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The wounds of the marathon

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Introduction:

A figure 4.1 injuries per 1,000 hours of practice in competitive runners.

Hold back :
- Avoid too rapid increase in training volume.
- Importance of quality footwear.
- Do not neglect stretching and warming up.
- Ensure good hydration and adequate food.

The main locations:

Foot
- Stress fractures of the second and third metatarsals, but all the foot bones may be involved.
- Plantar fasciitis.
- Achilles tendonitis.

The tibia
- Stress fracture.
- Shin medial tibial.

Knee
- Syndrome wiper.
- Chondromalacia patella (or patella syndrome).

The stress fracture

This is an adaptation bone disease during exercise.
Main contributing factor: too rapid increase weekly mileage.
It concerns all the bones but especially the tibia and the metatarsals 50% to 20%.
Treatment: some localizations (anterior tibial) require drastic measures, others a mere compliance with indolence.

The internal tibial shin

A separate stress fractures of the tibia.
The pathophysiology is still hypothetical: pain of the periosteum or muscle fascia, tendon sheaths see.

Contributing factors:
- Too fast Increase weekly mileage.
- Running on hard surfaces.
- Bad damping shoes.
- Feet pronator.


Treatment :
- Corrective insoles.
- Physiotherapy (deep transverse massage and physiotherapy).
- Respect indolence needed rest and sports gradual recovery in good conditions.

Achilles tendonitis

It is a condition of hyperutilisation responsible for repetitive strain injury to the tendon.

To distinguish :
- The body of the tendon tendinitis
- The tenosynovitis
- The insertion tendonitis
- The retro pr├ęachill├ęennes bursitis

Three evolutionary stages:
Stage 1 pain after sport, easily yielding to rest.
Stage 2 pain in the warm-up, disappearing only to reappear to fatigue.
Stage 3 constant pain resulting in a decrease or stopping training.

Contributing factors:
- Too fast Increase weekly mileage.
- Running on hard surfaces.
- Bad damping shoes.
- Stretches of failure or overheating.
- Feet pronators hollow and achilles courts.
- Poor hydration, poor diet.
- Metabolic disorders (uric acid, cholesterol ...).

Treatment :
A set off early to avoid chronicity.
Sports Recreation until disappearance of pain, in everyday life, and when hopping on the tip of one foot.
Enjoy this forced rest to correct any predisposing factors (stretching, footwear ...).
Physiotherapy (deep transverse massages, physiotherapy and stretching).
corrective insoles.
very gradual resumption of training.

plantar fasciitis

This is the most common injury to the foot of the rider.
It is a micro-traumatic pathology of the inner part of the plantar fascia, which may progress to rupture.

Contributing factors are the same as those responsible for Achilles tendonitis.

The 3 stages of evolution are also found.

Radiography sometimes shows a heel spur.

Treatment :
- Sports Recreation.
- Correction of predisposing factors.
- Corrective insoles.
- Physiotherapy (MTP and stretching).
- If necessary infiltration.
- Gradual recovery training.

Syndrome of the wiper or the iliotibial band.

It is a disease linked to repeated rubbing of the iliotibial tract on the lateral femoral condyle. It applies only to online sports (running, cycling, power walking).

Contributing factors:
Genu Varum, supination attack.
Exaggerated projection of the lateral condyle.
excessive internal rotation of the tibia.
too rapid increase weekly mileage.

Diagnostic :
Pain lateral compartment of the knee, appearing for mileage, upper bound is progressively persistent 24 to 48 hours in activities of daily living especially on stairs.

Treatment :
- Sports Recreation time to make corrective insoles.
- Local anti-inflammatory treatments or generals.
- Stretching of the tensor fascia lata, if necessary at the physiotherapist.
- Gradual recovery training.

chondromalacia patella.

It is a condition of the patellar cartilage essentially patellofemoral hypertension.

Contributing factors:
Genu valgum, hypermobility, recurvatum.
Insufficiency of the quadriceps (vastus) or hamstring.
Dysplasias.
traumatic history (patella ligament ...).
rapid increase in training volume.

Diagnostic :
knee pain, anterior, mechanical, plus the sport, down stairs, prolonged sitting (cinema, car) or getting up from that position.


Treatment :
- Sports Recreation minimum, respecting the pain.
- Anti-inflammatory.
- Physiotherapy (strengthening of the vastus).
- Gradual recovery training.

Doctor Yves GUGLIELMETTI. - 30 janvier 2009.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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