By Sports Podiatrist, Mo Ali
Why do you run? Is it to regulate your weight? To compete in an ultra-marathon? To keep fit and active? To enjoy a sense of belonging and wellbeing when you join a running group?
No matter what your reason, or how far along the journey you are, keep on running! Research shows that consistent aerobic exercise decreases cardiac load (and risk of heart disease) and encourages lipolysis (fat burning – yay!). To add to the physiological benefit, there is also a long list of psychological benefits that runners report like stress relief, increased sleep quality and subsequently concentration, and decreases in symptoms of depression.
But today I’m writing about the dark side of running: injuries. Each year, it is estimated that around 50% of the running population will develop an injury. Getting injured depends on a number of factors such as age, gender, weight, muscle strength, flexibility, and running style (gait). Here are the five most common injuries in runners.
Patella-femoral Pain Syndrome (PFPS)
This accounts for 40% of running complaints. The condition is so common in running that, along with ITB syndrome, it is colloquially known as “Runner’s Knee”. It is characterised by a pain in the front of the knee, typically beneath the patella (kneecap), and gets worse throughout physical activity. You may find it most painful when you run downhill or climb stairs.
PFPS is a complex injury as it is not due to a single muscular imbalance or biomechanical (human movement) issue, but rather a combination, resulting in a malalignment of the patella in the knee joint. To complicate it further, it can be confused with bursitis or tendonitis in the knee joint. Each PFPS case is as individual as the person who has it, so assessment by a qualified health professional is encouraged in order to accurately identify the issue and treat it. Due to the nature of PFPS, preventative measures differ between people, but maintaining good muscle tone and flexibility around the knee and hip joints is going to be your best bet.
Iliotibial Band (ITB) Syndrome
This is the less common cause of “Runner’s knee”, accounting for up to 22% of running injuries. The ITB connects the iliac crest (top of the pelvic bone) down to the outside of the knee and is integral in stabilising the knee and hip during gait. Expect to feel a sharp pain in the outside of the knee that gets worse when descending hills.
The predominant theory behind ITB syndrome is that the band “flicks” across one of the bony prominences at the knee causing it to get inflamed, resulting in sharp pain in the area. The reason the ITB rubs over the bony projection is varied as it comes down bone structure, muscle weaknesses and excessive tightness. For this reason, you are best off seeing a health professional in order to address the cause of the altered biomechanics. A simple remedy is to apply ice to the painful area and use a foam roller on the ITB to relieve the tension.
Coming in as the third most common of the running complaints, and accounting for 11% of injuries, is Achilles tendonitis. The Achilles is the thick tendon at the back of your heel and translates calf activity into ankle movement. If it is inflamed, you will feel pain in the back of the heel or anywhere along the tendon and may be aggravated when rising onto the balls of the foot.
Achilles tendonitis can be due irritation from the heel cup of footwear, habitual wearing of high heels or a sudden increase in exercise. More often than not, it is caused by excessive calf tightness and eversion of the heel bone (pushing out to the side). This changes the angle of pull of the calve muscles and results in irritation of the tendon. If it isn’t addressed swiftly, potential ruptures can occur and surgical intervention will be needed. Temporary relief may be experienced by raising the heel height (and reducing load on the tendon), massaging the calves, applying ice to the painful site and ceasing activity.
Tibial Stress Syndrome
This is another really common condition, also called “Shin splints”. There are two main types: medial (inside) and anterior (front), which denote the specific area in the leg that the condition affects. It typically feels like a strong ache in the leg somewhere along the length of the shin bone (tibia) and gets progressively worse throughout the run.
Tibial stress syndrome is due to the muscle’s inability to stop rapid foot and ankle movement. Its root cause is attributed to foot mechanics and flexibility, as well as improper running technique. The simplest preventative action you can take is to ensure you have good quality running shoes that will give the feet good shock absorption and offer support where necessary.
Unlike a common bone fracture, stress fractures are not due to a sudden impact or load. These fractures affect people who do a lot of running or activity resulting in overuse. Stress fractures are most common in the bones of the forefoot but can affect the midfoot, heel bone and shin bone.
Overuse stress fractures are the result of a bone’s inability to bear the force going through them repetitively, resulting in micro-cracks which do not heel between training sessions. Less commonly, fatigued muscled can result in stress fractures (such as in the case of shin splints). They typically present during a run, occasionally with an audible ‘crack’ and immediate pain and swelling. If this occurs, stop what you’re doing immediately and get checked by a health professional, or else further complications like bone and joint deformity can develop if not addressed.
Below are some other injuries that present similarly and simultaneously and it would be remiss of me to not mention them.
If you experience pain in the heel and bottom of the foot during or in the days following a run then plantar fasciitis may be your culprit. Inflammation of the big piece of connective tissue in the foot accounts for 15% of all lower limb medical consultations. Make sure you see your podiatrist.
This typically affects the deep muscles of the lower leg and is felt in the back of the calf. It happens when muscles swell within the “compartments” in the lower leg, preventing blood from entering the muscles and resulting in muscle cramps and very firm musculature.
Characterised by a sharp pain and immediate swelling, ankle sprains cause trauma to the outside (typically) of the ankle. It results in an inability to weight bear (depending on the level of damage) and bruising. It can be due to muscle tightness, gait, foot mobility or misfortune! We urge you to seek medical attention to check for fractures, test ligament integrity and begin a rehabilitation program.
They are painful collections of fluid that ‘bubble up’ underneath the skin. Common on the balls of the foot, the little toes, and the Achilles tendon, blisters are a result of rubbing and can be easily prevented by being fitted with correct footwear. Do not burst the blister as you can introduce bacteria and cause skin infections. If they are causing excessive discomfort, make an appointment with your Podiatrist.
If you find yourself experiencing any of the symptoms mentioned, or simply want to make sure you’re in good working order, make an appointment at Podiatry First at Cremorne Physio and we can work together to keep you running for years to come.