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Common running injuries

28 November 2017

Running is a great way to get fit, lose weight and generally stay healthy. However as with all physical activity, it can be associated with injury.

Running injuries can occur for all types of reasons, whether you are new to running or a seasoned marathon runner. Common areas for injuries are the foot and ankle, lower leg, knee, thigh and hip and are often caused by overuse, poor running technique or poor equipment. Here is an outline of some common injuries, their causes and basic treatment principles.

Foot and Ankle

Plantar fasciitis presents as pain under the heel and can radiate under the foot towards the toes or in the arches of the foot. Pain is worse when walking or running and patients usually report the worst pain to be first thing in the morning when they put their foot on the floor.

Cause:

The condition can be triggered by increases in running distance, volume or intensity over short periods of time, such as someone wanting to take up running to lose weight and going from no exercise to running three to four times per week for 20 mins. This represents a rapid change in the amount of stress put through the tendons which results in tissue overload, micro-tears, inflammation and pain. Early diagnosis and treatment from a physiotherapist or a doctor is vital to prevent the condition becoming chronic.

Treatment:

 Early treatment may involve rest from running, application of ice and/or heat, stretches and management strategies such as taping, wearing comfortable supportive footwear and in some cases night splints.

Longer term management and prevention strategies include:

  • physical conditioning of your foot, ankle, knee and hip relative to running (mobility, balance and strength)
  • load management (looking at the volume, frequency and intensity of your running)
  • running technique /style
  • appropriate running shoes

Achilles tendonitis is associated with pain and stiffness in the back of the lower leg towards the heel. Pain can often gradually get worse over time (chronic) or can come on relatively quickly (acute) and is often worse first thing in the morning. The Achilles tendon is the large tendon that runs up the back of your heel and joins your calf muscle to the underside of your heel. Achilles tendonitis by definition is inflammation of this tendon, but is more often associated with degeneration (thickening and weakening) of the tendon.

Cause:

Achilles tendonitis is usually due to overloading the tendon beyond its capability of strength, endurance and flexibility for a prolonged period of time. It can also be due to a number of other factors such as inappropriate footwear or a recent change in footwear, a change in training surface, poor running technique or poor physical conditioning of the muscles and joints associated with running.

Treatment:

Early treatment may involve rest from running, application of ice, gentle stretches and management strategies such as taping, wearing comfortable supportive footwear including a heel raise and in some cases night splints.

Longer term management and prevention strategies include:

  • strengthening exercises for the calf such as heel raises
  • physical conditioning of your foot, ankle, knee and hip relative to running (mobility, balance and strength)
  • load management (looking at the volume, frequency and intensity of your running)
  • running technique/style
  • appropriate running shoes

Calf and Shin

Shin splints is the common name for pain on or around the front of the shin bone (tibia). However there are several possible specific diagnosis’ such as medial tibial stress syndrome where pain is often worse first thing in the morning and at the onset of exercise and tends to ease off during exercise or activity only to get worse again after prolonged activity.

Cause:

Conditions that cause ‘shin splints’ are usually due to overloading the tendons that attach the muscles of the lower leg to the shin bone (tibia). In medial tibial stress syndrome the tendons repeatedly pull on their attachment to the bone which eventually can lead to inflammation of the periosteum (outer layer of bone). If this repeated trauma is sustained for a period of time the condition can become chronic and is associated with lumps or bumps along the bone where new bone is formed at the site of the small tears of the periosteum. Other factors that can cause shin splints are poor foot and ankle posture such as flat feet, poor footwear and poor conditioning of the muscles around the foot and ankle.

Treatment:

Early treatment may involve rest from running, application of ice, stretches and management strategies such as taping, massage, wearing compressive supports.

Longer term management and prevention strategies include:

  • strengthening exercises for the calf and lower leg, including muscles around the shin
  • physical conditioning of your foot, ankle, knee and hip relative to running (mobility, balance and strength)
  • load management (looking at the volume, frequency and intensity of your running)
  • running technique/style
  • appropriate running shoes 

Knee

Anterior Knee Pain is an umbrella term that can actually be caused by several different structures, but is essentially pain in the front of the knee. The pain is centred around the patella (knee cap) and its articulation with the femur (thigh bone) at the knee. Pain can come on gradually over time or occur more suddenly and is usually along the inside border of the patella with some swelling most commonly after exercise.

Patellofemoral Pain Syndrome (PFPS) – pain usually along the inside of the knee cap often with swelling and associated with increased clicking sounds around the knee.

Patella Tendonitis – pain along the patella tendon (the tendon that runs over your knee cap (patella) and joins your quadricep muscles (front of thigh) to your shin bone (tibia) which act to straighten your knee. Inflammation of this tendon due to overuse can cause pain and stiffness anywhere along the tendon from the lower part of the patella to the upper part of the shin bone.  

Cause:

Because there are several different structures around the front of the knee, rapid assessment by a physiotherapist will help identify a likely cause quicker which in turn can help form the most appropriate and effective treatment. In most cases, the cause is a combination of or solely overuse (sudden increase in running frequency), overloading (sudden increase in running distances or intensity), inefficient or poor running technique, poor conditioning around the ankle, knee or hip.

Treatment:

Early treatment may involve rest from running, application of ice, gentle stretches and management strategies such as taping the patella or wearing a knee brace can help.

Longer term management and prevention strategies depend on the structure involved and the cause but will most commonly include:

  • strengthening exercises for the muscles around the knee, mainly the quadriceps (muscles at front of thigh) initially
  • stretching exercises for the muscles around the knee.
  • physical conditioning of your foot, ankle, knee and hip relative to running (mobility, balance and strength)
  • load management (looking at the volume, frequency and intensity of your running)
  • running technique/style
  • appropriate running shoes

Thigh

Hamstring strains are commonly associated with running, and can be a sudden or sharp pain in the back of the thigh, or can be a gradual pain that comes on during running and which gets worse overnight.

Strains can be anything from a low Grade 1 which may be described as ‘cramp’ or a ‘twinge’, to Grade 2, which is a definite point of pain usually within the muscle belly and is apparent immediately during exercise often causing you to stop. Grade 3 strains result in near complete muscle fibre tears with significant swelling/bruising and inability to walk.

Cause:

The hamstrings are a group of 3 muscles which flex the knee and help extend the hip. They are vital for running as they help decelerate the knee and provide stiffness during footstrike and help propel the body forward during a stride. They move from a state of stretch to contraction rapidly and repeatedly throughout the action of running and are put under a lot of stress for prolonged periods of time. Poor strength, flexibility or endurance of these muscles can mean overloading them and failure resulting in a strain or tear.

Treatment:

Early treatment may involve rest from running, application of ice, and management strategies such as compressive supports.
Longer term management and prevention strategies depend on the structure involved and the cause but will most commonly include:

  • strengthening exercises for the hamstring muscles specifically to restore tensile strength and endurance
  • stretching exercises for the hamstring muscles to restore length
  • physical conditioning of your foot, ankle, knee and hip relative to running (mobility, balance and strength)
  • load management (looking at the volume, frequency and intensity of your running)
  • running technique/style
  • appropriate running shoes

All of these conditions can be resolved with good quality early diagnosis, treatment and management plans which our physiotherapists can guide you through. The earlier you seek help, generally the quicker and easier we can get you back to running pain-free.

Our Perform Physiotherapy team can provide full treatment planning for any condition affecting your muscles, tendons, joints or nerves. We can offer fast referral to scans and orthopaedic surgeons.

The content of this article is provided for general information only, and should not be treated as a substitute for the professional medical advice of your doctor or other healthcare professionals. 

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