Show us an injured runner and we’ll show you a frustrated runner!
Run long enough and you’ll likely be sidelined with an injury at some point. Fortunately, there are steps you can take to get back to the roads, trails and track.
Below, Calvin Deutsch, a Sports Physical Therapist with Deutsch Physiotherapy Co., explains how to treat some of the most common running injuries.
What are some of the most common running injuries?
The most common running injuries have to do with the knee joint. About 45 percent of all running injuries are associated with the knee, thus the myth that running is “bad for you knees”. The odd part is that most of these knee injuries are not a fault of the knee itself, and running is not bad for your knees. The knee joint is simply sandwiched between the hip and the foot/ankle, so many abnormal forces from above and below make their way to the knee and produce some type of pain. This underscores the importance of evaluating and treating each patient’s whole leg and trunk when working with most running injuries.
Patello-Femoral Pain Syndrome, Patellar Tendonitis and IT Band Syndrome are the most common injuries at the knee.
Plantar Fasciitis (heel pain), Achilles Tendonitis, lower leg muscle overuse and some hip issues round out the bulk of running injuries. About 5 to 8 percent of running injuries involve repetitive stress, i.e. stress fractures. There are also a wide range of foot conditions and some infrequent back problems that can present when running.
Nearly 70 percent of runners will suffer an injury at some point in their running career. So this means that either running is a higher injury risk sport, we are doing a bad job to promote/follow injury prevention programs, our daily lives are becoming less conducive to successful running (long-term postural adaptations due to prolonged sitting) . . . or a combination of all the above.
Small effective interventions can go a long way for runners, so there is huge potential to follow proven injury prevention/performance programs that create a high return on investment for runners.
Can you talk a bit about the symptoms and treatment for these injuries?
Patello-Femoral Pain Syndrome
This is just a fancy Latin name for “Knee Cap Pain”, so it is pretty easy to diagnose when the patient points to their knee cap and says, “It hurts here”.
Symptoms: Pain anywhere around the knee cap can be sharp or stabbing at times, usually occurring upon landing during running, negotiating hills/stairs, getting up/down from chairs, squats or lunges. Mild swelling can occur around the knee cap region and patients usually describe the pain as “under the knee cap”.
Treatment: Local anti-inflammatories are helpful (icing the painful area) and NSAIDS (Ibuprofen) but these things do not address the cause of the problem.
Evaluation of each runner’s hip strength and mobility are very important and might lend a treatment program towards hip/trunk strengthening or improving the mobility of the hip/lower back. Your hip muscles control rotation of the long thigh bone (femur) which makes up the top half of the knee joint. If this bone rotates too far, it alters the interaction of the knee cap joint, causing higher forces over a small surface area (PAIN). So the correct hip/trunk strength exercises when indicated can correct this and alleviate the problem in most cases.
Follow this link for some great examples of runner specific hip/trunk strengthening: https://www.youtube.com/watch?v=bOzhXX9JvuE
Foot and ankle factors can also be present. Namely, excessive pronation causing the same rotational issue at the knee. Current research supports a greater influence from the hip than the foot/ankle, however I have seen both areas clinically relevant. Footwear selection is very important and full-length inserts can be helpful in some cases.
Some training errors can tease this problem to the surface, mainly hill work or stairs, in which corrections in the training program can then be helpful.
This means inflammation of the Patellar Tendon, which sits below the knee cap and anchors into the top of the shin bone.
Symptoms: Pain below the knee cap which can be described as burning or aching. This is made worse by running, jumping, stairs/hills, getting up/down from chairs, squats, or lunges. Swelling is more likely here and the tendon can be very tender to the touch making kneeling difficult.
Treatment: Local anti-inflammatories, as mentioned above, are also helpful here to help with symptoms. A patellar tendon strap can help with force dispersion at the tendon’s insertion into the shin bone, but is only a band-aid to the problem. As with patellar-femoral pain, similar factors at the hip and lower back need to be evaluated to determine the real cause of the issue. Quad muscle strengthening can be helpful, but needs to consist of the right exercises introduced at the right time. Runners should not do seated knee extensions while they have patellar tendonitis as this will directly strain an already over-strained tendon. Incorporation of the right hill work, squat, lunges, etc, when introduced at the right time can be helpful.
IT Band (Friction) Syndrome
Symptoms: Sharper pain or rubbing/snapping sensation at the outer—>front of the knee. This pain is usually worse at a specific point in the stride, occurring when the knee is bent about 35-40 degrees (landing or lift-off of the leg). It can also be pain full with getting up/down from the floor, squats, lunges, etc.
Treatment: Again, local anti-inflammatories can help. ITB strap or taping can help with symptoms only. Mobility of the hip and low back, as well as strength of the hip, are crucial to normal function of the IT Band during running and are common causes to the problem.
Follow these links to see good video examples of hip and low back mobility exercises.
- Hip Flexor Stretch: https://www.youtube.com/watch?v=VdFkMN32ce0
- Prone Press Up: https://www.youtube.com/watch?v=hFcDGfzuoio
Foam rolling the thigh and the hip, in addition to footwear and altering your training route (avoidance of running on the same side of a cambered road every time) are also important. Lastly, cadence is very relevant here and improving your foot strikes per minute can be beneficial.
Follow this link to see how to use a foam roll on your thigh: https://www.youtube.com/watch?v=w-50YlLbIa0
This means inflammation/breakdown of the Plantar Fascia, which is a connective tissue at the bottom of the foot that anchors into the heel bone. This tissue helps support the arch and gets abused when the arch is collapsing for one reason or another.
Symptoms: The hallmark complaint is pain at the bottom of the heel with the first few steps in the morning, or after a prolonged period of sitting. This pain can be sharp and will cause a limp.
Treatment: Local anti-inflammatory treatment to help pain, however this problem is no longer thought to be an inflammatory issue, so it is most likely that icing helps to reduce pain or surrounding fat pad irritation. Footwear or insert selection can make a big change in symptoms. There is not any evidence for custom vs. over-the-counter orthotics at this point, but I have found results with either dependent on the patient. Rigid night splinting is well supported in the research, but can be inconvenient to use. Improving ankle, hip and low back mobility, calf stretching, and foam rolling the back of the lower leg can be very helpful.
Follow these links to gain ankle mobility and use a foam roll to the lower leg;
- Ankle Mobility: https://www.youtube.com/watch?v=xfj-mQXMvTA
- Foam rolling the lower leg: https://www.youtube.com/watch?v=rMNzicUIBfU
As with all running overuse injuries, your training plan and weekly-monthly-annual mileage plan is very important. Many times, I will spend as much time with a patient talking about mileage quality and quantity as we will on items specific to their injury.
Many overuse injuries start slowly, with mild symptoms at the onset and finish of a run. As the injury progresses, the symptoms last longer at the beginning and show up earlier at the end of the run. Finally, symptoms are present with non-running activities.
It is not advised to run through any symptoms that have become consistent and more frequent. This is a sign of a problem that will only build as you continue to run, costing more time, effort, energy, and money to figure out.
Thanks so much for all the great information, Calvin! For more information on other running injuries or for specific questions, you can connect with Calvin here:
Phone Number: 414-395-1079
Stay tuned, runners! Calvin will provide a second post about running injury prevention in the next few weeks.
Keep Running MKE – you’re doing great!