If you have been logging in the miles long enough as a runner, you have likely run into one of these common injuries. Understanding what is going on with your body and the cause is one step in the right direction to treating it and in the future preventing an injury from happening. Here you'll find the 4 most common running injuries, a short bit on anatomy, the cause and some advice on how to fix your problem.
#1 Iliotibial Band Syndrome (ITBS)
Iliotibial band syndrome is a term to describe increased tension on the Iliotibial (IT) band resulting in irritation. The most common symptom is pain on the outside of the knee, occurring most often when the foot contacts the ground. Other symptoms include burning or a snapping sensation.
Anatomy of ITBS: The the IT band is a thick piece of fascia that runs the outside portion of your upper thigh from your hip to your knee. For those interested in anatomy it originates from the iliac crest, fascia of the TFL (Tensor Fascia Latae) and Gluteus Maximus then inserts on Gerdy’s tubercle of the Tibia. It also has fascial slips into the lateral aspect of the patella. It's job is to create stability at the knee during dynamic activity such as running, cutting and jumping.
What causes ITBS? Typically ITBS is due to overuse and repetitive movements. It is considered chronic in nature, which means it develops over time. It is believed that the actual pain maybe due to compression and increased friction of the fat pad.
Most often the area of pain is not the primary cause of the problem. In individuals with ITBS the most common cause is weak hip abductors and poor ability to control dynamic movement of the lower extremity. This can result in what we call “dynamic valgus” at the knee. This results in increased strain on the ITB.
Another possible cause could be limitations in the foot and ankle. I’ve seen a lot of individuals with limited ankle dorsi flexion. Limited ankle dorsi flexion can result in compensatory movements such as duck walk or overpronation of the foot. These compensatory patterns overtime will cause strain due to increased demand and loading.
Treatment for ITBS: Common treatment for ITBS include soft tissue massage or foam rolling of the outside portion of the quad, TFL and glute max. Though soft tissue massage is helpful, it may not be the 100% answer to the problem. Addressing the possible problems above and below the knee as stated previously will be the most effective treatment. Some exercises I utilize to help with pelvic control along with glute and hip abductor activation are the bridge march or single leg bridge, airplane and side plank.
Although ITBS is a common cause of knee pain it’s not always the case. Pain can be deceiving as to the cause, let alone there are a variety of other dx out there that could cause pain on the outside of your knee. Finding a professional to appropriately diagnose and develop a customized plan with your goals in mind will be to your benefit. Walking around with knee pain is not normal nor is it something you should have to suffer with for the rest of your life. It is fixable without medication or surgery.
#2 Medial Tibial Stress Syndrome
Medial Tibial Stress Syndrome, or better known as shin splints, is a common injury amongst runners as well as any sport or activity that may involve high impact loading. Most often pain occurs in the front or along the inside of the tibia (aka shin bone) during activity. It may also hurt to the touch at rest.
Anatomy of MTSS: MTSS most often involves the posterior tibialis and it’s attachment to the bone ( more technically the periosteum). The posterior tibialis muscle begins in the lower leg crossing the inside ankle and attaching down into the foot. It acts as a mover of the foot and ankle and is an important stabilizer for the arch of the foot. At times increased strain on the posterior tibialis could lead to irritation and as a result pain along where it attaches.
The periosteum is the outside covering of the bone; it contains blood vessels and nerves to provide nourishment and sensation to the bone. Periostitis is the term used when the periosteum becomes inflamed. This is usually due to repetitive stress to the periosteum from forces placed upon it by the surrounding muscles such as the posterior tibialis or soleus. This is important not to ignore as continued stress to the area could result in a stress fracture.
A stress fracture is tiny cracks in the bone. Common symptoms that suggest stress fracture are pain at rest and more localized pain.
What causes MTSS aka shin splints to happen? There can be more than one cause. Often times it goes again to training. A rapid increase in training volume whether it’s going 0-10, quickly upping your miles per day/ week or increasing the intensity too quickly. It comes down to doing too much too fast
Other causes of shin splints could be due to muscle weakness or mobility deficits at the hip, ankle and/or foot. Altered gait mechanics when running can also add increased stresses to the lower leg. Having a professional with expertise in movement and gait assessment is helpful in diagnosing the problem.
Other possibilities that could contribute to MTSS are changes in shoe wear and running surfaces without the appropriate progression.
Treatment: MTSS can be prevented with the appropriate training plan and gait mechanics. Another very important subject frequently forgotten with training is built in recovery days. Recovery days are important for you body to repair itself from the demands you placed upon it. Without recovery there will be no improvement. If you’re not sure where to start seek out a running coach and an expert in gait mechanics.
Ways to manage MTSS are activity modification. Utilizing cross training to preserve cardiovascular capacity while you allow the area to heal. Soft tissue mobilization to the posterior tibialis and other lower leg muscles is also helpful in decreasing tension over the area. An assessment by a professional to determine if there's muscle weakness or mobility deficits contributing to your symptoms will also be helpful in determining the root cause.
#3 Achilles Tendinopathy
Anatomy of Achilles Tendinopathy: The Achilles tendon is the largest and strongest tendon in the body. It comes from the gastrocnemius and soleus muscle inserting onto the back of the heel bone (calcaneus). It’s job is to absorb force as well as generate force to propel us forward.
What causes Achilles Tendinopathy? Typically the Achilles tendon becomes inflamed when it is overloaded. This can occur from improper training such as increasing intensity, rapid increase in milage, and lack of rest. Improper gait mechanics, decreased flexibility in the calves, lack of mobility in the foot/ankle and weakness in the hip and/or foot and ankle are also contributors. Other risk factors associated with Achilles tendinopathy are age (individuals over 30), gender (more common in males), diabetes and increased body weight.
Common complaints are pain during or after a run, pain with activities that increase load on the Achilles such as stair navigation and going up on your toes. Those with Achilles Tendonitis may experience an increase in pain at the initiation of weight bearing as the Achilles tendon is put on stretch.
Treatments for Achilles Tendinopathy can include soft tissue massage/ foam rolling to the calf muscle (gastrocnemius and soleus). Addressing any mobility deficits found in the foot/ankle as well as weakness of the hip, foot or ankle. Achilles Tendinopathy responds well to eccentric loading for strengthening.
#4 Plantar Fasciitis
Plantar Fasciitis is a common diagnosis of foot pain. It is most often characterized by point tender pain on the bottom of the heel and sometimes on the inside of the heel. Most individuals will also experience pain when they take their first steps after a period of rest. This especially occurs when getting out of the bed in the morning.
The plantar fascia is a strong thick band of tissue that runs along the bottom of the foot connecting from the heel to the base of the toes. The plantar fascia is important for helping to maintain the arch of the foot along with the muscles and bones. It helps to distribute pressure over the foot during loading.
What causes Plantar Fasciitis? Common cause amongst runners for plantar fasciitis is a rapid increase in training. Other external causes could be due to changes in running surface and shoe wear. Plantar fasciitis may also occur from compensatory patterns due to weak musculature in the hip, lower leg and foot. Lack of mobility in the foot and ankle could also contribute to compensatory patterns , such as overpronation, resulting in increased stress on the plantar fascia.
Treatment: Initially treatment may call for activity modification to allow for the tissue to recover. This may result in decrease of run training intensity and use of cross training to maintain aerobic conditioning.
Some generalized treatment to reduce tension of the plantar fascia is massage, foam rolling and stretching to the both the calf and bottom of the foot. Addressing any mobility or strength deficits of the lower extremity are also key factors in reducing symptoms and re-occurrence.
As you can see most of these injuries are chronic in nature, developing over time due to increased stress to the region from either improper training or compensation. These injuries can be preventable with an appropriate training plan. If you do end up with one of these injuries and ignore the symptoms they can inhibit your performance and ability to participate in running or daily activities. The above are general guidelines on treatment, however remember that every individual's situation is unique. To get to the root cause of the issue seek a professional assessment so that treatment can be tailored to your needs. With the right assessment and treatment symptoms can be resolved to keep you running healthy.
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