Running is one of the most effective and efficient ways to exercise, and its popularity is growing fast since many gyms have been subject to closures recently. Although it is a great form of exercise it is not without its risks. It puts a lot of repetitive stress and load on the body which can result in injury. Although many of these injuries, in large part, are due to an “overload”, there are many variables that can be influenced to enhance your running and reduce injury. Here are some of the most common running injuries and their possible causes:
This usually presents as pain in the front of your knee (behind or around your knee cap). This is usually caused by an irritation in between the knee cap (patella) and the femur. These structures glide on one another as the knee bends and straightens during the running motion. Symptoms include sharp pain with squatting, going down stairs and walking down hill. Sitting for long periods can also cause aching in the knee. The most common causes are overuse and/or possible weakness in the lower extremity including the hips.
Initially pain control is important. This can be done with anti-inflammatories, rest, and the use of a bike with very little resistance. Once the pain has reduced and you can tolerate light load on the knee you should start a gradual progression of loading the knee through specific exercises. These should include strengthening of the hip, leg, and foot muscles which can affect the position of the knee when the foot hits the ground.
This one can be the most painful condition on this list. It is a sharp pain felt in the heel and/or the arch of the foot. This is thought to be an inflammation of the ligament that extends the length of the foot starting at the heel and attaching to the base of the toes. There are some other structures that may be involved that reside in the same area, so the exact source of the pain can vary. All of these structures are involved in maintaining the arch of your foot during the weight bearing portion of your running pattern. Some contributing factors are thought to be increased bio-mass index(a measure of body fat based on your height and weight), first-toe stiffness, compensating for an injury in the opposite limb, and low arches. In the early stages of this condition the pain is usually excruciating in the mornings with the first few steps out of bed. This can be debilitating in some cases.
Ice, anti-inflammatories, shoe inserts to support the arch and rest are often all that is tolerated in the early stages. Light stretching of the toes and calf can also help early on. When it is tolerated, loading the foot structures through specific foot and ankle exercises is next. This can be a long and frustrating recovery, taking 3-6 months and in some cases up to a year.
Although it is a great form of exercise it is not without its risks. It puts a lot of repetitive stress and load on the body which can result in injury.
This is an irritation of the tendon that attaches the calf muscle to the heel bone and it accounts for 10-15% of all running injuries. This can occur in the middle of the tendon (mid substance) as well as in the attachment to the heel (insertional). Both can creep up on you as just a “niggle” in the beginning stages. This is why many people often continue to run through these symptoms as it progresses to something worse. It can eventually turn into a sharp pain felt every step of everyday life if it is not addressed early enough. This condition usually occurs when people start to improve their conditioning, which in turn allows them to start pushing their pace and/or distance beyond the capacity of their achilles.
If the symptoms are at a tolerable level you can sometimes get away without stopping your running. Just backing off on your pace and/or distance, then working your way up at a slower rate may be enough. This, combined with specific exercises to increase the capacity of the tendon, can get you through it. If it is a more severe case it can take up to 3-6 months to resolve. The trick is catching it early and making the proper adjustments.
Sometimes called “medial tibial stress syndrome”(MTSS). This is usually an aching along the front of the shin that intensifies with increased exertion. The origin of this pain is not necessarily clear. The muscles that attach to the inside part of your shin bone (tibia), some of which run the length of the ankle and support the arch of the foot, are thought to be the source of pain. Alternatively, the bones themselves can develop “stress reactions” as a result of the repetitive load. These can progress to full stress fractures (see #5) if not recognized early enough. This is often seen in people returning to running, or new runners, where their tissues (muscles, tendons,and bones) have not built up the capacity to withstand the pounding that comes with running.
Again, not necessarily a scenario where you need to stop running. It may be enough to just dial back and then slowly build back up. It depends on the intensity and frequency of your symptoms as to whether you dial back or need to stop all together. As with the other conditions, stretches, strengthening and load management are all part of the fix.
Stress fractures can be classified as either low-risk injuries (less likely to become more serious fractures) or high-risk injuries (more likely to become serious fractures). Depending on which category your injury falls into will determine the path you will take to recovery. Low-risk stress fractures can be treated much like shin splints in that it may not be necessary to stop running completely. Reducing your pace/distance and building up slowly may work. If it is suspected that you have a stress fracture in a high-risk area you may require imaging, such as bone scans or MRI, to diagnose it and assess its severity. Since high-risk stress fractures have a tendency to progress to complete fractures, they require a more aggressive approach, such as a period of non-weight bearing and progression towards low impact activities and exercises.
All of these injuries have one thing in common, they are all, in part, a result of overloading the tissues and structures to the point of breaking down. As stated earlier, they would all do well with a period of calming down and building back up. Physical therapy can help with both of these phases. Manual therapy, modalities, and education can help reduce the inflammation and irritation of the affected area. Once the injury is to a point it is able to tolerate some load, and the therapist thinks it's ready, a graded exposure program applying the appropriate dose of stress to the structures should begin. This will involve specific exercises to address any imbalances and capacity deficiencies. There is also some benefit in having a running assessment with a licensed professional (not some untrained running shoe store employee) to determine if there are any adjustments that can be made to your form to reduce the stress to the area of injury. Running progressions and footwear should also be discussed.
Merely resting for a period of time and returning to your previous level of running rarely works. These injuries listed here, as well as many others that are due to possible “training errors”, require specific knowledge and experience for you to return in the most effective and efficient manner. We know how hard it is to achieve the gains and we want to help you get back there ASAP!