Running Related Injuries; When you should get help
Running has undoubtedly increased in popularity since the beginning of 2020, with many local run clubs popping up, likely related to the low cost and the fact that it can be so easy to do. Many runners experience pain and niggles, most often in the lower limb throughout training and in the lead up to an event. It can be difficult to know when it is ok to continue training through pain and soreness, or when you need to modify training or take a break from training. Runners are often hesitant and even sometimes even refuse to stop training, wanting to push through pain and injury. It can be helpful to know when it is ok to continue training with certain injuries and when it is imperative to rest. Before the running season starts, we will discuss some common running-related injuries in this blog.
A final note before we discuss specific running related injuries; the information below should always be taken into context of the individual’s running goals, biomechanics and injury history. It is also important that you gain an accurate assessment and diagnosis to ensure the appropriate management is being taken to improve your injury.
Medial tibial stress syndrome
Also known as 'shin splints' characterised by pain on the front of the tibial border during intensive weight-bearing exercise. Pain is secondary to inflammation of the periosteum (layer of connective tissue that surrounds bone) due to traction from muscle attachment (soleus, flexor digitorum longus and tibialis posterior). Medial tibial stress syndrome is an early stress response to repetitive overload on the continuum of tibial stress fractures. General management includes focusing on rest and activity modification from repetitive loading. Medial tibial stress needs to be closely monitored as it can lead to more serious bone stress injury, so this is one that should not be ignored.
Achilles tendinopathy
Achilles tendinopathy can often arise with increases in training loads and intensity. Pain may be experienced in the morning, following exercise or when an athlete can run through the pain, and it disappears once warmed up, only to return once cooled down. Tendinopathies are classified into three categories: reactive tendinopathy, tendon disrepair, and degenerative tendinopathy, based on changes and structure within the tendon. General management involves education and modification of activities. Tendons require progressive load rather than rest, taping, and manual therapy. In some cases, injections are indicated. This is an injury that you can continue to train with within reason, depending on symptoms.
Plantar Fasciitis
Plantar fasciitis is one of the most common causes of foot pain, characterised by pain under the heel at the plantar fascia (a connective tissue), which spans from the bottom of the heel along the arch to the front of the foot. An overuse condition is commonly associated with the calf, hamstring, and gluteal muscles tightening. Tightness in these muscle groups can predispose to plantar fasciitis by altering the foot's normal movement, function and loading. General management includes avoiding aggravating factors, regular ice therapy after activities, stretching, taping and strengthening exercises.
Patellofemoral Pain Syndrome
Also known as 'Runners Knee' and pain arising from the patellofemoral joint (the kneecap and thigh bone) or the surrounding soft tissues. Patellofemoral syndrome can be due to direct trauma to the kneecap, but more commonly, a combination of several factors, including muscular weakness, imbalances and biomechanics or anatomical abnormalities (i.e. location of the knee cap, foot position, reduced control in landing movements). General management involves addressing factors such as pain reduction, patella tracking, muscle flexibility, strength, and foot strike position during running. This injury can often be improved with an appropriate physiotherapy program in conjunction with making changes to cadence, stride length, footwear and monitoring the running surface and volume of training.
Bone Stress
A bone stress injury is the inability of bone to withstand repetitive mechanical loading, which can result in structural fatigue, bone pain and tenderness. Bone stress injuries are relatively common overuse injury in runners due to a fatigue failure injury of the bone. The continuum of bony changes with overuse occurs with increased activity levels and results in higher forces transferred from surrounding muscle activity, where the bone remodeling response may not be able to cope. Runners are at greater risk of stress fractures within the lower limb, including the pelvis, femur (thigh bone), tibia (shin bone) and bones in the feet. Stress fractures are classified into low-risk and high-risk categories, therefore determining the management. Bone stress injuries are the most important injuries to closely monitor and should not be ignored. These injuries require time off running to allow healing of the overloaded tissue.
What can we do to prevent running-related injuries?
It’s important to understand the reasons why a running injury may develop in order to be able to effectively rehabilitate the injury. Typically, at a physiotherapy assessment, there are key drivers or causes of running injuries we consider. They are:
Biomechanics (patterns of weakness, tightness, muscle strength imbalances that may lead to injury)
Running technique (technique flaws will contribute to adverse loading of lower limb structures)
Footwear selection (for example old and inappropriate shoes)
Hip & pelvis strength & stability (adequate hip stability is essential to decrease unwanted loads on lower limb structures and ensure appropriate lower limb alignment)
Errors in training (doing too much too soon, adding hills into a program, not scheduling sufficient rest)
As with all injuries, there is never a one-size-fits-all approach. Seeking a physiotherapist's assessment and tailored rehabilitation plan is recommended to ensure a graded and safe return to sport and physical activity.
Written by physiotherapist, Rachel Jeffrey
Rachel loves all things running and triathlon and is passionate about getting people back to physical activity and helping them achieve their running goals.
To book an appointment with Rachel, BOOK NOW
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