The Nature of Running Injuries
Running is considered the simplest and most convenient fitness activity, and many experts believe humans are built to run, the shape of our hips and feet, the length of our legs, our shock-absorbing spinal discs, and our ability to sweat rather than pant all support long-distance running. It's strongly associated with benefits for the body and brain, reducing stress, improving cardiovascular health, and even helping alleviate symptoms of depression.
Even so, it's estimated that 82% of all runners suffer injuries during their running careers, likely because the repeated movements involved can be hard on the body. Running injuries fall into two categories: acute injuries, which are sudden, sometimes violent injuries like broken bones, sprains, and lacerations; and chronic (overuse) injuries, caused by a low-grade, abnormal force applied repeatedly over a prolonged period.
Plantar Fasciitis, Achilles Tendonitis, and Runner's Knee
Plantar fasciitis involves small tears and inflammation of the tendons and ligaments of the foot, causing pain that can feel like a dull ache or bruise along the arch or heel, often at the start of a run, subsiding during the run, and recurring afterward. Prevention centers on intrinsic foot activation, arch stabilization, and stretching: strengthening the small intrinsic muscles of the foot, stretching the plantar fascia by pulling the toes upward, and stretching the calf muscles in a wall lunge.
Achilles tendonitis occurs when the tendon tightens and becomes irritated, causing pain in the back of the foot, often with heel strike, stepping off a curb, running stairs, or changing direction, and frequently worse in the morning since the calf muscle shortens overnight. Prevention includes proper stretching and postural awareness, such as wall stretches targeting the gastrocnemius and soleus muscles, along with proper shoe maintenance.
Runner's knee causes gradually building pain, usually beneath or around the kneecap, aggravated by squatting and using stairs, with stiffness after prolonged sitting. Hip strengthening, such as side-lying hip abduction and prone hip extension exercises, performed slowly and with good control, is important for preventing runner's knee.
IT Band Syndrome, Shin Splints, and Stress Fractures
Iliotibial (IT) band syndrome causes pain on the outside of the knee, and sometimes the hip, while running, often more noticeable on slower runs, hills, or stairs. Stretching the IT band, such as by standing with the affected leg toward a wall and dropping the hips, can help prevent it.
Shin splints are small tears around the shinbone that cause pain during running which can progress to persistent pain. Good shoe maintenance is the best prevention, wearing shoes appropriate for foot type and training intensity, since running shoes lose 30% to 50% of their shock absorption after about 250 miles and should be replaced every 400 to 600 miles.
Stress fractures cause persistent pain, most commonly in the shin but sometimes in the foot, hip, thigh, or pelvis. Causes and prevention mirror those of shin splints, though stress fractures are more severe and may require a walking boot, crutches, or in rare cases surgery. Cardiovascular training should shift to non-weight-bearing activities like swimming, and a physician should be consulted if a stress fracture is suspected.
What Physical Therapists Recommend
Foam rolling the calves and quads, moving slowly up and down the muscle, is an easy way to keep muscles from tightening, and is useful both before and after a run. Trigger point release of the tensor fascia latae (TFL), the small hip muscle that pulls on the IT band, can relieve the sensation of a "tight" IT band, often more effectively with a lacrosse ball than a foam roller.
A hip flexor stretch benefits runners who sit for much of the day, since tight hips limit how far the leg can extend behind the body during a stride. Squats build a strong foundation for running and address the common imbalance of tight quads, weak glutes, and weak hamstrings that contributes to many running injuries.
Walking lunges mimic the dynamics of running while keeping the knee from moving too far forward. Side lunges and rotational lunges open the hips in the frontal and rotational planes that runners often lack mobility in. Carioca is a dynamic stretch for the glutes, hips, and ankles that increases mobility and blood flow to soft tissue before a run.
Knowledge about preventing and recovering from injury is essential for runners, a timely response can help you avoid the kind of acute injury that pulls you off the pavement for an indeterminate stretch. To understand more about how physical therapy can help, please contact Tribeca Physical Therapy.