In the first 3 months of the UK national lockdown in 2020, the NHS saw a 92% increase in downloads for their running app “Couch to 5k” compared to the same period in 2019. As with any sport, running doesn’t come without it’s risk of injury, and with such an increase in participation it comes as no surprise that running injuries have been one of the most common complaints seen here in the clinic in recent months.
So what injuries are the most common in runners?
Due to the high impact of running, the most common injuries are to the lower limb, as these joints are responsible for absorbing the impact and providing the power to keep you going. The good news is that many of the most common injuries suffered by runners can be prevented/treated at home.
Shin Splints (Medial Tibial Stress Syndrome/MTSS)
Shin splints is a term used very broadly among athletes experiencing shin pain. Medial Tibial Stress Syndrome (MTSS) is the correct term for “Shin Splints”, but what is it, what causes it, and how can it be managed and treated?
MTSS occurs when the thin lining of the bone, called the periosteum, is pulled away from the bone by gastrocnemius (Calf muscle), the muscle which it is also connected to. This happens when the muscle becomes tight and/or overactive, especially in high impact activities involving lots of repetitive running and jumping. Pain is felt towards the inside of the shin bone, and can sometimes be tender to touch.
Shin splints usually responds well to a combination of rest, stretching and strengthening, followed by a gradual return to running once symptoms have resolved. It is also important to make sure that the footwear you wear when running have appropriate arch support for your feet, as well as suitable cushioning.
The planta fascia is a large fibrous structure which runs majority of the length of the foot. Plantar fasciitis refers to when this fibrous structure becomes inflamed, and is the most common cause of foot and heel pain in runners. Pain is usually most common in the morning when first getting up, and during activity.
The most common cause of plantar fasciitis is poorly fitting footwear which leads to an increased strain being placed through the plantar fascia and the development of inflammation. It is also possible for running biomechanics (how you move) to cause plantar fasciitis.
Whilst the plantar fascia is inflamed and painful, ice can be used, while sports therapy treatment will work to address any biomechanical issues, in addition to any muscle or joint imbalances, in order to encourage the tissue to return to its normal alignment. Often orthotics are used in cases when over pronation (collapsing of the arch) is believed to be the cause.
Runners knee (Iliotibial band friction syndrome)
Iliotibial band friction syndrome is often referred to as “Runners Knee”. It describes pain which is experienced on the outside of the knee when running, and is caused by the Iliotibial band (IT band) becoming inflamed.
The IT band is a thick fibrous band that runs down the outside of your leg from your gluteal muscles all the way down to your knee. Therefore the most common cause of runners knee is tightness and overactivity in the gluteal muscles, and treatment focusses on stretching and strengthening these. Running on uneven surfaces, and inadequate footwear can also contribute to gluteal tightness, and it is important that these elements are considered during treatment and return to activity.
Once symptoms have resolved it is important to slowly return to activity so that tightness and muscle overactivity does not return as a result of a sudden increase in training.
Patellofemoral pain syndrome
Patellofemoral pain syndrome is a generic term for generalised knee pain with no specific pathology. It is most commonly caused by muscle imbalance and mal-tracking of the knee cap (patella).
The patella is designed to sit within a natural groove in your femur (thigh bone), while the quadricep muscles are responsible for controlling the movements of the patella within this groove. If one of the quadricep muscles is stronger and more dominant than the others, the patella will no longer move evenly along this grove, and will likely be pulled to one side resulting in pain and inflammation.
Treatment and rehabilitation of patellofemoral pain syndrome is focused around restoring equal muscle lengths, and rectifying muscle imbalances. This can be achieved through a combination of hands-on treatment and rehabilitative exercises. Although patellofemoral pain syndrome can often take prolonged periods to fully resolve, conservative management is usually effective, allowing athletes to return to their chosen sport/activity.
Gastrocnemius (Calf) strain/tear
The calf is made up of two muscles, the soleus, and the much larger gastrocnemius, which is over the top of the soleus. Gastrocnemius strains/tears are often just referred to as the calf, however this is an umbrella term used for both muscles. Although both the soleus and gastrocnemius can become injured, due to its size and significant forces that it produces, the gastrocnemius is more common to become damaged.
Calf tears and strains most commonly occur when jumping or accelerating when running, and is more common in faster and more intense training, commonly associated with speed and power events. Usually athletes complain of a gradual tightening in the muscle which overtime escalates into pain when they attempt to run, and in severe cases when walking.
The rehabilitation of calf injuries can be broken down into three phases, settling initial symptoms, gradually increasing calf strength through progressive training, and return to running. These phases are not time bound, but are determined by clinical indicators being met.
Achilles tendinopathy is the degeneration and inflammation of the Achilles tendon. This is a condition which will gradually worsen overtime without the correct treatment and rehabilitation.
Achilles tendinopathy is most commonly caused by excessive forceful contraction, excessive stretching, overuse or new/sudden increase in activity. The tendon will often feel tender to touch, appear physically thicker than the unaffected side, and feel very stiff in the morning. Pain will be worsened by activity.
If return to activity occurs prematurely symptoms will return and rehabilitation will take longer. Pain and any swelling needs to be addressed, followed by the cause. Treatment methods often used are strengthening and stretching, alongside manual therapy and sometimes ultrasound treatment. When returning to running it is important to gradually increase activity, as well as ensuring appropriate footwear is being worn.
General self-help at home
It isn’t all about waiting to be injured before you help your body. Prevention is always better than a cure, and there are plenty of things you can be doing at home to help reduce the risk of becoming injured:
- Foam rolling
- Gradually increasing time/duration/speed/intensity of your activity so that your body has time to adapt
- Listen to your body/ don’t ignore aches and pains
- Keeping the key muscles for your activity conditioned appropriately
This blog briefly outlines just some of the injuries which runners may encounter. For further information and personalised advice/treatment/rehabilitation, contact us