Saturday, January 19, 2013

What should be in a runner's injury self-treatment kit?

As much as I like scientifically validated treatments for injury, I think there's a lot to be gained from "road wisdom" treatments for running injuries.  Over the years, an experienced runner picks up or stumbles upon many useful remedies for aches, pains, and injuries.  You probably have a shoe box or plastic container with the assorted treatment aids you've amassed over the years, from doctors, physical therapists, or running stores.  There's also a veritable army of online sellers who are looking to sell devices to "cure" common running injuries (most are worthless).  A lot of these road wisdom treatments involve special gadgets or materials, so I'd like to share what's in my own personal "injury treatment kit." I will also show some things I have not found to be particularly helpful, and a few items that I recommend but don't currently have.  You'll have to excuse the pictures from my sub-par camera.




A.  Rope for stretching (~10' long)
I picked this up at the local hardware store for a few dollars.  You can find nice quality rope for well under a dollar per foot.  The length might seem long, but it's actually necessary if you want to do hamstring stretching while laying on your back.  If you're into Active Isolated Stretching, having a stretching rope is a necessity.  Use a flame to fuse the ends so it doesn't fray.

B.  Elastic theraband for exercises

I have a lot of these laying around from visits to PT offices.  They come in various stretchinesses, and you can order them online for not too much money.  There are a few good exercises for your hips, knees, and ankles that require a theraband, so it's a good investment.  if you can, get a thicker one, as they are less prone to breaking—thin ones seem to have a tendency to get brittle and snap.

C.  Rolling tools: Tiger tail, golf ball, Rubz foot ball, tennis ball, lacrosse ball

There are a lot of theories on how soft tissue is involved in injuries, and a lot of these—like trigger point theory—purport to be a cure-all.  While I think these explanations are off the mark, I have found rolling to be pretty effective with soft tissue injuries.  The various "balls" are good for different parts of the body: the golf ball and Rubz ball for the arch of your foot, and the tennis ball and lacrosse ball for the hips, hamstrings, and especially the glutes.  There are a few variants of rubber textured foot balls; I highly recommend you get one for your arches. They are the right stiffness, and they don't slide away on hard surfaces like golf balls do.  You can pick them up online or at some specialty running stores.

Golf, tennis, and lacrosse balls can be found in reasonably abundant quantities nearby parks where the respective sports are played.  If you run on a golf course or do drills on a high school practice field, you're bound to come across some lost balls that would have ended up getting sheared apart by a lawnmower.

The "Tiger Tail" is a rip-off of "The Stick," the common muscle rolling tool.  I personally think the tiger tail  has marginally sturdier construction than The Stick, and if it does break, there won't be two dozen plastic rollers flying everywhere (as happened to one of my college roommates).  Either of the two are pretty great for calves and quads.  They are really good for other parts of your body too, but you'll need someone else to actually do the rolling. 



D.  Scissors

You'll need these to cut tape and moleskin.  Wipe them off with isopropyl (rubbing) alcohol to remove the sticky gunk that builds up.

E.  Adhesive tape spray

You'll need this if you apply any kind of tape (including kinesiology tapes) to your foot (a surprisingly rare need, however).  Your feet get very sweaty and as such don't take well to adhesives.  A quick shot of this will help it stay on.

F.  Strassburg sock

A Strassburg sock is a device you wear while sleeping which keeps your ankle and toes in a dorsiflexed position overnight, which can help prevent the early morning pain associated with plantar fasciitis.  This is one of the few treatment devices on this list that has actually been scientifically vetted, and it also happens to be one of the few "online gimmicks" for sale that I've actually found useful.  Some runners claim it's useful for Achilles tendonitis too.


G.  Tapes: Kinesio tape, athletic tape




While it's a staple of any athletic training room, standard athletic tape is surprisingly unhelpful with most running injuries.  It's much too restrictive for the repetitive and precise foot motions needed while running.  Low Dye taping for plantar fasciitis is one of the few uses of athletic tape in runners—though it can be handy to keep around to protect a blistered toe or bruised toenail.

Kinesio tape, on the other hand, is more versatile since it is stretchy and does not interfere with your normal movements.  Whether it's actually effective is up for debate, but there's at least some evidence that the tactile stimulation on your skin provided by the tape can help when you've got an injury.  I will use it for pretty much any injury, since it's easy to apply and it stays on for a week or more in most locations on the body.  And, unlike icing, you don't have to do anything after the initial application. 


H.  Surgery kit: Exacto knife, thread, thread ripper, razor blade



No, not surgery on yourself.  Surgery on your shoes! You'll occasionally find a pair of shoes that's close to perfect, but has a fatal flaw, or just something you don't want.  Often, this can be corrected.  With some deft hands, you can take off unnecessary cosmetic overlays or make a few cuts to expand a tight area.  Below is an example of some shoe surgery I did on a pair of racing flats.

Below: Original shoe.  Above: unnecessary cosmetic overlays removed, shaving a bit of weight off my racing flats
The Saucony Grid A4 comes with some overlays that are just for show; they don't add any structural integrity or support.  The threads that attach them to the shoe are easily dispatched with a razor blade or thread ripper, leaving the shoe a few grams lighter.  It might seem wrongheaded to cut into a pair of shoes that you paid good money for, but just remember that a shoe you can't wear isn't worth anything to you!  A few times, I've had to cut a horizontal slit in a shoe's upper to make a bit more room for  my pinky toe, which seems to stick out more than usual.



I.   Superglue

Superglue is sometimes necessary to fix up a shoe or other equipment.  In theory, it could be used to hold together skin, too, though I don't recommend it!

J.  Thermometer

I think the proper term for this is a "pocket thermometer," but in any case it's extremely useful for checking the temperature of a cold or hot water bath for your foot, leg, or whole body. You can pick them up for pretty cheap in the cooking isle at a big-box retailer or a grocery store.



K.  Antiseptics: hydrogen peroxide and neosporine

These are good to have handy for cuts, scrapes, and blisters.  When you drain a blister you'll want to put some antiseptic on it so it doesn't get infected.  Hydrogen peroxide is nice because it likes to "eat away" at wounds that aren't totally scabbed over; the fizzing is a dead giveaway for a wound that's open or irritated by bacteria. 

L.  Tuning fork

I read somewhere that if you hold a vibrating tuning fork up to a bone, it can diagnose a stress fracture if it causes sharp pain at the injured spot.  I'm not sure I believe this, but for some reason I still have it around.  I've also seen extra-large tuning fork like devices in training rooms, so maybe it's not so crazy.  Drop me a line if you know this works (or doesn't)!

M.  Compression tapes (self-adhesive, standard)

I end up using these mostly for strapping on an icepack to my foot or leg.  The old "RICE" (rest, ice, compression, elevation) paradigm is not very useful with running injuries since compression and elevation don't do any good in my experience.  Not bad to have around for an ankle sprain though.

N.  Moleskin

Moleskin can be used to cover up irritating areas inside a shoe, like the tongue or the heel counter.  You can also put

O.  Tolnaftate

A standard over-the-counter treatment for athlete's foot and ringworm.  These are both fungal infections that are usually mild and ultimately harmless (from a performance standpoint at least), but they are fairly contagious, so they ought to be dealt with promptly.  You might pick it up—the fungus, I mean—from the locker room, ice bath, or weight room at your school or local health club. Tolnaftate cream is at your local drugstore.

P.   Sewing needles

 Sewing needles are handy both for shoe surgery and for draining blisters.  My "blister kit"  consists of sewing needles, rubbing alcohol, neosporin, and band-aids.  While online medical resources will tell you not to pop a blister, they are often unrunnable unless you do so.  The problem is that puncturing the already-irritated ballooning skin puts it at risk for infection! The proper way to do it, as I learned in the Boy Scouts, is to use a needle sterilized with rubbing alcohol and pierce the skin at a healthy spot at a shallow angle, then come up under the blister to drain it. If you ever did the "I have a safety pin stuck in my finger!" trick in grade school, you'll know how this works.  You can put a needle through the first few layers of skin without causing any pain or drawing any blood.  After you've drained the blister, slather a bit of neosporin or other topical antiseptic and put a band-aid on it.  The band-aid should protect the small hole while it closes up; it is not intended to protect the blister itself!
The proper way to drain a blister


Q.  Foam roller

A foam roller is a great accessory for rolling out stiff or sore muscles.  For runners, an 18" roller is plenty wide—no need to shell out for the three-foot version.  Poor quality foam rollers have an unfortunate tenancy to  collapse in the middle after a while, so if you can, try to find one that feels a bit stiffer and more rigid. 


R.  Band-aids

Handy both for blisters and for minor cuts and scrapes from spikes, tree branches, and spills on ice.

S.  SuperFeet over-the-counter orthotic

Many studies have found that over-the-counter orthotics are more or less comparable to custom orthotics when it comes to treating injuries.  We've looked in detail at why custom orthotics are not always better than over the counter alternatives, but there's another reason to consider a good over the counter orthotic like SuperFeet or Powerstep insoles: timing.  It can take several weeks (and a fistful of cash) for a custom orthotic to be manufactured and shipped, whereas you can pick up an OTC orthotic for ~$40 any time from some running stores, outdoors/hiking stores, and online.  These types of insoles can also be modified with moleskin to take pressure off of certain areas of the foot.



Applying a moleskin pad to the red highlighted area below would create what's called a reverse Morton's extension, which takes stress off your big toe joint (the ball of the foot).  Just realize that reduced stress on your first metatarsal head comes at the expense of increased stress on the other four—this kind of amateur shoe modification worked very well for me when I ran in stiffer running shoes and would suffer from metatarsalgia when my mileage crept up, but Dathan Ritzenhein has reported the same type of DIY insole modifications led to him getting injured.  Your mileage may vary.  In any case, it is not a bad idea to hang onto a pair of OTC insoles in case something in your foot flares up and you need to take as much stress off it as possible when walking.  They are also great at making hard, stiff dress shoes much kinder on your feet.

Additional items:

Plastic tubs for icing, soaking, and heating + epsom salt

I usually keep two sizes of plastic containers on hand: one big enough to fit my foot in and another big enough to fit my lower leg in.  Foot-sized bins are fairly easy to find, but getting the right size for your lower leg can be tricky.  For me, at 5'10" (on a good day), I've found that a plastic wastebin about 18" tall is the perfect height to be able to soak my calf and below in water while sitting at my desk.  A container that's too short won't be able to heat or cool your entire calf muscles, and one that's too tall will not allow you to soak your leg while sitting.  I got a tall plastic bin and sawed it down to size with a crosscut saw.  I used the extra material as a "sleeve" to keep the tub from bowing out from the weight of the water. 



When soaking in hot water, which will increase blood flow and loosen up stiff tissue, I sometimes like to put in a cup or two of epsom salt.  Epsom salt, or magnesium sulfate, is a traditional component of bath salts that is sold at pharmacies as a laxative and as a soaking aid for bruises.  This is a trick I picked up from a veteran physical therapist, who said that pro soccer players swore by warm epsom salt soaks for stiffness in the joints of the foot.  According to an informal study (conducted by the "Epsom Salts Council"), soaking in magnesium sulfate can slightly increase the levels of magnesium and sulfate in your blood.  Not sure if that does any good or not.  On the topic of hot and cold water soaks, though, the ideal temperatures seem to be between 105-110° F (40-43° C) for a hot soak and around 50° F (10° C) for a prolonged cold water soak.  Soaking in true icewater (32° F / 0° C) can be done in an alternating style, where you stick your foot/leg into the bath until it starts to get too cold, then pull it out and let it warm up for a bit before repeating.

Business cards for doctors and PTs



If I have a good experience with a doctor or PT, I always make sure to grab a few of their business cards on the way out.  This way, I can refer a friend if he or she needs help, and I've got the doctor or therapist's number in case I have another issue a few months or years down the road.






Not pictured but recommended:

Other rolling devices

A foam roller is great for your quads and your IT band, but your hamstrings, hips, and calves sometimes need something harder or differently shaped.  I particularly like 3" PVC pipe as a harder version of a foam roller.  You can get a 18" section of it cut for you at most small locally-owned hardware stores for a few bucks.  Other runners like using Nalgene water bottles.  For the hip area, I particularly like a well-inflated basketball or a medicine ball.  It's just the right shape and size to dig into your hip flexor, adductors, and glutes.

Hair shaver or buzzer


If you get enthusiastic about using elastic kinesiology tapes like Kinesio tape, KT tape, and the like, you'll find that your tapings last a lot longer if you buzz or shave off your leg hair before applying it.  Your skin doesn't need to be silky-smooth; a quick run-through with a hair clipper with no comb attached will do fine.

Ziplock bags for icing and heating

Ziplock bags are a semi-reusable way to ice.  You can fill them up with ice cubes or crushed ice, and they come in different sizes which is handy.  They can also be used with mediocre success to heat up an area before running too—the only problem is they often leak out the corners.  Double-bagging them will buy you some time, but I'm still looking for a good solution to heating up a muscle or tendon in a way that won't get warm water all over my carpeting.  Post a comment if you've got any good tips!

Slant board for calf stretching and eccentric decline squats



A slant board is a nice thing to have around since it does double duty as a calf stretching device and a spot to do eccentric decline squats if you ever come down with patellar tendonitis.  They are very expensive to buy, but pretty cheap and easy to build (plans are above) if you are handy with power tools. 

 Things I don't recommend 

There are some things I have used but have not found very useful.

Gel ice pack (not pictured)

 This is nice for icing small, flat areas, especially if you have a compressive wrap to affix it to your skin, but gel ice packs ultimately fall short because the gel has a tendency to smush around and avoid the spot you're trying to ice.  Use one if you have one, but I can't recommend going out and buying one.


DMSO

Dimethylsulfoxide (DMSO) is an industrial solvent and biproduct of paper-making.  It also has the curious property of rapidly passing directly through your skin.  If you dab your finger in it, you'll get a buttery garlic-like taste in your mouth within 30 seconds.  In running lore, it allegedly heals injuries and reduces inflammation, but the scientific literature is anything but conclusive.  Additionally, I've never found it to be any help.  Since it's untested, leave it alone.

Non-steroidal anti-inflammatories (NSAIDS) 

NSAIDs are a category of anti-inflammatory drugs that includes popularly-prescribed brand names like Advil and Aleve (generic names ibuprofen and naproxen, respectively).  However, the "inflammation" paradigm has largely been tossed out the door when it comes to many running injuries, and additionally, there's no evidence that NSAIDs help at all with recovery.  In fact, there's even some preliminary evidence they impede healing.  Finally, in my own running, I've never even found them helpful for pain relief from injuries.  Save these for headaches.

Stretchy athletic tape


The stretchy brown athletic tape you see in training rooms seems like a solution to the rigidity of normal athletic tape, but unfortunately the adhesive properties of this stuff are just not very good.  You'll find your meticulous tape job falling apart after a mile or two.  Self-adhering tape, which is a rubbery mesh-like material, is marginally better, but is probably best suited for taping a healing ankle sprain.  The forces your foot encounters while running are far too great for any stretchy tape to significantly modify.  I recommend kinesiology tapes instead, since they are thinner, adhere better, and aren't restrictive of your range of motion. 

Pre-wrap

Again, normal methods of athletic taping are designed to protect acute injures and are not much help with overuse injuries.  I don't think I've ever used it for a running injury, though I do recall that it has a tendency to roll up along the edges.  On the bright side, however, it's a good way to secure long hair.

Sacro-wedgy (and other assorted online gimmick devices)

If you do an internet search for any common running injury, whether that's plantar fasciitis, shin splints, or piriformis syndrome, among the first things you'll find are websites looking to sell you their guaranteed-cure device to solve all your problems.  The sacro-wedgy is one of these.  It is a molded rubber block that you put under your sacrum and lay supine on; it's supposed to fix your alignment and cure sciatica, piriformis syndrome, and other problems that can be chalked up to pelvic misalignment.  While my opinion on pelvic alignment theory is a topic for another day, suffices to say I didn't find this helpful in the least.  Most people will find the same for any given online gimmick or device.  The two exceptions—gimmicks or devices for sale that I do recommend—are mentioned above, a rubber textured foot ball and the Strassburg sock.

Conclusion

Over the years, you will probably build up your own armory of devices to deal with injury.  Some will be helpful; many will not.  Do your best not to get swayed by marketing, since there's always somebody looking to make a buck by playing off your desire to get healthy.  Through cautious trial and error, you can figure out your own set of tips and tricks.  Other runners are a good resource for this too.  Just try to stay away from aggressive treatments or approaches that carry a chance of harming you.  Trying out the latest hot-pink kinesiology tape carries few downsides, but buying into the hype behind the latest aggressive fad, whether that's a paleodiet or barefoot running, could end up with even more injuries.  If you've got your own tips, tricks, or favorite gadgets for injury treatment or rehab, feel free to share in the comments section!

4 comments:

  1. great post . Thank you for sharing

    ReplyDelete
  2. The possible prospects and details are bringing about all those concerns which are indeed considered to be so essential.

    ReplyDelete
  3. Ha. DMSO has been tested and tested since at least the 60's. It is amazing at relieving I flamation and to a lesser degree, pain.

    I played high competitive rugby for 20 years and lots of other high impact sports like basketball and marathon... Use DMSO to treat basic sprains, strains and those rare periods of excess muscle soreness.

    Look. If DMSO is good enough to treat million dollar race horses... Who are you kidding? Really?

    ReplyDelete