Dysfunction or Injury?: The Key to Injury Prevention

Stay the Course‘Tis the season for summer running and, for most of us, big miles, big mountains, and hopefully some big fun. But with all that running, problems can arise. Not every ache, pain, or issue is an injury, though. Not at their outset, at least.

The key to avoiding injury isn’t necessarily avoiding any factor that could cause injury. If that were the case, most of us–especially us mountain trail ultrarunners–would simply have to quit running! Because each day and each run–especially those technical, long trail runs–have the potential for falls, or can and will provide ample impact stress to our bodies. And these factors can cause injury.

The key, instead, is to identify and correct any changes to our bodies that could lead to an injury. These changes I refer as ‘dysfunctions.’ To discern between a dysfunction and an injury, I usually ask the following question to clients in the clinic: “If I go out to your car in the parking lot and let all the air out of one of tires, is anything wrong with the tire? Is it damaged?” The answer is usually, “No.” I follow up, “But if you drove away, how far could you drive before the tire gets damaged?”

The ‘Tire Question’ and the Difference Between a Dysfunction and Injury

A blown-out tire is a damaged, ‘injured’ tire. Its physical structure is incomplete and will thus require substantial remediation before it can function normally. This is the essence of orthopedic injury. Either at the microscopic (single cells or a collection of cells) or macroscopic (muscle, tendon, or ligament fiber) level, tissue is damaged. We call them sprains or strains, or other unseemly terms such as tears, ruptures, or degeneration.

On the other hand, a deflated tire is ‘dysfunctional.’ By definition, a tire needs to be fully inflated to function normally. When deflated, it fails to operate as intended, which is to provide both a controlled and cushioned ride. But a tire devoid of air pressure isn’t necessarily damaged. It simply needs some adjustment or restoration to function normally.

A running problem can present as either a dysfunction or injury, and this can be confusing. To make matters worse, sometimes they hurt, and sometimes they don’t (yet)! This is because not all aches and pains are due to damaged tissue. Indeed, our body is skilled at providing pain well before tissue is truly damaged in hopes that we will stop or change what we’re doing before that happens! But the key to overcoming these problems is to discern between dysfunction and injury, and to provide the most appropriate treatment. Returning to the car analogy, we need to simply inflate the tire or to change it outright.

Another example, many folks can relate to the story of a stuck joint in the low back or neck. We are going about our business when, for whatever reason, we move a certain way and get stuck, and we cannot move the affected area. Sometimes this motion restriction can be incredibly painful while other times it’s completely painless but you just can’t move! A joint not moving properly is a classic example of a dysfunction. It was fine, but one false (inefficient, malaligned) move caused it to get stuck.

Is it injured? Specifically, are the bone, ligaments, and/or tendons sprained, strained, or broken? Not usually. In fact, this is quite rare in most cases, unless trauma was involved. It simply isn’t moving properly.

The solution, most people know, is to get it moving. Chiropractic is a thriving profession for this reason: the recognition that ‘joints can get out of place’ and joint mobilization (also done by skilled manual physical therapists and osteopathic physicians) can often restore motion–and immediately relieve pain–with a single adjustment.

When that happens, it’s a wonderful thing. Like a quick pit stop from the AAA truck, a quick ‘tire fill,’ and you’re back to normal! As a physical therapist, I love treating dysfunctions, because the right hands-on treatment can get immediate and powerful results. Case study, I’ve had the chance to treat several Western States 100 runners mid-race. Just a few minutes’ worth of treatment got ailing, distressed runners off the table and down the trail pain-free. This has been a factor in a few silver buckles that I know of.

However, what is happening with increasing frequency in our healthcare system is to prescribe medications: either anti-inflammatory or painkillers. They may relieve pain, but will a special pill or cream get that joint moving again?

The Key to Injury Prevention: Identify and Address the Dysfunctions

Dysfunctions are more common than you think, but we often fail to recognize them for what they are. To extend the analogy, we drive on that flat (or a more subtly half-deflated) tire until we damage it. Or we do notice it and we pull over. And then we sit there, waiting for the tire to inflate on its own. Or we rub some anti-inflammatory cream on the deflated tire. And we wait some more. Then we’re surprised and frustrated when the tire remains half deflated.

Here are some crucial differences between dysfunction and injuries:

FactorDysfunctionInjury
AcuteChronic
Inflammation present (warmth, swelling, redness, bruising)NoYesMaybe/Unlikely
Rest time requiredNo!YesNo/Gradual return
Restore mobilityYes!NoMaybe
Restore stabilityMaybeNoMaybe
Responsiveness to medicationPoorGreatOkay/Poor

The key differences lie in whether inflammation is present and whether all the parts of a system are properly aligned, stable, and moving. Inflammation (usually) means injury; impaired motion nearly always signifies a dysfunction.

For the acute dysfunction, motion restoration is usually all that is needed, for both the stuck neck example and those runners I’ve treated with stiff hips. Only when acute, inflammatory injury has occurred are rest or medications warranted.

This brings about one of my favorite sayings: a joint problem requires a joint solution! This means that if a joint isn’t moving properly (is dysfunctional), the solution lies in restoring motion (or occasionally stability). No amount of rest and pharmaceutical can restore a stuck joint!

This was the impetus behind the performance-mobility series that we published last year (hips, trunk rotation, ankles, knees, and trunk extension). We wanted to provide runners with a way to self-assess the body and identify motion dysfunctions before they become injuries.

A primary dysfunction is a joint that fails to properly move, and itself is prone to pain and injury. This is a frequent occurrence in the feet, ankles, and most prominently, the knees. Like the deflated tire, joints that aren’t properly aligned and moving, when exposed to load, can quickly become painful and injured.

Secondary dysfunctions are more subtle. These are areas that, if they fail to move, can cause stress elsewhere. The hips, pelvis, and spine are prime areas that, if they fail to move properly (or symmetrically), can cause strain and injury above or below–namely in the legs.

The performance-mobility series gives runners the tools to self-screen for dysfunction and treat them before they cause problems, or eventually lead to injury. Keeping the system moving–keeping joints functional–prevents the vast majority of inflammatory and destructive tissue injury that keeps people out of their running shoes for extended periods.

When running up and down mountains, over rocks, in water, and for hundreds of miles, dysfunctions will happen! The key to healthy and fast running isn’t extreme luck or avoidance altogether. It’s awareness and a bit of upkeep to keep things moving in the right direction. So keep on the lookout (or the feel-out), fix your problems, and you’ll keep running far and fast.

Call for Comments (from Meghan)

  • When was the last time you had a dysfunction, but not an injury?
  • What was the issue, what caused it, and how did you heal?
Joe Uhan

is a physical therapist, coach, and ultrarunner in Eugene, Oregon. He is a Minnesota native and has been a competitive runner for over 20 years. He has a Master's Degree in Kinesiology, a Doctorate in Physical Therapy, and is a USATF Level II Certified Coach. Joe ran his first ultra at Autumn Leaves 50 Mile in October 2010, was 4th place at the 2015 USATF 100K Trail Championships (and 3rd in 2012), second at the 2014 Waldo 100K, and finished M9 at the 2012 Western States 100. Joe owns and operates Uhan Performance Physiotherapy in Eugene, Oregon, and offers online coaching and running analysis at uhanperformance.com.

There is one comment

  1. Ben Pine

    I’ve had two problems in the last couple of years that qualify as a dysfunction. I have club feet which means my motion isn’t completely symmetrical anyway, and this actually loads my better leg. I tend to have problems oscillating between the plantar area and calf. Anyway one problem I had was a really deep calf issue where it felt like a I had a nail in my calf. I rested it and tested it and rested it and tested it… This went on for a couple of months before I went to my physio who found the bit of fascia causing it and sorted it out. I then knew where it was and could roll it. Rest had made this problem worse.
    The other problem was with my club foot. I do a lot of barefoot running in the summer, and somewhere along the line had overstressed my right ankle which responded by locking up. It had done this before, but this time refused to unlock. Again I rested and put off seeing my physio – this time as I was so busy with work – until, a couple of months down the line, I had time. She gave me some exercises and told me to carry on running. Like magic the problem shrank and went away.
    You articles are great, thank you.

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