Pain, strain and breakdown are occupational hazards for every runner, and so it’s paramount to know when to back off and when to head for the treatment table. Chartered Physiotherapist David Campbell describes the mechanics of the most prevalent injuries and offers sound advice on early intervention
RUNNING is the purest of athletic pursuits. It’s also a very personal journey: for some it’s chasing the feeling of invincibility that comes with winning races and breaking records; for others it’s about a private Everest in the form of a marathon finish or faster time; for many it can be escape from mundane pressures, or simply the means to a better figure.
Whatever the runner’s goals or motivation, injury respects no demographic and can scupper the best-laid plans. If you are a runner you will inevitably have encountered some niggle or pain or worse. In this article I hope to give you a basic understanding of the most common running injuries, what to look out for, how to treat injuries conservatively, and most important, how to prevent them from happening in the first place. Running is a series of repetitive motion that leaves the body vulnerable to overuse injuries.
Over time the cumulative load of this repetitive motion can find chinks in the armour and cause breakdown. Overuse injuries result from repetitive micro-trauma leading to local tissue damage in the form of cellular and extracellular degeneration and are most likely to occur when we change the mode, intensity or duration of training. Often the area injured is not the prime instigator, it is merely the victim. The culprit may be an area of weakness, hypertonicity, imbalance, dysfunctional movement pattern, genetic or biomechanical. The goal of the therapist is to hunt down the culprits and change their ways.
FOOTNOTE: It is important to address flexibility, strength and stability deficits/imbalances by incorporating individualised flexibility, stability and strengthening programmes in the treatment of running injuries. A more in-depth study of these injuries will follow in coming issues of Irish Runner.
RUNNER’S KNEE
Patella femoral pain syndrome (PFPS), or to give it its popular designation, runner’s knee, is the most common injury reported by runners, accounting for approximately 15 percent of running injuries.
PFPS occurs when the kneecap (patella) is tracking incorrectly: ‘the train is not gliding on the tracks’.
When the leg bends, the kneecap should ideally glide smoothly over the trochlear groove, between the thigh bone (femur) and shinbone (tibia). If it is not running smoothly the kneecap ‘grates’ and causes pain. Over time, a grating patella can erode cartilage on the back of the knee. If the cartilage that acts as a shock absorber becomes eroded behind the knee the result is chondromalacia patella.
SIGNS AND SYMPTOMS
Diffuse dull pain around or behind the kneecap; crepitus (crackling noise); giving way; knee soreness upon resisted leg extension; pain running (especially downhill), descending stairs, squatting and sitting with knees bent.
TREATMENT
Reduce mileage.
FLEXIBILITY
Quadriceps*stretching
Foam roll quads
STRENGTHENING
Gluteus medius*activation
Glute bridges 2×1 minute holds
Single leg squats with posterior chain bias 2 sets of 10
Side lying plank 2×1 minute each side
Swiss ball hamstring curl 2×15 double leg
PREVENTION
Build mileage slowly (10 percent increase per week as a rule); wear suitable shoes; hold back on running downhill
ACHILLES TENDINOPATHY
This condition accounts for 11 percent of running injuries and can be career-ending if mismanaged early on.
The Achilles tendon is the strongest tendon in the body and attaches the heel bone (calcaneus) into the two major calf muscles (gastrocnemius, attaching above the knee, and soleus, attaching below the knee).
The Achilles becomes injured when subjected to inordinate intrinsic and/or extrinsic loads. Aggravating factors can be speed training, age, biomechanics and excessive weight.
The precise site of the Achilles injury will dictate severity and the course of treatment/rehabilitation. Soreness where the Achilles attaches to the heelbone is called insertional tendinopathy and is notoriously more difficult to treat.
SIGNS AND SYMPTOMS
Weakness on heel raises; morning pain that eases with activity (degeneration); pain that worsens with activity (inflammation); swelling.
TREATMENT (specific to severity)
Modified run programme or rest; ice massage; cross friction; night splint; heel raise; orthotics
FLEXIBILITY (pain dependent)
Straight leg calf stretch
Bent knee calf stretch
Night splint/Strasbourg sock
STRENGTHENING (pain dependent)
Isometric calf holds 2×1 minute
Eccentric heel drops, straight leg and bent leg 2×15 twice daily (single leg), not off step for insertional tendinopathy.
PREVENTION
Build mileage slowly (10 percent rule); wear suitable shoes; develop strong, flexible calves; warm up before running.
PROXIMAL HAMSTRING TENDINOPATHY
This insidious injury manifests itself as a vague ache high up in the hamstring and deep into the buttock. The hamstring is made up of three muscles
(semimembranosus, semitendinosis and biceps femoris). It originates from the seat bone (ischial tuberosity) and attaches around the back of the knee to several insertions including the tibia, fibula head and popliteus tendon.
The hamstring flexes the knee, extends or hyperextends the hip and is responsible for forward propulsion and transferring power between the hip and knee joints required by running.
Early, accurate diagnosis of this injury is vital, as a number of other conditions have similar symptoms, including piriformis syndrome, bursitis, pelvic stress, sacral stress fracture and disc pathology, all of which have specific treatment protocols.
Treat this one with respect; if mismanaged early it can linger for your entire career.
SIGNS AND SYMPTOMS
Pain high up in hamstring; buttock pain; pain when increasing pace, sprinting; loss of sprinting power.
TREATMENT
Rest; ice massage; soft-tissue treatment.
FLEXIBILITY
Avoid aggressive hamstring stretching for early-phase rehabilitation
Address flexibility imbalances, quads
STRENGTHENING
Swiss ball hamstring curls 3×15 reps, slow and controlled full-range
PREVENTION
Appropriate functional range of hamstring flexibility; strengthen hamstrings and posterior chain; incorporate multidirectional drills.
Stress Fractures
Stress fractures result from cumulative submaximal overload of a bone. Approximately six percent of you will have suffered one this year: ‘bend a hanger enough times and it will snap.’
At a cellular level the regeneration of bone by osteoblasts is outpaced by the reabsorption of bone by osteoclasts, the bone gets no chance to recover and develops a stress fracture if not managed correctly.
The accumulation of extrinsic factors (training load, terrain, duration, intensity) and intrinsic factors (nutrition, biomechanics, muscle fatigue and hormone levels) are ultimately responsible. Think of each factor as a ball; a juggler may have no problem juggling six balls, but add a seventh and there are balls everywhere.
Common locations for stress fractures are the tibia, metatarsals, navicular and fibula bones. Less common sites include the femur, pelvis and sacrum.
SIGNS AND SYMPTOMS
Pain upon weight-bearing activity that begins non-specifically but over days and weeks becomes more specific; sharp pain on single leg hop at point of pain (for lower limb); pain upon finger-point pressure (MRI is the goldstandard diagnostic tool).
TREATMENT
Rest from running 6-12 weeks depending on bone stressed;
Slow, controlled return to run programme over 4-6 weeks to normal training; address flexibility and/or strength imbalances.
PREVENTION
Flexibility and strength programmes; build mileage slowly; cross-training; wear appropriate shoes; allow sufficient recovery between sessions/races; eat healthy; take vitamin D and calcium supplements.
