Many factors can contribute to the onset of running related injuries. Find out what causes these injuries and how to prevent them.

Typically athletes will let an injury progress for quite a while before they seek treatment, usually of the mindset that it will get better on its own. But as many of you know, that have experienced an injury, it typically will get worse to the point of preventing you from training rather than fixing itself. So, if you have a persistent problem related to your training you should seek out qualified medical help. This means someone who understands the type and volume of training you are doing, and is experienced in treating athletes that do similar activities. Just because there are hundreds of health professionals out there doesn’t necessarily mean they are privy to your specific needs, and this also goes for those that work in sports specific rehab facilities. Do your homework and ask as to which professionals would be best qualified to treat you in order to maximize your recovery.

As mentioned in my last article in this series, running technique and shoes can be a huge factor in causing running related injuries. With this in mind, sometimes there are pre existing injuries that have occurred before you have had a chance to make any of these positive changes. In addition to technique and shoe type, some other factors that can contribute to the onset of injuries are sudden changes or drastic increases in training volume, training intensity, training surfaces (ie. Treadmill vs road vs gravel pathways vs snow) It is important to keep these in mind and keep track of any sudden changes which may have contributed to any problems. This will help your coach and your health care professional in your treatment plan.

The most common running injury may have to be “runners knee” or iliotibial band syndrome. This is presented by pain in the lateral or outside of your knee which is worsened by running. Sometimes the pain can also be felt higher up on the outside of the thigh or even into the outside of the hip. The iliotibial band or IT band is a tendon that runs down the outside of your hip to your knee. It is not made of muscle and therefore not very elastic or stretchy. But it is attached to many muscles that are in the hip and the thigh, and thus tightness or dysfunction in these muscles can contribute to the stress on this structure pulling it very tight. The pain in the knee is caused by the IT band rubbing and causing friction as it passes over the lateral condyle of the femur (a ridge on the outside of your thigh bone) when the knee hits 30 degrees of flexion and becomes inflamed and irritated. Usually running will aggravate the pain where as cycling or swimming may be pain free. Treatment should consist of anti inflammatory modalities from your therapist in order to reduce the local inflammation at the site, as well as a biomechanical analysis of how your low back, pelvis and legs are working together. Muscle flexibility in this instance is very important. Intra muscular stimulation (IMS) of the related muscles can help reduce tightness in the muscles, as can massage or ART (active release technique). In order to help prevent the recurrence of this type of injury stretching the hips and thighs is important. Stretching the IT band is not possible because it isn’t elastic, but using a foam roller or a Trigger Point Quadballer© along the outside of your thigh will assist in breaking up resistance and scar tissue that forms in the tendon.

Another common knee pain complaint is pain under the kneecaps, mainly with running up or downhill, or climbing stairs, though not inclusive of these activities. It can sometimes be bothersome even sitting for long periods of time with your knees bent. This is called patellofemoral pain syndrome and is caused due to the kneecap tracking improperly in the groove of the femur. It is caused by muscle imbalance in the quads or fronts of your thighs. The kneecap is controlled by the muscles in the quadriceps of your thigh, and if they are not acting equally then it isn’t gliding smoothly within the groove and can cause inflammation and irritation in that area. This can be more common in females as their hips are wider than their knees and this emphasizes the tightness on the outsides of the quads, overpowering the medial aspect of the quads. Treatment will again consist of anti-inflammatory modalities in order to reduce the pain and swelling of the site, as well as specific exercises geared towards strengthening the weaker medial aspect of the knee and helping the kneecap glide in its proper place. If there is prolonged history of this type of problem the lateral muscles may need treatment in order to release their constant tightness, and this is typically accomplished by IMS or ART or both.

Foot pain is also a common complaint in runners and can present in many different patterns. Typically plantar fasciitis is common, and it presents with pain in the sole of the foot, usually but not restricted to the heel more than the arch. This can be worse first thing in the morning with stepping on it, or after a prolonged rest in which the foot wasn’t weight bearing.  The cause of this problem is inflammation in the plantar fascia, which is a big tendon that covers the feet underneath and attaches to the heel, and the pain is usually on the insertion point of the heel. Many reasons will contribute to this problem, the biggest of course is weakness in the foot muscles which will cause stress to the fascia and pull on it. Traditionally orthotics or very supportive shoes were the course of treatment in order to support the fascia and the arch. But this typically doesn’t work and as I mentioned in the previous article about shoes and running technique. This just leads to more weakness in the foot muscles as they are essentially being casted with all this support. It is important to strengthen the arches by using as little support as possible and running while using these muscles. If the pain is severe, temporary support may need to be used in order to commence exercises and strengthening, and then taken away once the muscles are strong enough. Treatment may also need to focus on reducing the pain and inflammation with modalities and ice. Stretching the fascia over a ball or a roller may also help with improving its mobility.

I cannot emphasize enough how important proper running technique and shoe type are to preventing these problems from occurring.  This list of injuries is definitely not inclusive of all problems that can be related to running, but they address the most common. A well trained physical therapist with a good knowledge base in running and endurance sports will be able to help you with any problems you are having with running. And it is important to read and research the new trends in running technique and get out of the old ways, as North America is thought to have the best technology in shoes and yet remain the most injured running society!!