How to Prevent and Treat Common Running Injuries

Every runner dreads an injury. It prevents you from doing the thing you love the most, and that is running! In this article you will learn about the 5 most common running injuries. You will also learn how to treat it and how to prevent future injuries.

Is running good or bad for you?

There is no research currently that shows that running is bad for you. In fact, the latest research shows many health benefits, including:

• improvements in the intervertebral discs (Belavy et all 2017)
• decreases inflammation in the knee joints (Hyldah et all 2016)
• improvements in the cartilage (Ponzio et all 2018) .
• A study done by Lee et all 2017  showed that runners live approximately 3 years longer than non runners.

There is clearly compelling evidence that running can only be good for you. So why is it that so many runners struggle with injuries? Research shows that 82% of all runners get injured. It does not matter if you are an elite runner training for a marathon, or a beginner that is doing a couch to 5 km program, the odds are that you will sustain an injury somewhere along the road.

Why are so many runners prone to injury?

Overtraining, incorrect running style and incorrect shoes are some of the reasons why so many runners sustain injuries.

Let’s dive into each one…

1. Overtraining

Most running injuries are due to the repetitive load that running puts on the body. Training programs are progressed too much to soon and the result is injuries. Injuries are a normal response to an abnormal load. Repetitive loading puts a lot of stress on the joints leading to tissue failure and injury.

There are 3 factors contributing to the load/stress:

1. Frequency: How often do you run? There must be a balance between training and resting
2. Intensity: How fast do you run? Other elements like shoes, terrain and inclines can also play a roll in intensity.
3. Time: How long do you run? This is a measure of volume and intensity.

When you get an injury, you should listen to your body. Reduce your intensity, decrease your distance and make sure there is adequate rest in between races.

2. Incorrect running styles

Most runners just put on their shoes, and go for a run. Runners come in all shape and sizes, and each one of them use a different running style to run, from the lady that looks like she is just walking fast to the shuffle runner to an Olympic runner. Professional golfers, swimmers, cyclist spend thousands of rands/dollars to learn the correct technique of doing their specific sport. Golfers spent many hours with a coach to train him/her on how to swing correctly. The same with swimming, a correct swimming style increases performance and uses less energy in the pool. Cyclist spend hundreds of rands on their bike set up. So why is it that runners almost never spend money or time to learn the correct running technique?

Learning the correct style of running can prevent many injuries. So what does the optimal running style look like?

• Trippel extension of the hip/knee and ankle when the leg goes backwards
• Trippel flexion when the leg comes forward
• Swing arms
• Heel strike more on mid foot for endurance runners
• Knee and ankle in neutral not collapsing to the middle
• Keeping head neural
• Cadence of less than 6 minutes a kilometer

If you look at the endurance runners that does the Olympics you will start to see why they run so effortlessly and fast.

Watch this video for an in-depth analysis on Paul Chelimo (Olympic Silver medallist)

https://www.youtube.com/watch?v=XV2vIEVCwzE

How can you improve your running style?

• Run on a treadmill and get someone to film you from the back and from the side.
• You can take this material to a physiotherapist that has a special interest in sport, more specifically running. Physiotherapists are excellent at analysing movement.
• Increase your cadence. A lot of correction can come from just running faster. Lift your hip higher. By lifting your hip you will atomically run faster.
• Lean forward
• If you pronate, use the line on the road and run wider
• Swing your arms more
• Keep your head neutral

3. Incorrect shoes

Shoes can play a big role in running injuries. The technology of shoes has evolved so much over the years! You get anything from a neutral shoe to a anti-pronating shoe to a minimalistic shoe. So where do you start when you want to buy a new shoe?

Look at the following when buying a new shoe:

• Comfort, Comfort, Comfort!

The most important guideline when selecting a running shoe is to make sure it is comfortable! If the shoe is not comfortable in the shop don’t buy it! Make sure you buy the right size. There needs to be a thumb width between the big toe and end of the shoe. The widest part of the foot needs to be a comfortable fit in the shoe. There should also be a finger width between the lacing and your foot in a weight baring position.

• Is there a problem?

Do you have a underlying biomechanical problem that the shoe need to address? Like pronation or one leg that is shorter than the other? Do you have a wider foot? Will the shoe be able to fix the problem? Always try to go simpler and start with a stable/ neutral shoe if you are unsure. Some specialist shops will assist in selecting the right type of shoe. But always try to first work on form before you change your footwear!

• Are you an experienced or a novice runner?

The more experienced runners will need shoes that cover long distances and that will last. Novice runners don’t spent so many hours on the road and thus need less fancy and expensive shoes. Mileage on shoes varies between the different running styles and biomechanics but a rough guideline is to replace your shoes every 1000 km’s.

4. Current BMI (Body mass index)

Runners need to look at their weight. If you have a BMI of more that 25 you put a lot of strain on your muscles and joints. The extra load will eventually result injuries. It’s therefore important for a new runner that wants to use running as a strategy for weight loss to start slowly and to consider a different form of exercises until the BMI is better.

5. Previous Injuries

Previous injuries can contribute to new injuries. People tend to compensate for the older injury resulting in bad running style and poor biomechanics. This can lead to a new injury. To prevent this from happening runners need to sort out their current and old injuries. Go to a physiotherapist so that they can sort out the cause of the problem. The physiotherapist will also give you a rehabilitation program to strengthen the weak muscles and to stretch the tight muscles.

What are the 5 most common injuries?

1. Pattela Femoral Joint syndrome(PFJ)/ “Runners Knee”
2. Iliotibialband Syndrome (ITBS)
3. Achilles Tendinopathy
4. Plantar Fasciitis
5. Stress fractures/ “Shin Splints”

 

Patella Femoral Joint syndrome (PFJ) / “Runners Knee”

Pattela Femoral Pain syndrome is the most common running injury we see. It can affect the young active sportsperson to the weekend elderly runner. Pain is usually located under the knee cap, also known as the patella. Pain is normally described as a dull achy pain that can also sometimes become sharp.

What is patella femoral joint syndrome?

Patellofemoral pain syndrome starts when there is poor kneecap alignment. In time the increase in pressure from the poor alignment affects the joint surface. The knee cap moves to the one side and rubs against the femur. This can cause a dull achy or sometimes a sharp pain in the front part of the knee.

What causes Patellofemoral Pain syndrome?

Muscle imbalances and poor biomechanics are the main cause of patellofemoral pain syndrome. Our bodies are so amazing that if one muscle does not work properly, we will recruit other muscles to do the job. What muscle groups can have an influence on patella femoral pain?

• Weak quadricep muscles, especially weak VMO muscles may cause the patella to mal-tract.

• Weak hip muscles can cause the hip to “lose” control, allowing the body to compensate by using the ITB or other muscles to do the work for the hip muscles, thereby putting a lot of strain on the muscles around the knee cap.

• Tight lateral structures such as ITB, TFL muscles will over time force the patella to drift sideways.

• Poor ankle biomechanics can also contribute to the sideway shift of the patella.

How do we treat patellofemoral pain?

It’s important to treat the cause of the problem, and not just the symptoms. Otherwise the pain may haunt you again and again. The best is to see a physiotherapist. Physio’s are experts at analysing movement and they will be able to identify which structures are the most affected and treat it accordingly.

Treatment will include:

• Massaging and mobilising the stiff muscles and tissues
• Stretching program for the stiff muscles
• Strengthening program for the weak muscles
• Treating the painful area with modalities like dry needling, laser, strapping etc.
• Return slowly to your running program. Remember you need to give your muscles some time to get stronger, adapt your training program to prevent future injuries.

 

Iliotibialband syndrome (ITB syndrome)

Iliotibialband syndrome is also a very common running injury. Pain is usually a dull ache located on the outside (lateral) part of the knee that worsens when you run. It can be a frustrating and difficult injury to treat. Longer training sessions, downhill running or cambered courses can aggravate the pain.

ITB syndrome starts when the tight iliotibial band causes friction on the bursa and other soft tissues at the bottom of the knee joint. Poor hip and ankle biomechanics are the main causes ITB syndrome. Although the pain is felt in the knee, treatment should focus more on the hip joint.

Treatment looks similar to that of pattelafemoral pain syndrome. Poor hip biomechanics will be addressed and local pain will be treated with modalities like ice, dry needling, laser, strapping and massage.

Achilles Tendinopathy

Runners are at 30 times greater risk for an achilles tendinopathy injury than with any other sport. Injury to the achilles tendon occurs when the load applied to the tendon, either a single episode or over a period of time, exceeds the ability of the tendon to withstand that load. The tendon can get micro damage that causes acute inflammation. If achilles tendinopathy is not treated properly it can lead to permanent damage to the tendon.

Symptoms normally develop gradually and patients typically complain of pain and morning stiffness. Pain usually gets better when walking around or when heat is applied (e.g taking a shower). Runners often report that the pain usually diminishes when training only to re-occur several hours afterwards.

Aggravating factors include:

• An increase in running activity (km’s, speed, gradient)
• Training on different surfaces
• Starting with new training techniques
• Poor or change in footwear
• Recovering from another underlying injury
• Decrease in recovery time between training sessions
• Men are more prone to sustain an injury

 

How do we treat achilles tendinopathy?

It’s important to understand how a tendinopathy heals, in order to treat it effectively. The healing process look very differently than with a muscle tear. Look at the diaphragm below:

When you tear a muscle the healing looks like this:

Pain is very acute but as times goes on the muscle heals and gets better.

With tendinopathies the picture looks like this:

A normal Tendon can respond to load without any injuries.

But if there is an excess load the tendon goes into the reactive tendinopathy phase.

The reactive tendinopathy phase is known to be very painful and there is normally some swelling.

Treatment will focus on getting the pain and swelling under control.

Modalities like ice, pain tablets, rest, dry needling, ultrasound, laser and strapping are good to help with pain relieve.

Once the pain is better treatment will focus on gradual return to activity through specific exercises. Modalities like massage, ultrasound, shockwave, PRP can be done in this phase. Specific eccentric loading exercises is very important in this phase to help the tendon adapt to loading.

It’s important not to increase the load to soon on an achilles tendon as it can aggravate again and move back to the acute painful phase.

Repetitive re-injuring of the tendon, will push the tendon into the tendon dysrepair and degeneration phase, where permanent damage will occur.  Permanent changes in the tendon include hard nodules, and unfortunately no amount of physiotherapy treatment or exercises can reverse these changes.

Runners therefore need to be vigilant when dealing with an Achilles tendinopathy injury. The sooner you address the pain and get the tendon used to loading the better the outcome will be.

Plantar Fasciitis

Plantar fasciitis is an overuse condition that involves the plantar fascia at the bottom of the foot. The plantar fascia consists of three layers in the foot that arise from the heel bone (calcaneus). The fascia plays an important role in supporting the foot arches and it will also help with shock absorption.

Pain is usually of gradual onset and felt in the inner aspect of the heel. Pain is normally worse in the morning and it then gets better with activity. Patients often describe their first steps out of the bed as though they are walking on burning coals. As the condition worsens the pain may present at the start of the weightbearing activity and worsens with activity. Patients often have a history of previous injuries in the same leg or the contra lateral leg. The plantar fascia is usually very tender to touch and the ankle joint can get very stiff.

Treatment can be divided into two groups:

Short-term treatment options:

• Avoidance of aggravating activity
• Ice therapy after activity
• Stretching of the calf and plantar fascia
• Self-massage with a frozen bottle
• Anti-inflammatory medication
• Taping
• Silicone heel pad
• Cortisone injection (research support the use of cortisone injections but it must be accompanied by a thorough rehabilitation program)
• Shockwave therapy

Long-term treatment options:

• Strengthening exercises of the foot to help with foot arch support
• Strengthening exercises of the hip and core muscles
• Footwear with well supported arches and midsoles
• Night splints or Strasbourg socks should be considered for patients with pain for more than 6 months
• Soft tissue and fascia release therapy for the whole muscle chain from the foot al th way to the head.
• Surgery – if pain does not get better with conservative treatment then surgery is recommended.

 

Stress fractures/ “Shin Splints”

Runners often complain of shin splints. Pain is usually in the lower third of the lower leg. Shin splints is actually stress fractures on the tibia bone.

Pain can start gradually and it gets aggravated by exercise. Patients often report that they increased their training intensity or that the trained on rigid surfaces. There is normally localised tenderness on the bone

Management of a stress fracture includes rest and modification of activities. Runners are advised to do cross training and look at their calorie intake. A brace can also help with the pain. Physiotherapists trained to work on muscle spasm and rehabilitation exercises and electrotherapy.

Physiotherapy can play a huge role in the runners world, whether it is to treat an injury or correct a running style. Injuries are a nuisance and something you want to quickly resolve to get back to your program. Physiotherapy should definitely form part of your training routine if you are training for a serious race.

Written by: Adrien Dannhauser (Bphyst, SPT)