At this time of year we have a deluge of running enthusiasts limping in to our Physioimpulse clinic rooms pleading to be healed in time for the Bath Half or the next big Marathon. We understand the pressures involved in completing the run for that special charity close to your heart or to knock spots off last year’s PB, so we have produced this guide to help you stay injury free!
5 Common running Injuries
1 Runner's Knee/Anterior Knee Pain
Patellofemoral pain syndrome (PFPS), or "runner's knee," is the irritation of tissue on the underside of the patella (knee cap). PFPS typically flares up during or after long runs, after extended periods of sitting, or while descending hills and stairs.
Anyone with biomechanical factors that put extra load on the knee such as quads shortening or gluts (gluteal or buttock muscles) weakness is vulnerable to PFPS. Changes in training surfaces/frequency/intensity or running style can also put you at risk.
2 “Shin splints”
Because we like fancy words at Physioimpulse, we call this condition Medial Tibial Stress Syndrome (MTSS). Basically it is when too much stress/load is placed through the inside of the shin muscles, tendons or bone resulting in a nasty shin pain with each step. Footwear and “overpronation” is often blamed for this condition but we find that training history, running form and muscle control are more likely culprits.
3 Achilles Tendinopathy /pain
The Achilles tendon connects the two major calf muscles to the back of the heel. Under too much stress, the tendon properties alter which may result in debilitating pain in the heel or just above. Runners who dramatically increase training, particularly hills and speed work or have tight weak calves are susceptible.
4. Plantar Fasciitis
A sharp, painful sensation at the base of the heel, often described as like having a stone in your shoe. At its worse when you first step out of bed this pesky injury can halt your training plan in its tracks. Overtraining and improper or worn-out footwear can cause pain in your heel, but the root of the problem lies in tight and weakened muscles in the foot. If your feet are weak, the heel takes on an excessive load and can’t handle your gruelling training regime.
5. “ITB Syndrome”
Symptoms of ITB (Iliotibial band) syndrome consist of pain on the outside of the knee, more specifically at or around the lateral epicondyle of the femur (the bony bit on the outside of the knee). It comes on at a certain time into a run and gradually gets worse until often you have to stop. After a period of rest the pain may go only to return when running starts again. The pain is normally aggravated by running, particularly downhill. People usually go straight to foam rolling or massage for this injury but an additional glutes strengthening programme with gait retraining will often be far more successful.
Injury Treatment and Prevention
Injuries are always multi-factorial and their management multi-modal so we will break this down in to 5 parts
1. Training Programmes/Progression
2. Running Technique and footwear
3. Strength and Conditioning
We love treating your aches and pains to help you get back to pounding the pavements but prevention is always better than cure so a graded training programme is essential when partaking in a race or increasing fitness. There is an age old injury mantra in physiotherapy which continues to hold true – too MUCH, too SOON, too OFTEN will overload your normally robust body and may result in injury.
If you do:
Too MUCH - E.G. Running 10 miles when you have only covered 1 previously.
Too SOON - E.G. Enthusiasm leads you to running that 10 miles in week 1 of training.
Too OFTEN - E.G. You run that 10 miles 5 times in a week as the race is only a month away and you spent Xmas in front of the fire rather than training.
You will predispose yourself to the injuries we listed previously and more.
Thankfully the human body is a fantastic piece of kit and will allow us to perform amazing feats so long as we prepare it adequately. It’s all about appropriate loading of tissue at the right time. If you gradually add load (increase training) at a responsible rate the cells and tissues of your body will adapt to the load and strengthen for your next training session. This will reduce the chances of you needing our help!
Luckily a host of excellent training programmes with graded progression are available to help you complete your race and stay injury free. Here is a link to a couple of programmes written by running experts for the Bristol 10k/Half
Running Technique and Footwear
Running technique is a tricky one as without tuition you will already have developed your own unique running style. We generally say that if you are enjoying your running and it feels easy then you are doing something right. If however your running feels laboured and you are picking up the odd niggle or a lot of injuries then it is likely your running technique could be improved. When we undertake our running analysis the most common finding is that people tend to brake slightly when they land, meaning that despite a good landing foot position, the impact through the heel/foot is increased because the hip position is sub-optimal. So how do we go about changing this? Well it’s hard to know for sure whether this is definitely you but it wouldn’t hurt to undertake a few hopping drills and show your body what it feels like to land with your hip over your foot at initial contact. Why not try it now? Stand on one leg, lean forward until you are able to fall forward and save yourself by hopping forward. Try repeating this for 10 seconds each side just prior to going running or a couple of times on your rest days and see how you feel.
Footwear is also key as we often find a biomechanical component to these lower limb problems. The two main things you find in a running shoe is that it either does or doesn’t have an arch support (look at the underside of the shoe and see if there is an extra piece of plastic or a bar in the middle near the arch of your foot) which firstly adds extra support and secondly a motion control adaptation, which is useful if you do land/strike with your heel. Although it’s hard to know for sure without analysing an individual style if you take the time to run up and down the street outside the running shop then you’ll get an idea of comfort and all good running shops will encourage you to do this.
A motion control device (dual density heel, normally with a firmer inner part to reduce the amount and the rate at which you pronate or how quick and how much your foot rolls in wards and flattens) is helpful if you tend to strike with your heel but superfluous if you have a mid-foot landing position. Obviously it’s hard to tell but if you are buying a pair of running shoes with motion control and it does transpire you have a good landing position then it won’t necessarily lead to any problems, it’s just like having cruise control on your car and never using it. It may also help with longer runs when you start to fatigue and who knows it may make all the difference if and when you hit the wall!
Strength and Conditioning
In clinic we consistently find injured runners present with impaired strength, power, balance or muscular control. This correlates with a host of recent research which points to reduced strength as one of the major risk factors of injury. When training for an event it is easy to get caught up in the need to carry out x number of miles in x number of weeks without consideration of any other training needs, particularly strength and conditioning. As discussed previously we need to load tissues appropriately and including some strength work in your weekly plan is a great way to prepare those tissues and also add variety to your training.
Pictured below is Mo Farah working on strength and stability
If a finely tuned Olympic athlete needs to work on this it makes sense that we should also devote some time to strength and conditioning.
There are many way to work at strength and conditioning and we have some great exercises on our website HERE A good starting point is to work on squats, lunges, and single leg dip variations focussing on balance, form and control. Research has found an association between dynamic knee valgus (the knees coming together) and increased stress load through the joints and muscles of the leg. It is therefore important to work on “alignment” throughout your exercises as depicted below.
There has been a lot of negative press recently, portraying certain stretching as harmful and strength inhibiting. These sensationalist headlines are generally based on a few cherry picked studies that cannot be applied to the population as a whole. In clinic we find stretching a useful tool to increase or restore range of movement as part of a multi-modal physiotherapy treatment programme. We use and recommend a combination of dynamic and static stretches depending on the goal of the individual patient. Runners tend to develop restrictions in particular movement patterns due to the repetitive nature of the sport and stretches are a useful way to retain range of movement whilst working at strength and control.
Yoga enthusiasts will be familiar with the sun salutation sequence pictured below. Usually we would recommend multi-planar stretching (stretching in all different directions) but the sequence below is often a priceless addition to a runners training programme. Give it a try!
Physiotherapy intervention can take many approaches ranging from hands on manual therapy and the provision of therapeutic home exercises to the use of acupuncture and electrotherapy and taping. However by far the approach we find most useful with running related injuries is the former. The main aims of treatment are to enable you to run pain free or more efficiently by treating the direct cause of your symptoms and to then teach you exercises to help maintain those beneficial effects. However it’s also just as important to treat the underlying causes of injury which are often associated with a variety of factors such as muscle imbalances around your hip and certain postural types. Whereas self-help is key, most people find it more effective to build on improvements made with ‘hands on’ physiotherapy which creates a ‘window of opportunity’ to both counter symptoms and their contributing factors.
Please do not hesitate in getting in contact if you have any questions and if you are running Bristol to Bath or any other upcoming event, good luck! Physioimpulse.
Physioimpulse Chartered Physiotherapists