Common Running Injuries
August 19, 2003
By Jessica Ross for Knee1
Reviewed by Dr. Joseph Sklar
Although they can be highly incapacitating if left untreated, many common running injuries can be prevented or treated by following proper techniques in training, form and equipment. By far, the major cause of running injuries is training errors. Some of the most frequently cited running injuries include Patellofemoral Syndrome (Runner’s Knee), Tibial Stress Syndrome (Shin Splints), Iliotibial Band Syndrome, Achilles Tendonitis, Plantar Fasciitis, and Stress Fractures. Because the likelihood of developing one of these injuries is related to one’s unique anatomic make-up, to equipment, and to surface factors, any treatment plan should incorporate a multifaceted approach.
Patellofemoral Syndrome (Runner’s Knee)
Patellofemoral Syndrome, sometimes called Runner’s Knee, is characterized by pain localized around the patella (knee cap) and is the generic name for an array of possible knee injuries. Resting in a grove of the femur (thigh bone), the patella is subject to enormous stress during sports like running. It normally acts in conjunction with the contraction of the quadriceps muscle, and connects to the tibia (shin bone) via the patellar tendon. A runner may initially experience a dull aching around the knee cap after their run, with later stiffness due to swelling of knee tissues. When the pain is localized to the patellar tendon, the injury is termed Patellar Tendonitis. Another pain source is softening of the patellofemoral cartilage –true chondomalacia. This is sometimes due to malalignment of the patella position in the femoral groove. This displacement wears down the underside of the patella over time, eventually causing the bone to roughen and degrade.
Generally, Runner’s Knee can result from one or a combination of several sources. As noted above, misalignment is a common cause. Tightness and inflexibility in the quadriceps, hamstrings, and calf muscles may all put undue stress on the patella, ultimately resulting in inflammation. Additionally, worn or improper footwear, and a program of exercise involving too many hills or miles run, may also be at fault. It is also possible that a runner’s gait may be abnormal, thereby increasing stress on the knee. Strategies for treatment should seek to rectify these problems by fully stretching leg muscles, maintaining proper footwear, and reducing the intensity of the running program. Ice and a period of rest should also help reduce inflammation.
Tibial Stress Syndrome (Shin Splints)
Many runners have known the pain of Tibial Stress Syndrome, or Shin Splints, at one time or another in their running career. Similar to Runner’s Knee, the term Shin Splints refers to a set of symptoms rather than one particular injury. This problem is recognized by an aching sensation along the front of the muscle, sometimes extending through the arch of the foot, which occurs at the start of running, but can dissipate during the course of the run. If untreated, the feeling will progress to a sharp, defined pain resulting from mere walking. Shin splints usually signify an inflammation of tendons along the front or inside of the shinbone (which connect to muscles along the shin). These shin muscles (tibialis anterior and posterior muscles) work to counteract the motion of the calf muscles and tendency of the foot to role inward; thus inadequate flexibility in the calves and improper footwear are often to blame for this problem. Another source of shin pain is an actual stress fracture of the tibia, a more severe and disabling condition which can sometimes require surgery.
In addition to tightness in the calves and improper footwear, following an overly accelerated running program (in terms of hills, length, speed, etc.) and running on hard surfaces may also result in shin splints. New runners are often deemed at higher risk for shin splints because they are placing new and different stresses on their calf muscles, increasing strain on the tendons. Treatment may entail icing the shins, reducing the running program, replacing footwear, stretching the calves, and running on softer surfaces to alleviate stress.
Iliotibial Band Syndrome (IBS)
The Iliotibial Band (ITB) is a thick, fibrous band of tissue that stretches from the outer hip to the inside of the knee. It is attached to the thigh muscles and functions to prevent inward rotation of the leg and stabilizes the knee joint. Iliotibial Band Syndrome (IBS) is an inflammation of this tissue, most often localized to the area where it connects at the knee. The inflammation occurs at the point where the ITB crosses over the outside of the femur at the knee, usually generating pain along the outside of the knee when the leg is moving through a particular angle. Symptoms are usually present at the beginning of a run; if left untreated, they will ultimately occur during walking as well.
As with many problems plaguing runners, IBS could be avoided by stretching properly. Tightness in the calves, gluteus muscles, and outer thighs all contribute to IB stress. Additionally, over-exertion during training, improper footwear and other training errors may also be at fault. Running on one side of the road always is thought to contribute to this syndrome in some cases. The primary recommendation for treatment is frequent icing, with stretching, reducing the intensity of the running program, and maintaining proper footwear also recommended as potential remedies.
The Achilles Tendon is the large tendon connecting the calf muscle to the back of the heel. Achilles Tendonitis often begins with a dull ache along the tendon after running, and can progress to persistent stiffness and aching when first arising from sleep. If left untreated the tendon will eventually scar and thicken, weakening it and making rupture more likely. The cause of this woe is multifactorial. In addition to tight calf muscles, improper shoes, an overly intense workout program, and improper running form can all contribute to the development of Achilles Tendonitis. Training errors, poor circulation to the tendon, and biomechanical problems also can cause related difficulty.
Treatment consists of a night splint, rest, stretching, ice and sometimes anti-inflammatories. If there is a lack of flexibility in the calf muscles stretching must be delayed until soreness has temporarily subsided, or else the problem will be exasperated. A temporary hiatus from running is often recommended. A small heel lift may also ease symptoms. Applying ice, gentle stretching, and reducing the exercise program are also potential methods of treatment.
The Plantar Fascia runs along the arch of the foot from the heel bone to the ball of the foot (where the toes begin), much like a ligament. This tissue stretches when the foot is planted, maintaining the arch of the foot and acting as a shock absorbent during walking or running. Inflammation of or micro-trauma to the Plantar Fascia, termed Plantar Fasciitis, is usually felt as an acute pain at the heel of the foot. This pain is usually more severe after getting up from a long period of rest and at the initial start of a run or walk. As with many other running injuries, Plantar Fasciitis may often be blamed on calf muscles that are overly tight or inflexible. This tightness of the calves places a high amount of strain on the Plantar Fascia when the foot is planted, ultimately resulting in micro-tears.
Tight calf muscles, inadequate footwear support, an overly intense running program, and improper running form may all contribute to the development of this problem. Treatment may include frequent icing, a program of stretching to increase calf flexibility, decreasing the time, speed, and hills of the running routine, a night splint holding the ankle at a 90 deg angle, and possibly correction of running form.
A stress fracture is one of the more serious problems a runner can encounter, generally requiring much more recovery time than other problems cited here. A Stress Fracture is a small sliver-like crack in the outside layer of a bone, and in runners they most commonly occur in the shin bone (tibia), thigh bone (femur), the feet (metatarsals), and sometimes in the pelvis. With a Stress Fracture, pain will be localized to the injured site, and persists even when the individual is at rest. There are several theories as to what causes Stress Fractures. Generally it is thought that muscles fatigued by repetitive exercises lose some of their shock absorbing capabilities, placing increased stress on bones. Additionally, it is possible that this same repeated stress prevents the healing of bones from such micro-trauma, ultimately resulting in fractures.
Repeated stress from repetitive exercises, over-intensity of training, improper footwear, and low bone mineral density (from low calcium content, for example) can all contribute to the development of stress fractures. Proper diagnosis of a Stress Fracture is usually accomplished via bone scan, and treatment can require anywhere from four to twelve weeks or more of rest. Weight-bearing activity may be gradually resumed, but any return to a running program must be very gradual. In some cases the stress fracture weakens the bone at a site that makes it susceptible to complete fracture, and in these cases a rod or plate is required to prevent complete collapse.
Most running injuries clearly result from the following common errors: inadequate stretching, improper footwear, and engaging in an overly intense workout. Engaging in a practical program of progressive increases in stretching, strength, and endurance are critical to avoiding side-lining injuries.