Most common running injuries affect the knees, legs and feet, but can be treated with proper methods.
Running is a relatively high-impact exercise where the body might be subjected to forces equivalent to one’s body weight or higher. While it is a good form of exercise to build cardiovascular fitness, repetitive loading can sometimes result in overuse injuries.
Here are five of the more common running injuries that you might encounter due to accumulative loading.
Patellofemoral pain syndrome: this is often one of the most common running injuries reported in studies. This condition often results in pain in the front of the knee which might not be very well localised or sometimes feels like it is coming from behind the knee cap.
The pain can occur during the run, or it can also be felt in daily activities that place more load on the knee, such as squatting and climbing stairs. Conversely, the pain is often absent at rest and swelling of the knee is not a common feature.
While there are other causes of pain in the front of the knee, e.g., patellofemoral arthritis which is degenerative, patellofemoral pain syndrome is primarily due to accumulative loading of the knee and the pain tends to improve with a period of rest and progressive strengthening of the muscles of the lower limb.
It may be beneficial to review the running shoes or even the running characteristics through analysis of video footage.
This is another common cause of pain in runners. Plantar fasciitis causes pain in the heel which is exacerbated by activities such as walking and running.
The pain might be more noticeable in the first few steps when getting out of bed in the morning. Some runners might experience pain on the initiation of running, which might improve after the warmup phase of running.
In more severe cases, the pain may persist and even curtail the running. Plantar fasciitis can be triggered by a big increase in running and has an association with overpronation.
Treatment may include medication to control pain, stretches and physical therapy to improve flexibility and strength and a period of rest. Shoe selection to provide adequate support to the arch is also important.
Chronic recalcitrant cases may benefit from fitting orthotics and treatment with extracorporeal shockwave therapy. Although corticosteroid injection has been used to manage plantar fasciitis, potential side effects could include plantar rupture and fat pad atrophy.
“Shin splint” (medial tibial stress syndrome) refers to pain in the front of the lower leg along the shin bone. It is commonly associated with athletes, especially runners.
The condition starts off as an inflammation at the attachment of the deep calf muscles to the shin bone due to the repetitive stress from running.
With rest, most people can recover from shin splints. However, if left untreated or if the pain is ignored, a shin splint may develop into a tibial stress fracture, resulting in a more extended period of rest from running.
To distinguish between the former and latter, investigations such as an X-ray might be necessary. There are other causes of shin pain that are not related to the bone, the treatment of which depends on coming to an accurate diagnosis to institute appropriate treatment.
The iliotibial band refers to a flat fascia band that runs from the pelvic brim to the side of the knee with a short muscle segment (tensor fascia lata). The structure may have role in storing elastic energy, which is reused with each step as we run. Repeated loading of the structure can result in pain on the side of the knee.
The runner often finds it painful to flex the knee to about 30 degrees and may prefer to walking the knee at a fixed angle. The condition is self-limiting and usually resolves with rest, sometimes with the help of icing and anti-inflammatory medications.
If the pain recurs on returning to running, assessing the biomechanical factors contributing to this problem may be necessary. Physical therapy in the form of exercises to release the iliotibial band and strengthen the gluteal muscles may be beneficial.
Sometimes referred to as Achilles Tendinopathy, this can affect the body of the tendon or at the insertion where it joins the back of the heel bone. Pain associated with Achilles tendinitis begins in the back of the heel or ankle and swelling is seen along the tendon on the back of the heel.
As the Achilles tendon is one of the elastic structures that recycles energy from one step to another, the repeated loading cycles can cause the tendon to break down. Older runners can also experience pain from degeneration of the tendon insertion due to ageing. The condition can respond to progressive eccentric calf strengthening and calf stretches, a selection of running shoes to control heel motion, and extracorporeal shockwave therapy.
In general, treatment of these common running injuries in the acute stage aims to control pain. This may necessitate a period of rest from running and the use of measures to control inflammation, such as icing and medication. Depending on the severity, sometimes rest may be partial, with a reduction in training supplemented with load impact activities such as swimming.
Overuse running injuries can sometimes occur because of training patterns where there is a sudden increase in training load (or when returning to running after a period of extended rest) or insufficient rest. What constitutes too much or too little varies between runners as well as the state of training. As such, regular runners might review their training history, especially if the injury is recurrent.
As running is a high impact repetitive activity and most running injuries are overuse in nature, one aspect of managing running injuries includes assessing the running gait. Certain running injuries are associated with features of running gait, which can see on analysis of video footage.
These, in turn, can be corrected with physical therapy or changes to the footwear or use of insoles. Some runners may require specific training to change their running habits.
Adjunct Assistant Professor Jason Chia is the Head of the Sports Medicine & Surgery Clinic and Senior Consultant at the Department of Orthopaedic Surgery, Tan Tock Seng Hospital.
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