In Stride

Without proper form, your love of running could land you in physical therapy.     Photo: Oscar Rethwill/Flickr

Common Running Injuries (and How to Fix Them)

You love to run. You hate to get hurt. Even if injuries are inevitable, there’s plenty you can do about them. Here’s your guide to fixing the most frequent problems.

If you run, eventually you’re going to get hurt. We know that’s not what you want to hear, but the numbers don’t lie (even if they do vary). According to the latest research, between 30 to 80 percent of you will suffer some sort of running injury. With this statistic in mind, we reached out to Nicole Haas, a doctor of physical therapy and board certified orthopedic clinical specialist, and Dr. Jamie Mieras, sports medicine podiatrist at Boulder Valley Foot and Ankle Clinic in Boulder, Colorado, to help you cope when one of these issues strikes.

#1: Runner’s Knee

Kneecap pain is such a common injury with runners—accounting for almost 20 percent of all running injuries—that it’s been bestowed with the moniker “runner’s knee.” This general term describes hard-to-localize pain under or around the kneecap that feels worse on downhills and stairs. “The old research was that the kneecap was off-track. We now think it’s caused by muscular weaknesses that apply abnormal forces to the knee,” says Nicole Haas.

The Treatment: Your first move is to reduce the inflammation with NSAIDs, rest, and ice. If you can exhibit some self-control, it’s okay to run on it as long as it doesn’t hurt, but skip the long runs and focus on rebuilding your form. Often, patellofemoral pain syndrome (PFPS) develops when you aren’t strong enough to keep yourself in proper biomechanical alignment. This puts undue stress on the patellar (kneecap), causing inflammation and irritation. “Focusing on glute strengthening and leg alignment (preventing the knee from collapsing inward) while strengthening the quads is crucial,” says Haas.

#2: IT Band Syndrome

Your iliotibial (IT) band runs along the outside of your hip down to your knee. When this thick tendon becomes inflamed, it causes pain on the outside of the knee that is especially noticeable when running downhill. “Weak hips, which can cause runners to have a knock-kneed gait, cause friction and irritation,” says Haas. Too much volume can also cause the IT band to be abnormally tight and pull at the point of attachment, causing pain. Surveys suggest that 12 to 14 percent of runners experienced IT band pain in the past year.

The Treatment: One common short-term treatment is a corticosteroid injection. If the pain is due to decreased mobility of the IT band, foam rolling, massage, and stretching will help loosen up the tissue. Because biomechanics also play a role, strengthen your hip abductors to help prevent the pain.

#3: Shin Splints (Tibial Stress Injury)

Shin splints are a vague and diffused pain on the front of the shin. The condition is usually caused by “too much, too fast” training, which doesn’t allow enough time for the tibia and surrounding musculature to properly heal between runs. The front of the tibia can be tender and inflamed, and this pain may decrease a few miles into your run. If left untreated for too long, shin splints can turn into a full-blown stress fracture. Women have a higher propensity for low bone density than men, increasing their odds of shin splints turning into a stress fracture 1.5 to 3 times.

The Treatment: Rest, NSAIDs, and ice can help reduce the acute pain and inflammation, but the underlying issues are typically training errors or biomechanical abnormalities that place more strain on the tibia and tibialis than they can handle. So, get a coach and a proper biomechanical assessment. Flexibility could also be a factor: “Classically, we see people with very stiff ankle joints, and that pulls on the muscle,” says Haas. “That stiffness can result in compensatory movements and muscle use that can lead to aggravation of those muscles and eventually their attachment on the tibia.” Work on mobilizing the ankle by stretching the calf muscles and working with a physical therapist on mobilization movements. Primary strength work should focus on the tibialis posterior, ankle-stabilization muscles, and calf muscles, with secondary work on the core and hips.

#4: Achilles Tendinitis

This continuous pain on the back of the lower leg occurs when the Achilles tendon, which connects your calf muscles to your heel, becomes inflamed and irritated. Sometimes caused by a poisoned arrow, Achilles tendinitis is more often the result of an increase in mileage, intensity, or hill workouts. Transitioning too quickly to a zero-drop shoe. Both will stress the tendon beyond its capacity, causing inflammation and pain.

The Treatment: “The first thing has to be immobilization,” says Dr. Jamie Mieras. Stop the daily hill climbs and work on strengthening the calf muscles, which is the key to long-term treatment. Calf stretches performed with special emphasis on the eccentric phase—where the muscle is contracted as it lengthens—are widely regarded as the panacea.

#5: Plantar Fasciitis 

Pronounced “PLAN-ter fash-ee-EYE-tus,” this is a painful inflammation of the thick tissue that runs along the bottom of the foot. The pain is typically a dull ache adjacent to the heel (calcaneus), but it can be sharp first thing in the morning. “Plantar fasciitis results from overuse on mildly ‘off’ biomechanics, which is usually exacerbated by weak feet,” says Mieras. Because the tissue receives limited blood flow, this injury tends to linger.

The Treatment: A shot of cortisone can be used in acute cases. Since this is an overuse inflammatory condition, ice it when it flairs. NSAIDs can also provide temporary relief. Mieras warns against pressure massage when it’s in the acute phase: “Rolling on a foot roller when it hurts will only inflame it more.” Upstream from the foot, tight calf muscles are thought to be a major cause, so consistently stretching them is key. If you’re having heel pain first thing in the morning, sleeping in a night splint can help keep the fascia elongated when it would normally overtighten. And reconsider your footwear. “Your biomechanics may benefit from more supportive shoes or adding rigid over-the-counter inserts to support the arch until the inflammation resolves,” says Mieras.

#6: Hamstring Strain

Three muscles on the back of your thigh are tasked with bending your knee, and the hamstrings are the tendons that attach these big, thick muscles to the bone. Injuries to the hamstrings are usually located at the attachment or involve tears or strains to the tendon. Although more common in athletes who sprint, endurance athletes can injure their hamstrings through chronic overuse or muscle imbalances.

The Treatment: A tight hamstring is susceptible to being overstretched and strained. Make sure the posterior muscles (located on your backside) and tendons have the required range of motion and appropriate mobility. If you can’t touch your knees, let alone your toes, we’re talking to you. “Eccentric strengthening of the hamstring has been shown to help recover from a strain and will be beneficial regardless of where the pain is in the hamstring,” says Haas. Long-distance runners with weak glutes might overcompensate with their hamstrings. Activating and strengthening your glutes will reduce hamstring demand and irritation.

#7: Stress Fractures

One of the more serious running injuries, “[A stress fracture] is that nagging pain that people don’t want to admit to themselves,” says Meiras. The pain is caused by tiny cracks in the bone. Presenting in runners most often in the shins (tibias), feet (metatarsals), or heels (calcaneus), stress fractures are caused by an overload of repetitive stress—the impact of the ground from running.

The Treatment: This pain will subside with rest and worsen with activity, so take some time off. You will need an X-ray to be sure it’s a fracture, and expect eight to 16 weeks of fun with crutches. Once it’s healed, research shows that weight-bearing exercises, like strength training, have a bone-strengthening effect. Enough stress helps your bones grow stronger, so plyometrics and even running will lessen your likelihood of suffering a future stress fracture—as long as you don’t overdo it. Long-term, Haas says, “Work with someone to analyze your biomechanics,” because poor form can increase ground-reaction forces and put more stress on your bones.

8. Ankle Sprain

An ankle sprain is an acute injury caused by a twisting or rolling movement that tears the ligaments surrounding the ankle. Whether it happens on the trail or after carelessly dropping off a curb, sprains are extremely painful and cause the ankle to become inflamed immediately.

The Treatment: “Ankle sprains will tell you how you should treat them,” says Mieras. “If it hurts, don’t run on it.” The classic RICE treatment works well with this injury: Resting it allows it to heal. Icing it causes the blood vessels to constrict and prevents further leakage of blood and serum into the area. Compressing, or wrapping the ankle with an Ace bandage, manually pushes out the inflammation. Elevation allows gravity to help remove some of the swelling. Once you are past the acute phase (usually two weeks), research suggests strengthening the surrounding musculature and balance training to improve ankle stability and avoid a repeat.

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