Advertisement

How to Avoid Injury from Walking Exercises

by Martica K Heaner

Although it's true that walking is generally a safe, easy form of exercise, it's still possible to find yourself with an unexpected and unwanted injury. Regular walkers are no doubt familiar with blisters, tender feet and aching muscles; if you ignore it, an innocent niggle can easily become a chronic problem.

Make sure a debilitating injury doesn't prevent you from reaching your weight-loss and fitness goals by taking note of these 10 common walking woes.




TENDERNESS ON THE HEELS OR THE BOTTOMS OF YOUR FEET
Could be: plantar fasciitis
The plantar fascia is the band of tissue that runs from your heel bone to the ball of your foot. When this dual-purpose shock absorber and arch support becomes strained, small tears develop, and the tissue stiffens in a protective response.

"Walkers can overwork this area when pounding the pavement, especially when they wear hard shoes on concrete, because there's very little give as the foot lands," says Teresa Schuemann, a US-based physical therapist.

Inflammation can also result from any abrupt change or increase in your normal walking routine. People with high arches or who pronate excessively (walk on the inside of the foot) are particularly susceptible.

You know you have plantar fasciitis if you feel pain in your heel or arch first thing in the morning (the fascia stiffens during the night). If left untreated, the problem can cause a build-up of calcium, which can create a painful, bony growth around the heel known as a heel spur.


What can you do about it? At the first sign of stiffness in the bottom of your foot, loosen up the tissue with this stretch: sit with the ankle of the injured foot across the opposite thigh. Pull toes towards your shin until you feel a stretch in the arch. Run your opposite hand along the sole of your foot; you should feel a taut band of tissue. Do 10 stretches, holding each for 10 seconds. Then, stand and massage your foot by rolling it on a golf ball or a full water bottle.

To reduce pain, always wear supportive shoes or sandals with a contoured foot bed. Choose walking shoes that aren't too flexible in the middle. "They should be bendable at the ball but provide stiffness and support at the arch," says Melinda Reiner, a podiatrist in the United States.

Off-the-shelf orthotic inserts or a custom-made pair can help absorb some of the impact of walking, especially on hard surfaces. Until you can walk without pain, stick to flat, stable paths (such as level dirt roads) and avoid pavement, sand and uneven ground that might cause too much flexing at the arch, says US podiatrist Phillip Ward.




SORENESS OR SWELLING ON THE SIDES OF YOUR TOES
Could be: ingrown toenails
Tender toes can develop when the corners or sides of your toenails grow sideways rather than forward, putting pressure on surrounding soft tissues and even growing into the skin. You may be more likely to develop ingrown toenails if your shoes are too short or too tight, which causes repeated trauma to the toe as you walk, says Ward. If the excess pressure goes on too long, such as on an extended hike or charity walk, bleeding could occur under the nail, and the toenail might eventually fall off.



What can you do about it? Leave some wiggle room in your shoes. Use toenail clippers (not fingernail clippers or scissors) to cut your toenails straight across instead of rounding the corners.

"People who overpronate when they walk can exacerbate existing problems in the big toes," says Ward, who suggests using inserts to reduce pronation. If you have diabetes or any circulatory disorder, have a podiatrist treat your ingrown toenails.



PAIN IN THE BACK OF YOUR HEEL AND LOWER CALF
Could be: Achilles tendonitis
You can irritate the Achilles tendon, which connects the calf muscle to the heel, by walking too much, especially if you don't build up to it. Repeated flexing of the foot when walking up and down steep hills or on uneven terrain can also strain the tendon.



What can you do about it? For mild cases, try not to walk so far, or substitute non-weight-bearing activities, such as swimming or upper-body training, as long as these don't aggravate the pain. "Avoid walking uphill, because this increases the stretch on the tendon, irritating it and making it weaker," says Schuemann.

Regular calf stretches may help prevent Achilles tendonitis, says Michael J Mueller, PhD, an associate professor of physical therapy at Washington University School of Medicine in the United States.

To reduce inflammation and pain in severe cases, limit or stop walking and place cold packs on the injured area for 15 to 20 minutes, as many as three or four times a day. When you return to walking, keep the foot in a neutral position by sticking to flat surfaces and gradually increase your distance and intensity.



PAIN ON THE BONY SIDE OF YOUR BIG TOE
Could be: a bunion
A bunion develops when the bones in the joint on the outer side of the big or little toe become misaligned, causing a painful swelling. Walkers with flat feet, low arches, or arthritis may be more apt to develop the problem.


What can you do about it? "Wear shoes that are wider, especially in the toe area," says Ward. If you don't want to shell out for new shoes, ask a shoe repairer to stretch your old ones. Cushioning the bunion with over-the-counter (OTC) pads can provide relief, and icing it for 20 minutes after walking numbs the area.

Ultrasound or other physical-therapy treatments may reduce the inflammation. Severe cases can require surgery to remove the bony protrusion and realign the toe joint.



AN ACHE IN YOUR MID TO LOWER BACK
Could be: lumbar strain
Walking doesn't usually cause lower-back problems, but the repetitive movement can worsen an existing lower-back injury. It's easy to throw out your back when you overwork tendons and ligaments around the spine. Arthritis in or inflammation of surrounding nerves can also cause pain in this region.


What can you do about it? For general back health, keep the muscles in your trunk strong. While you walk, engage your abdominal muscles by pulling your belly button towards your spine as if you were trying to flatten your belly to zip up tight jeans.

"Avoid bending over at the waist, which is a tendency when you are walking fast or uphill," says Schuemann. "Instead, keep your spine elongated and lean your whole body slightly forwards from your ankles."

A 'shirt-pull' exercise might also prevent slumping by realigning your posture. You can even do it while you walk. Simply cross your arms at the wrists in front of your waist and raise your arms as if you're pulling a shirt up over your head. Act as if you're growing taller as you reach up, then lower your arms, letting your shoulders drop into place.

Tight hamstrings and hip flexors can also cause postural distortions that put pressure on the lower back, so be sure to keep those areas flexible, too.



PAIN IN THE BALL OF YOUR FOOT OR BETWEEN YOUR TOES
Could be: neuroma
If tissue surrounding a nerve near the base of the toes thickens, it can cause tingling, numbness or pain that radiates to surrounding areas. It may feel as though you're treading on a marble. This condition, known as Morton's neuroma, frequently develops between the base of the third and fourth toes. It's as much as 10 times more common in women than in men, possibly because women's feet are structured differently and because women tend to wear narrow, high shoes or very flat ones. "If you have Morton's neuroma, walking can irritate it," says Ward.


What can you do about it? Treatment varies from simply wearing roomier shoes to surgery, depending upon the severity of the neuroma. See a podiatrist at the first sign of pain, as this condition can worsen quickly. Make sure your walking shoes have a spacious toe box. Limit the time you spend in heels; if you must wear them, travel in comfortable shoes and then slip on the more stylish pair. OTC insoles or pads that relieve pressure and absorb shock may help, too.



STIFFNESS OF SORENESS IN YOUR SHINS
Could be: shin splints
Your shins bear as much as six times your weight while you exercise, so foot-pounding activities can cause problems for the muscles and surrounding tissues and create inflammation. The strain results from strong calves pulling repeatedly on weaker muscles near the shins.

"Walkers who walk too much, too soon, or too fast, too soon, or who go up a lot of hills are susceptible to this injury because the foot has to flex more with each step, which overworks the shin muscles," explains Dr Frank Kelly, an orthopedic surgeon and spokesperson for the American Academy of Orthopaedic Surgeons.

Spending too many hours walking on concrete can also lead to this sort of inflammation. Severe or pinpointed pain in the shin could also be a stress fracture of the tibia, the leg bone between the knee and ankle.


What can you do about it? Cut back on your walking for three to eight weeks to give the tissues time to heal. "If it hurts to walk, avoid it," says Dr Joel Press medical director of the Spine & Sports Rehabilitation Centre at the Rehabilitation Institute of Chicago. You might need an anti-inflammatory medication, such as ibuprofen, or cold packs to reduce swelling and relieve pain.

In the meantime, keep in shape by cross-training with low-impact exercises such as swimming or cycling. You should also strengthen the muscles in the front of the lower leg (anterior tibialis) to help prevent a recurrence. Use this simple exercise: while standing, lift toes towards your shins 20 times. Work up to three sets and, as you get stronger, lay a 1 kg or 1.5 kg ankle weight across your toes to add more resistance.

Once you're ready to start walking again, choose a dirt path and walk for 20 minutes at a moderate pace. Increase distance or speed slightly each week. "If your shins start to feel sore, rest for a day or two, and when you exercise again, take it even more slowly," says Byron Russell, PhD, chair of the department of physical therapy at Eastern Washington University, US.



SORENESS ON THE OUTSIDES OF HIPS
Could be: bursitis
Although there are many potential causes of hip pain, it's common for the fluid-filled sacs (bursae) that cushion the hip joint to become inflamed with repetitive stress. People with one leg slightly longer than the other are more susceptible to this condition. Too much walking without building up gradually can cause this problem.


What can you do about it? Instead of walking, ride a stationary bike, swim, or do some other non-weight-bearing activity for a few weeks, says Kelly, who also suggests an over-the-counter anti-inflammatory medication to lessen the discomfort.

"When you begin walking again, don't just step back in where you left off. Start gradually: walk every other day at first. Spend the first five minutes warming up by walking slowly and do the last five minutes at a slower, cool-down pace," he says. In more severe cases, you may temporarily need a cane or crutches to reduce pressure.



THROBBING IN THE FRONT OF YOUR KNEECAP
Could be: runner's knee
Every time your shoe strikes the ground, your knee feels it. Eventually, your kneecap may start to rub against your femur (the bone that connects your knee to your hip), causing cartilage damage and tendonitis. Walkers with a misaligned kneecap, prior injury, weak or imbalanced thigh muscles, soft knee cartilage, or flat feet, or those who simply walk too much, are at greater risk of runner's knee. The pain usually appears when walking downhill, while doing knee bends, or during prolonged sitting.


What can you do about it? Shift to another type of exercise until the pain subsides, typically eight to twelve weeks. Do some quad strengtheners to help align the kneecap and beef up support around the knee: sit with your back against a wall, right leg bent with foot flat on floor and left leg straight in front of you. Contract quads (thigh muscles) and lift left leg, keeping foot flexed. Repeat 12 times; work up to three sets per leg. While standing, place a looped band around both feet and sidestep 12 to 15 times to right, then back to left.

When walking or hiking downhill, take smaller steps and try not to bend your knees too much, or try walking sideways to give your side hip muscles a workout.



ACUTE PAIN IN YOUR FOOT OR LOWER LEG
Could be: stress fracture
If you feel tenderness or pain when you press on a specific spot on your foot or lower leg, you may have a stress fracture—a tiny crack in a bone. Most common in the lower leg, they tend to occur when leg muscles become overloaded from repetitive stress because the bone absorbs the shock, rather than the muscle. This can happen if you ignore a shin splint, for instance; the continued strain on muscles and tissues will eventually shift to the bone.
Walking is more likely to lead to a stress fracture if you walk too far, to fast—especially if you have high arches or rigid, flat feet. Women may be more vulnerable because their muscle mass and bone density don't always act as adequate shock absorbers.


What can you do about it? Kick back and let the area heal for several weeks. "You need to get off your feet to avoid loading the bones," says Dr Sheila Dugan, a physiatrist and an assistant professor at Rush University Medical Center, Illinois, in the US. Try replacing walking with swimming, aqua aerobics, or upper-body weight training.

When you return to your regular regimen, stop before you feel any discomfort. Replace walking shoes when the interior cushioning has worn down to ensure that you have adequate shock absorption. To optimise bone health, do some lower-body strength training twice a week and eat calcium-rich foods like yoghurt, cheese and dark green leafy vegetables such as kale, or take a supplement. Women should generally get 1,000 mg of calcium a day and 1,200 mg if over the age of 51.

More from our new walking centre



Calculate how many kilojoules you burned on your walk



Train for long-distance walking