Out of all the sports we know today, running is probably the most natural and primal way of activating your whole body, and – to our great satisfaction – rarely produces injuries. However, those running injuries that do occur can be very unpleasant. Fortunately, over the years, we have gained a lot of knowledge and information on how to avoid and prevent running injuries, with proper running technique topping this list.
Regardless of how experienced we are, perhaps with many marathons under our belts, there is no invisible shield that can keep us safe from injury. Sometimes, one single misstep can become your worst nightmare, depriving you of the pleasure of running for months. On the other hand, a good warm-up, stretch, and a wise choice in running shoes, combined with the proper running technique, can keep you safe for many years.
Let’s check out some of the most common running injuries, with tips to prevent and avoid them, as well as some practical treatment information.
Probably the most common injury amongst everyday runners, runner’s knee presents itself as excruciating pain in the area around the knee, most likely in front of or on either side of the kneecap. Initially, it may feel as if someone is poking you with small needles. This sensation should prompt a visit to the doctor, or at least a reduction in mileage.
Symptoms & Causes
As we all know, mild pain does not distract a runner quite so easily, and often, a runner’s daily routine will not change until the condition progresses and the pain becomes unbearable. The runner may start having a difficult time going up or down the stairs or the knees may begin to hurt after sitting for long periods of time. Eventually, it becomes absolutely necessary to completely stop running.
The cause of this injury is a miss-tracking kneecap, most commonly the result of excessive foot pronation (now is a good time to determine whether you are a pronator or a supinator), rotation of the knee, or sometimes, wide hips.
In the case of mild pain in the early stages of runner’s knee, the best way to treat the injury is to stop running completely. Nowadays, you can also find a variety of cooling gels that can be applied to the area around the knee, or you can simply put some ice in a cloth, wrap it up, and place it on the knee. This should be done at least three times a day for 15 minutes, preferably for at least two weeks.
An excellent preventative exercise is knee extensions, which are specifically recommended during the winter, when runners are more likely to visit the nearest fitness center and work on building muscle and body strength. The most important muscle group to build is the quadriceps. Lunges and leg presses may also be helpful.
Shin splints are probably something that most runners have dealt with at one time or another. They comes from either running too much (especially following an increase in daily/weekly mileage when training for a marathon), overexertion in speed or interval training (especially if a proper warm-up was not completed), and excessive downhill running.
Symptoms & Causes
The pain appears on the front and side of the lower leg, around the shinbone, between the ankle and the knee. There are three common types of shin splints. The first of these is ‘tibial periosteum’, which refers to the inflammation of the tissue covering the tibia. The tibia is one of the two bones of the leg below the knee (the other being the fibula). The pain, in this case, is usually felt on the inside of the shin, beginning as a mild pain in the early stages, and progressing as the injury develops. The pain is not bothersome during daily activities, such as walking and cycling, but as soon as pressure is applied – such as in running – the pain increases to the point where the runner must immediately stop.
The second type of shin splint is a ‘stress fracture’, where small cracks form either in the tibia or a fibula bone, causing pain and discomfort. The pain is easy to localize and is sensitive to the touch. If a stress fracture is suspected, diagnosis and treatment by a physician are urgent and required!
The third type of shin splint, called ‘anterior compartment syndrome’, is where the muscles in the front of the lower leg become enclosed within membranous walls. This happens when muscles grow too large for these compartments, which leads to the building of pressure, causing pain.
We usually treat shin splints with a lot of rest and ice compresses (if you don’t have ice, you can also use frozen peas or other veggies from your refrigerator). In the case of severe inflammation, full immobilization and a visit to the doctor is required. If rest doesn’t help, some appropriate medication for pain may also be needed. Apply ice to the area 4-5 times per day, for as long as necessary. The pain is usually resolved after a couple of days. Recovery and the length of time a rest is required depend on the seriousness of the injury, but shouldn’t take more than a month or so.
For future prevention, strength training and a thorough stretching before and after practice is highly recommended. A running stride analysis is also helpful, as there’s always room for improvement.
Another ‘too much’ running injury, well known to the majority of runners is called plantar fasciitis. Though given a highly technical name, it is basically a severe pain in the heel or, sometimes, in or around the arch of the foot. Plantar fascia is thick connective tissue on the bottom of the foot, and the injury related to it is one of the most common amongst runners, more so in the case of excessive pronators.
Symptoms & Causes
Plantar fasciitis usually indicates more stress than the body can handle – whether it comes from overtraining, working too hard, dietary stress (too much sugar, lack of protein), emotional stress, or other physical trauma. It starts with mild pain in the morning, but can become so severe that walking without first stretching and massaging the area around the heel can become impossible. Because the cause of the inflammation is usually an imbalance in the muscles that causes the plantar fascia to tighten in spasms as it tries to support the foot excessively, the calf muscles and other leg muscles may also become involved in plantar fasciitis inflammation. Addressing the reason for this imbalance will probably improve the plantar fasciitis problem.
Treatment of plantar fasciitis includes a running rest for at least a couple of weeks, a quick self-check on your dietary regime (more protein with some nutrient supplementation as well as some natural anti-inflammatories should be considered). Once you get back to running, you should analyze your running stride, and in case of excessive pronation, get a proper running shoe with a lot of cushion. You should also consider some training and exercise adjustments, which means more aerobic and less anaerobic training, as well as some local muscle therapies.
One of the easiest practices you can perform to strengthen the Plantar fascia is to perform toe pulls.
Moving from the lower to the upper leg, the first injury we should mention is a quadriceps strain, which is a stretch, tear or rapture in one of the four muscles on the front of the thigh.
The name ‘quadriceps’ itself comes from the fact that four muscles (Rectus femoris, Vastus lateralis, Vastus intermedis and Vastus medialis) operate together in order to extend the lower leg at the knee joint and flex the upper leg at the hip. The integrity of the quadriceps as well as their balance with the hamstrings and gluteus maximus muscles are of utmost importance.
Symptoms & Causes
During running, the quadriceps are used when slowing down, especially when running downhill, where a strain can range from mild discomfort to a full blown tear encompassing most of the muscle. The latter is most likely to happen when running downhill excessively, without proper training. It is common for runners that participating in mountain runs without proper training to give it their all in the downhill sections, resulting in serious quadriceps tears or raptures. Running in cold weather without a proper warm-up and a lack of stretching can also both play a vital role in this injury.
Quadriceps strains come in three degrees. A first-degree strain is a small tear including less than 25% of the muscle fiber, with less severe consequences. Mild pain is experienced in the few days after the injury occurs, but walking and even running are fairly normal. During a second-degree strain, the pain is more severe, and is usually felt instantly. Some discoloration around the thigh area may also appear. Further running and walking may be fairly painful. A third-degree strain is a complete rupture of the muscle, which of course, requires immediate medical assistance. Walking and running over the next few days are impossible. In the first two cases, treatment usually consists of pain and inflammation medication combined with resting and icing the area a couple times a day.
Since the quadriceps are partially responsible for lower leg muscle function, it is key to warm them up properly in order to avoid further injury. Once you feel ready to run again, you should reduce your weekly mileage for at least a couple of weeks, before gradually building back to your pre-accident level.
Iliotibial band syndrome – also known as ITB frictional syndrome
In case you’re wondering whether or not you’ve had this injury in the past but were unaware of it, the answer is ‘no, probably not’. The pain around the knee or on the outside of the leg is usually so severe that people almost immediately want to know what they’re dealing with. The feeling of a sharp needle constantly poking you at (usually) a single, exact point, seriously messes with your gait.
Symptoms & Causes
The Iliotibial band (ITB) is a thick tendon, extending from a short muscle on the side of the hip, called the Tensor fascia lata (TFL), and the gluteus maximus muscle (that’s your behind), down to the outside of your knee, and onto the outside of the shinbone. The purpose of this band is to increase knee stability. When the ITB is under constant pressure in an unnatural position (running on slanted surfaces, sharp corners, sudden stops in motion), it rubs against the outside of the knee joint, causing inflammation and pain.
Another reason for ITB syndrome is an imbalance between the inside and the outside of the leg. The muscles that support the inside of the knee are related to the adrenal glands. If there’s adrenal involvement from overtraining and/or too much emotional/mental stress, these muscles will weaken, causing an over-firing of the ITB.
Treatment of Iliotibial band syndrome is to simply stop either running or the activity that caused the injury (often dynamic group sports like basketball, football, etc.). The next thing you should do is apply ice to the area 3-5 times a day for 15 minutes.
In case of severe inflammation, longer treatment is required, often by a doctor. This may include pain medication and, in the worst case scenario, surgery. This level of injury will require a running break of at least 3 to 6 months.
A calf strain is a tear or rupture of either the Gastrocnemius or Soleus muscle, the two muscles in the calf. A calf strain most commonly occurs at the point the two muscles join the Achilles tendon. Gastrocnemius is the larger of the two muscles, and runs from above the knee joint and into the heel bone through the Achilles tendon. The Soleus runs from below the knee joint to the heel through the Achilles. Either of these two muscles can be strained or torn, although it is more common for the gastrocnemius to strain.
Symptoms & Causes
There are three grades of calf strains. Grade 1 is a minor tear with up to 10% of fibers involved. Grade 2 is the most common strain, with 20 – 90% of the fibers involved. Grade 3, being the last and the worse injury, is a complete rupture.
Usually, a visit to the doctor is urgent at grades 2 and 3. With a grade 3 strain, rehabilitation can take up to several months, often with full immobilization. A minor tear can be treated within a couple of days, mostly with ice compresses and a lot of rest. Renewed sporting activities should be resumed gradually, starting with about 25% of your normal mileage, and then slowly building the distance.
When we speak of Achilles tendonitis, we are usually referring to pain in the Achilles tendon, most likely where it attaches to the heel bone. The suffix ‘itis’ is sometimes questioned, because there’s doubt of actual inflammation in the injury. The Achilles is the tendon attachment of the two calf muscles – also mentioned above in the section titled ‘calf strain’ – the Gastrocnemius and the Soleus. These muscles provide us power when running (especially uphill) and jumping, in other words: in the push off and foot plant phase of the running stride.
Symptoms & Causes
The calf muscles are among those muscles which are most susceptible to stress, as their function is closely related to the adrenal gland organs and cortisol (stress hormone) production. This is why overworking the body, training too much, too often, or too hard, increases the likelihood of sustaining a lower leg injury, such as Achilles tendonitis, calf strain, or shin splints. Often, runners suffering from Achilles tendonitis have suddenly increased their volume of running. Weak or tight calf muscles, excessive pronation, and worn running shoes may also contribute to this injury.
As with calf strain, there are several grades of Achilles tendonitis (Graded 1-4). Grade 1 represents a mild pain that usually goes away after a few days of rest. Grade 4 necessitates a surgical procedure immediately, and walking is impossible without the help of crutches. Fortunately, for the lower grades, the old R.I.C.E. (Rest, Ice, Compression and Elevation) is often the way to go; and remember, get back to running slowly and gradually.
If you are experiencing pain in the back of your thigh that began after logging in fast runs on the track, then you are probably suffering from a pulled hamstring. A hamstring strain, or a pulled hamstring, as it is sometimes called, is a tear in one or more of the three hamstring muscles: Semitendinosus, Semimembranosus and Biceps femoris. These three muscles provide our legs’ flexibility.
Symptoms & Causes
Mild to severe hamstring strains are fairly common amongst sprinters and hurdle jumpers, as well as in all sports that involve sprinting activities, such as football, rugby, tennis, and baseball. The reason for this is that the specific role of the hamstring muscles is to decelerate the tibia (shin bone) as it swings outward. It is at that exact moment, just before the foot strikes the ground, that the hamstrings approach their maximum length and most often get injured.
To avoid such strains, an adequate warm-up is needed, as well as a lot of flexibility practice (stretching, balance control, squats, etc.) before practicing sprints or participating in speed interval training. In the case of what is called ‘a violent overstretch of the hamstring’, the consequence can be a complete rupture. When this occurs, medical treatment and possibly even surgery, is urgent, resulting in a recovery period of up to several months. Other mild hamstring strains may be treated with rest and ice patches, as well as some massage and acupuncture.
Hip flexor strain
A Hip flexor strain is a rare, but not an exclusive injury, which causes pain at the front of the hip. The hip flexors are a group of muscles whose role it is to lift the thigh upwards and assist in lifting the upper body when in a laying position. In other words, although a hip flexor strain is a pretty rare injury, we are largely dependent on its proper function in everyday life.
Symptoms & Causes
A hip flexor strain also comes in three Stages, Stage 3 being fairly rare and often the result of ignoring the early signs of stages one or two. The main symptom of a hip flexor strain is pain at the front of the hip, which usually develops suddenly and is made worse by raising the thigh against resistance. As a result, any stretching of these muscles may cause pain. The area around hips may be sensitive to touch, although it’s hard to exactly pinpoint the source, and in severe cases some swelling and bruising may occur.
While a hip flexor strain may result from running activities, it is more often the result of a strenuous hip flexing motion, such as when kicking a ball. Again a proper warm-up and some hip flexor stretches are recommended. After a few days without experiencing any pain, you can begin with walking a bit faster, slowly progressing to running. Combine this with strengthening exercises such as lifting the legs in the air while laying on the back, slow sit-ups, and similar exercises.
Stress fracture of the heel bone
Probably the most treacherous of all running injuries is the stress fracture of the heel bone, also known as the calcaneus bone. The large heel bone is located at the back of the foot and is sometimes prone to stress fractures due to overuse. This type of injury is most often a consequence of carelessly landing on the back of the foot from a height, but there are also a number of known cases that resulted from repetitive impact on the foot, such as in running and dancing.
Symptoms & Causes
It is usually pure road runners, those that swear by asphalt running, that are the ones who get stress fractures of the heel bone. The danger of a stress fracture of the heel bone is that it often goes unnoticed for long periods of time, as it causes only low grade pain in its early stages. As running continues, the pain progresses to the point that it’s almost impossible to walk normally, let alone run. The pain results from small cracks in the bone, which will grow larger with time if the activity that caused the injury in the first place is continued.
This injury is another case of ‘sudden increase of running activity’ or the consequence of overtraining, especially in weight bearing activities. The problem is, when a stress fracture is suspected, the X-ray often shows no signs of a fracture due to how small the cracks in the bone are. Even doctors may be unable to confidently diagnose this condition. However, when suspecting a stress fracture of the heel bone, complete and proper rest – minimally 6 to 8 weeks – is needed. In more serious cases, you may even end up with a cast or a heel pad, but this is more often the result of height landing than ordinary running. Crutches can also come in handy, regardless of the severity of the stress fracture. Once running is resumed, ensure the muscles of the lower leg are stretched and supple.