Every runner considers injuries to be their nemesis. These can vary from minor niggles to fractures and can side line runners from their practice, performance and passion for days, weeks or sometimes even months leading to them requiring rehabilitation and graded return to running.
Most running injuries occur when you try to train too hard, some may be caused by poor running form or through overuse. Videbæk et al (2015) in their systematic review found that Running-related injuries per 1000 hours of running ranged from a minimum of 2.5 in a study of long-distance track and field athletes to a maximum of 33.0 in a study of novice runners. This indicates that novice runners are most at risk of injury as compared to professional runners.
But what are the most common running injuries? Here I enumerate the 5 most common running injuries –
Medial Tibial Stress Syndrome (MTSS aka Shin Splints)
MTSS refers to the inflammation of the periosteum or muscles leading to pain on the front or side of the shin bone (tibia). It can also occur on the medial portion on the inner side of your leg. Shin splints are the result of sudden increase in distance, speed or intensity of running e.g. running longer distances or increasing the number of running days without adequate preparation.
Increased hip external rotation during the stance phase (in males only), higher body mass index, prior use of orthotics, navicular drop (indicator of resting foot pronation) and fewer years of training experience were all linked to higher risk for sustaining MTSS (Newman et al 2013).
Treatment of MTSS or shin splints is active rest (rest from aggravating injury e.g. running, but cross training with other activities such as swimming). Return to running must be graded. A stretching and strengthening regime has also been recommended by Knowles (2014).
Whilst there are several tendon related conditions such as tendinosis (degenerative injury with no or little inflammation), tendinitis (injury with inflammation of tendon), tenosynovitis (inflammation of tendon sheath) and peritindinitis (inflammation of muscle tendon junction), tendinopathy is an all-encompassing term used to denote all painful conditions of the tendon.
Achilles tendinopathy is one of the most common running injuries. It can involve the insertion of tendon into the calcaneus (insertional Achilles tendinopathy) or involve the mid-portion of the tendon. Generally the pain (sharp, poking sensation) will occur within the tendon, usually about 5-10 minutes of running.
Some of the factors associated with development of these condition include unequal leg length, poor plantar flexor flexibility, strength imbalances, sudden changes in training load, inappropriate footwear, poor running technique and excessive foot pronation during stance phase.
Plantar fasciitis is the soreness or tenderness of the heel that is restricted to the sole of the foot. It often radiates from the central part of the heel pad or the medial tubercle of the calcaneus, but may extend along the plantar fascia into the medial longitudinal arch of the foot. The origin of the pain is the plantar fascia, a connective tissue spanning from the inferior surface of the calcaneus towards the bones in the front of the foot.
Suggested risk factors include being overweight, older age, prolonged standing, and having a reduced range of motion in the ankle and first metatarsophalangeal joint. A pronated foot posture has also been linked with the condition, but this has not been consistently found to be a risk factor.
There is some indication that the condition may be self-limiting to a certain degree though it may also respond to several conservative interventions such as stretching, strengthening calf muscles, corticosteroid injections, plantar iontophoresis, and extracorporeal shock wave therapy.
Iliotibial band syndrome
Iliotibial band syndrome (ITBS) is the result of inflammation and irritation of the distal portion of the iliotibial tendon as it rubs against the lateral femoral condyle, or less commonly, the greater tuberosity. ITB is a connective tissue on the lateral aspect of the leg, extending from the pelvis to the knee, entering the lateral tibial condyle. It encompasses the m. tensor fascia latae and is connected to the muscles of the gluteal region and to the lumbar fascia.
This overuse injury occurs with repetitive flexion and extension of the knee. Inflammation and irritation of the iliotibial band (ITB) also may occur because of a lack of flexibility of the ITB, which can result in an increase in tension on the ITB during the stance phase of running.
Suggested biomechanical factors for ITBS include excessive hip adduction, excessive peak knee internal rotation, and excessive peak trunk ipsilateral flexion during stance phase. Other factors include tightness of the ITB, increased knee flexion range of motion during stance phase and the dominance of the quadriceps over the hamstrings.
Patellofemoral Pain Syndrome
The patellofemoral pain syndrome (PFPS) is characterised by diffuse pain over the anterior aspect of the knee and aggravated by activities that increase patellofemoral joint (PFJ) compressive forces, with running being one such activity. It is more common in females.
Patellar maltracking is considered to be the most common factor influencing the development of PFPS. Some of the reasons proposed for maltracking include delayed activation of vastus medialis, dynamic knee valgus, increased foot pronation during stance phase and weakness of hip abductors.
It is generally managed through various strengthening protocols.
In a previous post Running doesn\’t ruin your knees, I have reviewed the literature on the long term impact of running on knees and whether running can cause osteoarthritis. There was moderate evidence that running doesn’t cause long term damage to knees and may not cause osteoarthritis. However, one of the factors that consistently emerged was that if you experience injuries, those injuries may in turn contribute to earlier onset of osteoarthritis.
Have you experienced any running injuries? Feel free to share your experiences in the comments below.