a brief guide on common running injuries and the benefits of physical therapy.
By Meghen Flaig, PT, DPT
Running is one of the most convenient and vastly popular forms of exercise that has become a common language for millions of people worldwide. Its simplicity is refreshing; just grab a trusty pair of shoes (or not, if you’re into barefoot running) and hit the pavement anytime, anywhere. But ask any runner about “pain-free” running and they’ll probably give you a quasi-confused response. To run with no “tweak” or “twinge” somewhere between the head and the toes is the ever-elusive race to pure runner’s bliss. Current research reports that the incidence rate of lower extremity injuries in runners is between 19.4% and 92.4%. So on average, in a room full of 100 runners it is likely that more than 50 are currently experiencing some type of injury or have dealt with one in the last 12 months. With these statistics in mind and aligning with the theory that knowledge is power, it is best to be well educated and in-tune with our running vehicle so that we can identify and treat these issues head on. Deciding whether to “run through it” or not is an impactful choice that we make when it comes to those nagging pains. As difficult as it is to run through some level of discomfort, it is equally as challenging to acknowledge when we should give those laces a break. Listed below are the most prevalent types of running injuries and a guideline for how and when physical therapy can be helpful.
1. Shin splints (Medial Tibial Stress Syndrome): Most everyone has heard of shin splints and/or dealt with them at some point in life, so it’s no wonder they are consistently at the top of most injury résumés 2. Pain is typically felt on the front (tibialis anterior muscle) or inside (tibialis posterior muscle) of the tibia and is thought to be caused by micro-tearing/inflammation of these muscles, which may also be accompanied by inflammation of the sheath that surrounds the bone. Shin splints are often a result of a sudden increase in mileage, increased hill-work, muscle imbalances and dysfunctional knee and ankle biomechanics.
*Other causes of shin pain to consider include stress fractures and compartment syndrome.
2. Plantar Fasciitis: Ah, that fancy name for heel and arch pain. The plantar fascia is a thick, fibrous tissue that originates at the heel and courses through the arch into the toes. And with a fancy name, comes fancy function. The plantar fascia or aponeurosis is critical for arch support and plays an intricate part in energy absorption and propulsion during the push-off phase of gait. This tissue can become irritated or inflamed (hence the “itis”) with an increase in mileage, muscle weakness (especially the flexor digitorum brevis-a muscle responsible for supporting the plantar fascia and flexing the toes) 3 and unsupported or fallen arches.
*Other causes of heel pain to consider include stress fractures and heel spurs.
3. Achilles Tendinopathy: The Achilles tendon connects the gastrocnemius-soleus (aka the calf) muscle complex to the heel and has a simpler, yet equally important responsibility in the lower leg compared to the plantar fascia. This muscle-tendon unit is a “heavy hitter” in all gait and running activities as it allows forward movement via flexion at both the knee and ankle. A little pain can go a long ways in the Achilles tendon and thus should not be taken lightly. This can result from muscle weakness, abnormal foot and ankle biomechanics, improper footwear and an increase in hill/speed work.
*Other causes of calf/heel pain to consider include DVTs (blood clots), compartment syndrome and ankle impingement syndrome.
4. Runner’s Knee (Patellofemoral Pain Syndrome): Nearly 40% of all running injuries are related to the knee 4. This makes sense as it is always “caught in the middle” between the hip and the ankle and therefore takes the brunt of multiple (and not always friendly) vectors. Runner’s knee is an umbrella term that can encompass many different causes: mal-alignment of the hip, knee or ankle, poor patellar tracking and running mechanics, disruption of the cartilage underneath the patella, quadriceps and hamstring muscle imbalances (almost like constant sibling rivalry) and poor hip and core stability. This type of knee pain tends to increase with high mileage and frequent downhill running.
*Other causes of anterior knee pain to consider include patellar subluxation, ligamentous or meniscus involvement.
5. Iliotibial Band Syndrome (ITBS): Yet another thick, fibrous structure that is one of the primary stabilizers for the entire lower extremity. It anchors in at the hip and attaches at several points in and around the knee. The IT band is grossly underestimated when it comes to its size and shear thickness. Pain with this condition is often sharp and felt on the outside of the knee. Factors that can contribute to IT band irritation include: mal-alignment at the pelvis and hips, muscle weakness and imbalances (sensing a theme yet?), improper footwear and poor biomechanics. Repetitive track or downhill workouts can significantly increase pain.
*Other causes of lateral knee pain to consider include lateral ligamentous or meniscus involvement.
So how do you know when you can run through the pain, or when you should stop? This is a question that many of us have faced and the answer is not always as clear-cut as it might seem. It can be easy to negotiate the pain if we tell ourselves “just one more mile” or “I can’t stop now.” But it’s good to remember that taking a few days or weeks off now, is better than taking a few months off in the future. Here are a few things to keep in mind if and when you stand at the fork of these crossroads.
Keep on Running: intermittent and/or mild pain, minimal swelling, no lingering pain post running and minimal pain with other daily activities.
Proceed with Caution: moderate pain towards the end of your run, lingering pain for several hours post running, moderate swellingand pain with other daily activities. In this case it may be possible to continue running, but the amount and frequency should be modified.
Stop and Seek Help: moderate to severe pain shortly after the onset of a run, lingering pain for several days post running, a noticeable limp and moderate to severe swelling and pain with daily activities.
What exactly do physical therapists do and how can they help? Glad you asked. Physical therapists are the masters of the musculoskeletal system; our job is to assess and restore body movement (or lack thereof) to achieve an optimal level of performance. Can we identify muscular weakness and imbalances? You bet. Are we able to find areas of limited or excessive motion? Definitely. Do we analyze body mechanics, footwear and posture? Absolutely. And so much more. Whatever the injury or condition may be, we strive to solve the root of the problem in order minimize and even prevent global dysfunction. Following a thorough evaluation process, a collaborative plan of care is established to address these impairments (i.e. pain, swelling, muscle weakness, restricted motion, poor mechanics, etc) in order to keep those who like to move, in motion.
So whether you’re new to the sport or a multi-year veteran, the more miles you put on the more likely you will be to encounter one or more of these prevalent injuries. Seek support from fellow runners-you are not alone! And as a good rule of thumb, when in doubt, get it checked out.
Meghen Flaig DPT is a runner, mom and physical therapist at CorePhysio in Fairhaven.
1. Bierma-Zeinstra et al. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med 2007;41:469–480. doi: 10.1136/bjsm.2006.033548
2. Alexandre Dias Lopes et al. What are the Main Running-Related Musculoskeletal Injuries? A systematic Review. Sports Med 2012; 42 (10): 891-905 0112-1642/12/0010-0891 .
3. Wearing S, Smeathers J, Yates B, et al. Sagittal movement of the medial longitudinal arch is unchanged in plantar fasciitis. Med Sci Sports Exerc. 2004;36:1761- 1767.
4. Aschwanden, Christie. The Big 7 Body Breakdowns. Feb 3, 2011. http://www.runnersworld.com/health/big-7-body-breakdowns?page=single