There are plenty of different types of injuries that can occur while running. In this post we will take a detailed look at four of the most common running injuries.
- Plantar Fasctitus
- Leg Up?
- IT Band
- Shin Splints
According to Tim Noakes, author of the Lore of Running, plantar fascitis accounts for only 5-14% of running injuries. Obviously Tim has not been to The Washington D.C. area where it seems to be occuring in much greater numbers.
Plantar fascitis is an inflammation of the connective tissue which runs along the bottom of the foot attaching at the metatarsal heads and inserting on the underside of the heel. It is noted by point tenderness beneath the heel and/or generalized soreness along the arch.
Running is a bilateral sport where equal demand is placed on both sides of the body. However, most of the time running related injuries occur on only one side of the body. Why you ask? Good question. Muscle flexibility and strength imbalances along with faulty skeletal alignment cause altered biomechinical function. Altered biomechanics in turn will focus stress unequally on various parts of the body. These areas become the subject of overuse and are ultimately the sight of injury.
Plantar fascitis is an overuse injury thought to be caused by prolonged excessive stretching of the fascia. Although the exact mechanism of the injury is still debated, it is most common in runners who have high arches, over-pronate, or have a tight calf muscle/achillies tendon complex.
Proper management of the injury includes symptomatic treatment and biomechanical correction. Begin treatment with ice massage (see training tip below) over the affected area, especially after running. In the acute stage, minimize stress to the plantar fascia by wearing arch supports in all footwear. Before you spend hundreds of dollars on orthotics, try a pair of sorbothane graphite arch supports which can be purchased at most reputable running stores for under $20 dollars. Modify your training by avoiding hills and speed work and break long runs into two shorter runs. Heel cups and horseshoe shaped pads can provide relief by reducing pressure at the heel. It may be necessary to change to a straight lasted training shoe.
Biomechanically, the entire spine, pelvis, lower extremities and feet should be evaluated for abnormal alignment and muscle flexibility and strength imbalances. Identifying these discrepancies will help in eliminating the underlying cause.
If the condition continues to worsen, do not try to run through it. Chronic plantar fascitis can lead to the formation of a heel spur. This will prolong recovery and may require surgery. For the best advice, consult a Doctor who has experience in working with and treating runners.
To prevent plantar fascitis, build up your mileage slowly. Allow enough time to recover from fatigue and microtrauma after long runs and high intensity workouts. Maintain balance between muscle flexibility and strength by using proper stretching techniques and performing resistive exercises with surgical tubing. Also, roll a golf ball under your foot to massage the fascia and relieve fixations. Strengthen your arch by using your toes to pick up marbles and scrunch newspaper. Finally, have your gait and biomechanics checked periodically before problems begin.
Remember, the best way to enhance your performance is to remain injury free!
TRAINING TIP: The best home care for aches, pains and acute injuries is ICE MASSAGE. Fill some dixie cups with water and put them in the freezer. When needed, take out a cup and peel away the top layer exposing the ice. Apply the ice directly to the affected area in a circular motion. Do this for no more than five minutes. During this time, sensation will progress from coolness, to burning, to aching, and finally numbness. This can be repeated up to once an hour. This method is colder and more time efficient than the traditional ice pack.
Unequal leg length is so common in the general population that many consider it normal. Though structured with bilateral symmetry, every human body presents some degree of asymmetry. Minor differences in leg lengths will not affect most sedentary people because they do not have to adapt too much biomechanical stress. Runners, on the other hand, are forced to absorb five to seven times their body weight with each strike of the heel.
Running is a sport that requires equal movement, strength and impact on both sides of the body. Running on a short leg is comparable to running repeatedly on a curved road. Over a few miles, the difference is hardly noticeable. However, over the course of days, weeks, months and years, altered biomechanics and the resulting stress will exceed the body’s capacity to repair and adapt. This is when the injuries occur. Common injuries associated with leg length discrepancies include low back pain, sciatica, hip pain, knee problems, IT Band Syndrome, chronic muscle strain and tendonitis.
There are two classifications of leg length differences: anatomical and functional. An anatomical short leg is one in which there is a measurable difference in bone length between the two legs. This may be due to fractures, knee or hip degeneration, deformities or unequal growth rates. A heel lift utilized on the “short” side will help compensate for this difference.
By contrast, a functional short leg appears shorter, but measures the same length as the other leg. The two most common causes are overpronation of the foot and backward rotation (misalignment) of the pelvis. Pronation can be corrected by strengthening the ankle joint with an orthotic or surgical tubing and resistive exercises. Spinal manipulation will correct misalignment of the hip. Manipulation should be performed in conjunction with stretching of the hamstrings, quadriceps, gluteus, and hip flexor muscles to achieve lasting results. A heel lift is not the proper solution to a functional short leg. This will serve only to reinforce the altered biomechanics and resulting stress.
One of the simplest ways to determine the classification of a short leg is to measure both legs. Measure from the front of the pelvis (anterior superior iliac spine) to the inside ankle bone (medial malleolus) and compare. Many runners have been diagnosed with unequal leg lengths but not told whether the discrepancy was anatomical or functional. This is an incomplete diagnosis and the resulting treatment may be inappropriate or inadequate.
Running injuries are greatly influenced by unequal leg lengths. If you have suffered from injuries that are chronic or recurrent, have your leg lengths checked!
Iliotibial Band Syndrome is the scourge of running injuries. Although easy to diagnose by its location and pain pattern, recovery from this injury has proven to be extremely difficult. One research study found that 17% of all runners never fully recovered from this condition. The Iliotibial Band, commonly known as IT Band, is a broad band of connective tissue (fascia) which extends from the top of the hip (Ilium) down the outside of the thigh. It crosses over the knee joint and inserts on the tibia bone. See Figure #1.
Injury can occur anywhere along the IT Band, however, the most common location is along the outer edge of the knee. While running, as the knee flexes towards 30 degrees, the IT Band slides over the outer edge of the knee (lateral epicondyle). Excessive rubbing over this bony portion causes the band to become inflamed. Once inflamed, the band’s ability to slide across the knee becomes hindered. The difficulty in recovery is related to the fact that the IT Band is a connective tissue with a poor blood supply, thereby delaying the healing process.
The resulting pain can be intense, yet may disappear suddenly with the cessation of running. This pain pattern has frustrated many runners. The outside of the knee may appear swollen and will be tender to the touch.
As with most running injuries, the cause of IT Band can be traced to biomechanical factors, both external and internal. External factors, those outside the body, include:
Sudden increases in mileage
Increased training intensity.
Running on hard surfaces.
Running shoes that lack shock absorption or limit normal foot motion (motion control shoes or improper orthotics).
Running in one direction around the track.
Running consistently on the same side of the road (usually sloped for drainage)
Internal biomechanical factors, those relating to the body or the runner’s gait, is more subtle and often overlooked. They include:
Gait abnormalities: oversupination (rolling out excessively) or limited pronation due to improper shoes.
High arched “rigid” feet reducing normal shock absorption and limiting normal motion of the foot.
Structural imbalances: having a short leg on one side is equivalent to running on a sloped road constantly.
Misalignment of the pelvis or spine will cause abnormal biomechanics of the hips and associated muscles and connective tissues.
Muscle flexibility or strength imbalances: tight gluteal (butt), hip flexor, hamstring, quad or adductor muscles may increase stress and tension on the IT Band.
Training modifications are necessary. To begin with decrease your mileage and running intensity. Run on soft, level surfaces. Cross training activities including cycling and swimming will not irritate this condition in most cases. Switch to running shoes with good cushioning that allow normal motion of the foot. Ice massage over the affected area for five minutes at a time is the best way to reduce inflammation. You may try over the counter anti-inflammatories. They can be beneficial if they are not used to “mask” symptoms allowing further damage to occur. Gentle stretching of the IT Band is important, but should only be performed in pain-free range of motion (see Figure 2).
A sports medicine doctor or therapist experienced in treating runners will be able to identify the more subtle internal biomechanical factors and recommend a course of action. Your gait should be analyzed for abnormalities. Shoes need to be judged on their appropriateness and wear patterns checked. Examination of leg lengths, spinal and pelvic alignment will identify structural imbalances. Muscle strength and flexibility should be tested for balance and range of motion.
Treatment must focus not only on pain relief but also on eliminating causative factors. The specific internal and external biomechanical factors unique to each runner must be addressed. Early intervention is the key to a successful recovery.
Various treatments have been employed to eradicate IT Band. Ultrasound, muscle stimulation, iontophoresis (a procedure whereby anti-inflammatory agents (often cortisone based) are directed to the injured tissue for symptom relief. Cross friction massage and stretching techniques have been used to restore flexibility and range of motion. A short leg syndrome may require a heel lift or spinal manipulations depending upon causative factors. Since IT Band is such a difficult and chronic injury to overcome, a multidisciplinary approach using a combination of therapies should be implemented for best results. Runners should take this injury serious in the early stages as early intervention will give the best chance for a full recovery.
A recent University of Washington study of athletic injuries provides some interesting insight into the stress running places on our bodies. 60,000 high school athletes from 18 sports were surveyed and the results are rather surprising. The study found girls cross country running to be the sport with the most casualties, and topping the list of injuries were those of the lower leg including “shin splints” and stress fractures. Chances are at some point in your running career you have experienced pain or soreness in the lower leg.
“Shin splints” is a nonspecific term describing pain in the tibia or shin bone. This term has been replaced by tibial stress syndrome, a more anatomically correct term. The pain results from “periostitis,” an inflammation of the outermost layer of bone called the periosteum. The periosteal layer is the sight of insertion for muscle tendons and fascia. It is also rich in blood vessels and nerve endings. These characteristics make the periosteum a common area for irritation and inflammation.
The condition begins with prolonged stress on the muscles and bones of the lower leg causing fatigue and strain. Pain is diffuse in nature and dissipates while running. When stress continues, microtears occur at the sight of muscle tendon and fascial insertions, resulting in periosteal inflammation. This is Tibial Stress Syndrome. Pain at this stage will intensify as a run progresses and will linger after finishing. Training beyond this point will further damage the bone and lead to a stress fracture.
Tibial Stress Syndromes are named for where they occur in the lower leg. Anterior Tibial Stress Syndrome involves the tibialis anterior muscle which acts to pull the foot upward and inward while running. Pain is felt along the front outer edge of the tibia bone. This muscle is twice as active as any other muscle in the lower leg during running, making it more susceptible to fatigue and strain. Risk factors include: running on hard surfaces, increased mileage, downhill running and tight calf muscles.
Posterior Tibial Stress Syndrome involves the tibialis posterior muscle giving rise to pain along the inside edge of the tibial bone. This muscle helps to stabilize the arch and assists the calf in the toe off phase. Runners who overpronate and “toe out” are at increased risk.
Appropriate treatment begins with ice massage of the affected area. This should be coupled with a decrease in mileage and intensity of running. If necessary, switch over to nonweight bearing exercise such as deep water running until the pain subsides. Avoid hills and hard surfaces while also working on increasing calf flexibility. Adding arch supports and switching to a more stable shoe will also help.
Use the “Rule of Thumb” for early detection of Tibial Stress Syndrome. Run your thumb down the inner and outer aspect of the tibia, looking for any tender or irregular areas of the bone. Ice over these after each run. As with any injury, prevention is the best treatment. Strengthen lower leg muscles in all directions, concentrating on movements around the ankle joint. Toe raises with feet turned in slightly will help strengthen tibialis posterior muscles. Hooking your feet under a couch or bed, etc. and pulling them up and inward will strengthen the tibialis anterior. Do 12-15 repetitions of these exercises on both legs not just the injured or weaker side. Unfortunately, running does not always strengthen these muscles sufficiently. Concentrating on the strength and flexibility of the lower leg can ensure you will not be the next victim of the dreaded “Shin Splints!”