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Running aches & pains: The signs & symptoms

By Michael Gordon, MD, Milwaukee Orthopaedic Group, Ltd. Orthopedic Surgery, Sports Medicine Fellowship

Plantar fasciitis, Achilles tendonitis, metatarsal stress fracture, posterior tibial tendonitis, exertional compartment syndrome, shin splints, anterior knee pain, iliotibial band syndrome (ITB). What do they all mean?

How do you know when you or your runners have a serious problem? Part of running is dealing with the occasional aches and pains that come with the repetitive pounding on the body. Sore muscles and some mild joint aching are generally okay and respond well to rest and gentle massage. But, what about the more constant ache that doesn't seem to respond to these simple measures?

This article will highlight the signs and symptoms that raise red flags for the more serious problems that may require medical attention. Let's get the obvious ones out of the way: chest pain, racing heart rate, dizziness and shortness of breath are automatic go to a physician for an evaluation. Now, let's move on to the orthopedic or musculoskeletal problems that I routinely see in my practice (as well as the several that I have personally experienced as a runner!).

Bone pain or pain that you can recreate by pushing on a bone is a very concerning sign for a stress fracture. Commonly, runners will experience this specific pain over one of the long foot bones at the base of the toes (metatarsals), the heel bone (calcaneus), and/or shin bone (tibia). This pain can also be present at night.

Groin pain or deep thigh pain is a warning sign for a potential femoral stress fracture that can be catastrophic if missed. This groin pain can be differentiated from a simple groin strain or muscle ache by pushing on the groin muscles and recreating the symptoms. If touching the muscles doesn't hurt, then worry about a stress fracture.

Achilles pain is pain that is present with the palpation of the Achilles tendon. The Achilles is the most posterior structure of the ankle and sits just deep to the skin so it's easily palpated. Swelling and pain over this tendon is a sure sign of Achilles tendonitis that will require a significant alteration in running and training. Trying to run through this pain/problem can lead to permanent changes in the tendon, and ultimately chronic pain.

Medial ankle pain or pain that occurs on the inside part of your ankle just deep to the tip of the bone. The posterior tibial tendon runs just distal to the bony prominence on the inside part of your ankle helping to maintain your arch. And, just like Achilles tendonitis, attempting to run through this pain can lead to permanent changes in the tendon and chronic pain.

Numbness and tingling in your foot can be a sign of exertional compartment syndrome, essentially due to the excessive swelling of your muscles compressing the nerves serving your foot. People can rarely "run through" this pain as it becomes quite disabling. This problem generally leads to surgery to release the compartments and create more space for the muscles to swell.

There are plenty of other signs and symptoms that are easily linked to many of the common diagnosis listed above. Even if these aren't career ending problems, they can most definitely affect your training and performance. A visit to a sports medicine specialist can help to expedite your return to running and help you to achieve peak performance.

Remember to listen to your body. Be smart about training.

Dr. Michael Gordon, of the Milwaukee Orthopaedic Group, Ltd. is an orthopedic surgeon with a fellowship in sports medicine. For questions, you can reach Dr. Gordon at 414-276-6000.