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What Are Some Common Skating-Related Overuse Injuries?

Overuse injuries occur when a repetitive motion irritates nerves, bones, a muscle, or other connective tissue in the body. An overuse injury typically becomes a "chronic" injury, which develops over time and can be long term, vs. an "acute" injury, which is a sudden injury usually related to some sort of accident (i.e. a broken bone or ankle sprain). Because overuse injuries are a result of repetitive stress on a body part, they can often be avoided by listening to the body's warning signals. The problem is that many active and/or athletic people don't want to listen to those warnings because it usually means stopping what they are doing for a while until the early signals go away. For myself, that is the case. I have had tendonitis in my foot now for at least 6 months and had I listened to the warning signals, I would most likely be over it by now. In this column, I would like to address some more common skating-related overuse injuries and also add a personal note regarding the "psychological" aspects of dealing with a chronic sports-related injury.

Some overuse injuries which can affect inline skaters include: plantar fasciitis, tendonitis, neuroma, and low back strain. Causes of these injuries include poor body mechanics/posture, inadequate flexibility, improper equipment (i.e. skates), and increasing skating mileage or intensity too rapidly.

Plantar fasciitis is intense inflammation of the plantar fascia, a band of fibrous connective tissue that spans the bottom of the foot from heel to toe. Heel spurs may also develop, causing further pain and discomfort. Plantar fasciitis is characterized by severe pain under the heel and arch of the foot. Lack of adequate arch support can be a contributing factor to developing this as can intense gripping (with toes) or poor calf muscle flexibility.

Common treatments include ice and anti-inflammatory medicine. Many people find relief by wearing supportive shoes, good arch support, foot massage and stretching, and stretching the calf muscles. In severe cases, the foot may have to be immobilized by a brace or walking cast.

Tendonitis is the inflammation of a tendon and/or the tendon sheath (a tendon connects muscle to bone). In general, this is a very common overuse injury in different parts of the body for many different sports-related activities. Tendonitis is characterized by pain and stiffness with movement and localized swelling. If left to worsen over a long period of time, mineral deposits can even accumulate in the tendon tissue. In some cases, it is more noticeable in the morning and improves slightly when the tendon is warmed up through mild exercise.

Skaters could potentially develop tendonitis in the foot (from excessive edging or heel-brake stopping), below the knee cap (patellar), or even in the achilles tendon (lower calf). If skating is not a direct cause of these problems, it certainly can exacerbate them. The achilles tendon is the largest tendon in the human body and can withstand forces up to 1000 pounds or more. Overuse of this tendon is often directly related to a lack of proper flexibility in the calf muscles.

Treatment of tendonitis is to stop the activity that is irritating the tendon. Anti-inflammatories, ice, and elevation are prescribed. Some people find relief with a combination of ice and heat or liniment (i.e. Tiger Balm). Doctors might use ultrasound treatments, cortisone injections (should not use in the Achilles Tendon), taping or restrictive bandages, insoles or, as a last resort, surgery. I have chosen to try acupuncture and have found that the treatments are quite helpful. The important thing to note is that nothing is an instantaneous cure. Tendonitis can take a while to go away, according to some people, even up to one year or more. Any of the previously mentioned treatments must be coupled with rest for the injured area! The hardest thing to do is to stop doing the activity that is causing the discomfort.

A neuroma is another potential overuse injury that could affect skaters. It is a pinched nerve in the ball of the foot that causes pain. Actually, the nerve becomes enlarged due to too much pressure on the ball of the foot, usually as a result of over-pronation or other technique flaws. Neuroma often manifests itself initially as a feeling of numbness or dull ache between toes 2-4. Eventually, this condition becomes painful.

In the early stages, treatment can be as simple as addressing the technique (i.e. correct the over-pronation), wear shoes that provide stability, orthotics, and eventually anti-inflammatories and ice. Worst-case scenario is surgery.

The other most likely over-use injury or problem to afflict inline skaters is low-back strain. It is estimated that 60-80% of the population has low back pain at some time. This is almost inherent with the different degrees of forward flexion that skaters adopt. Most people don't have adequate core strength to support their low backs and that can be the source of a lot of the problems. Another cause is tightness in the low back and/or hamstrings and even hip flexors. Low back strain manifests itself as a dull ache and tightness in the muscles of that area (erector spinae muscles).

Massage, ice, heat, and anti-inflammatories can be used for more serious low-back strain, while treatment of mild low back strain generally includes stretching the muscles of the hip, trunk, spine, and hamstrings. This should be coupled with strengthening of the core musculature, especially the abdominals. Ease gently into strengthening the back muscles, but these should ultimately be included in any fitness program. A good stretch for the low back is the "cat/cow" stretch, which can be done from a standing position by resting your hands on your knees or a hands and knees position on the floor, and alternating rounding the back and flattening it. When you round the back, pull the abdominal muscles up toward the spine.

"Psychological " Side to Dealing With a Chronic Skating-Related Injury

I want to say a few personal words about dealing with a chronic overuse injury. I have had tendonitis in my right foot for probably 6 months or so now. It has totally affected my ability to skate, which I basically stopped doing for exercise mid-July, and stopped teaching on skates early August. I could deal with this better if skating wasn't my passion and my livelihood.

Because I didn't want to be slowed down in my race training by anything, I went for 2-3 months in total "denial" about the potential severity of my foot discomfort. I was aware of the growing pain, but chose to keep right on training in hopes that it would just "go away". Suspecting tendonitis, when, after the Solstice skate (mid June), it got a lot worse, I finally made an appointment with a medical doctor. He suggested taping my foot to limit range of motion and taking anti-inflammatories. Well, that didn't do it, so about 3 weeks later I went to see a sports medicine doctor who diagnosed the tendonitis and added icing several times a day and modifying my activities.

After still stubbornly not giving up teaching on my skates, the pain still didn't go away, I decided to completely get off skates. The point here is that for some people, like myself, I hung on to every hope of still being able to maintain my lifestyle of skating for fitness and for work. I finally started acupuncture treatments in early August and have seen improvements from these treatments, but find that it doesn't take much to have a minor setback in progress. Good days are those days when I am not aware of the achy sensation in my foot and I know it is healing, bad days are those when am aware of it and I know that I have begun to re-injure it again. It is so tempting to "test" it out when it feels better and it is easy to over do that.

Psychologically, what can you expect when you are injured? It is very difficult to stay enthused about something that in the back of your mind you are not sure when you will be able to return to that activity. It is a lot easier to deal with an acute injury where you know that in just a matter of time it will heal. You may find yourself withdrawing from social activities related to skating. You may experience depression and hopelessness, while at other times be able to remain positive and moving forward. My own personal experience with the tendonitis has given me an appreciation of what a person with a chronic illness has to deal with. There are a lot of "ups and downs".

The injury allows you to step back and let your body rest. Resting is a good thing for your body. Admittedly, I have enjoyed having more time on my hands to spend with family, get work done, and just relax, because I am spending a lot less time focusing on exercising and race training. My exercise routine has been modified severely, but has been creatively adapted to incorporate exercises that don't bother my foot. I can actually now look forward to the process of "getting back in skating shape" when the time comes. Fortunately for my skate school, I have wonderful instructors who help me teach my skating classes, and students willing to have me instruct them while on my bike, so it is still business as usual. Would I rather be skating? Of course!