Running is an incredibly rewarding fitness and stress relieving activity for many individuals. Unfortunately, many runners deal with injuries every year and injuries aren’t reserved for the elite. Runners of all abilities may struggle with acute or chronic conditions. While some aches and pains may never progress beyond an ‘annoyance’, it is important to have any injury that doesn’t improve with rest evaluated by a competent practitioner. Running injuries can involve the ankles, knees, hips, and even the low back and SI joints, and weakness or pain in one body region can affect the mechanics and form of the entire body. Not only can these types of symptoms progress to a more severe injury, they are equally likely to limit performance and keep individuals from reaching their fitness goals.
At Life’s Work Physical Therapy we see patients with a multitude of different symptoms and conditions. The following list will give examples of some of the things we most often see in runners. Don’t worry if your symptoms aren’t included here, the list is not all inclusive!
Patellofemoral Pain Syndrome (i.e. Runner’s Knee)
While most runners will feel some aching in the knees at some point (especially after a lot of downhill runs or when increasing mileage) Runner’s Knee, or as it is more accurately known as, Patellofemoral Pain Syndrome (PFPS), is more than just soreness. It most commonly presents as pain behind the kneecap and pain in front of the knee. In a mild case it may appear as pain which occurs after prolonged sitting, or during deep squatting or a lot of downhill walking and/or stair-descending. Someone with a more severe case may complain of pain that is always present and does not decrease with rest. PFPS can occur from a multitude of other conditions, such as hip and/or core weakness, chronic lower back conditions, chronic foot injuries, etc. Recent research shows PFPS comes on from issues away from the kneecap joint, which in-turn affects the mechanics around the knee and patellofemoral joint leading towards pain. Chronic kneecap pain is common, and frequently affects the ability to progress as a runner when untreated, but improves well after a detailed evaluation from a physical therapist and individualized treatment aimed at targeting those areas influencing the patellofemoral joint and causing pain.
To Help Prevent It: Perform strengthening exercises for the hips and knees with a focus on the hip abductors, extensors, and quad muscles. Maintain adequate core strength, and perform regular stretching of your lower extremity (calf, quadriceps, adductors, hamstring, and hip flexor) musculature.
The achilles tendon forms from the calf muscles and crosses the back of the ankle. It works during plantarflexion, which is the movement when you raise your heel off the ground and bear weight on your toes. Running places an increased load on the tendon, especially during speedwork and hills. Weak and tight calves can contribute to its development as well as increasing or changing training too quickly. Proximal issues (i.e. history of hip and/or knee issues, hip weakness, low back conditions) can also contribute to calf tightness/weakness, and lead towards an Achilles tendonitis/tendinosis. In a tendonitis, micro-tearing occurs resulting in inflammation, pain, and limited range of motion. It may feel like aching, soreness or burning and is often worse during or after activity. While a mild ‘twinge’ may recover with RICE (rest, ice, compression, and elevation), if left untreated, achilles tendon injuries can take months to recover.
To Help Prevent It: Perform regular stretching and strengthening of the calf muscles. Avoid increasing mileage, speed, or hill workouts too quickly. A graduated training plan will help to prevent overuse symptoms.
Every time you step or stride forward, the foot has to absorb several times the weight of the body, placing a high-level of force on a small surface area. Plantar Fasciitis is the degeneration, inflammation, micro tearing, and breakdown of the plantar fascia (a thick connective tissue that supports the arch of the foot) located on the bottom of the foot. It is the most common injury of the plantar fascia and one of the most common reasons for complaints of heel pain. Pain is typically felt on the bottom/inside portion of the heel and is worse during the first few steps after getting out of bed or after prolonged sitting. Pain typically improves with continued walking, unless the condition is acute which also worsens with increased activity. The ankle movement of dorsiflexion (the movement where you bend the ankle upwards) may be limited when compared to the non-painful side. Just like the previous conditions described, a history of ankle and/or foot injury, knee/hip/low back issues, and/or hip/core weakness may contribute to changes at the foot that contribute to plantar fascial pain, and treatment aimed at improving these regions has shown to be successful in the management of chronic plantar fascia pain.
To Help Prevent It: People with high arches or flat feet are more susceptible to plantar fascial pain, so it is important to wear appropriate supportive footwear for your foot-type. Maintain adequate calf flexibility, and seek a physical therapy evaluation if plantar foot pain begins to affect your ability to meet your running goals.
Shinsplints or “Medial Tibial Stress Syndrome” occurs when an athlete increases the stress on the bones and muscles of the lower leg too quickly. Simply put, it can be thought of as “too much, too soon”. Symptoms typically present as pain on the front and inside of the shin bones between the ankle and knee and are usually caused by repetitive trauma to the muscles in this region. Pain symptoms can range from a dull ache to intense soreness that increases with exercise. Some individuals may have swelling in the area where pain is felt. Shinsplints most commonly occur when someone increases their training too quickly, and can occur in new runners, runners who return to running after a break, or in runners who increase mileage or hills too quickly.
To Help Prevent It: Avoid increasing mileage too quickly, the 10% rule is a good baseline- don’t increase miles more than 10% per week. Ensure you are wearing appropriate footwear and scale back running to a comfortable level before slowly increasing mileage again.
Stress fractures are overuse injuries which occur when the muscle and soft tissue are unable to absorb repeated shock, generated by an activity over time, and excessive force is transferred to the bone. When this happens, small cracks occur in the bone. Stress fractures most commonly occur in the weight bearing bones of the lower leg and foot and the most common complaint is pain with weight bearing that increases with activity and decreases with rest, although pain can be constant with a more severe injury. Symptoms are usually fairly localized and are often aggravated by palpation and vibration. Women, and those who wear improper footwear, or increase their training too quickly, are more susceptible to stress fractures. Diagnosis can be complicated by the fact that stress fractures can take more than two weeks to appear in an standard x-ray film.
To Help Prevent It: Cross training can help to work toward fitness goals while avoiding overloading the tissue. Increase fitness incrementally, and gradually build toward specific goals. It is also important to eat a healthy diet with sufficient calcium and vitamin-D foods. Most importantly, do not attempt to run through a stress fracture- doing so will only prolong and risk further injury.
While injuries plague many runners there are numerous ways to help prevent and address injuries. At Life’s Work Physical Therapy, our goal is to both prevent minor complaints from developing into more serious injuries, and to help those who are already dealing with a more severe condition. The rehab of an injury can be frustrating and complicated, but our goal is to see athletes of all abilities return safely to the sport(s) they love.