Running Injury Prevention
Running is extremely popular, very time efficient and a fantastic way to stay fit and healthy, but it can also lead to various injuries if not done correctly. In this post with Dynamic Osteopaths, we'll explore some of the most common running injuries and provide practical tips on how to prevent them.
With any form of exercise, you will be putting the body through its paces, so niggles and strains are often a part of the program. However, the main focus is preventing them becoming injuries which further impact you doing the things you enjoy.
Below are a list of common running injuries we see at our sports injury clinic in Birmingham.
Foot Pain Injuries
Plantar Fasciitis
This is a very common foot related of running injury we see in the clinic practically every day. This is chronic heel pain. Further information can be found here at info on plantar fasciitis.
Advice starts with proper supportive footwear. Invest in running shoes that provide adequate support and cushioning for your feet. It is also very important to take into account every day and occupational footwear.
Orthotics/corrective insoles with appropriate arch support. One of the biggest predisposing factors for Plantar Fasciitis is collapsing arch along with tight calf muscles and under foot fascia.
It is highly recommended to stretch regularly. Perform calf and plantar fascia stretches before and after running to maintain flexibility. With a good routine, it is also recommended to stretch - quads, hamstrings, glutes and spine.
Finally, we prescribe tailored stabilisation exercises and work on gradual progression and loading. Increase your mileage and intensity gradually to avoid overloading your feet.
Big Toe Pain
Big toe pain is another cause of a running injury. This can be caused from repetitive irritation or arthritis changes, leading to pain and restriction of movement.
Check your footware to ensure that your shoes have enough room in the toe box to prevent over compression on your toes.
Strengthen your feet. We sometimes prescribe exercises like toe curls and picking up small objects with your toes to strengthen the muscles in your feet.
Pay close attention to your running form, and avoid excessive toe pushing off during the stride. Sometimes it may be a good idea to get a biomechanical/running assessment.
Achilles Tendinitis
Achilles tendinitis is another very common running injury we see regularly, often related to overuse and factors mentions above.
Ensure adequate warming up
and stretching of lower extremities prior and following running. This is increase local blood flow and increase the calf muscle responsiveness, taking pressure off the Achilles tendon.
Correct footware with good arch support to reduce arch, collapsing and overpronation of the foot.
Foam rolling and massage. This is good to break down local scar tissue and increase blood flow.
We regularly prescribe strength and stabilisation exercises which works on load and injury prevention. Two important exercises include: single leg calf raises off a step (figure 1) and single leg stability holds (figure 2).
Figure 1
Figure 2
NOTE: exercise prescription following injury should be tailored to the individual and presenting symptoms. The above exercises would not be done during acute inflammation and would be graded appropriately to the individual.
Ankle Pain Injuries
Tibialis Posterior Tendinitis
This is another running related injury, which affects the inside of the ankle, and is specifically related again to collapsing arch, poor foot mechanics and overpronation.
Similar advice to above in regard to strengthening and stability exercises.
Corrective footwear. Consider using orthotic inserts or shoes with arch support to reduce strain on the tendon.
Cross-training is a low impact exercise that can be helpful. This along with activities like swimming or cycling to give your tendons a break from the repetitive stress of running.
Ankle Spain
Ankle sprains are again very common and can often be associated with running on uneven ground. The most common form is sprain to the lateral (outside) ligament of the foot and ankle - ATFL (anterior talofibular ligament). This can cause tearing to ATFL, and can be graded 1-4 in severity.
Tearing is often associated with pain and swelling. In more severe cases that could be associated with severe bruising. Acute injury is importantly, followed by basic RICE principles – Rest, Ice, Compression, Elevation. Depending on the severity of injury to the ankle ligaments will depend on how long it takes to repair, and when graded exercise can begin.
Ankle sprains can sometimes follow with periods of ankle instability, so it is very important to avoid recurrence of ankle sprain from returning to running too soon.
Again, here at Dynamic Osteopaths, we will prescribe a structured return to running plan, following ankle sprain, which will focus on regaining ankle stability, proprioception, and strength.
Ankle Osteoarthritis (OA)
Running with ankle osteoarthritis can be challenging but not necessarily impossible. It is highly recommended to consult with a musculoskeletal professional, ideally with a particular interest is sport and running, who can assess the severity of the ankle condition and provide personalised advice. Depending on the severity of your arthritis, we may recommend modifications to your running routine, such as choosing softer surfaces, wearing supportive footwear, and incorporating strengthening exercises for the muscles around the ankle joint. It is essential to listen to your body and avoid activities that exacerbate pain or discomfort. Osteoarthritis is a progressive condition of cartilage degradation, so it is imperative to slow this progression.
Further information on foot and ankle pain can be found here
Leg Pain Injuries
Shin Splint
Shin splint/shin injuries are again very common running related injuries. This is often caused from excessive irritation and inflammation at the front of the shinbone.
Shin splints are commonly caused from poor foot and ankle biomechanics, improper footware, and muscular imbalances. In some cases, a biomechanical assessment may be a good thing to locate possible contributing factors.
Ensure adequate warming-up. Always warm up before running with dynamic stretches to prepare your muscles for activity. This should include calf stretches.
Work on gradual loading and intensity increases. Avoid sudden increases in mileage or intensity, as this can lead to overuse injuries like shin splints. Often shin splints can be aggravated with repetitive downhill running and hard based footwear.
Progressive strengthening and stability exercises. Incorporate exercises that target the muscles of the lower leg, such as calf raises and toe taps.
Fundamentally, it is a good idea to work on flexibility, appropriate footwear and arch support along with running modifications and adequate rest. Obviously, each individual case would very so in some cases a further assessment maybe needed to further assist in the treatment of shin splints.
Further information can be found here on shin splints.
Recurrent Calf Strain
Often, recurrent calf strains can be due to a number of reasons - ankle restrictions, muscular tightness or balances, poor foot mechanics, or increased muscular scar tissue.
Calf stretching and eccentric exercises. Perform eccentric calf raises to strengthen the calf muscles and improve their resilience to injury.
Rest and recovery. Allow adequate time for rest between runs to prevent overloading the calf muscles.
Cross-training. Mix up your workouts with activities that don't stress the calves as much, such as swimming or yoga.
Proprioception and stabilisation exercises. Similar to exercises as reported above.
Stress fractures
Stress fractures are common among runners due to repetitive impact. This is small microfractures in bones caused by overuse and poor bone remodelling. Common sites are the lower leg and foot. To prevent them, ensure proper footwear, gradually increase training intensity, vary your running surfaces, incorporate strength training, and listen to your body, allowing for rest and recovery when needed. Proper nutrition and hydration also play a role in bone health.
Recovering from stress fractures usually requires rest, but you can also aid recovery by maintaining a balanced diet rich in calcium and vitamin D for bone strength. Low-impact exercises like swimming or cycling can help maintain fitness without putting too much strain on the affected area. Additionally, following your provided advice from your musculoskeletal profressional and gradually easing back into activity is crucial for a successful recovery.
Knee Pain Injuries & Running
Meniscus Tear
A knee meniscus tear is anither very common injury we see at our clinic at Dynamic Osteopaths. The knee meniscus are very important cartilaginous structures of the knee that act as shock absorbers. They provide cushioning and stability between the bones at the joint. Running can cause meniscus wear and tear due to repetitive stress and also twisting movements, especially if the runner suddenly changes direction, lands awkwardly, or increases mileage too quickly. These actions can put excessive pressure on the knee joint, leading to tears in the meniscus. Severe meniscus tears and may require surgery due to poor healing rate.
It is important to maintain a healthy weight. Excess weight can increase the load on your knees, putting you at a higher risk of meniscus tears.
Work on strengthening and stability exercises that focus on strengthening the muscles around the knee, including the quadricep, hamstrings and the gluteals, to provide better support and stability. Further information can be found here at our Pre-Hab guide.
Maintain proper running technique and stretch your thigh muscles regularly. Ensure that you're running with good form, avoiding overstriding and excessive twisting motions that can strain the knee.
Patellar Tendinitis
Patella tendinitis is a cause of tendinitis either just below of just above the knee cap. Often caused by overuse, improper warming up, poor flexibility, or altered biomechanics, causing patella maltracking.
Acute tendinitis is treated with rest from aggravating exercises and intermittent ice is required. This can help reduce pain and inflammation associated with patellar tendinitis.
Patellar straps may also be consider or a knee brace during running to provide support and alleviate pressure on the tendon.
Flexibility and stretching to reduce pressure on the tendon. This, in a line with strengthening and stability exercises.
Gradual return to running. If you've been sidelined by patellar tendinitis, ease back into running slowly and listen to your body, and gradually work on the principles related to stabilisation exercises.
Further information can be found here at patella tendinopathy.
IT Band Inflammation
Iliotibial (IT) band inflammation, often referred to as IT band syndrome (ITBS), is a common issue for runners and something we see very regularly here at Dynamic Osteopaths. Further information can be found here at Best practices in treatment and prevention of Iliotibial Band Syndrome.
The IT band is a thick band of fascia that runs along the outside of the thigh from the hip to the knee. ITBS occurs when this band becomes tight or inflamed, typically causing pain on the outer knee. This is often caused from repetitive friction at the outside of the knee. Other causes include - overuse from repetitive knee bending, poor biomechanics, poor running form, leg length discrepancy, or foot and hip muscular imbalances. Of courses may include inadequate warm-up or stretching, uneven surfaces or excessive downhill running.
Symptoms may include, sharp or burning pain on the outer knee, which can extend up the thigh. Pain that worsens with activity, especially running, tenderness and sometimes swelling along the outer knee, also a feeling of tightness along the IT band.
Rest and ice - reduce activity to allow inflammation to subside. Apply ice to the affected area. Stretching and Strengthening - we often prescribe exercises that focus on stretching the glutes/IT band, hip flexors, and quada. Strengthen the hip abductors and glutes to improve stability and lower extremity control. Often, poor gluteal and hip abductor strength can result in increased leg internal rotation which can cause consequent friction at the outside of the knee.
Foam rolling - use a foam roller to massage and loosen the IT band and surrounding muscles. This is good to break down scar tissue and also increase blood flow to stimulate healing.
Proper footwear - ensure you have supportive shoes suitable for your running style and replace them regularly. Gradual increase in activity - avoid sudden increases in running distance or intensity. Cross training - incorporate low-impact activities like swimming or cycling to reduce stress on the IT band.
Physical therapy - appropriate physical therapy and rehabilitation can provide tailored exercises and treatments to address the underlying causes. Also, address running form. Consider consulting a running coach to evaluate and improve your running mechanics.
Osteoarthritis
This is by far the biggest problem we see and treat. Further information can be found here at knee osteoarthritis. This is a very common of progressive cartilage degeneration and inflammation.
Cross-training activities like swimming or cycling are good to reduce the impact on your knees while maintaining cardiovascular fitness and mobility.
Strengthening and stretching are very important forms that focus on strengthening the muscles around the knee and hip, as well as stretching theses mucucles to alleviate tightness and over compression of the knee joint. We often prescribe a very specific set of exercises that works of mobility and stability, subject to the individual's needs and abilities.
Correct footware. Ensure that your shoes provide adequate support and cushioning to reduce stress on your knees.
Weight loss will also help greatly to take pressure of the load barring joints.
Hip Pain Injuries
Hip Bursitis
Hip bursitis is the inflammation of the bursa, a fluid-filled sac that reduces friction at the side of the hip or around the hip joint. Running can aggravate this condition due to repetitive motion that can increase friction over the side of the hip bone (trochanter). This can lead to pain, swelling, and chronic discomfort. Often, hip bursitis is caused from overuse, poor running form, inadequate warm-up, or tight muscles around the hips that can contribute to hip bursitis in runners. It also very often can be related to gluteal tendinitis. Further information can be found here at hip bursitis and tendinitis.
Modify your activities - avoid activities that exacerbate hip pain, such as running on hard surfaces.
Follow appropriate hip strengthening exercises that incorporate exercises that target the muscles around the hip joint, including clamshells and hip bridges. However, it is important that gluteal exercises do not place excessive repetitive stress on the area. We always teach our patients that there needs to be an appropriate tailored balance between - healing, flexibility, strength, stability and returning to running.
The use of foam rolling can be of assistance to massage and release tension in the muscles around the hip joint, including the glutes and hip flexors. This is also a good way to work out muscular trigger points.
Gluteal Tendinitis
This is another very common condition that runners suffer with that often relates interchangeably with bursitis. The gluteal tendon is a very strong tendon that attaches to the side of the hip, and is often subject to overuse use and repetitive trauma. Further information can be found here at hip bursitis and tendinitis.
Always allow for appropriate warm-up. Warm up before running with dynamic stretches to prepare the muscles around the hip joint for activity. Further information can be found here at Dynamic Stabilisation.
Strengthening exercises that focus on strengthening the gluteal muscles to improve hip stability and reduce strain on the tendons. Again, it is important that gluteal exercises do not place excessive repetitive stress on the area. We always teach our patients that there needs to be an appropriate tailored balance between - healing, flexibility, strength, stability and returning to running.
Appropriate rest and recovery, paying particular attention to overuse. Allow adequate time for rest between runs to prevent overuse injuries like gluteal tendinitis.
Follow guidelines for Pre-hab prevention for running injuries.
Back Pain Injuries
Sacroiliac Joint Inflammation
The sacroiliac joint (SIJ) is a very important joint that attaches your spine to your pelvis. The sacroiliac joint is mainly responsible for transmitting forces from above and below. This joint can often be irritated and inflamed with repetitive activity and acute injury. SI joint pain is often related to biomechanical issues. Further information can be found here at back pain and SI joint pain.
It is very important to reduce repetitive forward bending and inappropriate heavy lifting. Injury recovery/rehabilitation, and pre-hab should focus on appropriate spinal and sacroiliac joint stabilisation exercises. These can be found here back pain rehabilitation, hip stabilisation exercises, and spinal pre-hab.
Exercises will focus on spinal, hip and core stabilisation and strengthening. Strengthening these muscles can help stabilise the pelvis and reduce strain on the sacroiliac joints.
Proper lifting technique. Use proper lifting mechanics to avoid putting excessive stress on the sacroiliac joints during everyday activities.
Stretching and mobility. Perform regular stretches that target the muscles around the pelvis and lower back to alleviate tension and improve flexibility. We regularly prescribe stretching exercises for the lower back, gluteal region, quadriceps, hip flexes, and hamstrings.
Lumbar Spine Inflammation
Lower back pain is the biggest cause of musculoskeletal pain and injury. This can be due to many different causes. Further information can be found here at back pain.
Posture awareness - pay close attention to your posture throughout the day, and avoid prolonged periods of sitting or standing in one position.
Ergonomic adjustments - make ergonomic adjustments to your workspace and seating to support a neutral spine position and reduce strain on the lumbar spine.
Muscle strengthening and stability exercise - follow the guidelines above to work on strengthening the spinal, hip and core muscles to provide better support for the lumbar spine and reduce the risk of injury.
Take home…
By incorporating these tips into your training routine, you can greatly reduce your risk of common running injuries and enjoy a safer and more enjoyable running experience. This can further be supported by visiting an osteopath for hands on joint mobilisation and manipulation to promote musculoskeletal balance and function. Also, a musculoskeletal specialist with a particular interest in sports and running, who will be able to focus on rehabilitation and running form.
Remember to listen to your body, and if you experience persistent pain or discomfort, consult with a musculoskeletal professional for proper diagnosis and treatment. Happy running!
Please do not hesitate to get into touch if you require any of the further information.
Dynamic Osteopaths
01564 330773
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