Management of Common Running Injuries
Injuries suck – they zap your motivation, halt your progress and hinder your day-to-day living. Furthermore, they require careful attention and rehabilitation if you plan to return to your favorite physical activities and operate at peak performance.
Running is a stressful physical activity. The repetitive nature of foot strikes, especially on flat terrain, heavily taxes the muscles, joints, tendons, and ligaments in the lower body. While a select few runners will avoid injury for their entire career, many will experience the pain and discomfort of a running-related injury a handful of times.
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Some trainers and athletes may claim that resistance training and stretching will prevent or cure all injuries, but I would argue otherwise. Sometimes our body just downright suck and let us down. You could be the strongest and most limber athlete out there, but incorrect form, unbalanced biomechanics, or a wrong step may cause injury.
The purpose of this article is to outline some of the most common running-related injuries. We will discuss the physiology of the injury, signs, and symptoms of the injury, as well as provide high-level recommendations on recovery from the injury. Any advice in this article is NOT meant to replace consultation and treatment by a healthcare professional. This article simply provides a jumping off point, allowing you to proactive learn about and mitigate the impacts of common running injuries.
Common Running Injuries
Patellofemoral pain syndrome, also known as runner’s knee, is the name assigned to generalized pain and discomfort in the front of the knee and around the kneecap.  A number of factors may contribute to developing runner’s knee – your age, activity level, bodyweight, and bone structure.
Surprisingly, runner’s knee more commonly occurs in young adults rather than older individuals.  This may be due to underdeveloped muscles, tendons, and ligaments around the kneecap, as young adults round out their growth and development.
With a name like runner’s knee, it’s easy to assume only individuals completing physical activity involving repetitive and high impact foot strikes are affected. Unfortunately, even weekend warriors and athletes in other sports (e.g. basketball, baseball, football) involving frequent foot strikes, may develop this injury. Those holding excess weight may also develop runner’s knee more rapidly than someone at a healthy weight and/or with lower body fat.
Finally, bone structure also plays a role in developing runner’s knee. Sadly, some individuals are not built to run as fast, far, and efficiently as other athletes. A physical therapist would be helpful in determining if bone structure, specifically kneecap misalignment, plays a role in your runner’s knee.
Runner’s knee most commonly develops due to kneecap misalignment and overuse.  Symptoms typically manifest internally – you’re going to feel pain and discomfort but do not expect to have bruising or swelling around the knee. If you believe the pain largely stems from kneecap misalignment, consult with a healthcare professional.
They will be able to provide the most accurate diagnosis as well as created a specialized rehabilitation and rehabilitation routine to have to back in-action as quickly as possible. This routine may involve resistance training to strengthen the abductors and muscles around the knees as well as stretch the abductors.
For those experiencing runner’s knee due to overuse, I suggest taking moderate amounts of a non-steroidal anti-inflammatory drug (NSAID) like ibuprofen and giving your knees some rest. Swimming is my favorite physical activity for those with knee pain as it has virtually zero impact on the knees. Your knees may also tolerate the seated bike, but be mindful; if you feel pain or discomfort then you should stop immediately.
As an ex-medium distance runner, I remember shin splints vividly. You’re warming up at a leisurely pace and feel great; you then decide to pick up the tempo only to encounter intense pain along the inner edge of the shinbone, also called the tibia.
Shin splints, also known as medial tibial stress syndrome, occur when the muscles, tendons, and ligaments around your tibia become inflamed.  Much like runner’s knee, shin splints are a product of overuse, but also develop more frequently in those new to running, those wearing improper shoes, and those with biomechanics inefficiencies.
If it’s your first time hitting the pavement, track, or trail, chances are you begin to notice muscles you didn’t know you had, begin to engage, stretch, and flex. The musculature around the tibia is one of the first areas to experience significantly increased stress due to the repetitive high-impact foot strikes involved with running.
With the proper programming whereby you gradually increase mileage and intensity over time, the likelihood of shin splints can be minimized. However, if you decide to crank out a five-kilometer run after munching on cheese puffs and beer for the past five years, then you should expect some accompanying pain in the shin region.
Ill-fitting or worn-down footwear may also expedite the development of shin splints. A shoe that is too large or too tight may cause you to alter your foot strike in an unnatural way in an effort to prevent the shoe from moving around or causing pain. Individuals with no arch/flat feet or an exceptionally high arch are also at risk for developing shin splints. These conditions negatively impact your biomechanics when running and unless managed, can speed the development of lower body pain.
Thankfully, shin splints are fairly easy to manage. Rest, ice, compression, NSAIDs like ibuprofen, and supportive shoes should be the primary tools in your arsenal if you encounter this injury. If you’re new to running, consider either decreasing the frequency, duration, and/or intensity of your runs until you build up strength in your lower body muscles.
Pre and post-workout shin stretches will also help to alleviate and prevent shin splints in the future. Consulting with your local running store to obtain a pair of high quality and supportive running shoes is absolutely critical for ensuring shin splints don’t come back to haunt you. For those with abnormally low or high arches, consult a physical therapist as they can provide custom-made orthotics to improve your running form and decrease injury risk.
Finally, consider retiring your shoes after 300 to 500 miles of running as that tends to be the time when support and cushion break down. If after all of the above steps you still encounter shin splints, consult with your healthcare professional and consider performing low-impact physical activities like swimming and bicycling riding until you can effectively manage the pain.
Iliotibial Band Syndrome
Iliotibial Band Syndrome, also known as IT band syndrome, occurs when you experience tightness, inflammation, and pain in the tissue running from the outside of your thigh to the outside of your knee.  You may notice this injury develop along the entire IT band or it may be localized to the hip, thigh, or knee region.
Runners and athletes who frequently climb hills or stairs are more likely to develop IT Band syndrome. How you run and the conditions under which you run may also increase your likelihood of developing this injury.
Similar to the injuries discussed above, improper running form due to flat feet, high arches, and/or kneecap misalignment can negatively impact your running form. As a result, your IT band, while tough, may attempt to compensate for overpronation (rolling inward of your knee, ankle, and foot) or under pronation (roiling outward of your knee, ankle, and foot).
Over time, the IT band can become tight and inflamed from trying to compensate for suboptimal form during high-impact foot strikes. Carrying excess weight and running on hard surfaces like pavement also add additional stress to all muscles, tendons, and ligaments during physical activities involvement notable amounts of running.
As a previous sufferer of IT band syndrome during my middle distance running days, high quality running shoes, orthotics, foam rolling, and lower body strength training are essential for recovering from this injury. I found that when my shoes logged about 400 miles, my IT band issues would flare up due in part to the support of the shoe breaking down.
Having no arch or an excessive arch places your knee, ankle, and foot in a disadvantageous position. Consulting with a physical therapist and creating a pair of orthotics custom to your biomechanics may have the largest positive impact on your IT band issues.
I also found foam rolling my IT Bands pre-workout and post-workout helped to relax and elongate the muscles along the side of my thighs. The incorporate of resistance training, specifically exercises to strengthen the abductors and quadriceps as well as stretch the adductors, can provide almost night-and-day difference to your IT Band issues after just a few weeks.
Virtually every athlete I’ve met or worked with has experienced some type of heel pain during their athletic endeavors. While many of those injuries are uncomfortable, they typically do not compare to the discomfort caused by plantar fasciitis.
This injury is the most common cause of heel pain and occurs when the thick band of tissue running from your heel to your toes becomes inflamed.  As expected, this injury most frequently occurs in runners or athletes performing a high volume of foot strikes, especially on hard surfaces like pavement.
You may notice the most severe pain in your plantar fascia upon waking up, after long periods of standing, or post-run. Under these conditions, your plantar fascia is cold or cooling down, placing the tissue in a contracted state. Your age, favorite physical activity, biomechanics, weight, and day-to-day job can impact your chances of developing plantar fasciitis.
Those between the ages of 40 and 60 are more likely to develop plantar fasciitis, likely due to a combination of minor tissue deterioration as well as decrease activity levels as we age.  Physical activities involving frequent heel strikes such as running, jumping, and dancing and being overweight may also increase your chances of developing plantar fasciitis.
As with many other running injuries, no arch or a high arch can throw off your standing, walking, and running biomechanics, which may equate to more frequent bouts of plantar fasciitis. Unlike the other injuries discussed above, your occupation also plays a role – if you find yourself spending the majority of your day standing or walking on hard surfaces such as pavement or tile, then you may also find yourself encountering this injury with high frequency.
While I have been lucky enough to avoid long bouts of pain in the plantar fasciitis, resting, icing, and stretching the affected area are your best bets for recovering as quickly as possible. If your occupation permits, intersperse periods of sitting after long periods of standing to give your plantar fascia a break.
Applying ice to the affected area, slowly rolling your plantar fascia on a tennis or lacrosse ball, as well as consuming moderate amounts of NSAIDs may also expedite the recovery process. If you’re still experiencing pain along the base of your foot, then consult a physical therapist or other healthcare professional. They will provide you with exercises to stretch and strengthen the appropriate muscle groups.
In certain circumstances, they may also create custom-made orthotics to alleviate biomechanical inefficiencies that negatively impact your stride and plantar fascia. Finally, ensure you are not wearing poor-fitting or worn down footwear during physical activities as this will worsen plantar fasciitis.
What have you found to work best for rehabbing the above injuries? Is there another injury you would like to see discussed? Let me know in the comments below!
References1) Hettrick, Carolyn M, and Daniel Liechti. “Patellofemoral Pain Syndrome.” OrthoInfo, American Academy of Orthopaedic Surgeons, Feb. 2015.
2) “Shin Splints.” OrthoInfo, American Academy of Orthopaedic Surgeons, May. 2012.
3) “Iliotibial Band Syndrome.” Orthopedics & Sports Medicine, UC San Diego Health, 2018.
4) “Plantar fasciitis.” Mayo Clinic, Mayo Foundation for Medical Education and Research (MFMER), Mar. 2018.
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