knee-pain

The 10 most common running injuries and our top tips to get you back on track

With the London Marathon only six weeks away and the sudden infiltration of panic-struck entrants knocking at my practice door, I thought it may be both helpful, and topical, to write a quick blog discussing the top 10 most common running injuries… And, in case you fall victim, or just fall over, I’ve also added three of my top tips for managing each condition.

So let’s get warmed up!

To set the scene: after a 10 minute mind battle with yourself trying to justify a duvet day on this cold winter’s morning (you crazy human), you drag yourself from the sofa and put on those running shoes. The earphones are in, and the motivational track which once made you feel alive and pumped, now instils only hatred and anger towards the artist who made it (it’s a Justin Bieber album on repeat, don’t even deny it). Now you’re off, you push through, loosen up and slowly but surely, the solitary settings allow you to feel calm, composed and free from the stresses of the world. You’re half way to your target distance and you notice a niggle developing that doesn’t feel quite right… Question; do you stop, take a slow walk home then re-assess the following day, or do you take a ‘no pain no gain’ approach and push through?

If your approach is the latter, you my friend are not alone.

Typically, I see patients who have either coped with an injury for a number of weeks before finally coming to the realisation that it’s ‘there to stay’, or those for whom – despite reducing their mileage – running through the pain has become unbearable.

In hindsight, ‘pushing through’ seems like a less than favourable approach, but the fact is, it’s human nature to enter a state of denial when we’ve put so much time and effort into our passion.

So, starting from the hip and working down, see if your symptoms match any of my ‘Top 10 most common running injuries’. It could save you a whole bundle of grief!

1. Gluteus medius tendinopathy

Where is the pain?

The outer hip and glutes

Symptom:

Pain, stiffness and weakness around the hip

What is it?

Your gluteus medius tendon is a tough, fibrous tissue connecting one of your glute muscles to your hip bone (femur). A glute medius tendinopathy occurs when this tendon is repetitively or excessive loaded, causing micro-tears to develop. Normally, it’s able to cope with the forces applied, or at least recover from them in a relatively short time. But… if the forces are too great or applied too often i.e. long distance running, the damage can override the healing rate and tendon deterioration can set in.

What are the symptoms?

My patients often describe pain on the outermost side of the hip and/or the upper side of their buttock. They find the pain repeatedly kicks in after running pain-free for a certain distance – but if left unmanaged this condition generally progresses and that ‘pain free’ running distance becomes shorter and shorter! Other symptoms to look out for:

  • Inflammation, redness or heat around the area
  • Pain and stiffness after pro-longed periods of rest and first thing in the morning
  • Tenderness when sitting or putting pressure onto the glutes.

Top tips

  1. Trigger point massage to the glutes with the aid of a tennis ball. 1 minutes each side, 3 times daily.
  2. Rest from running until symptoms reduce significantly. Maintain cardiovascular health through cross training which places a smaller load onto the tendon.
  3. Strengthen weak hip and gluteal muscles through lateral side steps, clams and hip hitches. Use thera-bands to increase resistance.

2. Hamstring tendinopathy

Where is the pain?

‘Sitting bone’ and/or along the back of the thigh

Symptom:

A vague aching, soreness along or high up in your hamstrings, deep to the glutes’

What is it?

Your hamstring muscles are attached to your skeleton by tendons: tough fibrous structures that anchor muscles to bone.  The hamstrings are attached to the top of your lower leg bones (tibia and fibula) then run all the way up the back of your legs to connect to the Ischial tuberosity, or sometimes referred to as the ‘sitting bone’ in your pelvis.

If a tendon becomes over-stretched, stressed or strained, it may sustain micro-tears, causing acute, localised inflammation. This is an early stage tendinopathy often resulting from a rapid increase in tendon loading, i.e. an increase in activity.

Like any acute injury, it should not be ignored; if managed appropriately, the tendon should make a complete recovery and heal in a relatively short period of time.

Serious issues occur when the tendon is subjected to continuous repetitive forces. Those of you who adopt a ‘no pain no gain’ approach beware – the injury rate overrides the healing rate, causing tendon deterioration and symptoms can become far more stubborn.

What are the symptoms?

Unless associated with a one-off trauma, symptoms tend to creep up out of nowhere, gradually becoming progressively worse and aggravated by activities such as running, kicking, jumping.

  • Pain in the gluteal region, or in simpler terms – your bum. This can become particularly painful when sitting on hard surfaces
  • Stiffness and pain along the hamstring muscle – particularly in the mornings or after a prolonged period of rest
  • Pain and a perceived weakness on contraction – i.e. bending the leg against a resistance

Top tips

  1. Stop stretching your hamstrings! Stretching will only place further stress onto the tendon potentially causing more damage! In the early stages try to reduce tone in the hamstring through foam rolling, massage or trigger pointing.
  2. Cold compression: reduce pain and inflammation by applying an ice pack directly to ‘sitting bone’– particularly after provocative activity (10 minutes on x 5 minutes off: repeat 3-4 times).
  3. When you return to training, reduce the length of your running stride and avoid hill runs.

hamstring-tendinopathy

 

3. Iliotibial band syndrome

Where is the pain?

Outer knee

Symptom:

Pain on the outside of the knee made worse by bending and straightening the leg

What is it?

It’s a weird name, but it’s simply due to friction when the IT (iliotibial) band’ – a tough length of tissue (or ‘facia’) – continually rubs against a small bony protuberance on your thighbone (the femur), just above the outside of the knee. The IT band runs from the top of your hip all the way down to your calf-bone (fibula) head. It’s so tough it feels like a bone or a thick tendon, but it needs to be this strong because it stabilises your knee throughout its whole range of movement. But, tough as it is, friction causes serious inflammation and lasting pain.

This condition is common in runners and cyclists. It’s often due to weak hip and gluteal muscles, poor running technique or increased activity levels, such as long distance running. So beware!

What are the symptoms?

IT band syndrome will cause pain on the outside of the knee made worse by bending and straightening the leg. This usually begins as a pinching or twinging sensation which can soon become astonishingly painful. Other symptoms to look out for are:

  • Pain on the outside knee when running (particularly downhill and on heel strike), which resolves after a short period of rest, only to return on activity.
  • Popping, snapping or squeaking on the outer knee; often when bending and straightening the knee between 30-45º
  • Redness or swelling at the outer knee (when severe).

Top Tips

  1. Like many others, this is an overuse injury so the best way to prevent symptoms becoming chronic is to rest immediately. When you do return to running, increase mileage gradually!
  2. Foam roll: target the outer thigh (IT band), quads, glutes and hamstrings. Stretches to the same muscle groups will also be beneficial. Try to do these twice daily.
  3. Cold compression: reduce pain and inflammation by applying an ice pack directly to the outer knee – particularly after provocative activity. (10 minutes on x 5 minutes off: repeat 3-4 times)

4. Patellofemoral pain syndrome

Where is the pain?

Kneecap

Symptom:

sharp pain and discomfort beneath, around or below the kneecap

What is it?

You probably know patellofemoral pain syndrome as ‘runner’s knee’. This condition occurs when the stress of activities such as – you guessed it – running, causes irritation or tissue damage to structures beneath and around your kneecap (patella). In a healthy knee, the patellar should normally move smoothly up an down as the leg muscles contract. But, if you have a muscular imbalance it can overload and affect the movement of your kneecap, potentially causing damage to the cartilage and connective tissues.

Muscular imbalance is very common condition. Typically, the outer muscles of the thigh becomes stronger and tighter than the on the inner muscles This creates tension which drives the patella out of line and causes irritation

What are the symptoms?

Typically, discomfort beneath, around or below your knee cap. It’s often described as a sharp pain which can quickly or immediately resolve at rest. Other symptoms to look out for are:

  • Pain when running uphill
  • Pain when walking up or down stairs
  • Aching at the front of the knee when sitting with knees bent for prolonged periods
  • Grinding, crunching or ‘catching’ of the patella
  • Buckling or giving way of knee

Top tips

  1. Kinesiology tape can be applied to encourage patella alignment and reduce symptoms.
  2. Correction of muscular imbalance: reduce tone in the outer quads (vastus lateralis) and hamstrings through foam rolling and stretching.Strengthen the inner quadriceps (vastus medialis or VMO exercises) working the last 20º of knee extension through a resistance.
  3. Modification of gait: shortening stride and landing with the knee slightly bent can reduce patella loading by up to 30%

knee-pain

 

5. Shin splints

Where is the pain?

Along the inside of the shin

Symptom:

Pain in the middle, lower and inner side of the shin, which can feel like pressure building inside the lower leg

What is it?

Contrary to the popular belief, shin splints are not small fractures along the shin bone (tibia). The condition is, in fact, inflammation of the connective tissues which joins the muscles to the inside of your tibia. The medical term used to describe shin splints is ‘medial tibial stress syndrome’.

The cause is simple – exercise induced: too much too soon. Additionally running on hard surfaces  on an incline and with poorly fitted footwear may all contribute the development of symptoms.

My patients usually tell me that pain is first experienced soon after a certain distance into their run, however, as it develops it may come on during activity such as  walking, ascending or descending stairs and forcibly trying to flex the foot at the ankle.

What are the symptoms?

A reoccurring pain which occurs along the inner part of the lower leg. This is typically experienced as ‘building pressure’ or an ‘aching sensation’ which intensifies until you are forced to stop. Other symptoms to look out for:

  • Tenderness or swelling along the lower leg

Top tips

  1. STOP running. Sorry to say it, but it’s a necessity, if you continue to run, your symptoms will not resolve. Eventually return to activity and build up cardiovascular health with ‘off weight bearing exercise’ – swimming, cycling etc.
  2. Cold compression: apply an ice pack as regularly as possible for 10-20 minutes as a time. Consult GP for anti-inflammatory medication if severe
  3. Consider gait analysis. There’s often an association with over-pronation at the ankle.

6. Achilles tendonitis

Where is the pain?

Achilles tendon

Symptoms:

A mild to moderate ache along the Achilles tendon which is typically worsened by activity

What is it?

The Achilles tendon connects the calf muscles (gastrocnemius and soleus) to the back of your heel bone. Both strong and flexible – it’s the biggest tendon in your body. It has to be – just imagine the job it does when you are running! Typically Achilles tendinitis is not associated with a single injury; more frequently it results from overuse and repetitive stress to the area from, for example, running and jumping. The pain associated with Achilles tendinitis usually begins as a mild ache at the back of the leg or above the heel after running or other sporting activity. A poor running technique, inadequate footwear, uphill running or a recent increase in intensity of activity may trigger symptoms to develop.

What are the symptoms?

Diagnosis is generally straightforward; it causes a mild to moderate ache along the tendon, which is typically worsened by activity. Depending on the severity of symptoms you may or may not be able to run through it, but whatever the case I urge you not to try: this is sure-fire way to make things worse, and believe me, a bad Achilles injury can take a looooong time to rehab. Other symptoms to look out for include:

  • Redness or swelling along the back of the ankle
  • Tightness or pulling at the base of the calf
  • A thick nodule within the tendon, or a snapping sound with ankle movement (this would suggest a large build-up of scar tissue over a substantial time period)

Top tip

    1. Cold compression: reduce pain and inflammation by applying an ice pack directly to the Achilles– particularly after provocative activity. (10 minutes on x 5 minutes off: repeat 4-5 times daily)
    2. Short term symptomatic relief with the use of a small heel lift. This enables the calf muscles to be taken slightly off stretch and so can reduce aggravation of the tendon
    3. Avoid forceful stretching in the early stages. When the acute pain has reduced, prevent a relapse by strengthen the tendon via eccentric loading – heel drops from a step.

 

7. Ankle sprain

Where is the pain?

Ankle

Symptom:

Varying degrees of swelling, stiffness, instability, pain and bruising

What is it?

I see a lot of these, and let’s face it, most of us have sprained an ankle at least once in our lives but that doesn’t make it any less serious. An ‘inversion sprain’ most commonly occurs when we lose footing during a sudden or rapid change in direction – especially on uneven surfaces. It refers to an injury where your ankle ‘rolls’ inwards causing damage to the soft tissues around the outside of ankle. The severity of damage can be classified grade 1 -3 ranging from mild damage to a complete rupture.

What are the symptoms?

In milder cases the patient may experience a small degree swelling, tenderness and stiffness and continuing with day-to-day activity should be manageable. When severe, an immediate onset of swelling may occur with stiffness, intense pain and bruising developing and intensifying over the following days. Other symptoms to look out for

    • Ankle instability
    • Red flagsevere pain, inability to weight bare, substantial bruising with loss of function – don’t simply assume it’s ‘just a sprain’, you could have a fracture, so get yourself to A&E without delay.

Top tips

  1. Immediate action:
  • R- Rest – avoid further damage, be sensible and rest up
  • I – Ice – cold applications regularly for the next 24 – 48 hours. 10 minutes a time
  • C – Compression – apply a compression bandage immediately to reduce swelling
  • E – Elevation – use a few pillow under the affected ankle to reduce inflation in the area
  1. If there is a complete inability to weight bare and swelling or bruising is severe, rule out the potential of a fracture and visit A&E.
  2. Improve the stability of the ankle to reduce potential of a reoccurrence via proprioceptive and balancing exercise.

ankle-pain

 

8. Planter Fasciitis

Where is the pain?

Sole of the foot

Symptom:

A very tender, bruised feeling in the sole of your foot, but predominantly at the base of the heel bone

What is it?

On the underside of the foot we have a thick, strong band of connective tissue (the plantar fascia) which runs from the heel of the foot to the middle of the toe bones. This band supports your foot arch and acts a bit like a car’s shock absorber to cope with the impact of walking and running. Unfortunately, when we run hard, these impacts are heightened considerably and with each foot strike we have to absorb a force several times our own body weight. In some of us, this repetitive action can cause micro-tears to form in this tissue causing the condition to develop with subsequent inflammation and pain.

This condition may also be due to weight gain, change in footwear (flat shoes), increased activity levels or poor lower limb mechanics

What are the symptoms?

My patients often present with a very tender, bruised feeling in the sole of their foot, but predominantly at the base of their heel bone. It’s often possible to run through this discomfort, but be warned, this can cause a considerable delay to healing time. Other symptoms to look out for:

  • Particular pain during the first few steps in the morning, or after prolonged periods of rest
  • Discomfort when bare foot, or wearing unsupportive footwear.

Top tips

  1. Apply a moderate degree of pressure and roll the sole of your foot over a frozen water bottle for five minutes at a time, five times a day
  2. Stretch and foam roll the calf musculature regularly! Studies have demonstrated strong links between tight calf muscle and plantar fasciitis
  3. Avoid non-supportive footwear such as pumps and sandals. Your practitioner will be able to assess foot mechanics and advise whether orthotics are necessary.

9. Stress fractures

Where is the pain?

Anywhere along the entire leg or foot

Symptom:

A small degree of swelling and pain that’s aggravated by activity and may subside with rest.

What is it?

So, maybe not as common as some other conditions but definitely worth a mention. Stress fractures are very small cracks in the bone due to repetitive stress and overuse. Most commonly, stress fractures occur in the small bones in your foot, lower leg or the hip. It’s also worth noting that stress fractures may go undetected on X-ray imaging up to weeks after the pain was initially noted.

Stress fractures can occur in anyone, but those at greater risk are those of you who suffer from osteoporosis or from reduced bone mineral density level. Other considerations are:

  • Post-menopausal women
  • Low BMI
  • History of eating disorders i.e. anorexia.
  • Hormone abnormalities
  • Some long term medication use i.e. steroids

What are the symptoms?

The initial symptoms of a stress fracture can be minimal; typically they develop over time with a small degree of swelling and pain that is aggravated by the provocative activity i.e. running. Pain will typically subside during periods of inactivity or rest.

Top tips

  1. For the next six to eight weeks, or until you’re free of pain, avoid load bearing activities. If you exercise again too soon, you could delay the healing process.
  2. A walking boot, brace or crutches may be necessary to reduce stress to the bone and speed up recovery time.
  3. Seek investigation and address the potential of any predisposing factors. As formerly discussed, nutrition, hormones, and some long term medication (to name a few) can all cause weakness of bone structure.

10. ‘Joggers’ toe’

Where is the pain?

Toes and toenail

Symptom:

Pain in the toes with blackened/bruised nails

What is it?

If you are a serious runner, you might have known we’d end up down here with this common problem. But while ‘Joggers’ toe’ (JT)doesn’t sound like a medical term, it can become a clinical problem if it’s left unchecked. The reason JT happens is fairly straightforward; as each foot impacts the ground, your foot slides forward a fraction and slams into the toe of you running shoe. Damaged toenails trapped inside the hot, moist, dark environment of a running shoe are prime targets for opportunistic infections.  And, fungal nail infections are difficult to treat (yes, feet were designed for running – but not inside shoes). Black, damaged nails may be painful and look unsavoury – but don’t assume it’s ‘just one of those things’ – they could be hiding a more serious condition. So, if it’s not clearing up, or you are concerned, get those toes checked out by your GP.

Top tips

  1. Avoid down hill running
  2. Keep good hygiene – don’t wear sweaty socks and allow your trainers to air after each run!
  3. Make sure your shoes are a good fit and are laced up at the right tension. If you have to stop to retie a loose or over-tight shoe, do it – don’t risk toe-trouble! Runners’ toes do take a serious beating, and they’re unlikely to be your loveliest feature, but look after them and they’ll do you proud.

Good luck & stay injury free!

The Osteo Practice