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Approximately 11 million people in the United States run more than 100 days per year. Recreational exercise is attractive because it improves the quality of life and increases longevity. Runners note a range of salutary effects, from improved cardiopulmonary capacity to enhanced mental health, less depression and anxiety, and a greater sense of tranquility.

Regular exercise enhances sleep patterns; promotes a stronger and more stable musculoskeletal system; and results in decreases in disability, hypertension, diabetes, cancer, stroke, and osteoporosis. Runners report increased appetite and healthier weight, a desirable combination. Except for walking, running may be the most easily accessible and least expensive form of regular exercise.

However, there are important health concerns that develop as a consequence of running as well. These include the risk of sudden death, musculoskeletal injuries, and potentially deleterious effects on joints. Approximately 45–70% of runners will experience musculoskeletal injuries each year.

Risk Factors

Repetitive use, rather than a single traumatic event, causes the majority of running injuries. Table 72–1 lists the 10 most common injuries seen in one clinic and is representative of reports from other large series. Risk factors for running injuries include history of a previous injury, competitive running, high weekly mileage (>25 miles per week), and abrupt increases in the intensity or duration of training. Injuries are more likely to occur when the runner’s shoes are worn down, leading to the recommendation that shoes be replaced every 6 months or after 400 miles of use.

Table 72–1. The 10 Most Common Running Injuries.

Stretching is of particular interest because runners frequently report performing better and feeling better after stretching. However, a large controlled trial of stretching as taught by an Olympic marathon coach showed no difference in injury type or frequency between the intervention and control groups. Thus, the well-entrenched lore of stretching and running does not have evidence-based support. Similarly, there is little or no evidence to support proposed links between running injuries and age, gender, body mass, hill running, running on hard surfaces, time of year, and time of day.

Physical Examination

The physical examination of an injured runner should not only focus on the area of pain but should also include an examination of adjacent joints, alignment, and flexibility. Approximately 20–40% of running injuries can be related to structural abnormalities. The foot must dissipate 110 tons of force for every mile run, and alignment abnormalities of the foot are associated with ...

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