This article was written in collaboration with Movement Sports Clinic, the official Medical Tent Partner for the Servus Calgary Marathon.
In polling our physiotherapists and massage therapists, these are the running injuries we see most often at Movement Sports Clinic.
The most common cause is rapid increase in training, also referred to as ‘too much too soon’. Reduced muscle stability and biomechanical issues are other key reasons for soft tissue or bone break down with the repetitive nature of running. Recovery pillars of fueling hydration, stress management and sleep are also important to address.
It is impossible to prevent all injuries but knowing what to look for and addressing them early can minimize the down time needed to recover. The Movement Sports Clinic team is here to help!
1. ACHILLES TENDINOPATHY
Achilles tendinopathy, also known as Achilles tendonitis, is a pain, tenderness, and sometimes thickening in the middle of Achilles tendon. For a runner it can be triggered with speed work and rapid volume builds. Typically, the Achilles can feel better once warmed up so will give a false sense that running is safe to continue. Diagnostic imaging studies do not typically find acute inflammation but do show alterations in collagen fibre alignment.
Other types of injury in the same location are tenosynovitis, insertional tendinopathy, partial tendon tear, or calcaneal bursitis. It is important to have a proper diagnosis to develop the optimum plan for recovery.
A rehabilitative assessment will examine posterior chain strength and flexibility, particularly the calf, and ankle mobility. It is important to determine what phase of irritation the Achilles is in to give the correct exercise prescription. Treatment will typically require a layoff from running and involve progressive loading of the calf and Achilles complex. Tendons need load to stimulate reorganization and growth of the tendon cells so the right exercise prescription at the right time is important. A small heel lift can help unload the tendon as it repairs.
Tendon problems like this one can easily become persistent and recurrent through the lifetime of a runner. Without proper restoration of the springy nature of the Achilles tendon, performance and training tolerance will also suffer.
2. ILIOTIBIAL BAND STRESS AT THE KNEE
Iliotibial band stress at the knee or ITB syndrome is a pain typically felt at the outside of the knee. In the runner it can be triggered by rapid changes in speed, volume, and downhill running. The pain can be an extraordinarily strong feeling that comes on suddenly or a discomfort that slowly builds. The ITB is a tendon-like band that runs from the lateral hip muscles to just below the knee.
Through the ITB, hip muscles influence support and movement of the knee. Rehabilitative assessment will look at hip and leg muscle strength, hip, and leg mobility as well as muscle tension of the lateral quadriceps, calf, and hip. Attention is paid to lateral hip stabilizers like Gluteus Medius and Minimus as they help support the hip during the running stride.
Resolution may require a run lay off. Stride changes that increase run cadence (steps per minute) can reduce strain on the knee joint and ITB. Walk / run strategies or uphill walking on a treadmill can help to rebuild or support fitness while working on a rehabilitation plan. Addressing weakness, flexibility and muscle tension are key factors to address this injury challenge. Massaging and rolling the tight hip and leg muscles can also temporarily reduce strain on the knee.
3. PELVIC STRESS INCONTINENCE
Pelvic stress incontinence is a condition where a person leaks urine during a physical activity like running, jumping, or coughing/sneezing. Post-partum and perimenopausal female runners are more susceptible to this condition due to associated changes of the pelvic floor musculature at these times of life.
Ideally pelvic floor muscles are in a harmonious and fluid state between contraction and relaxation depending on loading forces. Adequate strength is required for running with each heel strike loading approximately three times your body weight through your lower limb joints and pelvis. The pelvic floor muscles absorb impact forces and act like a springy trampoline. If muscles are weak, tight or the timing is off then you may be prone to experience symptoms of leaking.
If leakage happens only with long runs, it could mean your pelvic floor muscles do not have enough endurance to sustain their function for running more than 60-120 minutes. If it occurs with high intensity interval training your pelvic floor might require more power specific exercises.
While you are running, pelvic floor muscles should be in a state of relative relaxation. You should never run with intentionally squeezing your muscles. This leads to state of hyper-tension where the muscles cannot do the job they have been designed for.
If you experience symptoms of leakage, an assessment with a Pelvic Health Physiotherapist will provide the answers you need. You can also learn more in our previous blog linked here.
4. HAMSTRING MUSCLE STRAINS
Hamstring muscle strains can occur suddenly or slowly build. The hamstring muscle group is situated at the back of the thigh and includes three muscles with one having two bellies. The muscles work together to power the hip and bend the knee. Hamstrings are used a lot in running and particularly with faster training.
Strains can happen with overload from new and repetitive use. Muscle and connective tissue fibres can become damaged with a sudden pull, or more slowly if the tissue cannot repair between training sessions. Weakness, tightness, low back pain, and fatigue can contribute to hamstring failure. Pay attention to twinges in this area as this sensation can be a warning sign.
Strengthening can begin soon after a hamstring strain. Within a few days isometric holds can help the repair process. Building up to more resistance with both hip extension and knee flexion will help recovery and build in protection. Depending on degree of injury and underlying weakness, this can take a few weeks or months to recover. Core muscle control is also important to support the back and balance the hip forces of running.
5. LOW BACK PAIN
Low back pain can happen with running, particularly as distance increases or with speed work. It may be that your body has not quite adapted to new loads or it could be the sign of underdeveloped trunk and hip muscle strength. Hip, abdominal, pelvic floor and back muscle strength all help support the back. Sometimes back pain with running can be due to tightness in the back or hip joints and muscles such that yoga or stretching might be helpful.
Running lighter on your feet and increasing cadence may help decrease forces on the back. An assessment can help figure out what you can do to help the back pain or stiffness. There are several causes of back pain and often a directional preference is often present, either extension or flexion. Exercises should initially work with what the back can do and then become more comprehensive as you get better.
If back pain is associated with leg pain, numbness, and weakness, these are signs of nerve compression and would be managed differently.
Here is an Honourable Mention for the list. This one can be serious, so we did not want to leave it out!
6. BONE STRESS INJURIES
Bone stress injuries are a serious concern in the runner. Not just because they require time away from running, but because these injuries sometimes can be quite difficult to heal or progress to a more significant problem.
Commonly known as stress fractures, the term ‘bone stress injury’ speaks to the sliding scale nature of this problem. Bones are constantly remodeling according to loads going through them. When increased load exceeds the bone tolerance then a bone injury occurs and the bone becomes weaker and vulnerable to further damage and fracture. Fortunately, our body will tend to let us know in early stages because of pain in the foot, shin, thigh, or hip with weight bearing activities like running. The key is to take notice and not run with persisting bony pains.
Risk factors are rapid increases in run load, hormonal changes, and under-fueling. Sometimes biomechanical issues with movement patterns and the running stride can be in play. Younger and older women are more prone, but men are not immune.
All pains in bony areas are not necessarily stress fractures, but it is a consideration if risk factors are present. The foot, shin, hip, and pelvic bones can all be susceptible to a BSI. Seek help for unexplained bone area pains particularly with rapid builds in run training.
Have further questions or looking for support with any injuries? Reach out to Movement Sports Clinic at https://movementsportsclinic.ca/
Movement is a physiotherapy, health and wellness clinic located in downtown Calgary. Physiotherapists and owners, Tyson Plesuk and Louise Taylor collaborate with their team of forward-thinking rehabilitation and performance-oriented professionals. Assisting Calgarians in their quest to move well and live well, we provide innovative, evidence-informed care sensitive to your unique mobility needs and treatment goals.
