Conditions treated at Run Physio Southampton
The common running injuries such as Achilles tendinopathy, plantar fasciopathy, patellofemoral pain syndrome (runner’s knee), medial tibial stress syndrome (shin splints), ITB syndrome, calf and hamstring strains and stress fractures.
Running injuries are very common, but rarely serious. Listed below is a synopsis of the common injuries and how they are managed. It is not an exhaustive list.
Achilles Tendinopathy
This is one of the most common, and frustrating, running injuries. The Achilles acts like a coiled spring when we run, giving us the recoil to push forward. It is about 15 cm long and connects the calf muscles to the heel bone. It is the strongest tendon in the body but it has to be as running can load it by 7 x body weight.
The preferred term is now tendinopathy rather than tendinitis, as we now know there is no significant inflammation at work so there is not much point icing it!
Commonly, it affects the mid portion of the Achilles and is stiff when we first get out of bed in the morning but tends to improve once we warm up but then can be worse the next day after a run.
Causes have been linked to too much fast running or sudden changes in training or footwear – for example, suddenly doing fast interval training on the track in Spring or using minimalist footwear after wearing cushioned shoes. Tendons do not like sudden change.It is a frustrating injury as tendon healing is usually a lot slower than with muscle strains and it tends to recur.
Treatment includes off- loading the tendon, for example with heel lifts, then gradually reloading with heel raises and drops and finally with plyometrics. Finally, it is essential to look at the previous training and modify as necessary.
Patellofemoral Pain Syndrome (PFPS)
This is also known as runner’s knee but is also common in other sports! It is pain around and behind the patella (kneecap) and often painful on squatting, sitting with a bent knee and descending stairs. The knees can sometimes be noisy (crunchy, grindy) but this is usually not clinically significant but can be alarming.
The patella is embedded in soft tissue (the quads tendon) and attaches to the tibia (shin bone) via the patella tendon. Its function is to increase the mechanical advantage of the quadricep muscles which straighten the knees.
The patella sits in the femoral (thigh bone) trochlear groove and slides up and down it when we bend and straighten the knee. Muscles imbalances such as hypermobility can cause issues with this mechanism as can the opposite, short quadriceps. The mechanism can also be affected by what happens below the knee (feet/ankles) and above (hip and pelvis) and by faulty running gait such as over striding.
Treatment may therefore include addressing these issues after a thorough assessment. I have also found kinesiology taping effective in this condition.
ITB Syndrome
The iliotibial band (ITB) travels from the lateral hip to the lateral tibia and is composed of fascia, a connective tissue. Its main function is to act as a knee and pelvis stabiliser. It tends to get painful on the outside of the knee and it is believed that the source of pain is a highly innervated fat pad under it which is overly compressed.
The ITB has the flexibility of steel so cannot be stretched, but it is attached to the gluteal and TFL muscles so stretching these may help. Issues have also been linked to gait patterns so as narrow or cross-over gait which will need to be corrected to off-load the ITB. It is also known to be a volume type injury – i.e., you are doing too much mileage for your body to cope with so training patterns will have to be addressed.
Plantar Fasciopathy
As with Achilles tendinopathy, this can be very stubborn to treat and is still commonly referred to as plantar fasciitis when we now know it is not inflammatory. The plantar fascia runs the length of the sole of the foot, originating on the inner part of the plantar heel and this is where the pain tends to be. It usually has an insidious onset and is caused by microtears. Its main function is to support the arches of the foot and aid propulsion in running and can be seen as a continuation of the Achilles.
Like Achilles tendinopathy, the plantar fascia should first be off-loaded such as with taping or using insoles and then reloaded and strengthened with a modified heel raise/lowering protocol. Historically, steroid injections have been used but this has been linked to rupture and are best avoided.
Medial Tibial Stress Syndrome (MTSS)
Commonly known as "shin splints". This is very common in novice runners and is characterised by diffuse pain on the medial aspect of the tibia (shin bone). As this area is highly innervated it can be quite disabling and does not respond well to carrying on running. Therefore, a break from running may be indicated as it can become chronic and ultimately lead to the more serious stress fracture (see below).
It is linked to too much fast running and "too much, too soon" so that the body has not had enough time to adapt to the stress of running. Calf muscle weakness may also be an issue.
Stress Fractures
In the normal course of events, these are the most serious injuries a runner can have. They are more common in young female runners and menopausal women. They are most common in the foot and lower leg areas, such as the medial tibia, metatarsal bones and navicular. However, they can also occur higher up in the thigh and hip area (neck of femur). There is usually a specific area of pain that will worsen the longer you run. There may also be visible areas of swelling and night pain. As it progresses, there may be pain on walking leading to limping and difficulty weight bearing.
Causes can be from a deficient diet, lacking in vitamin D and calcium, or just not getting enough food energy, the so-called Relative Energy Deficiency in Sport (RED-S). Insufficient recovery between runs, a sudden increase in training and lack of quality sleep can also be factors. It is essential that possible stress fractures are diagnosed quickly, especially for “high risk” stress fractures such as those affecting the navicular and anterior tibia. X-rays often miss them, whilst a MRI scan is the diagnostic medium of choice but a good physiotherapy assessment should clinically raise suspicions.
Depending on the site of the stress fracture and its severity, there would be a period of non-running and sometimes non-weightbearing and a gradual return to running as well as addressing possible causes.
Muscle Strains
Common muscle strains are in the main calf muscles (gastrocnemius), the hamstrings (a group of three muscles at the back of the thigh) and the rectus femoris (part of the quadriceps group at the front of the thigh). All these muscles have one thing in common – they are biarticular, meaning they work over two joints. This means they can generate a lot of power but in turn create extra tension and as such are associated with quicker running.
Muscle strains are graded, in ascending order of severity, 1 to 3. There is a partial or complete separation of the muscle fibres and the runner usually pulls up with sharp pain and cannot continue running. With severe strains, there may be bruising, caused by bleeding, and marked weakness. Recovery can be 6 weeks to 3 months and is with graded rehabilitation exercises. In rare occasions, surgery is indicated if there is total separation.
Prevention of these injuries is by strengthening exercises, especially eccentric (lengthening under tension) such as the Nordic Curl for hamstrings and by allowing suitable preparation and recovery from quicker runs.
