If you’re concerned about a running injury, it’s important to get assessed and see a specialist. A tailored strength and conditioning programme along with simple running technique tips can go a long way. The two best predictors of likely running injury are previous injury and consecutive days running (accumulative over training). 50% of running injuries are reoccurrences, and if you’ve been injured before you’re likely to get injured again. It’s also proven that keeping the same weekly volume over fewer consecutive days reduces injury rates.
The most common running injuries are overuse injuries. They reoccur. If you have reoccurring sore spots in the front (runner’s knee) or outside (ITB irritation) of your knee, front or inside of your shin (shin splints or MTSS), around your Achilles’ tendon (Achilles tendinopathy) or under the sole of your foot (plantarfasciitis), that don’t ease within 48 hours, then it’s likely you’ve got one of the more common running injuries!
‘Shin splints’ aka medial tibial stress syndrome (MTSS), is one of the most common running injuries, and is an overuse injury that is rarely a short-term issue and is usually persistent and recurrent. The injury usually produces a dull, nagging soreness, on the inside of the shinbone spreading down towards the ankle or on the front of the shinbone. This is usually evident at the start of the run, tends to ease once into the run, but then intensifies. Depending on how intense, this can reach a level causing runners to have to stop and then suffer discomfort over the next few days.
There are many common biomechanical, neuromuscular and technique faults that result in the shins getting overloaded. Every time you land on one foot during running, a force up to x 2.5 body weight will be going through the leg! For a four-hour marathon, run at an average pace of 155 steps per minute – that’s 37,200 steps. That’s a lot of force … and it needs control!
Therefore, the key message is ‘get assessed’. Use a running specialist to analyse technique for mobility, strength and control. A tailored strength and conditioning programme along with simple running technique tips can go a long way. Common technique faults include slow step rates, and over-striding. Adjusting your step rate towards the more desired level (170-190 steps per min) can always help reduce the overload on landing. A quicker, shorter step rate is what you should aim for. Using a running specialist to help with this is recommended.
ITB friction syndrome
ITB friction syndrome is an overuse injury that is rarely short term. Short-term ‘PRICE’ (Protection, Rest, Ice, Compression & Elevation) treatment, taping, correcting footwear and rolling can help but again … get assessed!
There are several reasons why this problem might occur, and you need to work out the cause – whether it be a pure mobility issue, strength, control or simple technique fault. It usually produces a dull, nagging soreness on the outside of the knee. This can be tight at the start of the run, ease once warmed up then intensify again once reaching a certain distance, or if pushing intensity (e.g. sprint intervals or hills). Again, this can stop a runner early in their run if irritated, and hang around for a few days, especially stiffening up when trying to move after sitting for long periods.
Typically this can be caused when landing too flexed at the knee or due to a dynamic knee valgus or hip drop when landing during running. As a result, lateral glut strengthening, hamstring mobility work, and checking step rate again can aid pain relief.
Runner’s knee occurs when the stress of running causes an irritation where the kneecap (patella) sits on the thigh bone (femur). The common causes of runner’s knee include overuse due to repeated bending and loading to the knee joint, direct trauma eg a fall, misalignment of the kneecap and a muscular imbalance of the thigh muscles which can lead to a disproportionate load applied to the knee cap. It is often due to an ITB injury.
Symptoms of runner’s knee may include pain behind or around the kneecap, especially where the thighbone and the kneecap meet, pain when you bend the knee eg when walking, squatting, kneeling, running, or even rising from a chair. It may also be painful when walking downstairs or downhill, and it is common to experience a popping or grinding sensation behind the kneecap.
In the initial stages of pain it is important to rest the knee for a few days, with elevation, compression and regular application of ice if the knee is swollen. Taking anti-inflammatory medication may also be required if the pain and swelling is moderate to severe. Exercises recommended for runner’s knee include the use of a foam roller to release the ITB, quads, hip flexors and gluteal muscles, hip flexor and gluteal stretches and strengthening exercises for the gluteal muscles in a non-weight bearing position initially, with progression into standing exercises. If pain persists with return to running after 5-10 days, consult your doctor, an orthopaedic specialist, or a physiotherapist for further guidance or treatment.
Plantar fasciitis creeps into the top running injuries. Again, the same principles apply. Short-term ‘PRICE’ treatment, correcting footwear, orthotics and heel gel pads can provide some relief. Symptoms include soreness underneath the pad of the heel and inside of the heel when irritable.
Plantar fasciitis typically occurs when landing onto the heel during foot strike, walking and running. It can be worse during the first few steps of walking in the morning or after sitting for a while. The injury is common with over striding heel strikers with a slower step rate, and flat-footed runners. Calf weakness and intrinsic foot control tend to be poor with these runners. Therefore, high load calf strengthening and isometrics for foot control can be very useful.