Treating the Big 5 Running Injuries

Is your body plagued with bumps, bruises, aches and pains? Overuse injuries are common for runners. There are many factors that lead to injuries. The most frequent cause of injury is simply overuse, or running too much. If your body performs the same exercise over and over again, the same joints are stressed in the same, repetitive motion. With time, ligaments and tendons as well as bursas (the sacs that provide shock absorption) will wear and tear.

Let’s take a look at the “Big 5” injuries—the most common knee-related ailments that sideline runners.

1. ITB Syndrome 

Definition: One of the most common knee injuries is iliotibial band (ITB) syndrome, which is defined as pain and inflammation on the outside of the knee. This is where the ITB becomes tendinous and runs along the side of the femur past the knee joint. Inflammation occurs as the ITB constantly rubs on the femur.

Symptoms: A common symptom of ITB syndrome is a dull ache within 1-2 kilometers of running. In the beginning of this injury, the pain will stop when the running stops. As the injury progresses, any running downhill or on uneven surfaces will increase the painful symptoms. Inflammation and tenderness are common at the lateral (outside) of the knee since this is where the ITB runs and causes friction. The most common cause of this injury is excessive stretching of the ITB or rubbing. This happens most to overpronators (those whose feet turn in and have flat arches) without proper footwear.

Treatment: If you are an overpronator, make sure you have shoes with proper arch support. Also, one of the biggest mistakes runners make is running in the same direction on the road. If the road is crowned, one leg has its ITB stretched more than the other, as it hits the ground lower and bears more bodyweight. To treat this injury, start by running on a flat surface with no crown. Also, ice and rest. Try taking anti-inflammatory medication (consult your physician first) and ice for 10-20 minutes every hour to reduce inflammation and pain.

2. Runner’s Knee

Definition: Runner’s knee is defined as the wearing away or cracking of the cartilage under the kneecap, resulting in pain and inflammation. This torn cartilage becomes like sandpaper and causes excessive rubbing between the kneecap and tibia (lower leg bone).

Symptoms: Symptoms might include crepitus (grinding) when the knee is in motion as well as pain around the knee during and after activity. Overpronation can lead to this injury, causing the kneecap to slide more in one direction than the other. Weakness on the inner side of the quadriceps and tight hamstrings are also common causes, as well as too much running, which wears down the cartilage.

Treatment: The best way to treat this injury is to stop running. Try a non-impact activity such as swimming or bicycling. Increase your quadriceps strength with basic exercises, such as placing a pillow under your knee and contracting your quads while you lift your foot. Hold for 5 seconds and repeat 10 times. Try bodyweight squats while focusing on keeping your knees facing forward, in line with your toes as you squat down. This will strengthen both sides of your quadriceps. Also, try taking non-steroidal, anti-inflammatory medication (consult your physician first) and ice to reduce swelling. Try ice massage right under the knee cap after running. The best method for doing this is to freeze a Dixie cup of water, then peel back the top half of the cup to expose a portion of the ice. You can then hold the paper covered ice and massage the areas of pain for about 10 minutes.

3. Achilles Tendonitis

Definition: Achilles tendonitis is the inflammation of the Achilles tendon, which is caused by overuse and excessive force on the tendon. Over time, rubbing and tightening of the Achilles tendon causes the formation of scar tissue, which is less flexible than the tendon during motion. With continued force, the tightened tendon can rupture.

Symptoms: Runners often experience sharp or dull pain on the back of the heel as well as decreased range of motion in the ankle. A person might also notice reddening of the area caused by extreme inflammation. Tightened or fatigued calf muscles can transfer too much load to the Achilles tendon during exercise. Rapidly increased mileage, poor stretching, or increased hill running can cause the calf muscles to become over-worked, transferring too much force to the Achilles. Also, inflexible running shoes and overpronation can cause excess stress on the Achilles.

Treatment: Try non-weight bearing exercise and stop running for at least one week. Ice the area for 10-20 minutes every 2 hours and try a non-steroidal, anti-inflammatory drug (consult your physician first) to reduce inflammation and pain. Also, keep your foot elevated after exercise or when you feel pain.

4. Shin Splints

Definition: Shins splints are inflammation of the muscle attachments and interosseous membrane that run along the tibia (shin bone).

Symptoms: This injury is common among new runners whose muscles are not yet conditioned to pounding and stress. Pain and tenderness is focused along the inside part of the shin bone and halfway down the leg. Pain is usually worse at the beginning of a run until the muscles are warmed up. If pain persists or worsens with weight bearing activity, it might signal a stress fracture. Inflexible and tight calf muscles can put excess stress on the shins, and overpronation can cause the Achilles tendon to tighten and force more pressure onto the front of the leg. A common cause is excessive running on concrete surfaces, which have very few absorptive properties.

Treatment: If pain is mild you might be relieved by continuing to run but eliminating any hill (up or down) running. Also, ice the painful area for 10 minutes every 2 hours. For severe cases, stop running completely or only run on forgiving surfaces, such as a treadmill or soft trails. Stretching the calf muscles will help alleviate some strain placed on the shins.

 

5. Plantar Fasciitis

Definition: Inflammation of the plantar fascia – a thick, broad band of tissues that span from the heel to the base of the toes. Excessive strain on the fascia can cause tearing, inflammation and scarring. Scarring can make the fascia almost immovable and very painful during motion.

Symptoms: Pain is felt at the heel of the foot and is most severe first thing in the morning and at the beginning of a run or walk. Pain should lessen as the fascia is warmed up. Excessive pressure on the fascia can cause tearing, and if you have high arches and rigid feet you need shoes that provide suitable support. Overtraining and heavily worn shoes can exacerbate this problem.

Treatment: Reduce your running load and try a non-impact sport. Try icing the area and massaging anti-inflammatory gel (consult your physician first) into the plantar fascia. Full recovery can take 6-8 weeks, so return to running gradually to prevent re-injury. Jeff Blanchard, MS PT from Therapeutic Associates in Salem, OR, recommends ASTYM (Augmented Soft Tissue Mobilization) to treat extreme cases of plantar fasciitis. When the fibrous tissue becomes hard and scarred, ASTYM can help flexibility, strengthening and muscle re-education. This specific type of treatment is highly effective but requires the expertise of a trained physical therapist.

ASTYM is a useful tool for treating most of the “Big 5” injuries above and is most appropriate for severe cases that have formed scar tissue or extremely tight fascia.

Todd Cruz, a PT at Northwest Portland Physical Therapy, highly recommends athletes get a full musculoskeletal and biomechanical evaluation for most injuries. Cruz explains that many injuries can be traced to a lack of flexibility, leg length discrepancies, or weak core muscles.

The majority of running injuries can be caused by overtraining and improper footwear. If you feel any of the symptoms of the injuries described, take time to treat them to prevent long term damage.

Special Thanks to Jeff Blanchard, MS, PT of Therapeutic Associates in Salem, OR for the photos used in this article. – Ed.

Written by Shannon Simmons

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