Common Running Injuries

If you’re a runner and want to decrease your risk of sustaining a running related injury, then you will need to learn how to run “softly”. Today we explore the most common types of running injuries, including causes, symptoms, home remedies and preventative measures. If you’re a Long Island Runner looking to avoid the need for Long Island Physical Therapy, then read on.

Research published in the December 2015 British Journal of Sports Medicine, which looked at running form and injuries demonstrated that runners who run or land “softly”, will have a decreased risk of injury. It seems that landing “hard” onto the heel can adversely affect your risk of being hurt. When controlling for running mileage, body weight, and other factors, running form was the most important factor when it came to injuries and injury avoidance. Based upon the findings of this study, it may be advisable to work towards landing away from your heel and more towards the mid-foot.

The following information is intended to provide runners with information regarding six of the most common running injuries: Achilles tendonitis, patella tendonitis (Jumper’s Knee), tibialis posterior dysfunction, plantar fasciitis, iliotibial band friction syndrome (ITB Syndrome), and patello-femoral pain syndrome (Runner’s Knee). This information is by no means meant to replace a physical therapist’s or physician’s diagnosis. Various pathologies may elicit similar symptoms. If you feel you have any of the following symptoms, please contact a sports medicine specialist for recommendations. The physical therapists here at Physical Solutions are always available to help, and have extensive experience working with runners of all levels and abilities.

Achilles tendonitis

The Achilles tendon connects the muscles of the calf to the calcaneus (heel bone). Its main function is to allow the foot to push off the ground (plantarflexion) when walking and running. Achilles tendonitis refers to the irritation or inflammation of the tendon as a result of repetitive stress. Exerting rapid stress on the Achilles tendon when it is inflamed can result in further injury and if left untreated possible rupture of the tendon.

CAUSES
• Tight calf muscle or Achilles tendon
• Hill running
• Sudden increase in the intensity or volume of training
• Poor shoes (too stiff, loose heel cup, lack of arch support)
• Changing between shoes (such as wearing high heels all day and then changing into low running shoes)
• Over pronation (flat feet)

SYMPTOMS
• Swelling and inflammation of tendon
• Tendon painful to touch
• Tightness of the Achilles tendon
• Pain on rising up onto the toes
• A painful heel for the first few minutes of walking after waking in the morning
• Range of motion of the ankle may be limited

HOME TREATMENT
• Rest the affected ankle in an elevated position
• Use an ice compress to ease pain and inflammation
• Avoid weight-bearing exercise (especially running) until pain subsides; use alternative exercise such as swimming to maintain fitness
• See your sports medicine specialist for further advice on rehabilitation and ongoing management

SPECIALIST TREATMENT
• Anti-inflammatory medication
• Cross friction massage, stretching and modalities (ultrasound, electrical stimulation)
• Specific muscle strengthening exercises

PREVENTION
• Complete proper and adequate stretching and strengthening exercises prior to participating in any sports
• Always increase the intensity and duration of training gradually
• Allow adequate recovery time before the next sporting event
• Wear properly fitted running and other sports shoes

Patella Tendonitis

The patella tendon is located just below the kneecap (patella). This tendon attaches the quadriceps muscle at the front of the thigh to the shinbone (tibia). The quadriceps is responsible for extension (straightening) of the knee and is involved in most weight bearing activities including running. Patella tendonitis is an inflammation of the patella tendon. This inflammation tends to be caused by overuse during running.

CAUSES
• Decreased flexibility of quads
• Sudden changes in training intensity or volume
• Poor muscular control and endurance
• Decreased patella mobility

SYMPTOMS
• Pain that is present just below the kneecap
• Pain when sitting for long periods
• Pain when resisting knee extension
• Pain before and after training

HOME TREATMENT
• Avoid weight-bearing exercises (especially running) until pain subsides; use alternative exercise such as swimming to maintain fitness
• Use an ice compress to ease pain and inflammation
• See your sports medicine specialist for further advice on rehabilitation and ongoing management

SPECIALIST TREATMENT
• Anti-inflammatory medication
• Cross friction massage, stretching and modalities (ultrasound, electrical stimulation)
• Specific muscle strengthening exercises

Tibialis posterior dysfunction

Tibialis posterior refers to a muscle of the lower extremity, which is located on the inside of the calcaneus (heel). The muscle courses down the rear of the shin (tibia) to behind the inner bone of the ankle (medial maleolus). The end of this muscle (tendon) attaches onto a bone (navicular) at the top of the innermost portion of the arch of the foot. The term tibialis posterior dysfunction refers to pain and/or inflammation, which can occur anywhere along this muscle tendon unit. If this condition is left untreated, rupture of the tendon can occur.

CAUSES
• Overpronation (flat feet)
• Unstable medial arch
• Limitations of motion in other joints (i.e., calf tightness, decreased hip or knee extension, varus knee (bow legs), excessive external rotation (turning out) of hip, and leg length discrepancy)
• Poor shoes (too stiff, too floppy, worn shoes under arch, or overly wide shoes)
• Change in running surface (must adapt to new surface, and as a result muscles are overused)
• Hard running surface (increased forces transmitted through the foot)
• Soft running surface (allows excessive pronation)
• Sudden increase in training intensity or volume

SYMPTOMS
• Pain in the area where the tibialis posterior tendon attaches to the navicular bone in the arch of the foot (painful area can be 7 to 10 cm in length)
• Swelling around the medial malleolus (bony area on the inside of the ankle)

HOME TREATMENT
• Rest the foot until pain subsides
• Apply ice for the first 3 days then apply heat and use a heat retainer
• See a sports injury specialist for advice on rehabilitation, assessment of causative factors and recommendations to minimize recurrence (i.e., replace shoes, change running surface, change running direction on track or street side, create an orthotic to control foot pronation or address a leg length discrepancy)

SPECIALIST TREATMENT
• Anti-inflammatory medication
• Cross friction massage, stretching and modalities (ultrasound, electrical stimulation)
• Muscle strengthening exercises
• Application of a plaster cast for 3 weeks if pain persists
• Unrelenting pain may warrant injection with an anti-inflammatory steroid
• In severe cases surgery may be indicated (note – this is an important reason to adhere to the advice of your rehabilitation specialist)

Plantar fasciitis

Plantar fascia refers to the tough, fibrous tissue that begins at the bottom of the heel (calcaneus) and flares to attach at the ball of the foot (metatarsophalangeal joint). Plantar fasciitis occurs when this tissue becomes inflamed and painful.

CAUSES
• Overpronation (flat feet), which places excessive stress on the plantar fascia
• A rigid, high arched foot with a plantar fascia that is too tight places excessive stress on the plantar fascia
• Limitations of motion in other joints (i.e., calf tightness, decreased hip or knee extension, varus knee, excessive external rotation of hip, and leg length discrepancy)
• Poor shoes (too stiff, too floppy, worn shoes under arch, or overly wide shoes)
• Change in running surface (must adapt to new surface, and as a result muscles are overused)
• Hard running surface (increased forces transmitted through the foot)
• Soft running surface (allows excessive pronation)
• Sudden increase in training intensity or volume

SYMPTOMS
• Point tenderness on the bottom of the foot near the heel
• Pain on the bottom of the foot when first getting out of bed, or after any period of rest

HOME TREATMENT
• Rest the foot until pain subsides
• Apply ice (roll a frozen water bottle under the arch of the foot)
• Massage sore area of foot after activity
• Calf muscles and toe flexor tendon stretching
• See a sports injury specialist for advice on rehabilitation, assessment of causative factors and recommendations to minimize recurrence (i.e., replace shoes, change running surface, change running direction on track or street side, create an orthotic to control foot pronation or address a leg length discrepancy)

SPECIALIST TREATMENT
• Prescribe anti-inflammatory medication
• Cross friction massage, stretching, and modalities
• Unrelenting pain may warrant injection with an anti-inflammatory steroid

Iliotibial Band Friction Syndrome

The Iliotibial Band (ITB) is a strong chord-like tendon, which attaches the Tensor Fascia Latae to the outside part of the knee. The ITB stabilizes the knee against external forces to help maintain an upright position. Iliotibial Band Friction Syndrome (ITBS) is an overuse condition, which is the most common cause of lateral knee pain in runners.

CAUSES
• ITB rubbing over the lateral femoral epicondyle (outside part of the knee) which creates friction leading to pain
• True leg length discrepancy- alters pattern of mechanical stress, affect muscle tension patterns of joint
• Functional short limb- downhill limb while running on canted surface
• Crossover running style
• Mild varus position of heel- soles of feet turned inward
• Genu varum (bow legs)
• Weak Gluteus Medius- leads to early firing/over activation tightness of TFL/ITB
• Decreased flexibility of Gluteus Maximus, Quadriceps
• Thicker ITB

SYMPTOMS
• Tenderness/pain at outer part of knee
• Snapping occasionally
• Insidious onset aggravated by running
• Crepitus (joint cracking)
• Decreased flexibility of ITB
• Excessive wear along lateral part of shoe (midsole and forefoot)
• Chronic inflammation of ITB leads to thickening

HOME TREATMENT
• Avoid running until symptoms of pain reside
• Ice
• Run on level surface or alternate directions in road to avoid always having the same lower extremity in the downhill position
• Stretching ITB
• See a sports injury specialist for advice on rehabilitation, assessment of causative factors and recommendations to minimize recurrence

SPECIALIST TREATMENT
• Ice friction massage
• Ultrasound
• Strengthening
• Stretching and modalities

Patello-femoral pain syndrome

Patello-femoral pain syndrome is a common running injury. The patella is a fulcrum, which gives leverage to the Quadriceps muscles (consisting of four muscles on the anterior thigh). The patella rides in a groove on the femur (thigh bone). Improper tracking causes pain and inflammation under the patella. Long- term patella-femoral pain syndrome may cause a degenerative cartilage condition (Chondromalacia Patellae).

CAUSES
• Muscle imbalance of the Quadriceps where the outer muscles overpower the inner muscles and pull the patella out of the groove during knee bending and straightening
• Too rapid increase in training duration, intensity
• Contracture of knee-inability to fully straighten or bend knee
• Position of one of the Quadriceps muscles, which attaches to the patella
• Patella position, stability, mobility
• Genu valgus (knock knees)
• Arch height -pes planus (flat feet) or pes cavus (high arched feet)
• Excessive laxity
• Obesity
• Excessive internal rotation (turning in) of hips

SYMPTOMS
• Pain at undersurface or around patella after activity (running)
• Inflammation around the patella
• Complaints of stiffness after prolonged sitting
• Psuedolocking-feeling of instability
• Cracking of knee during straightening which usually relieves discomfort

HOME TREATMENT
• Avoid running until symptoms of pain reside
• Ice
• Stretching of Quads, Hamstrings, Tensor Fascia Latae/Iliotibial Band
• See a sports injury specialist for advice on rehabilitation, assessment of causative factors and recommendations to minimize recurrence

SPECIALIST TREATMENT
• Taping patella
• Orthotics
• Quad strengthening
• Unilateral proprioceptive activities
• Biofeedback
• Electrical Stimulation
• Patella mobilizations
• Stretching and modalities