Running injuries are an unfortunate, yet all too common occurrence. Understanding a running injury is the key to prevention, early detection, and effective treatment. Here are some resources that explain common problems and offer information about types of treatment for a running injury.
6 MOST COMMON RUNNING INJURIES (CLICK TO EXPAND)
Achilles tendonitis is an injury commonly noted with runners, walkers, and those who participate in jumping or stop/start activities. It can be persistent, frustrating, and challenging to alleviate once it starts. The following covers causes, symptoms, and prevention strategies.
The Achilles tendon is the large band that connects the musculature in the calf to the heel bone. Inflammation of the tendon occurs when the structure becomes irritated. This irritation usually results when one or more of the following conditions are present:
- Tightness or inflexibility of the gastrocnemius or soleus muscles.
- Jumping in too quickly to a new routine or starting too aggressively after injury, illness, or vacation. If your body has been inactive, it will need time to adjust.
- Insufficient support of the foot/arch during activity. Those who have excessive pronation of the foot may need to reassess their shoe wear choice or consider additional arch support.
- There is more risk for injury to the tendon if the activity of choice involves frequent stop/start motions, excessive jumping or bouncing, or highly repetitive actions. If the first three common causes are not taken care of, these types of motions could lead to injury of the Achilles.
If you are suspect to having an injured Achilles, you may note some of the following symptoms: tenderness over the tendon or attachment at the heel bone, mild swelling at the back of the heel or thickening of the tendon, a nodule (bump) on the tendon, squeaking/creaking sound when the tendon is moved. Throughout the day there may be more difficulty with stairs or rising up on the toes, or stiffness in the morning or at the beginning of an activity that improves with movement. If there is significant swelling, redness, and pain that does not resolve or improve with rest/ice/elevation/anti-inflammatory medications, consult a primary care physician (PCP).
What can be done to prevent Achilles Tendonitis or help once it starts?
- Start slowly! If you have not been active for a while, are taking on a much more challenging program, or are returning to a sport/activity that is being revisited after a long layoff, remember that the body may need time to adjust. Increase levels gradually.
- Remember to warm up. For high impact activity, be sure to allow your body to increase the circulation in the tendon prior to going full participation.
- Take a good look at shoes. Make sure that they have adequate support and cushion and are not excessively warn. Consider making a trip to a technical shoe store for suggestions if needed.
- Stretch! Muscles in the calf are prone to tightness and daily stretching is a must. This is extremely important if you are experiencing a problem or injury to the Achilles tendon.
- Consider cross training. Regular participation in only running and jumping activities may require some biking or swimming to give the tendon time to rest. If injured, stay away from impact activities until the pain has lessened and can comfortably skip and tolerate stairs without pain.
IT Band Friction Syndrome
There are many beneficial aspects of participating in a cardiovascular training program. These benefits include improved blood pressure, improved blood glucose levels, decreased resting heart rate, better ability to maintain target weight, improved metabolism, and even potential improvements in mental faculties and improved lifespan. However, as with any exercise program, there is always the possibility of developing a traumatic or overuse injury. One such overuse injury that is very common in runners and cyclists is IT Band Friction Syndrome.
What is IT Band Friction Syndrome?
IT Band Friction Syndrome is a common overuse injury that occurs when the IT band (or Iliotibial band) becomes very tight and creates excessive friction over the outside of the hip or the outside of the knee. When the IT band becomes tight and exercise is continued, the repetitive friction of the IT band rubbing over the outside of the hip or outside of the knee creates irritation, inflammation, and ultimately pain. This pain may prevent participation in cardiovascular exercise until the symptoms are alleviated. The best way to address IT Band Friction Syndrome is to PREVENT it from occurring! This is most effectively done with a comprehensive stretching and foam roller program, and possibly some specific hip strengthening exercises. A good maintenance program performed 2-3 times a week can do wonders in helping to prevent IT Band Friction Syndrome, along with a number of other overuse injuries.
What can I do if I get IT Band Friction Syndrome?
The first thing to understand when addressing IT Band Friction Syndrome is the actual anatomy of the IT Band. One common mistake that many people make when trying to self-treat IT Band Friction Syndrome is focusing on foam rolling and stretching the IT band in isolation of any other muscle or muscle group. The basic idea that drives this self-treatment mistake is “if the IT Band is tight then I need to stretch and foam roll the IT band.” The fallacy behind this idea is that the IT Band is a non-contractile tissue. This means that the IT band cannot contract, and therefore cannot get “tight” unless it is being pulled by some other muscle or muscles that attach to the IT Band.
Notice that the white tissue of the IT band runs from the outside of the hip to the outside and below the joint line of the knee. This white tissue is called fascia and does not have any (or at least very little) capacity to shorten like a muscle can. The muscles that attach to the IT Band can potentially create the tension. In the anatomy picture above there are two main muscles that attach to the IT Band: the Gluteus Maximus and the Tensor Fascia Latae (TFL).
The Gluteus Maximus is the largest and most powerful of all the gluteal muscles, and some literature indicates that up to 80% of the muscle fibers of the distal Glute Max insert into the IT band. Looking more anteriorly, (towards the front of the hip) notice the large TFL which acts as a powerful hip flexor while running and cycling. 100% of the distal fibers of the TFL insert into the IT Band. Therefore, where the IT Band gets tight, it is more often than not the glutes or the TFL that is the culprit creating the tension and the IT Band is the victim. If IT Band Friction Syndrome is attacked by stretching and foam rolling, this only targets the victim, not the culprits – the glutes and the TFL. Start with a comprehensive stretching and foam roller program that addresses the glutes and the hip flexors.
Another common mistake that people often do when trying to self-treat IT Band Friction Syndrome is “massaging” the spot that hurts. The IT Band Friction Syndrome is being caused by excessive tension in the IT Band, and that tension is predominately coming from tight glutes and a tight TFL. The pain may be on the outside of your knees, but the problem is in the inflexibility. Self-massaging the part of the IT band that is inflamed and irritated may just be further irritating and inflaming that tissue. Instead of massaging the painful part of the IT Band, using ice for 10-12 minutes several times a day may be a better option, as the ice will help decrease some of the inflammation without further aggravating the tissue.
Lastly, IT Band Friction Syndrome is often times associates with weakness in the lateral hip stabilizers. This type of muscle weakness tends to be common in runners and cyclists due to the linear aspect of those sports (very little lateral movement).
Plantar Fasciitis is a painful condition of the foot involving inflammation of the plantar fascia (aponeurosis) and is one of the most common injuries to the foot. Pain is typically most prominent with the first steps taken in the morning, or after an extended period of time non-weight bearing. The plantar fascia essentially spans the full length of the sole of the foot. It most often occurs due to repetitive micro trauma to the fibers of the fascia at, or near, the heel bone. Biomechanically, the plantar fascia provides strong support for the foot during both pronation and supination phases of the gait cycle. A viable plantar fascia helps to allow the muscles of the leg and ankle/foot to work efficiently, and is very important in activities such as running and jumping. The most common cause of plantar fasciitis is overuse or repetitive trauma. Training errors often contribute. Further information elaborating on basic anatomy, biomechanics, and causes, with a focus on rehabilitation considerations, are included in this article.
Plantar Fasciitis is commonly treated by physical therapists. Symptoms include pain near the heel, and into the arch on the inside of the sole of the foot. Pain is typically most prominent with the first steps taken in the morning, or after an extended period of time non-weight bearing. The plantar fascia essentially spans the full length of the sole of the foot. It originates at the medial tubercle of the calcaneus (the heel bone) and inserts at the proximal phalanges (bones of the toes), including the sesamoids of the great toe. It most often occurs due to repetitive micro trauma to the fibers of the fascia at, or near, the site of the origin (at the calcaneus). Further, excess loading or weight-bearing on the medial calcaneal tubercle can cause inflammation of the periosteum (outer layer of bone).
Biomechanically, the plantar fascia provides strong support for the foot during both pronation and supination phases of the gait cycle. Pronation involves unlocking of the foot and shock absorption during the initial- to mid-stance phase of the gait cycle (from the heel contacting the ground until the leg is essentially vertical). Supination entails unloading and locking for stability, which allows for propulsion/explosion of movement, especially during the last part of stance phase. A viable plantar fascia helps to allow the muscles of the leg and ankle/foot to work efficiently. One example of this is the plantar fascia’s support of the arch of the foot allowing for a forceful calf (gastrocnemius) muscle contraction, which lifts the heel for propulsion. Thus it is very important in activities such as running and jumping.
The most common cause of plantar fasciitis is overuse or repetitive trauma from flat feet, over-pronation (a reduction in the arch of the foot), a tight Achilles/calf complex, limited great toe movement, weakness or tightness in other areas of the body, nerve compromise from a back injury, and/or training errors. Errors in training could include, but are not limited to, poor foot wear or arch support, large adjustments in training volume, running on a cantered road, too many hills, not enough rest time, or too firm of a surface (i.e. always running on pavement).
Rehabilitation for plantar fasciitis includes RICE (Rest, Ice, Compression, and Elevation) during the acute or initial phase of the injury. It is important to take stress and loading off of the plantar fascia to allow the tissue time to heal. Then, activity should be modified to minimize weight bearing, including decreasing mileage. Begin, or increase cross-training to include more low-impact activity, such as swimming or cycling.
Many times, taping by a well-trained and skilled physical therapist can help relieve pressure and support the arch, plantar fascia, and heel foot pad. It can also improve lower-extremity biomechanics.
Footwear may need to be modified to provide for adequate arch support. Orthotics can be used for additional arch support as needed.
It is important to perform appropriate exercises to tolerance (i.e. not to push into pain).
Further care and guidance can be provided by a skilled physical therapist. Treatment could include therapeutic exercises/activities to increase strength and flexibility; manual therapy, including joint and soft tissue mobilizations; myofascial release to address joint stiffness and adhesions in the muscle or fascial systems; iontophoresis, such as Dexamethasone (an anti-inflammatory medication); ultrasound; or electrical stimulation, etc. The ASTYM™ System can be used by a certified provider to stimulate/enhance the healing response. It will do so by stimulating the breakdown of adhesions and inappropriate fibrosis that may contribute to the pain.
Runner’s Knee (Chondromalacia)
“Runner’s Knee” is a condition of over-use affecting the knee cap area. Most often it is aggravated with running, squats, stairs, and lunges. This condition can have multiple factors leading to its development and thus a treatment approach often includes multiple areas. Focus will be on selected flexibility and strength exercises for the lower extremity.
What is it?
Chondromalacia is a degenerative process that leads to irritation and eventual softening and destruction of cartilage (a padding material) in a joint. “Runner’s Knee” is a multifaceted problem that is often related to chondromalacia patellae (knee cap) or simple overuse of this joint with no destruction of the cartilage. The knee cap needs to maintain a delicate course of tracking during running, and if this course is disrupted through inflexibility, weakness, poor foot mechanics, or poor training habits, an overuse condition can begin. The knee cap must track in a groove within the femur (long thigh bone). Often times the knee cap can track slightly to the outside or even upward, causing it to create friction between the cartilage undersurface and the femur below.
Symptoms & Causes
The condition is often characterized by a diffused ache over or just below the knee cap after periods of activity (especially running, stairs, lunges, and squatting). Pain can also be felt at night and first thing in the morning, as these are often times of day where inflammation is the greatest due to prolonged periods of immobility. The condition can start without a known cause but can often be traced back to a period of increased activity level, a change in training regime, a return to activity after a period of lay-off, or a change in shoes.
Culprits that often lead to the development of “Runner’s Knee” include weak inner quadriceps muscles, hip abductors, external rotators, and gluteal muscles. Collectively, weakness of these muscles can force the limb to internally rotate with weight bearing, which affects the tracking of the knee cap. Tightness in the hamstrings, calf muscles, IT band, and hips can further irritate the knee. Finally, altered gait mechanics, especially a prolonged or excessive pronated phase of the gait cycle, can contribute to overuse at the knee.
Treatment of “Runner’s Knee” includes stretching the inflexibilities and strengthening the weak areas, along with assessment of your foot mechanics and use of orthotics or motion control shoes for stability as necessary. Ice can also be helpful in the acute phase of the condition or after activity. Ice massage with an ice cube over the painful area for 3-5 minutes or until the skin is numb to the touch. This can be done as often as necessary, up to every couple of hours as needed.
If weakness of the hip abductors and external rotators is the culprit, a simple exercise can be to lay on the non-affected side with the top knee straight and hip slightly extended. Trace the ABC’s with your top leg while keeping the knee extended. Fatigue should be felt in the outer and posterior gluteal muscles. Progress from A to Z and if this becomes easy add an ankle weight as necessary. Do this exercise two times per day.
If tightness of the hamstrings is the culprit, a hamstring stretch can include standing in front of a step with hips facing the step. Place the heel of the involved leg on the step with knee straight. Lean forward with chest stuck out and back in a straight position until a stretch it felt behind the thigh. Hold the stretch 30 seconds and repeat 2-3 times per day.
Altering the running program may also be necessary. Decreasing hill work (especially downhill), limiting stairs and lunges, and running on a softer surface (track or trail) can all help. Alternating side of the road can also help, as the crown of roads can often alter gait mechanics.
Physical Therapists are trained in the assessment and treatment of conditions such as “Runner’s Knee.” Evaluation by a physical therapist can include strength and flexibility assessment, biomechanical assessment of running, assessment for any other contributing factors, and review of the training regime with advice on adjustments as necessary. Physical therapists can utilize a combination of manual therapy techniques (massage, joint mobilization/manipulation), exercise, and modalities for inflammation such as ultrasound and electrical stimulation. It is important to keep in mind that “Runner’s Knee” is a condition of over-use, and simply alleviating the pain for the short term is not the only goal. Prevent future worsening of symptoms by finding the cause of the condition.
Do you experience pain in your hip or down the leg while beginning or advancing a fitness program? This pain may stem from the piriformis muscle in your hip. This muscle can cause local buttock pain or pain down your leg if it is irritating your sciatic nerve. This condition is termed Piriformis Syndrome. One of the causes is overuse or sudden change in a walking, running, or lifting program. The best treatment for Piriformis Syndrome is stretching and strengthening of the hip musculature. Changes in training regimen may also take the stress off of this muscle, but good results can be achieved by implementing a good stretching and strengthening program. It is always a good idea to address any symptoms early on. The longer the wait, the harder it is to resolve the problem.
The piriformis muscle is a small muscle in the hip that runs from the sacrum to the outer hip bone. If the piriformis muscle becomes tight or cramps, it can put pressure on the sciatic nerve, which passes underneath or through the piriformis muscle, depending on the individual’s anatomy. This can result in pain in the buttock or down the leg (sciatica). This pain typically increases when the muscle contracts, when sitting for an extended time, or with direct pressure on the muscle. Shortening of the muscle and compression of the nerve is the most common cause of Piriformis Syndrome, but overuse of the gluteal and other muscles in the hip can also cause muscle spasms of the piriformis. Other factors in this syndrome include poor body mechanics and poor alignment of lower extremities (foot, ankle, and knee) that contribute to gait problems.
Stretching & Strengthening
Stretching and strengthening are the best treatments for piriformis syndrome. This muscle rarely gets stretched, so a simple stretching routine can often work wonders. To stretch the right piriformis: lay on your back, bend knees and cross the right leg over the left so the right ankle rests on the left knee in a figure four position. Bring the left leg towards the chest by bending at the hip. Reach through and grab the left thigh to help pull things towards the chest.
Holding this stretch for a minimum of 30 seconds and repeating for 3 sets per day should be enough to get started. If possible, stretch the muscle while it is warmed up.
It is also important to make sure to be flexible throughout the lower extremities to relieve some of the biomechanical stresses that may be placed on the hip musculature. Some of the important muscles to stretch would be the hamstrings, quadriceps, gastrocnemius, and soleus muscles. Deep-tissue foam rolling is also a very good option to reduce fibrotic patterns in these muscles that can lead to dysfunction.
Strengthening the appropriate musculature to take the biomechanical strain off of hip muscles is also very important. The best way to strengthen this musculature is by performing closed-chain (feet on the ground) exercises concentrating on keeping the proper form. Some examples of these exercises are squats, lunges, and step downs. When starting a strengthening program, it is important to have someone assess your form so you do not stir up other issues. Starting with 2-3 sets of 10-15 repetitions of each strengthening exercise 3 times per week should be enough to get you started.
Another thing that may need to be addressed with Piriformis Syndrome is your biomechanics. Sometimes proper footwear, inserts, or orthotics can make a huge difference on the forces at the hip. Along these lines, proper training is also important. As mentioned before, overuse is one of the major causes of this syndrome, and getting guidance for proper training is a critical piece.
Physical Therapists are trained to diagnose and treat this condition. Seek your Physical Therapist if you think you are dealing with Piriformis Syndrome so the correct diagnoses can be applied and the correct treatment can be prescribed.
Shin Splints are a common problem for runners. Shin Splints may indicate overtraining, muscle imbalance, or improper footwear. Runners who find themselves with Shin Splints should rest and ice to reduce symptoms, seek the help of a physical therapist to address biomechanical causes of their symptoms, and have their shoes checked for excessive wear and proper fitting. Maintaining muscle balance and building mileage gradually will generally allow most runners to return to running without symptoms.
What are Shin Splints?
The term “Shin Splints” is a general term that describes pain in the lower leg associated with running and other athletic activities. Pain may be felt in the front (anterior) or in the back (posterior) of the lower leg. Anterior Shin Splints occur more commonly than posterior. The pain felt is due to very small tears in the muscles at their attachment to the shin. Pain is present with activity and generally (but not always) subsides with rest. Shin Splints are a common injury for beginning runners, but can affect runners of all levels of ability and experience.
What Should I Do?
Rest is the first step of recovery from shin splints, so take a few days off from running. Low-impact cross-training activities are fine as long as they are not painful. These include swimming, pool- running, biking, or using an elliptical trainer. Anti-inflammatory medication may help as well as ice treatment. Muscle imbalances are usually a major factor in Shin Splints, so evaluation and treatment by a physical therapist is recommended to address musculoskeletal issues. The physical therapist may also use ultrasound, massage, iontophoresis, or other treatment modalities to help with acute symptoms.
Shin Splints can be caused by overtraining. If the runner is running too many miles without sufficient rest days or if they are building weekly mileage too quickly, these factors may contribute to the symptoms.
Shin Splints can also be an indication that it is time to change running shoes. Typically, running shoes are good for about 300-500 miles, and if the shoes have logged more miles than that, they may be contributing to Shin Splints symptoms. On the other hand, if the shoes are fairly new and Shin Splints begin to develop, this again could be the cause. Having the right amount of motion control for pronation and a shoe with good shock absorption is important to keep symptoms from developing. Buying running shoes from a store with experts who analyze gait can help ensure that the shoes are correct.
Normally, with treatment, shin splints will resolve within a few weeks. If pain persists, it is possible that there is either a stress fracture or compartment syndrome and a doctor should be consulted.
How Do I Prevent Shin Splints from Returning?
Return to running slowly and build mileage gradually. Try to run on softer surfaces when possible. Be sure to take rest days and incorporate cross-training activities.