Sports Massage: It’s Worth It

Whether you are a beginner or a seasoned marathoner, your body is adjusting to more stress of a different type than it has experienced before. A sports massage isn't medically necessary, but your muscles will thank you, and you may be preventing injuries by promoting circulation and reducing stiffness during your training. Also, sports massage can be helpful when you are returning to running after an injury. Any injury causes scar tissue to form, which makes the injured area less flexible. Massaging that area breaks up some of the scar tissue and promotes circulation, which promotes healing.

Some insurance companies will cover sports massage or reimburse you if you have a flexible spending account, so investigate. Ask a fellow runner or a sports medicine professional to recommend a massage therapist who has had experience with athletes. A one-hour massage ranges from $60-$80, depending on where you live.

Some therapists will do half-hour sessions that focus only on the legs, but I recommend a full-body massage a day or two before the marathon. Your upper body gets tight when you run, too, and why not give your muscles every advantage?

Ease Achy Muscles

Not all running injuries are serious. Here are few tips to manage the minor aches and pains that are part of training for a marathon:

• When you feel especially stiff after a tough workout, fill a bathtub with warm water and add 3-4 cups of Epsom salt, which you can buy at most grocery stores or drugstores. Soak for 15 minutes, and you will notice a difference the next day.
• Muscle rubs such as Biofreeze and the arnica gels sold at health food stores can provide topical, short-term relief of minor aches. But if you have severe, persistent muscle pain, seek professional advice.
• Ice. You can rarely go wrong putting ice on a sore spot.
• Heat. Don’t use a heating pad on an area that is red or swollen, but placing a heating pad behind your back or sitting on a heating pad at work can relieve low back or upper hamstring stiffness. But limit heating pad use to 15 minutes a few times daily to avoid skin irritation.

Rule #1: Be Sure Your Running Shoes Fit

Of all the injury-prevention techniques available, the simplest – and one of the most effective – is making sure that your running shoes fit properly. Here are a few tips to help make sure your running shoes fit:
• When you try on shoes, wear the socks you'll wear when running.
• Our feet swell as we walk around during the day, so try to shop later in the day or in the evening.
• The heel shouldn't be loose, but neither should there be any pronounced “pressure spots” – especially at the Achilles tendon.
• You should have about a finger's width of space between your longest toe and the front of the shoe.
• If you have to lace the shoe so tightly that there's noticeable pressure on the top of your foot to make it fit, the shoe is too big.

Runner's Toe

Also known as “black toe,” this injury is a blood blister beneath a nail. The condition is uncomfortable, can be prone to infection, and usually results in the eventual loss of the nail.

The most common cause of runner's toe is tight running shoes, although jamming the toe running downhill can also cause the same problem. Your best prevention strategy is to make sure your running shoes fit.

Shin Splints

Shin splints is a catch-all term for pain along the front of the lower leg, and actually refers to a handful of mostly minor compalints. The most common causes of shin splints are running on hard surfaces and running on the toes, though overpronation can also cause shin splits.

If overpronation appears to be the culprit, a good pair of pronation-control shoes may be your simplest solution. In all cases, cut back on training and try to stick to soft surfaces like grass. An over-the-counter anti-inflammatory can be helpful if the cause is tendonitis.

Be cautious, though; more serious injuries – like stress fractures – can have the same symptoms. If your pain is significant or persists, see a doctor.

Rule #2: Buy a Running Shoe Designed for You

Understanding your feet will help you select the right shoe. Bio-mechanically, we're all a little different, but we all fall into three broad categories.
• Overpronators. Pronation is the natural tendency of the foot to roll inwards as it moves from heel to toe. Overpronation occurs when the foot rolls too far inward. Do this a few hundred thousand times, and injuries such as shin splints, fractures, plantar fasciitis and “runner's knee” could result.
Overpronators tend to have low insteps (“fallen arches”) and wear their soles excessively on the inner sides. Pronation-control shoes are designed to prevent the excessive inward roll of the foot. This is typically accomplished with a wedge of denser cushioning material on the inner (medial) side of the insole.
• Supinators have the opposite problem of overpronators: Their feet roll slightly outwards, which can result in ankle injuries.
Supinators tend to have high, rigid arches, and wear their soles excessively along the outside edges. Supinators and underpronators (whose feet don't roll inward enough, but also don't roll outward) should look for “cushioned” running shoes. Supinators may require additional arch support – and some shoe manufacturers include wedges for extra arch support with certain models of shoe.
• Neutral. Most runners have a normal arch, and their foot pronates about four to six degrees. This is considered a normal or neutral gait, and requires no correction. These runners should generally avoid motion control or “stability” shoes, and stick with a cushioned shoe. However, they generally don't need as much cushioning as supinators, unless they're heavy.

Plantar Fasciitis

Plantar fasciitis is caused by inflammation of the plantar fascia – a band of tissue connecting the heel to the forward part of the foot. It can also be characterized by stiffness and soreness along the plantar (bottom) surface of the foot. Typically the soreness and stiffness is worst at the beginning of an activity, and then subsides somewhat.



Stress on the arch of the foot, over-training and tight calf muscles are common causes of plantar fasciitis. Rest, icing after a workout, gentle stretching of the calf muscles and a reevaluation of your running shoes can help resolve the problem. If the arch of your current shoes doesn't fully support your instep, try switching to a running shoe with greater arch support.

Runner's Knee

Runner's knee is a painful condition characterized by degradation of the cartilage behind the kneecap. Two major causes are overpronation and weak quadriceps muscles. Wearing pronation control shoes can control most cases of overpronation. Strengthening the quads can also help prevent this cause of runner's knee.

Modified step-ups are a good exercise to strengthen the quads. Use a platform, box or step that's at least 4” above floor level. Stand on the platform with one foot, while the other foot hangs off the side. Gently lower the hanging side by bending the supporting leg - till the toe nearly touches the floor. Gently straighten the supporting leg. Repeat ten times on each side, and build up to three sets of ten.

Ankle Sprains

A sprained ankle is the most common injury to the foot or ankle. And a sprain can be serious. Running makes you susceptible to ankle sprains – and trail running especially so. The most important thing to remember about a sprained ankle is that it's not “just” a little sprain.

A sprained ankle is the result of an over-stretched or torn ligament. Tears are serious injuries and require medical attention. If there is significant swelling present, you're unable to walk on the affected joint, or if there is pain above the ankle or in the foot, see a doctor.

Self-treatment for ankle sprains should include an immediate cessation of training, and using “R.I.C.E.” – Rest, Ice, Compression, Elevation – for 24 to 48 hours. Work gently back into your training schedule to avoid aggravating the injury.

Muscle Pulls

Pulled muscles are the most common sports injury, and are caused by a sudden over-stressing of the muscle. Runners frequently pull hamstring and groin muscles, but quadriceps, calf muscles and others are also subject to pulls.

Don't try to “work through” a muscle pull. This could result in worsening the injury – and lengthening the time you'll be sidelined. Instead, ice and rest the affected muscle. As soon as you reasonably can, gently stretch the muscle to help promote flexibility. Don't overdo it, though. Gradually return to your training program.

Severe pulls and muscle tears require a doctor's care.

Achilles Tendonitis

Though technically not tendonitis, this malady is one of the legendary banes of runners. An Achilles tendon injury can linger for weeks or months… or even longer.

Achilles tendonitis is often associated with a sudden increase in training or the addition of speed and hill training to your workout schedule. Over-cushioned heels and a stiff sole are two running shoe design issues that can contribute to Achilles tendonitis.

However it starts, this problem requires immediate attention if you don't want months of discomfort. Cut back on training, and avoid stretching the affected area excessively. If you've been running hills or doing speed work, cut these back especially. Stay away from very flat shoes – like flip-flops and sneakers - and make sure your running shoes fit properly. Icing after a work out may also be useful.

Use R.I.C.E.

Many minor soft-tissue injuries, such as muscle pulls and sprains – respond well to a treatment regimen known as “R.I.C.E.” That's the acronym for “Rest, Ice, Compression, Elevation.” The first 24 – 48 hours after any injury are the most critical, and R.I.C.E. can help reduce both the severity of symptoms and the length of time the injury sidelines a runner.
• Rest. Take the weight or stress off the affected area, and give it some tie to start healing.
• Ice. An ice pack on the affected area can help reduce both pain and swelling. Don't leave an ice pack in place for more than about a quarter-hour at a time.
• Compression. Wrap the affected area in an ACE bandage – but not too tightly – to help keep swelling down.
• Elevation. Putting the injured area at a level higher than the heart helps reduce swelling.

Basic First Aid Revisited

Most people know the maxim RICE: Rest, Ice, Compression, and Elevation. This basic first-aid principle applies to most running injuries.



From a runner’s perspective, rest can mean no running, or it can mean a shorter run. Ice means putting ice on the sore spot, using an Ace bandage for compression and for holding the ice pack in place. Elevation may not be possible depending on the injury, but if you have a foot injury and you can spend 20 minutes lying down with your foot elevated above the level of your heart, you will promote circulation and help with healing. I would add an M to this acronym, for mobility. Once the swelling decreases, start some stretching exercises to increase the circulation to the injured area and cut down on the formation of scar tissue.

Ice With Veggies

Almost any running injury, major or minor, will feel better if you put ice on the area. You can buy commercial ice packs, but a bag of frozen peas is the most effective ice pack available because it conforms easily to the shape of your foot, leg, elbow, or any other injured area. You can reuse the same bag until it falls apart. Just make sure to label the peas with a marker of some sort so no one cooks and eats them by mistake!

The most effective way to ice an injury is to apply ice to the injured area at 10-15 minute intervals. After 15-20 minutes, the ice pack starts to warm up and lose its effectiveness, so return it to the freezer and ice the spot again in a few hours. Put ice on an injury as soon as possible after activity, or any time that is convenient.

Neuromas: Surgery Is The Best Treatment

Surgery is a last resort for most running injuries. But if you reach a point where conservative methods fail and you want to continue running, surgery may be necessary. In some cases, a simple surgery is the easiest and most effective treatment.



A neuroma is a common foot injury for which surgery provides the most effective long-term solution. A neuroma occurs when the bones of the foot move in a way that causes a nerve to shear off and start forming a piece of scar tissue. Over time, the piece of scar tissue will become larger, and eventually it becomes large enough to press on the nerve and cause pain. You may have a neuroma if you notice a tingling sensation every time you step, but there are no outward signs of redness or swelling.

The most common site for a neuroma is between the third and fourth toes, although it can occur anywhere in the foot. Non-runners develop neuromas, too. Some people can get sufficient relief by wearing wider shoes or by getting an occasional cortisone shot, but the most effective treatment, especially for runners, is a short, outpatient procedure in which the foot surgeon uses a pair of surgical scissors to cut out the neuroma.


If you have surgery for any kind of running injury, get a recommendation for a surgeon who has experience in dealing with athletes, and pay attention to the surgeon’s instructions about post-operative care. You can cross train by walking, biking, or pool running after many types of surgery, but be sure to return to running gradually. If you have dissolvable stitches (which are used in neuroma surgery), avoid excessive stress (such as running) on the area until the stitches have dissolved, which takes about 6 weeks.

Prevention Is The Best Medicine For Marathon Training Injuries

Ideally, runners can build up their mileage and train for a marathon with no injuries. In reality, injuries happen, even to the most careful and well-conditioned runners. But you can reduce your risk of injury and reduce the severity of the injury with some preventive tips:

• Check your shoes (and orthotics): Don’t train in worn-out shoes. Be sure to replace your shoes after 300-500 miles, depending on when you notice significant wear or any foot or leg pain. Even if you think that your shoes look and feel great, retire them at 500 miles. When you try on a new pair, you’ll notice the difference. Many knee, hip, and back problems (as well as foot problems) are caused by poor foot alignment, which can occur when your shoes are worn out or because you need orthotics.
• Cross train: See the section on cross training tips for ways to keep your muscles strong and balanced.
• Rest: Don’t forget to factor in a rest day each week so your muscles and joints can to recover from your tough training days.

Plantar Fasciitis Pain: A Runner’s Bane

Plantar fasciitis is one of the most common injuries in runners. If you feel pain on the bottom of your foot at the front edge of your heel where it meets the arch, you may have plantar fasciitis. The fascia is a band of tissue that runs along the bottom of the foot. This band is flexible, and it flattens out and springs back with each step as you run. But if it is overstretched or if it rubs against something (like an ill-fitting shoe), it can become inflamed. Plantar fasciitis is caused by uneven weight distribution across that foot, which can arise from ill-fitting shoes or a lack of arch support. Running on concrete surfaces every day can aggravate the plantar fascia, too.

Start by putting an ice pack on the sore spot for 10-15 minutes at a time a few times a day, especially after you have been running or walking. Review your shoes with a podiatrist. Your running shoe may have too much motion control and you may need a shoe with more flexibility, or vice versa. Plantar fasciitis will usually resolve within a few weeks if you address the cause. Some runners find that ultrasound treatment relieves plantar fasciitis, but it’s important to find the cause of the problem and solve it to prevent chronic pain.