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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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Treatment of Calf Pain in Runners

Posted on 11th August 2017 by

Calf pain for runners is common complaint. Your calf muscles are used extensively and repeatedly during running, so it’s no surprise that sometimes they can become overloaded and develop pain. Here’s a great infographic from Tom Goom from the PhysioEdge series of podcasts, that highlights the recommendations for the treatment of calf pain.

So, what does it mean for you if you’re a runner with calf pain?

  1. Exercise Therapy is a crucial part of the treatment of calf pain. Exercises should be specifically targeted to increase your calf’s capacity for the demands of running. There are some great examples below. Your Physio would be able to identify exactly where any weakness may lie and subsequently advise on the most effective exercises for you. It may not only be your calf muscles that are weak, muscles around your hip and knee support the work of the calves during running, so strengthening these muscles is crucial too. Pilates is great for this! And don’t forget your feet. Working on the static strength of the muscles in your feet that bend your toes can help your running technique.
  2. Neural Mobility is how well your nerves ‘slide’ or move in your body. We all know that our joints and muscles move and stretch but our nerves also have to be able to move freely. When they don’t, this itself can cause pain and restricted flexibility. Reduced neural mobility may not be local to your calf, it could be originating from a more central source (your back/spine). Your Physio would be able to identify whether you have reduced neural mobility and advise on the best exercises to improve neural mobility. It may be that some manual therapy would help too.
  3. Training Loads, so distance, time, speed, terrain, will all have an impact on calf pain. Our aim is to always try and keep you running wherever we can (always keeps runners happy!). So, we offer customised advice in modifying your load to keep you running whilst your calf pain is addressed. This is not always possible though and there are cases where resting from running and doing some specific rehabilitation is essential to your recovery.
  4. Gait Retraining can have a massive impact on recovery and prevention of calf pain. Your running technique and style can improve your efficiency of your running and reduce demands on the structures involved in running. Here at goPhysio we offer a specialist Running Rehab service, where a biomechanical and video running analysis is carried out to guide any beneficial changes to your running technique. Small adjustments to technique can often have a massive impact on your running.

Treatment of calf pain in runners

The trap many runners fall into when they get calf pain is to stop running, rest completely until their pain is gone and then go straight back to their normal running routine. Then they’re frustrated when the pain comes back again and they repeat the cycle. When you pick up an injury, particularly an overuse injury like calf pain, it is crucial to identify and address the cause to prevent the potential long term cycle of injury.

Read More

What’s physiotherapy got do with a dripping tap? Overuse injuries explained.

Top 6 Pilates Exercises for Runners

Top Tips for Injured Runners

Running Rehab Service


Running Injuries: The Basic Principles

Posted on 8th July 2016 by

There are 2 main types of running injuries that we commonly see at goPhysio:

  1. Traumatic injuries
  2. Overuse injuries

Traumatic injuries are caused by an accident or ‘traumatic event’ for example tripping over when you’re running or having a fall.

These type of injuries usually happen unexpectedly and are therefore difficult to prevent, however there are a few things you can do to help reduce the risk of these types of injuries.

  • Invest in good quality running shoes that are suitable for the type of running (trail, road etc.).
  • Wear the correct shoes and clothing for the weather conditions.
  • Warm up well to help prevent injuries that may be caused by sudden movements.
  • Listen to your body – if you’re not feeling 100%, are overly tired or recovering from an injury, you’ll be more at risk of having an accident.

If you suffer a mild to moderate traumatic injury, the best course of action is to follow the P.O.L.I.C.E. acute injury management programme. This will give you the best chance of a speedy recovery and return to running.

It’s important to remember that even if you need to rest from running, try and stay as active as you can and find alternative forms of exercise like swimming or cycling, where you can maintain your fitness, strength and flexibility but still allow your injury to recover.

It’s also very important to do specific exercises to work your injured are to recover strength and flexibility. This is particularly important to help prevent any re-injury once you’re back to running.

Overuse injuries are caused by repetitive movements that build up over time, that eventually your body can’t cope with. Given the repetitive and high impact nature of running, overuse injuries in runners are extremely common.

There are 2 main causes of overuse injuries:

Extrinsic Causes

These relate to external factors such as:

  • Footwear – wearing the wrong type of shoe for you or a shoe that’s worn out.
  • Running surfaces – repeated running on overly hard surfaces or on a certain camber.
  • Your training programme – normally overtraining, so increasing speed or distances too quickly and not allowing adequate recovery time.

Intrinsic Causes

These are related to your physical build and design. These include:

  • Muscle imbalances
  • Lack of flexibility or even over flexibility
  • Running technique
  • Biomechanics
  • Your own skeletal design

It can often be a cumulative combination of extrinsic and intrinsic factors that lead to an injury. You can read more about overuse injuries on another one of our blogs.