COMMON CHRONIC OR RECURRING RUNNING INJURIES
The severity of running injuries can vary from those which prevent you from running to those nagging injuries which cause you mild discomfort and reduce enjoyment of your chosen sport. Obviously if you have an injury which prevents you running you need to seek physiotherapy treatment in order to get back on the road but if you have a nagging injury which does not actually stop you running – then you have a choice. You can either carry on and hope that it doesent get worse or seek treatment. Treatment may involve reducing your running initially, orthotics, and starting on a long term proactive injury prevention strategy such as stretches, strength training and retraining your gait. Runners homework!!
COMMON PHYSICAL FACTORS WHICH MAY LEAD TO RUNNING PROBLEMS.
Weak lower back or core muscles
Strong back/stomach muscles are essential to stabilize your lower back when running so that there is not excessive movement of your vertebrae and pelvis as your legs pound out those miles. As your legs swing forward and land your pelvis and back should be stable. Your pelvis should not go up and down with each foot strike, it should not rotate excessively and your lower back should not arch as you push off.
Weak hip abductors, extensors and lateral rotators
Hip abductors are the muscles which move leg out sideways and as such stabilize the pelvis when you are weight bearing. The hip extensors also help to stabilise your hip when weight bearing.The hip lateral rotators rotate the hip/knee outwards and stop the hip/knee turning in when weight bearing.
A – The hip abductors don’t exhibit any weakness
B – The whole upper body shifts to the right – very weak hip abductors
C – The hip/pelvis is raised on the weight bearing side – weak hip abductors
D – The hip and knee turn in on the weight bearing side – weak abductors and lateral rotators
Weak hip abductors and lateral rotators allow the lower leg to rotate inwards and lead to increased torsional stress from the hip down to the foot as in diagramme.
Conditions such as patella femoral syndrome( pain over the front of the knee), hip pain, plantar fasciitis, shin splints and Ilio Tibial Band Syndrome may result.
Weak, tight and/or unbalanced quadriceps.
The quadriceps muscle is the large muscle on the front of the thigh and is made up of four muscles which end at a common tendon below the kneecap. Problems occur when the medial and lateral parts of the quadriceps become unbalanced and there is an uneven pull on the patella giving rise to patella femoral syndrome(PFS) where the patella is pulled out of alignment ( as in 2b )
Tightness of Rectus Femorus, which is the most superficial of the quadriceps muscles, will cause the patella to ride higher than normal which can also be a factor in PFS. Research has shown that weakness of the whole quadriceps mechanism is a major factor in long term anterior knee pain (PFS)
The hamstrings are the large muscles on the back of our thighs which bend our knees, extend our hips and drive us up hills when running. The hamstrings can be a problem if they are weak. They can be short and weak or long and weak. Either way it is important to strengthen the hamstrings and in the case of the short hamstring – to stretch it.
Pronated or supinated feet
When running the foot naturally pronates as the foot hits the ground and supinates at push off. There is a problem however when there is excessive pronation or supination. A person with a pronated foot has a reduced arch/flat foot and one with a supinated foot has a high arch.
Factors which will influence gait and lead to excessive pronation or supination are incorrect hip rotation at foot strike, poor lumbar stability, pain and injury leading disturbed muscle function in the leg or foot and anatomical discrepancies .
COMMON RUNNING INJURIES
PATELLOFEMORAL SYNDROME (PFS) (anterior knee pain)
Commonly known as “runners knee” this is an irritation of the cartilage on the underside of the patella or kneecap because the patella has migrated laterally and is not sitting in its specially designed groove at the bottom end of the patella. See diagramme under Weak, tight and/or unbalanced quadriceps. It is usually noticed during long runs, going up or down hills and stairs and after sitting for a long time especially with the knees bent.
The risk factors are weak quads, gluts, lumbar and hip stabilizing muscles, excessive pronation and tight hip flexors.
Rehabilitation involves strengthening the quads, gluts, lumbar stabilizers, stretching the hip flexors if tight, corrective taping of the patella, orthotics and gait retraining – see below
There are special knee braces which can be used instead of corrective taping of the patella.
The above Mojo brace can be used for anterior knee pain.
The Achilles tendon attaches the two major calf muscles to the back of the heel. When under too much stress the tendon becomes irritated and inflammed. A tender lump is usually able to be palpated on the tendon.
Risk factors are suddenly increasing training, especially hill and speed work, tight or weak calf muscles, poor hip and lumbar stabilizers, faulty foot mechanics such as pronation or supination.
Rehabilitation involves ice if acute, massage, stretching (gentle) and eccentric strengthening of the calf muscles, taping, addressing any hip and lumbar instability and orthotics if necessary.
The hamstrings can become a problem when they are weak and either too short or too long.
If the pain in your hamstrings comes on quickly and the area bruises it is likely that you have strained the muscle in which case you will need to stop running and seek physiotherapy treatment. If it is a less severe chronic nagging injury you can usually run but you need to take it easy. A good alternative while healing takes place is bicycling, pool running or swimming.
Rehabilitation consists of stretching and strengthening exercises for your hamstrings, buttock strengthening exercises, taping and deep tissue massage. Wearing compression tights during and after a run can be helpful.
The plantar fascia is a thick band of fibrous connective tissue which supports the arch of your foot and runs from the arch to the toes.
At risk factors are excessive supination or pronation, increasing your running mileage too quickly, standing on a hard floor for too long without corrective footwear, weak or tight calf muscles, tight hip flexors, weak lumbar stabilizing muscles and a history of low back pain.
Rehabilitation consists of ice ( rolling your foot over a frozen bottle five times a day), stretching and massaging the plantar fascia, strengthening or stretching the calf muscles and strengthening the lumbar stabilising muscles, taping and orthotics.
Running through it can delay healing which is notoriously slow and can take up to a year or more. It is advisable to do alternative exercise such as pool running or swimming to keep the weight off your feet.
Shin splints are small tears in the muscle which lies over the shin bone, or where the muscle meets the bone. They cause an ache down the front of your lower leg.At risk are those new to running or who have returned to running after a long period of no running and have done too much too quickly. They can affect those people with excessive pronation or supination, those who are wearing old shoes or the wrong shoes.
Rehabilitation initially involves stopping running and dealing with the inflammation by using ice, anti-inflammatory medication and rest. Kinesio tape can help by inhibiting the muscle action, correct running shoes and orthotics can help. When returning to running it is important to increase the mileage gradually.
ILIOTIBIAL BAND SYNDROME (ITB)
The ITB runs down the side of the thigh from the hip to the knee and while running with the knee bending and straightening, friction can occur between the band and the side of the knee causing pain.
At risk are those runners who increase their mileage too quickly, do a lot of down hill running, have weak hip and lumbar stabilizers, over pronate or have a leg length discrepancy.
Rehabilitation initially involves rest, strengthening the hip and lumbar stabilizers and knee extensors, shoes or orthotics to correct excessive pronation, stretching or using a foam roller on your ITB to make it more flexible. Returning to running should involve a gradual increase in mileage.