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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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Breaking the injury cycle: Calf Tear in a Runner

Posted on 3rd November 2017 by

We were recently asked some advice from a regular recreational runner. It’s a story that we hear a lot of here at goPhysio (not always calf related, but the same principles apply), so we thought it warranted a little blog post!

The runner in question was concerned, as they’d picked up a calf injury when out for a run a few weeks previously. Nothing major, but felt a bit of a tug on the calf when they had to move suddenly during the run. The calf was painful, so they did what they thought they should and rested for a week from running. The calf then felt fine, so they went back to running. Since then, the calf pain comes and goes. They don’t only feel it when they try and run but can feel it driving, going up & down stairs and first thing in the morning.

The dilemma is……….what is the best thing to do? Carry on running (because they love it and it they were progressing so well!)? Stop running (because it’s making the injury potentially worse)? Exercise? Ice? Heat? Strapping? New trainers? Taping? See their GP? Have a sports massage? Ask a friend? Use a foam roller????????? So many questions?

This is a really common story that we hear a lot in physio. A simple calf tear should take 3-6 weeks to repair itself, however its easy to get stuck in a cycle of tear, rest, repair, tear again, making the recovery much longer and much more frustrating.

How do we break this cycle?

Whilst rest is important it is not enough to adequately repair our damaged muscle to take the strain of running again, which is why it keeps being re-irritated. If we continue to do this we cause a lot of scar tissue to form in the healing muscle. Scar tissue is neither as strong nor as flexible as normal muscle fibres which make it easy to re-tear when stressed by anything more than day to day activities.

In the early stages of recovery from an injury, relative rest is important to help with healing. What that means is avoiding any activity which aggravates the injury, but trying to do alternative activities or modified activities so that you aren’t resting totally.

However, the important thing is to rehabilitate the calf muscle during the ‘rest’ period – gently stressing it with progressive strengthening exercises and stretches to regain its normal strength and elasticity. Ready to run again!

Physiotherapists are experts at guiding you through this process, making sure you are exercising at the optimal level for your stage of healing. They will make sure you are doing the right exercises (technique, loading, reps etc. all carefully worked out) and that you progress them at the right stage – all tailored to you individually and your own goals.

A programme for a minor calf tear for an ultra marathon runner would look very different to a programme for a severe tear in a Saturday morning Park Runner. There isn’t a one size fits all approach and although ‘Dr Google’ or Joe Bloggs at running club who also had a calf injury can be useful resources, relying on such information won’t always give the best long term outcome!

In addition to a specific exercise programme, Physio’s can also carry out a range of other treatments such as hands-on therapy, ultrasound and taping which can help to speed up your recovery. They an also advise on treatments you can do at home, such as foam rolling. A crucial part of your recovery is obviously returning to running at the right time. We know taking time out of running can be very frustrating, so we limit this as much as possible, guiding you with your return programme so you don’t do too much too soon and risk re-injury. If you have a specific event or race coming up, this is factored in.

So, if you love running and are worried about a calf injury, don’t hang about, book in to see an expert to guide you out of the injury cycle and back to running!

Here are two great simple exercises for a calf tear

Calf raise exercise Heel raises – standing on both feet, slowly rise up onto your tip toes then lower back to the ground. If you can manage 20 or more of these try doing it just on the injured leg, holding onto a support for a little balance, remember slow and controlled is key!


Calf stretch – stand in a long stride position with the injured Calf stretch exercise leg behind. Bend the front knee and gently press the back heel down towards the ground until you feel a stretch in your calf. Take it to where you feel a mild to moderate stretch (but not pain!) then hold for 30secs.


More information

Treatment of calf pain in runners

Top Pilates exercises for runners

Top tips for injured runners

Get your running back on track

How to warm up for running