts agree that runners need 10 to 20% of their daily calories from protein.

Most people, however, eat two to three times their protein requirement each day!

As a runner, your increased caloric intake needed to maintain a sufficient energy level for running should be more than enough to meet your recommended protein and nutrition requirements.

Water
Did you know that water makes up between 60-70% of your total body mass? Although water doesn't provide energy (or calories), your body requires large amounts of H2O in order to function properly. It's a running nutrition requirement.

Water regulates the core temperature of your body. As you run, your working muscles produce large amounts of heat that must be released in order to prevent your core temperature from rising to dangerously high levels. To dissipate this heat, your body perspires causing water loss and potential dehydration.

As a runner, you should consistently hydrate yourself during both warm and cold weather. By the time you are thirsty, your body is already suffering from dehydration, causing your running to suffer, and putting you at risk. Most runners fall short on their fluid replacement and manage only to replace about half of their losses. You know you're drinking enough water if you urinate about once an hour and it is clear.

Finally, spread out fluid intake during the day to maintain steady water levels and remember to drink past the feeling of thirst to adequately replenish lost fluid.

Vitamins/Minerals/Supplements
Concerned that your running nutrition needs are not being met? In most cases, all you have to do is follow the advice your Mom gave you: Eat a varied, well-balanced diet.

A varied, well-balanced diet will include plenty of fruits, vegetables, and non-processed foods. One way to ensure that you are getting all the fruit and vegetables you need is to eat them as healthy snacks throughout the day. While fruits are an obvious snack, crispy handfuls of carrots, celery, cucumbers or other favorite vegetables make great desk foods. Juices are also a great way to consume your daily allotment of fruits and vegetables. The advantages of juices include helping to keep you hydrated, contain a wide variety of vitamins and minerals, and they provide a source of energy all day long.

In recent years, several major studies have shown that it makes sense for runners to supplement their normal dietary intake with the antioxidants vitamins C and E and betacarotene. Vitamin C can be obtained easily through either fruit juices or supplements. Vitamin E, on the other hand, is not so easily obtained within the diet. Sports nutrition supplementation is an answer. Shoot for 30 to 200 international units per day.

If your diet is somewhat unbalanced and/or you feel you need some sports nutrition insurance, daily multi-vitamins with minerals are the answer

What is the patellar tendon?
The patellar tendon connects the kneecap (the patella) to the shin bone. This is part of the 'extensor mechanism' of the knee, and together with the quadriceps muscle and the quadriceps tendon, these structures allow your knee to straighten out, and provide strength for this motion. The patellar tendon, like other tendons, is made of tough string-like bands. These bands are surrounded by a vascular tissue lining that provides nutrition to the tendon.

What causes patellar tendonitis?
Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called "jumper's knee."

When overuse is the cause of patellar tendonitis, patients are usually active participants of jumping-types of sports such as basketball or volleyball. Patellar tendonitis may also be seen with sports like running and soccer. Also, some patients develop patellar tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.

What are the symptoms of patellar tendonitis?
Patellar tendonitis usually causes pain directly over the patellar tendon. Your doctor should be able to recreate your symptoms by placing pressure directly on the tendon. The other common symptom of patellar tendonitis is pain with activities, especially jumping or kneeling. Less common, but not unusual, is swelling around the tendon itself.

What is the treatment for patellar tendonitis?
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee-if an activity hurts in the area of the injured patellar tendon, then you should rest from that activity. Your doctor may prescribe anti-inflammatory medication to take by mouth. Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once you do resume activities. Also, icing the area of patellar tendonitis after being active can help to minimize symptoms and accelerate healing. Occasionally, your doctor will provide a support strap (called an infrapatellar strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

Iliotibial band syndrome (ITBS) is a common cause of pain in the outer (lateral) side of the knee. ITBS is also a common overuse injury in runners. The iliotibial band is a belt-like band of tissue that runs from a muscle on the outer side of the hip, the tensor fascia lata, down the outer side of the thigh and attaches to the outer side of the patella and the tibia. Other muscles of the hip also attach to the iliotibial band and together with the tensor fascia lata control outward hip movement (abduction). The iliotibial band also provides stability to the lateral side of the knee.

ITBS is usually the result of overuse or over training. ITBS is found predominantly in runners and is often associated with changes in training such as a sudden increase in distance or intensity. Running on uneven surfaces such as the shoulder of the road may also cause ITBS, most commonly in the "downhill" leg. Other predisposing factors include prominent lateral femoral condyles or tight iliotibial bands.

As mentioned above, the pain from ITBS is felt on the lateral aspect of the knee. The pain may also radiate up the lateral aspect of the thigh or around to the front of the knee. The pain is usually made worse by repetitive flexion and extension movements of the knee. Initially, the pain may only be felt during a run. If training continues, pain may be felt even at rest.

On examination of the knee the iliotibial band is usually tight. There is often tenderness of the iliotibial band where it passes over the lateral femoral condyle. When pressure is applied to the lateral femoral condyle and the knee is repetitively flexed and extended the pain that is felt during training can often be reproduced. X-rays are usually normal.

Treatment of ITBS may include relative rest, icing, medications to reduce inflammation and pain, stretching, and strengthening exercises. Doctors and physiotherapists

Proper sports nutrition is often the most neglected part of a runners training. The entire message here is as follows:

Eat right and you'll perform better.

It's that simple.

Your body functions best, and you perform better, when your diet includes the right kinds of foods in the right amounts at the right times. The following sports nutrition information will enable you to put together your ideal diet, one that will help you achieve your ideal body weight, and get the most out of your running. You'll learn the basics of good sports nutrition. Finally, you'll learn how to hydrate and fuel your body before, during and after your workouts.

Listed below are the sports nutrition topics we will be discussing in this section:

Carbohydrates
Fats
Protein
Water
Vitamins/Minerals/Supplements
Eating Before, During, and After a Run
General Nutrition Tips for Runners
Top Running Nutrition Recommendations

Carbohydrates
Why are carbohydrates so important?

Here's the easy one-word answer: Energy!

Carbs (as they're sometimes referred to), are your body's main source of energy for aerobic exercise. Your body coverts the carbohydrates you eat into glucose (a simple sugar). Glucose is then immediately used by your body for energy or is stored in the muscles as glycogen. Glycogen stores are utilized by runners and help keep you from "bonking" or "hitting the wall". You've run out of carbohydrates if you have to slow dramatically to continue running.

So, how do you keep from "hitting the wall" or running out of glycogen stores?

The trick is to store energy by eating carbs on a continuous basis. Experienced runners focused on meeting their nutrition needs eat the right carbs in the right amounts at the right times! Experts recommend that your diet should consist of 60 to 65% carbohydrates. This amount will keep your muscles well-fueled so that you can meet both your nutrition and training goals.

Carbohydrates are broken down into two basic categories:

Simple carbohydrates
Simple carbohydrates are the most basic form of sugar. Examples of foods containing simple carbohydrates are candy, fruit and sodas. These foods can provide a quick burst of energy-but it's only temporary. For this reason, you should keep simple carbohydrate snacks to a minimum. But feel free to enjoy a treat every now and then, especially after a good run.

Complex carbohydrates
Complex carbohydrates provide energy on a more consistent, long-term basis. That's why experts recommend that the majority of the calories you get from carbohydrates be in the form of complex carbohydrates. Foods that are high in complex carbohydrates include cereals, pasta, breads, rice, potatoes, and vegetables. It's important that you maintain a diet high in complex carbohydrates to support your running program and meet your sports nutrition needs.

Fats
Fats, in many cases, get a bad rap. The confusion lies in how much fat is healthy in your diet as well as the type of fat you should be eating.

So what's the bottom line?

Your body needs fat but not all fats are created equal!

Each type of fat is okay in limited amounts, but some fats better meet your running nutrition needs than others. Fats are classified as:

Saturated
Poly-Unsaturated
Mono-Unsaturated

Saturated fats
Saturated fats are easy to spot. They remain solid at room temperature. Common examples include red meat and dairy products. These fats are required by the body in small amounts and should make up just 10% of your overall caloric intake.

Poly-unsaturated fat
These fats stay semi-solid at room temperature. Many margarine and butter alternatives as well as vegetable oils are made with poly-unsaturated fats. Poly-unsaturated fats are a step closer to the "good" fat you should make a staple of your diet. However, you can go one step farther.

Mono-unsaturated fat
Mono-unsaturated fats are liquid at room temperature. Examples include olive oil and most other natural oils. Recent studies have shown that diets with a higher proportion of mono-unsaturates seem to reduce the risk of heart disease and better meet your sports nutrition needs. As a result, you should obtain 20 to 25% of your daily calories from fats with the majority of those coming from mono-unsaturated fats.

Protein
As you exercise and eat right, you'll feel your body getting stronger.
Why?

Proteins absorbed during consumption.

Protein helps to build muscle and tendons, repair broken down muscles, and regulate hormones. Meats, eggs, beans and nuts are common examples of foods that contain significant amounts of protein. Experts agree that runners need 10 to 20% of their daily calories from protein.

Most people, however, eat two to three times their protein requirement each day!

As a runner, your increased caloric intake needed to maintain a sufficient energy level for running should be more than enough to meet your recommended protein and nutrition requirements.

Water
Did you know that water makes up between 60-70% of your total body mass? Although water doesn't provide energy (or calories), your body requires large amounts of H2O in order to function properly. It's a running nutrition requirement.

Water regulates the core temperature of your body. As you run, your working muscles produce large amounts of heat that must be released in order to prevent your core temperature from rising to dangerously high levels. To dissipate this heat, your body perspires causing water loss and potential dehydration.

As a runner, you should consistently hydrate yourself during both warm and cold weather. By the time you are thirsty, your body is already suffering from dehydration, causing your running to suffer, and putting you at risk. Most runners fall short on their fluid replacement and manage only to replace about half of their losses. You know you're drinking enough water if you urinate about once an hour and it is clear.

Finally, spread out fluid intake during the day to maintain steady water levels and remember to drink past the feeling of thirst to adequately replenish lost fluid.

Vitamins/Minerals/Supplements
Concerned that your running nutrition needs are not being met? In most cases, all you have to do is follow the advice your Mom gave you: Eat a varied, well-balanced diet.

A varied, well-balanced diet will include plenty of fruits, vegetables, and non-processed foods. One way to ensure that you are getting all the fruit and vegetables you need is to eat them as healthy snacks throughout the day. While fruits are an obvious snack, crispy handfuls of carrots, celery, cucumbers or other favorite vegetables make great desk foods. Juices are also a great way to consume your daily allotment of fruits and vegetables. The advantages of juices include helping to keep you hydrated, contain a wide variety of vitamins and minerals, and they provide a source of energy all day long.

In recent years, several major studies have shown that it makes sense for runners to supplement their normal dietary intake with the antioxidants vitamins C and E and betacarotene. Vitamin C can be obtained easily through either fruit juices or supplements. Vitamin E, on the other hand, is not so easily obtained within the diet. Sports nutrition supplementation is an answer. Shoot for 30 to 200 international units per day.

If your diet is somewhat unbalanced and/or you feel you need some sports nutrition insurance, daily multi-vitamins with minerals are the answer

What is the patellar tendon?
The patellar tendon connects the kneecap (the patella) to the shin bone. This is part of the 'extensor mechanism' of the knee, and together with the quadriceps muscle and the quadriceps tendon, these structures allow your knee to straighten out, and provide strength for this motion. The patellar tendon, like other tendons, is made of tough string-like bands. These bands are surrounded by a vascular tissue lining that provides nutrition to the tendon.

What causes patellar tendonitis?
Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called "jumper's knee."

When overuse is the cause of patellar tendonitis, patients are usually active participants of jumping-types of sports such as basketball or volleyball. Patellar tendonitis may also be seen with sports like running and soccer. Also, some patients develop patellar tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.

What are the symptoms of patellar tendonitis?
Patellar tendonitis usually causes pain directly over the patellar tendon. Your doctor should be able to recreate your symptoms by placing pressure directly on the tendon. The other common symptom of patellar tendonitis is pain with activities, especially jumping or kneeling. Less common, but not unusual, is swelling around the tendon itself.

What is the treatment for patellar tendonitis?
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee-if an activity hurts in the area of the injured patellar tendon, then you should rest from that activity. Your doctor may prescribe anti-inflammatory medication to take by mouth. Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once you do resume activities. Also, icing the area of patellar tendonitis after being active can help to minimize symptoms and accelerate healing. Occasionally, your doctor will provide a support strap (called an infrapatellar strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

Proper sports nutrition is often the most neglected part of a runners training. The entire message here is as follows:

Eat right and you'll perform better.

It's that simple.

Your body functions best, and you perform better, when your diet includes the right kinds of foods in the right amounts at the right times. The following sports nutrition information will enable you to put together your ideal diet, one that will help you achieve your ideal body weight, and get the most out of your running. You'll learn the basics of good sports nutrition. Finally, you'll learn how to hydrate and fuel your body before, during and after your workouts.

Listed below are the sports nutrition topics we will be discussing in this section:

Carbohydrates
Fats
Protein
Water
Vitamins/Minerals/Supplements
Eating Before, During, and After a Run
General Nutrition Tips for Runners
Top Running Nutrition Recommendations

Carbohydrates
Why are carbohydrates so important?

Here's the easy one-word answer: Energy!

Carbs (as they're sometimes referred to), are your body's main source of energy for aerobic exercise. Your body coverts the carbohydrates you eat into glucose (a simple sugar). Glucose is then immediately used by your body for energy or is stored in the muscles as glycogen. Glycogen stores are utilized by runners and help keep you from "bonking" or "hitting the wall". You've run out of carbohydrates if you have to slow dramatically to continue running.

So, how do you keep from "hitting the wall" or running out of glycogen stores?

The trick is to store energy by eating carbs on a continuous basis. Experienced runners focused on meeting their nutrition needs eat the right carbs in the right amounts at the right times! Experts recommend that your diet should consist of 60 to 65% carbohydrates. This amount will keep your muscles well-fueled so that you can meet both your nutrition and training goals.

Carbohydrates are broken down into two basic categories:

Simple carbohydrates
Simple carbohydrates are the most basic form of sugar. Examples of foods containing simple carbohydrates are candy, fruit and sodas. These foods can provide a quick burst of energy-but it's only temporary. For this reason, you should keep simple carbohydrate snacks to a minimum. But feel free to enjoy a treat every now and then, especially after a good run.

Complex carbohydrates
Complex carbohydrates provide energy on a more consistent, long-term basis. That's why experts recommend that the majority of the calories you get from carbohydrates be in the form of complex carbohydrates. Foods that are high in complex carbohydrates include cereals, pasta, breads, rice, potatoes, and vegetables. It's important that you maintain a diet high in complex carbohydrates to support your running program and meet your sports nutrition needs.

Fats
Fats, in many cases, get a bad rap. The confusion lies in how much fat is healthy in your diet as well as the type of fat you should be eating.

So what's the bottom line?

Your body needs fat but not all fats are created equal!

Each type of fat is okay in limited amounts, but some fats better meet your running nutrition needs than others. Fats are classified as:

Saturated
Poly-Unsaturated
Mono-Unsaturated

Saturated fats
Saturated fats are easy to spot. They remain solid at room temperature. Common examples include red meat and dairy products. These fats are required by the body in small amounts and should make up just 10% of your overall caloric intake.

Poly-unsaturated fat
These fats stay semi-solid at room temperature. Many margarine and butter alternatives as well as vegetable oils are made with poly-unsaturated fats. Poly-unsaturated fats are a step closer to the "good" fat you should make a staple of your diet. However, you can go one step farther.

Mono-unsaturated fat
Mono-unsaturated fats are liquid at room temperature. Examples include olive oil and most other natural oils. Recent studies have shown that diets with a higher proportion of mono-unsaturates seem to reduce the risk of heart disease and better meet your sports nutrition needs. As a result, you should obtain 20 to 25% of your daily calories from fats with the majority of those coming from mono-unsaturated fats.

Protein
As you exercise and eat right, you'll feel your body getting stronger.
Why?

Proteins absorbed during consumption.

Protein helps to build muscle and tendons, repair broken down muscles, and regulate hormones. Meats, eggs, beans and nuts are common examples of foods that contain significant amounts of protein. Experts agree that runners need 10 to 20% of their daily calories from protein.

Most people, however, eat two to three times their protein requirement each day!

As a runner, your increased caloric intake needed to maintain a sufficient energy level for running should be more than enough to meet your recommended protein and nutrition requirements.

Water
Did you know that water makes up between 60-70% of your total body mass? Although water doesn't provide energy (or calories), your body requires large amounts of H2O in order to function properly. It's a running nutrition requirement.

Water regulates the core temperature of your body. As you run, your working muscles produce large amounts of heat that must be released in order to prevent your core temperature from rising to dangerously high levels. To dissipate this heat, your body perspires causing water loss and potential dehydration.

As a runner, you should consistently hydrate yourself during both warm and cold weather. By the time you are thirsty, your body is already suffering from dehydration, causing your running to suffer, and putting you at risk. Most runners fall short on their fluid replacement and manage only to replace about half of their losses. You know you're drinking enough water if you urinate about once an hour and it is clear.

Finally, spread out fluid intake during the day to maintain steady water levels and remember to drink past the feeling of thirst to adequately replenish lost fluid.

Vitamins/Minerals/Supplements
Concerned that your running nutrition needs are not being met? In most cases, all you have to do is follow the advice your Mom gave you: Eat a varied, well-balanced diet.

A varied, well-balanced diet will include plenty of fruits, vegetables, and non-processed foods. One way to ensure that you are getting all the fruit and vegetables you need is to eat them as healthy snacks throughout the day. While fruits are an obvious snack, crispy handfuls of carrots, celery, cucumbers or other favorite vegetables make great desk foods. Juices are also a great way to consume your daily allotment of fruits and vegetables. The advantages of juices include helping to keep you hydrated, contain a wide variety of vitamins and minerals, and they provide a source of energy all day long.

In recent years, several major studies have shown that it makes sense for runners to supplement their normal dietary intake with the antioxidants vitamins C and E and betacarotene. Vitamin C can be obtained easily through either fruit juices or supplements. Vitamin E, on the other hand, is not so easily obtained within the diet. Sports nutrition supplementation is an answer. Shoot for 30 to 200 international units per day.

If your diet is somewhat unbalanced and/or you feel you need some sports nutrition insurance, daily multi-vitamins with minerals are the answer

What is the patellar tendon?
The patellar tendon connects the kneecap (the patella) to the shin bone. This is part of the 'extensor mechanism' of the knee, and together with the quadriceps muscle and the quadriceps tendon, these structures allow your knee to straighten out, and provide strength for this motion. The patellar tendon, like other tendons, is made of tough string-like bands. These bands are surrounded by a vascular tissue lining that provides nutrition to the tendon.

What causes patellar tendonitis?
Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called "jumper's knee."

When overuse is the cause of patellar tendonitis, patients are usually active participants of jumping-types of sports such as basketball or volleyball. Patellar tendonitis may also be seen with sports like running and soccer. Also, some patients develop patellar tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.

What are the symptoms of patellar tendonitis?
Patellar tendonitis usually causes pain directly over the patellar tendon. Your doctor should be able to recreate your symptoms by placing pressure directly on the tendon. The other common symptom of patellar tendonitis is pain with activities, especially jumping or kneeling. Less common, but not unusual, is swelling around the tendon itself.

What is the treatment for patellar tendonitis?
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee-if an activity hurts in the area of the injured patellar tendon, then you should rest from that activity. Your doctor may prescribe anti-inflammatory medication to take by mouth. Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once you do resume activities. Also, icing the area of patellar tendonitis after being active can help to minimize symptoms and accelerate healing. Occasionally, your doctor will provide a support strap (called an infrapatellar strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

What is the patellar tendon?
The patellar tendon connects the kneecap (the patella) to the shin bone. This is part of the 'extensor mechanism' of the knee, and together with the quadriceps muscle and the quadriceps tendon, these structures allow your knee to straighten out, and provide strength for this motion. The patellar tendon, like other tendons, is made of tough string-like bands. These bands are surrounded by a vascular tissue lining that provides nutrition to the tendon.

What causes patellar tendonitis?
Patellar tendonitis is the condition that arises when the tendon and the tissues that surround it, become inflamed and irritated. This is usually due to overuse, especially from jumping activities. This is the reason patellar tendonitis is often called "jumper's knee."

When overuse is the cause of patellar tendonitis, patients are usually active participants of jumping-types of sports such as basketball or volleyball. Patellar tendonitis may also be seen with sports like running and soccer. Also, some patients develop patellar tendonitis after sustaining an acute injury to the tendon, and not allowing adequate healing. This type of traumatic patellar tendonitis is much less common than overuse syndromes.

What are the symptoms of patellar tendonitis?
Patellar tendonitis usually causes pain directly over the patellar tendon. Your doctor should be able to recreate your symptoms by placing pressure directly on the tendon. The other common symptom of patellar tendonitis is pain with activities, especially jumping or kneeling. Less common, but not unusual, is swelling around the tendon itself.

What is the treatment for patellar tendonitis?
The most important first step in treatment is to avoid activities that aggravate the problem. Your body is the best guide to know how much to rest the injured knee-if an activity hurts in the area of the injured patellar tendon, then you should rest from that activity. Your doctor may prescribe anti-inflammatory medication to take by mouth. Stretching the quadriceps, hamstring, and calf muscles prior to activity is very important once you do resume activities. Also, icing the area of patellar tendonitis after being active can help to minimize symptoms and accelerate healing. Occasionally, your doctor will provide a support strap (called an infrapatellar strap), a knee brace, or custom orthotics. The benefit of these measures in the treatment of patellar tendonitis is not well known, but some patients find complete relief from using these products.

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

When your first few steps out of bed in the morning cause severe pain in the heel of your foot, you may have plantar fasciitis (fashee-EYE-tiss). It's an overuse injury affecting the sole or flexor surface (plantar) of the foot. A diagnosis of plantar fasciitis means you have inflamed the tough, fibrous band of tissue (fascia) connecting your heel bone to the base of your toes.

You're more likely to get the condition if you're a woman, if you're overweight, or if you have a job that requires a lot of walking or standing on hard surfaces. You're also at risk if you walk or run for exercise, especially if you have tight calf muscles that limit how far you can flex your ankles. People with very flat feet or very high arches are also more prone to plantar fasciitis.

The condition starts gradually with mild pain at the heel bone often referred to as a stone bruise. You're more likely to feel it after (not during) exercise. The pain classically occurs again after arising from a midday lunch break.

If you don't treat plantar fasciitis, it may become a chronic condition. You may not be able to keep up your level of activity and you may also develop symptoms of foot, knee, hip and back problems because of the way plantar fasciitis changes the way you walk.

Treatments

Rest is the first treatment for plantar fasciitis. Try to keep weight off your foot until the inflammation goes away. You can also apply ice to the sore area for 20 minutes three or four times a day to relieve your symptoms. Often a doctor will prescribe nonsteroidal anti-inflammatory medication such as ibuprofen. A program of home exercises to stretch your Achilles tendon and plantar fascia are the mainstay of treating the condition and lessening the chance of recurrence.

About 90 percent of people with plantar fasciitis improve significantly after two months of initial treatment. You may be advised to use shoes with shock-absorbing soles or fitted with a standard orthotic device like a rubber heel pad. Your foot may be taped into a specific position.

If your plantar fasciitis continues after a few months of conservative treatment, your doctor may inject your heel with steroidal anti-inflammatory medications (corticosteroid). If you still have symptoms, you may need to wear a walking cast for 2-3 weeks or positional splint when you sleep. In a few cases, you might need surgery to release your ligament.

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

Definition
Shin splints are a common lower extremity complaint, especially among runners and other athletes. They are characterized by pain in the front or inside aspect of the lower leg due to overexertion of the muscles. The pain usually develops gradually without a history of trauma, and might begin as a dull ache along the front or inside of the shin (Tibia) after running or even walking. Small bumps and tender areas may become evident adjacent to the shin bone. The pain can become more intense if not addressed, and shin splints should not be left untreated because of an increased risk of developing stress fractures.

Shin splints usually involve small tears in the leg muscles where they are attached to the shin bone. The two types of shin splints are: anterior shin splints, in the front portion of the tibia; and posterior shin splints, occurring on the inside of the leg along the tibia.

Cause
Shin splints can be caused when the anterior leg muscles are stressed by running, especially on hard surfaces or extensively on the toes, or by sports that involve jumping. Wearing athletic shoes that are worn out or don’t have enough shock absorption can also cause this condition. Over-pronated (flat feet) are another factor that can lead to increased stress on the lower leg muscles during exercise. People with high arched feet can also experience shin splint discomfort because this foot type is a poor shock absorber.

Treatment and Prevention
The best way to prevent shin splints is to stretch and strengthen the leg muscles, wear footwear with good shock absorption, and avoid running on hard surfaces or excessive running or jumping on the ball-of-the-foot. Insoles or orthotics that offer arch support for over-pronation are also important.

Treatment for shin splints should include taking a break from the exercise that is causing the problem until pain subsides. Icing the area immediately after running or other exercise can also be effective, along with gentle stretching before and after training. Another option is taking aspirin or ibuprofen to relieve pain and reduce inflammation.

It is important not to try to train through the pain of shin splints. Runners should decrease mileage for about a week and avoid hills or hard surfaces. If a muscle imbalance, poor running form or flat feet are causing the problem, a long-term solution might involve a stretching and strengthening program and orthotics that support the foot and correct over-pronation. In more severe cases, ice massage, electrostimuli, heat treatments and ultra-sound might be used.

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

Strains, sprains and fractures all cause pain and swelling but it can be hard to tell them apart. A strain is caused by overstretching a muscle. A sprain is an injury to muscles and ligaments, tendons, or soft tissues around a joint.

A fracture is a broken bone, and stress fractures are weak spots or small cracks in bones, common with sports training.

If you have a severe fracture, your leg is twisted out of shape or a bone is poking through the skin on your arm. It needs urgent care. Contact your healthcare provider immediately to determine what you should do next.

In the meantime, splint it, apply ice and don't put any weight on the fracture. Severe sprains also need immediate attention.

Most other minor sprains and strains can be treated at home with RICE: Rest, Ice, Compression, and Elevation.

Rest. Don't put any weight on your injured joint for at least 24 to 48 hours. Use crutches to rest an ankle or knee and a sling to support an injured shoulder, wrist or elbow. Rest a sprained finger or a broken toe by taping it to the one next to it.

Ice. Apply ice or a cold pack immediately and for 10 minutes each hour for up to 72 hours after the injury. (Wrap the ice pack in a thin, wet towel so you won't freeze your skin.) Cold will ease your pain and reduce swelling and bruising.

Compression. Wrap your injury securely with an elastic ( "ACE") bandage to compress it and keep it from moving. (Don't wrap it so tight that you cut off your blood supply and cause swelling below the bandage.) Don't use your injured part even though it feels better wrapped.

Elevation. Prop up your injury on a pillow while resting and icing to cut down on swelling. Try to keep your injury at or above the level of your heart.
Begin the RICE treatment immediately after you're injured to ease pain and lessen swelling, even if you think you need to see a healthcare provider.

Take aspirin or ibuprofen to reduce pain and inflammation; use acetaminophen (e.g., Tylenol™) for kids and teens under age 20.

Prevention, of course, beats treatment any day.
Warm up before exercising and cool down afterwards.
Gradually increase your exercise time and how hard you work out.
Change your exercise regularly (i.e., cross-train). For example, switch off between walking, biking and swimming to rest different sets of your muscles.

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg

Stretching before and after exercise is very important for all runners. The benefits from stretching are that you may prevent injury, bring the shortened muscles back to their original length, and to reduce or avoid post exercise stiffness. When you stretch you are trying to increase the range of movement around a joint or a group of joints. This helps to strengthen the joint and to increase the flow of blood into the muscles around the joint.

Before exercise, in the warm-up, you want to prepare the muscle for activity. The best time to stretch is just after a short easy jog and to hold each stretch for 10 seconds. It is especially important if you intend to start an intense activity such as sprinting or speed-work.

After exercise, in the cool-down, you want to bring back the muscles used to their original length. During activity the muscle shortens, you notice this when the muscle gets tight and hard. To reduce or even prevent post exercise muscle stiff-ness you are now trying to lengthen and loosen the muscle back to its pre-exercise level. You should hold the stretch for longer - 30 seconds.

Below are stretches we recommend you as a minimum do before and after running. There are many more good stretches but these five exercises will be a good start to prevent you from getting injured.

Ten tips on how to stretch
Move slowly into the stretch.

Hold the stretch for 10 seconds prior to exercise (warm-up) and for 30 seconds post exercise (cool-down).

Breathe and relax while holding the stretch.

NEVER do any bouncy stretching, always hold and relax.

Focus on the muscle you are trying to stretch and then try to lengthen it.

You may be able to breach in and push the stretch slightly further half way through the stretch. This is most important during cool-down.

Move slowly out of the stretch again.

Remember to stretch both sides.

Increasing the range of movement around a joint will help the blood flow to the muscles surrounding the joint and increase circulation that will carry away any lactic acids that may build up in the muscle.

Do more stretching than just warm-up and cool-down. A lot of gyms offer stretch-classes where the aim is to permanently and progressively to increase your flexibility.

5 essential stretches
Calf – Gastrocnemius
Step one foot a large step in front of the other
Feet parallel, pointing forward
Back heel flat on the ground
Hands on the front bend knee
Back straight and head slightly down
FEEL the stretch in the calf of the back leg

Lower calf - Soleus
One foot in front of the other, small step
Weight on the back leg
Feet parallel, toes pointing forward
Both heels down
FEEL the stretch in the lower calf of the back leg

Hamstrings
One foot in front of the other, a small step apart
Sit back on the back leg (weight on the back leg
Stretch front leg (flex foot upwards for extra resistance)
Lift your buttocks
Hands on bend leg
Stomach in, head lifted and back straight
FEEL the stretch in the straight leg – just below your buttocks

Quadriceps and Hip-flexors
Back straight
Stomach in
Supporting leg soft (slightly bend)
Push bend foot into your hand at the ankle – Not your toe
Use a wall or partner for balance
FEEL the stretch in the quad (hip) of your bend leg and try to move the muscle out for extra flexibility

Iliotibial Band
Cross feet by taking one foot in front of the other (the right foot in front)
Find your balance and keep your back straight
Front leg slightly bend
Push left hip slightly left, away from the centre of you body
Hands along side of your body
FEEL the stretch on the outside of your left leg