‘Running’ is a hobby that is becoming increasingly popular, especially here in London. More and more people are eager to improve their physical and mental well-being, and with running being a very easily accessible form of exercise, with minimal financial input, it’s easy to see why so many are getting involved.
However, both elite and recreational runners are susceptible to injuries and the following list identifies some of the most common running injuries people sustain:
- Patellofemoral pain syndrome (runner’s knee)
- Achilles tendinitis/tendinopathy
- Gluteal tendinopathy (hip pain)
- Plantar fasciitis (heel pain)
- Iliotibial band syndrome (outside of the knee/thigh)
- Bone stress Injuries (shin splints or stress fractures)
- Muscle strains
The reasons why people sustain these injuries is vast. From the latest evidence collated we are aware of certain causes that increase the risk of sustaining these injuries and as clinicians, it is our job to try and understand these reasons to enable us to get runners back on their feet as soon as possible.
What are the potential causes of pain?
Training Error #
High incidences of running injuries are thought to be as a result of ‘training error’, due to either a sudden increase in distance or intensity of running, or returning to a previous running distance after a long break. Our body comprises of tissues that are very good at adapting to increasing loads; however, when overloaded too quickly, injuries can arise.
Load Tolerance/Muscular Weakness #
Tolerance is defined as “the capacity to endure continued subjection to something such as a drug or environmental conditions without adverse reaction”. Our bodies’ tissues, whether bones, muscles, tendons or ligaments can withstand a certain tolerance, so if we overload these too quickly without adequate time for rest, recovery and adaptation, problems can occur.
There are correlations between certain muscle groups being weak, and specific injuries. In relation to runners, our body needs to be able to endure the continued extra forces put through it, so if there are areas in the lower limb (hips, knees, and ankles) that are weak, they can be more susceptible to injury.
Gait Mechanics #
Running gait mechanics can vary considerably from person to person. Research shows that there doesn’t appear to be a style of running that causes pain. However, there are indications that show how certain running ‘styles’ can put different bodily structures under more load than others. This may not be a problem but if there are structures that are weak and painful, a certain running style could be contributing to the presenting symptoms.
Flexibility #
There is evidence to suggest that restrictions at certain joints can affect the rest of the kinetic chain (other joints and muscles of the leg) putting stress on other tissues. For example, ankle stiffness has been linked with plantar fasciitis (heel pain), one of the common injuries listed above. There may also be a difference in tissue length on one side of the body, which may not have been addressed correctly from a previous injury and ultimately causing pain or affecting performance.
Alternatively, sometimes having too much functional range of particular joints during running can also increase the stress certain tissues are put under.
This is, however, not an exhaustive list of why injuries occur when running. Pain is very complex and could be a result of several other physical and psychological factors.
What should a running assessment include?
Subjective Assessment #
Firstly, a subjective history should be taken. This would typically include some of the following questions:
- How often do you run?
- How long have you been a runner?
- What pace do you run at?
- What type of footwear do you run in?
- Have you had any previous injuries?
- Where is your pain and at what point during your run does it hurt?
- Do you participate in any other active activities?
Questions like these help towards building a picture of why someone may be experiencing pain. As identified earlier there can be several causes for pain, so a detailed history is an essential part of the assessment process, which will help towards developing an appropriate treatment plan.
Objective Assessment #
This part of the assessment considers a collection of physical data including observation of the following aspects:
- Muscular, impact and control testing – several lower limb muscle groups should be put under a series of tests in order to screen for any weaknesses. Weaknesses may be evident on one side of the body, both sides or there might be an inability to control certain movements demonstrating that a single/multiple muscle group(s) are showing signs of weakness. Some muscle groups may not be able to withstand certain impacts or there may be a lack of control.
- Joint range of motion/Flexibility — All lower limb joints should be assessed to screen for any joint or soft tissue restrictions a person may have. Generally, the joints that are most relevant are the hips, knees and ankles. Similar to muscle strength, an imbalance or a restriction in both sides could be something that needs to be addressed, depending on the structures being irritated.
- Gait analysis – An accurate gait analysis is best achieved by a trained expert such as a Sports Physiotherapist or Podiatrist. They will analyse the runner, by looking at the kinematics (the way we move), with the use of video gait analysis to identify any potential variables contributing to the running related injury. These may include strike pattern, function of the foot, knee, hip and pelvis, and cadence (steps per minute). An example may be “over striding” which we know can irritate the knee joint. However, this doesn’t necessarily mean it’s the cause of the pain; we know some elite athletes have these traits but run without pain. Therefore, a runner’s gait might not necessarily be the cause. BUT, what we do know is that different running styles will put more load through certain structures when exposed to repetitive loads (e.g. forefoot striking puts more load through the front of the knee), which could be where the pain is originating from. Meaning that these structures could benefit from being offloaded by adjusting the running style.
Once you’ve had an initial assessment, treatment will usually consist of a mobility/flexibility programme, muscular strength/loading programme and running cues. This will vary from person to person depending on the presenting issue.
In summary, there are numerous ways people become injured, and not knowing what to do can become increasingly frustrating.
It is important, therefore, to get to the root of the cause through a detailed, subjective and objective assessment so that an individualised plan can be developed to treat the issue correctly.
