At a Glance
- Running is a very popular sporting activity; sources estimate around 80% of Americans involve running in their workout routine.
- As with most forms of exercise, running carries some risk of injury, and it’s important to know how to minimise the risks.
- The most common running injuries include Achilles and other forms of tendinitis, plantar fasciitis, shin splints, iliotibial band syndrome, sprains and muscle strains.
For many people, getting out in the fresh air and getting a few miles on the clock is a pleasurable form of exercise which helps to clear the mind, release some tension and generally feels good.
Millions of people choose running as part of their regular workout routine. It’s a very beneficial form of exercise which gives lots of advantages for good health and fitness.
Although I’m not a natural runner, I have included running in my workout routine, and I can really see the attraction. It took me a while to gradually build up by firstly doing a combination of slow paced running and brisk walking to really be able to run any kind of distance continuously.
I invested in an inexpensive wireless mp3 player, and found a different kind of exercise high; a more all-encompassing feel good factor with a lasting effect on mind and body.
But one problem that many people who go running regularly face is injury, and there’s a higher incidence of some injuries than others. We take a closer look at running, and find out what are the most common running injuries.
What Is Running?
Although most of us know that running involves putting one foot in front of the other in a rhythm that’s faster than walking, some of the edges are a little blurred. For example, is jogging classed as running?
Running is defined as a type of forward locomotion on foot which involves a phase where both feet leave the ground simultaneously. Walking differs from running because when we walk, one foot is in contact with the ground at any given time.
So while sprinting is clearly a form of running, whether or not jogging is classed as running depends on the pace and intensity of exercise as well as jogging technique.
The Benefits of Running
Running is a great activity which has a lot of advantages for any health and fitness programme. It increases aerobic fitness and reduces the risk of obesity and diabetes. Research shows that regular running for even as little as five to 10 minutes per day at slow speeds can reduce the risk of mortality from cardiovascular diseases by between 29 and 50 percent.
As well as his observations that running promotes longevity, cardiologist and associate director of the Cardiovascular Performance Program at Massachusetts General Hospital, Dr. Aaron Baggish notes that running also elevates mood and improves perceived overall quality of life for the runner.
So there are lots of great reasons for getting involved in running. There are, however, a few things you might want to consider before you slip your feet into your 3-year old sneakers and hit the road.
The Not So Good News…
Scientific studies also show that the benefits of running do come at a price. Of the 64 million people in the US who went running or jogging in 2016, around 80 percent of them are likely to have suffered a running related injury of one kind or another.
When you think about it, it’s not really surprising that there’s a high level of injuries involved in running. Even with all the money in the world to buy the latest and best running equipment and perfecting your running technique, there’s no getting away from the fact that running involves a high level of repetitive stress as the feet strike the ground.
What Causes Running Injuries?
Exactly what structures are prone to injury depends on several different factors. An individual’s biomechanics, running technique, the age and type of running shoes you use and the use of orthotics can either increase or lower the chances of injury. The type of running surface and camber (the amount of transverse gradient), all have an impact on the likelihood of a running injury.
One research review found that women were generally at lower risk of injury compared to men, whereas a history of previous injury was associated with increased risk of further injury. Age, previous sporting activity, running experience and running distance and intensity were also found to impact on the likelihood of injury.
When it comes to injuries that are caused by running there are numerous different variables which can have an impact. This explains the wide range of common injuries experienced by runners.
What Are the Most Common Running Injuries?
Some research studies suggest that the occurrence of running injuries can be as low as 19 percent, while other findings suggest an incidence as high as 79 percent. Research is generally in agreement, though, that acute injuries in running mainly consist of muscle strains, ligament sprains or skin abrasions and blisters.
More often than not, injuries sustained by runners are related to longer term, or chronic problems. Some sources suggest 80 percent of running injuries are overuse injuries, with a high incidence of injuries affecting the knee, lower leg, foot and upper leg. Ankle, hip, pelvis, groin and lower back injuries related to running do occur, but are less common.
Studies have noted that tissues and structures with relatively poor blood supply, such as articular cartilage, ligaments and tendons have particularly high susceptibility to running injuries.
This is due to the mechanical load running requires of many structures, and because these types of body tissues adapt more slowly to being placed under greater stress compared to muscles.
Working from the top down, here’s a description of some of the most common running injuries, and what causes them.
Iliotibial Band Syndrome
In the running world, there’s often lots of talk about iliotibial band syndrome (ITBS). Many people have their theories about what it is and how it needs to be dealt with so it’s important to do your own research and make sure you’re clear and well informed.
The iliotibial band (ITB) is a thick band of connective tissue which runs down the outside of the upper leg from the outer pelvic bone and attaches to the top of the fibula and tibia—the bones in the lower leg. The ITB is attached to several different structures, muscles and bones, as it passes down the outer thigh and is stretched out across parts of the lateral thigh by the gluteus maximus and tensor fascia latae muscles.
When it gets to the knee area, the ITB is much thinner, and as the knee flexes and extends, the ITB flicks across the underlying structures. In a dysfunctional situation, this can cause friction which results in irritation and inflammation in the ITB.
The bursae, fat pads that are strategically placed around all joints to reduce friction and help everything move smoothly, can also become irritated, inflamed and painful.
ITBS is thought to be associated with weakness in the hip abductor muscles. This can increase the amount of internal rotation at the hip and changes in knee biomechanics which places the ITB under excessive stress.
The most common symptom is pain, often reported as a burning type of pain on the outside of the knee. People commonly report that the pain is worse during activity, especially running and in particular running downhill and over long distances.
Diagnosis of ITBS should be done by a professional; there are many other possible reasons for similar symptoms. Initially, treatment often consists of immediate rest from whatever is causing the irritation and pain relief.
In the longer term, most cases of ITBS are effectively treated with an appropriate physical therapy programme, which may include manual stimulation of muscle and soft tissue, stretching, strengthening and correction of muscle weakness. Ultrasound and other electrotherapy treatments have also been found to help some patients.
Again, however, we have to ask ourselves why the irritation is happening in the first place, and do whatever we can to stop it and allow our body to function normally.
So called due to a high incidence in runners, although the official medical name for this is patellofemoral pain syndrome (PFPS). It’s characterized by pain around the kneecap.
Scientific investigations have suggested PFPS may be due to damage caused by the forces generated when running, and the effect this has on the cartilage covering the surface of the back of the patella, or kneecap and the underlying bony tissue.
Some studies indicate PFPS may be also be caused by lesions in the cartilage at the distal end of the femur.
The patellar tendon connects the distal ends of the four strong quadriceps muscles to the kneecap and the front of the shinbone, or tibia.
While the correct medical term is patellar tendinitis, this condition is often referred to as jumper’s knee as it’s commonly associated with the strong repetitive force generated in the patellar tendon by jumping.
It’s not so much the jumping that’s the problem, though, it’s landing that generates the force. As this happens repetitively every time the foot strikes the ground, it’s not surprising that jumper’s knee also affects runners.
The force generated can cause microscopic tears in the tendon which don’t necessarily cause a problem individually. Problems start to occur when the microtrauma happens over and over again without enough time for rest and repair.
The tendon will get irritated and inflamed—a classic tendinitis which requires rest from the cause of injury, physical therapy and correct rehabilitation.
Also known as medial tibial stress syndrome (MTSS), shin splints can be a common injury in running. MTSS is an inflammatory condition involving the muscles, tendons and bony tissue in your shin.
Repetitive running on hard and uneven surfaces, hill training, inappropriate footwear and increases in training intensity can significantly contribute to shin splints, and if the problem isn’t addressed, damage becomes worse and more widespread, and can result in stress fractures.
The most common symptom of shin splints is pain along the inside edge of the shin. Initially, it’s often an intermittent low level niggle which gradually (if the problem is ignored) increases in tenderness, pain intensity and becomes more constant.
Some people may notice swelling in the area, there will certainly be some inflammation, and some experience poor function, muscle weakness and numbness in the foot.
Often shin splints are associated with muscle imbalances which change the way forces are directed through the leg, so to address shin splints properly, hip, knee and ankle function all need to be assessed. Natural postures like flat feet or high arches can both be associated with shin splints.
To heal, shins mainly need rest from high impact activities—like running—but to avoid recurrence, it’s important to identify what caused the shin splints and make changes to avoid future problems.
The thick rope-like structure which can be palpated above the heel, the Achilles tendon is an important structure in running. It connects the rear calf muscles—the gastrocnemius and the underlying soleus to the heel and blends with the plantar fascia—the tough connective tissue under the skin on the soles of our feet.
The Achilles tendon is placed under load whenever we bend our knees or plantar flex (point your toes) our ankles, both of which happens a lot in running. How each foot lands can stress specific areas of the tendon to excess. Having naturally flat feet can make you predisposed to Achilles tendon injuries.
A specific program to stretch the Achilles tendon under load can help to improve symptoms and stimulate healing, and movement analysis can help to offload a problem area and address any muscle imbalances which can be contributory factors.
As we’ve already mentioned, the plantar fascia (pronounced fasha, just in case you were wondering!) is the thick, connective tissue which lies underneath the skin on the bottom of the foot.
It’s pretty tough stuff which is anchored on to the heel and spreads out to cover the whole of the sole of the foot in three distinct segments which eventually divide into five parts, one of which attaches onto each of the metatarsal bones in the toes.
The purpose of the plantar fascia is to protect the foot from damage, prevent the foot from collapsing by supporting the natural arches and also absorb tension.
It plays an important part in what’s called the windlass mechanism of foot biomechanics, providing tensile strength to lift the arches of the foot to enable the big toe to flex and play its vital role in walking and running.
As with the Achilles and patellar tendons, any area of the plantar fascia can potentially be irritated depending on the amount and frequency of force it’s required to manage.
The repetitive, pounding forces of running, particularly on hard surfaces can easily cause problems like irritation and inflammation in the plantar fascia.
Excessive load and stretching can cause tiny tears, or microtrauma to the origin of the plantar fascia at the heel bone. Symptoms are often exquisite pain on the medial side of the bottom of the heel, especially on weight bearing, and particularly when you put your foot to the floor first thing in the morning when you get out of bed!
Specific stretches can help to ease symptoms, ice can help to manage the pain and resting will give the plantar fascia time to heal, but as it doesn’t have a great blood supply, this can take many weeks or months.
There are various taping techniques which can help to offload affected parts of the fascia and reduce pain, but ultimately, to correct resolve plantar fasciitis in the long term, we need to understand what caused it to start with and modify this in some way.
Sprains are a specific injury which occur in ligaments—the tough bands of connective tissue which hold our bones together, literally!
A sprain occurs when it’s placed under load and is overstretched. This is very easy to do when running, especially if you train on uneven surfaces. The most common types of sprains which occur in running are ankle sprains. Specifically, it’s the ligaments on the outside of your ankle that are most at risk, such as the anterior talofibular ligament that connects the end of the fibula with the talus, which forms part of the ankle joint.
Ligament strains are graded on a scale of one to three, grade one being a mild tear with no ligaments laxity or joint instability and grade three being a complete tear of the ligament and probable ankle instability.
While grade three tears need immediate professional help and probable surgery, less serious tears can be managed conservatively. With rest, reducing the load on the ankle and an appropriate rehabilitation plan, ligaments can recover well from an acute injury.
Ligaments, however, are another form of tissue in the body that don’t have a great blood supply, so healing can take weeks or months. In some cases, athletes can take longer to recover from a ligament injury than from a broken bone.
There are many different injuries that are common in running. The vast majority of these injuries are usually related to overuse.
Exactly why these injuries occur in some runners and not others is attributed to a wide variety of factors that can help us understand the root cause of the specific problem. Running shoes, intensity and weekly mileage, the surfaces you run on and the individual biomechanics of your specific running technique are all important to consider. There’s a great video here on good running technique:
An important part of every workout should be a thorough warm up and cool down. A proper warm up increases the temperature in the structures used and the body in general, promoting a good blood supply and making the soft tissue more pliable.
Include regular rest days in your training program to help your body recover from exercise and give it the time it needs to heal and repair any areas of damage. The body is actually very good at repairing itself if we give it the right circumstances to do so.
Diet Can Help Avoid and Repair Injuries
Another factor which puts the body in an advantageous position to heal and repair is a good, balanced diet with a wide range of fresh, preferably raw, fruit and vegetables.
Good sources of protein provide all the different amino acids the body needs to repair cells and good-quality energy sources to help it work efficiently.
Although fats and dairy produce tends to get a bad press in some circles, we need to include these food groups in moderation to provide a complete nutritional profile.
The various main food groups are facilitated by the micronutrients—the vitamins and minerals—and are able to provide the body with everything it needs to work effectively and repair damage.
When trying to identify the specific way your body operates when you’re running and how this might be contributing to injuries, the signs and symptoms are often so subtle that they require a professional opinion.
The first step is to march, walk, jog or run to your nearest specialist running store. Find one that has a treadmill and staff who are trained in running analysis.
You may need to make a specific appointment before you go, and take a well worn-in pair of your running shoes with you—the tread pattern on the bottom can reveal important information to a well-trained eye.
OK, so these people and services are there to help the company sell their merchandise to you. However, they can often provide you with great insight into what the different parts of your body are doing when you’re running, and how well the different components are working together.
Listen to what they have to say about your running technique, do your own research and try to build up a comprehensive picture. You may find that the recommended equipment will help to solve your injury issues, at least in part.
If, having had a store running analysis and making some changes as a result, you’re still experiencing symptoms, it’s time to head to the specialists.
Consult the Experts
Physical therapists with a particular interest in sports injuries or biomechanics specialists are the people to see if you’re struggling to resolve an injury.
They can take your history, analyse your daily activities and assess your movement, and explain how these could be impacting your injury. A management plan can then be formulated to deal with the symptoms and prevent future injuries.
Podiatrists are medical lower limb specialists. They treat many different leg and foot conditions, but if you can find one who has a particular interest in lower limb biomechanics, they can be invaluable to a runner trying to manage and avoid injury.
Treatment for running injuries often involves a range of exercises designed to address any specific muscle imbalances, and may require changes to your running technique and equipment.
It’s possible you may require orthotics to help your body work more efficiently and reduce the risk of injury.
There are, however, many different ways in which orthotics can provide support, and many running injuries have been caused by the incorrect use of orthotics. They’re best left to the experts—don’t try to self-prescribe orthotics!
The one common theme which emerges from most running injuries is that the most important information we need to understand about an injury is the root cause of the problem.
If we know why structures are becoming irritated, and sufferers get the right advice about how to address that problem, it then becomes possible to treat the root cause rather than just the symptoms. This is the only way of resolving an injury permanently and avoiding recurrent injuries.
You may have to look at your running equipment and the surfaces you’re running on. Training programs might have to be adjusted to become more balanced, and you may have to adapt your running technique. Diet is also a very important factor to consider.
Of course none of this is easy, that’s why full time amateur and professional athletes have specialists working with them constantly, but it’s possible that making some small changes can help you become injury free.