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Top 5 Running Injuries & How to Manage Them

Posted on 29th January 2018 by

The top 5 running injuries. In this blog, I will share with you some insider information built up over a lifetime of clinical practice in the sports injury sector, treating 1,000’s of active patient’s with overuse, lower limb injuries.

I’d like to shed some insider light on the 5 most common running injuries and debunk some myths, helping you understand these injuries better, and give you some guidance on how to prevent and manage them if they do occur.

5 Most Common Running Injuries

The 5 most common running injuries we see here at goPhysio are:

  • Plantar Fasciitis
  • Achilles Tendonopathy
  • Calf Tears and trigger points
  • Anterior Knee Pain
  • Gluteal / Piriformis syndrome

Interestingly enough, all these injuries can originate from a similar movement dysfunction.

Starting at the foot with flattened foot arches or over-pronation, there is often a chain of biomechanics events leading up the leg to the trunk. These are nicely illustrated in this diagram. .Biomechanics chain of events

 

Plantar Fasciitis

Plantar-fasciitis is a fancy, latin word for inflammation of the plantar fascia. The plantar fascia is a thickened sheet of fascia (connective tissue) on the sole of the feet, it’s elasticity gives us a spring in our step when walking or running. The cause of plantar-fasciitis is linked to it being on an excessive stretch for prolonged periods of time, when the arches in your foot are too flat. So on push off when walking or running it’s excessively overloaded and stretched and overtime micotrauma, inflammation, pain and injury can result. Read more about plantar fasciitis here.

Achilles Tendonopathy

Flattened foot arches results in an inwards collapse of the heel bone (calcaneum) into which the achilles inserts. Thus with each step the heel bone excessively moves side to side, in a side-to-side whipping type motion of the achilles resulting in a build of force, overuse, microtrauma, inflammation, pain & injury! Read more about achilles tendon injuries here.

Calf Tears & Recurrent Myofascial Trigger Points

Again a similar mechanism to above. Over time, the calf muscles become tense and tight, they tend top hold a long term dull background contraction in an attempt to control the inward collapse of the heel bone. This increased tone is aggravated by running (we take approx 1,000 steps per km, per foot), resulting in tense, tight, overactive and painful muscles, which worsen with running and can become a long term or chronic issue. It feels especially tight after hill sessions, when the calf or achilles is also on stretch. Read more about calf tears here. 

Read more about the treatment of calf tears here.

Anterior Knee Pain

Anterior knee pain is an umbrella term, used to describe a wide range of injuries causing pain in the front of the knee. Although everyone is unique, in runner’s it is often linked to flattened foot arches and the inward collapse of the heel with it’s knock on effects felt through the whole kinetic chain (as per the diagram above). This inward heel collapse causes the shin bone (tibia) to rotate inwards and the knee will fall inwards, resulting in an asymmetrical build of of forces in structures around the front of the knee and some of the most common running knee injuries, namely; Infra-patellar tendonopathy, Patello-femoral joint map-tracking and Ilio-tibial Band friction syndrome (ITB syndrome). Read more about runners knee here.

Gluteal / Piriformis Syndrome

So, as the heel collapses inwards, we get internal rotation of the legs and hips. Subsequently, the gluteal (buttock) muscles become tense and tight in an attempt to control the inward rotation and movement of the leg and hip. This increased tone over a run (approx 1,000 steps per km, per foot), can result in tense, tight, overactive painful muscles. This often worsens with running and can become long term or chronic, which often results in referred pain travelling down the leg mimicking sciatica. Over my career I’ve even seen patients with this condition that mistakengly have been operated on, (the Surgeon thought it was a disc injury causing the sciatica) when it was merely this “Piriformis syndrome” referring into his leg.

The Solution

With all of these conditions, it’s crucial to understand that……..

the injured structure is actually the victim, the true cause is the uncontrolled movement!

Effective management of such injuries therefore needs to address the following:

From the foot upwards – Fully assessing foot position and biomechanics, looking at incorporating custom orthotics to correct the foot positioning and alignment and control excessive movement and rotation from the foot up the whole lower limb.

From the spine / “core” downwards – This is a crucial and often forgotten element, improving muscle stability and movement control throughout the body. Pilates is great for this.

Reduce inflammation – Ice and non-steroidal anti-inflammatories are an effective way to reduce inflammation in the early stages.

‘Hands-on’ Physio treatments – In the early stages, massage and acupuncture to normalise muscle tone, taping to correct alignment and ultrasound to stimulate natural healing, can all be effective ways to help ease pain and discomfort to help you quickly progress into active recovery.

Selective rest – Means to just rest from the aggravating (pain causing) activities, whilst actively participating in non-aggravating activities such as swimming or cycling to maintain movement and fitness. As we’re designed to move, movement in itself is therapeutic. We can really help guide you on this, as many people think if they have an injury they just need to completely rest.

Running Rehabilitation – Specific exercises, training advice and a return-to-running programme are all crucial to ensure a positive, long term return to running injury free.

Preventing these Injuries

We are our own normal

I want to reassure you that we are all different. We all have biomechanical differences that our bodies cope just fine with, we are our own ‘normal’. So, if you have ‘flattened arches’ but are able to run a marathon with no issues, nothing needs to change! You don’t need to address this ‘just in case’. Pain or injuries, such as those above, often arise when we are demanding too much of our body too soon, without giving it time to adapt to the demands – so in running, increasing distance or speed too quickly, changing the terrain etc. So much of the skill in preventing these injuries comes down to our training technique and running habits, combined with our body’s own ability to adapt.

However, what we often see is that a small biomechanical issue such as those explained above, combined with demanding too much of our body too soon, results in the body complaining with one of these injuries. Runners then get stuck in an injury cycle, where they can’t run without getting pain. By fully understanding and addressing the combination of biomechanical issues and training, this is the most effective way to overcome the injury and continue to enjoy a lifelong love of running!

By Paul Baker MCSP, goPhysio Clinical Director

The Injured Runner Project
We are trying to find out more about what injured runners do to get back to pain-free running, and would love to hear from you! If you’re interested in helping us out, please take a few moments to answer a couple of questions by clicking on this image. Many thanks.

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Achilles Tendon Injuries

Posted on 13th April 2017 by

What is Achilles Tendinopathy?

Achilles tendinopathy refers to any problems with the Achilles tendon, the part of your body that connects the calf muscle to your foot via your heel bone.

The ‘-opathy’ part refers to a disorder of the tendon and is used as an umbrella term to cover a range of issues that can affect the Achilles tendon.

Problems with the Achilles Tendon are graded:

  • Grade I: Mild strain.
  • Grade II: Moderate strain.
  • Grade III: Complete rupture.

Achilles Tendinopathy

 

 

 

 

 

 

 

 

What causes Achilles Tendinopathy?

A tendinopathy results when the forces placed through the tendon exceed it’s ability to function.

Achilles tendinopathy can be caused by several factors:

  • Overuse of the area
  • Traumatic injury
  • Poor foot biomechanics
  • Sudden changes to sports or training patterns
  • Improper footwear
  • Calf weakness or tightness

The most common cause is repetitive ‘micro’ trauma to the tendon or overuse. The repetitive strain can result in a chronic Achilles tendinopathy, where there is a gradual breakdown of the tissue of the tendon. You might have heard it as tendinitis previously. It can either affect the middle portion of the tendon or the point where the tendon inserts into the heel bone.

What might Achilles Tendinopathy feel like?

  • Mild to moderate pain and stiffness around the back of the heel in a grade 1 or 2 strain. The more severe the strain, the more severe the symptoms would tend to be.
  • Swelling or a small lump on the Achilles tendon in a grade 1 or 2 strain.
  • Tightness into the calf muscles.
  • A complete rupture (grade 3) is often characterised by a ‘pop’ with immediate pain and an inability to bear weight through your foot.

How do the symptoms of Achilles Tendinopathy progress?

  • A mild Achilles tendinopathy can resolve itself with relative rest and POLICE pretty quickly.
  • A more moderate strain or mild strain that lasts more than a few weeks, usually needs some input to fully resolve.
  • If left untreated, Achilles tendinopathies can develop into a chronic problem leading to permanent changes to the structure of the tendon, with scar tissue forming. In non-traumatic cases, if you don’t do something to address the cause, it is unlikely resolve.
  • A grade 3 complete rupture will require surgery or conservative management in the form of immobilisation in a special boot or cast.

How is Achilles Tendinopathy diagnosed?

  • A Physiotherapist will be able to diagnose an Achilles tendinopathy from a thorough assessment. This will include taking a detailed history to identify the potential cause of the problem, analysing muscle strength and length, looking at your foot biomechanics, looking at your kinetic chain (so this is the link between your foot, knee & pelvis to see how they work together), linking this into your activity levels and sports.
  • Occasionally, you may be referred for an ultrasound scan if the Physio is concerned about a possible tear or rupture to the tendon. This is normally quite obvious when it happens but we’ve certainly had a few through the clinic over the years that we’ve diagnosed with a complete rupture and sent straight to A&E.

What is the best treatment for Achilles Tendinopathy (Grade 1 & 2) 

  • Addressing the cause in non-traumatic cases is key. Your Physiotherapist will be able to help you with this once they’ve identified the root of the issue.
  • Physiotherapy – this will help reduce scar tissue formation and improve the rate of healing. It may consist of manual soft tissue work, electrotherapy, taping and specific exercises.
  • Selective rest – avoid any high impact activities and take a break from any aggravating sports or activities to allow the injury to recover.
  • Ice – helps to manage the pain and swelling
  • Painkillers – allows you to keep moving and do all your Physio exercises!
  • Orthotics – if foot biomechanics are contributing to your Achilles problems, a GaitScan to identify any issues and a pair of orthotics will address this to stop the problem reoccurring.

Prognosis for Achilles Tendinopathy

  • With early and appropriate treatment, Achilles Tendinopathy issues tend to resolve within 8-16 weeks.
  • Chronic problems may take up to 6 months to resolve.

Products that may help Achilles Tendinopathy

  • Foam Roller
  • K-Tape
  • Ice pack
  • Orthotics

Can Achilles Tendinopathy be prevented? 

Maintaining general health and fitness, maintaining muscle strength and flexibility throughout your whole body, can be a good way of preventing injuries such as tendinopathies. Paying special attention to your training regime and programme if you take art in regular sports such as running, is really important. Too much, too soon, too far, too often, can all increase the risk of a tendon problem. Allow your body time to adjust to the demands you place upon it.

If you do start to feel a niggle, don’t ignore it. The longer you leave problems like this without addressing the cause, the more severe they can become.

Think about your footwear too, wearing good quality, supportive footwear at all times can help prevent Achilles tendinopathy.

Related injuries

If you’ve suffered an injury or pain in your Achilles tendon, call now for an accurate diagnosis and comprehensive treatment programme, or book your appointment online.

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