Common running injuries

If you’re struggling to keep running and persistent issues keep hampering your training or progress, then you may want to read what Dr Alastair Jones – a Sports Medicine and Musculoskeletal Physician based in Leeds thinks are some of the most common running injuries and how they are assessed and managed.

Introduction

Running is a great way of getting out and escaping from your daily pressures as well as keeping fit and its popularity only continues to grow. As you might expect with more people running and at an increased frequency, running injuries have also increased. It is thought about half of all runners annually will pick up an injury of some description. Acute injuries such as muscle strains or falls leading to cuts, bruises and fractured bones occur, but are far less common than overuse or chronic injuries.

The term overuse in terms of injury simply means doing something too frequently or at too high an intensity so that the body does not have time to adapt and a part of it breaks down. As musculoskeletal and sports medicine physicians we see this frequently when runners build their distance to compete in longer races (going from 10 kilometre runs to half marathons for example). Chronic injuries can also be triggered by changing footwear, altering the surface you run on or adapting or modifying your running style. If the body is not used to the altered pattern of running, then it will fatigue, and injuries can follow.

Below is a brief run through of the more common chronic injuries that can plague runners and affect their ability to perform and enjoy the sport they love. This list is by no means exhaustive and seeking medical attention when you experience persistent pain brought on by running is often essential to ensure the correct diagnosis is made and the correct treatment plan is delivered.

Plantar Fasciitis (Plantar Fasciopathy)

The Plantar Fascia is a tough piece of connective tissue that runs from the toes to heel bone. It is crucial for the normal movement of the foot and ankle and it supports the arch on the inside of the foot. Plantar Fasciitis (or Fasciopathy) is a common cause of heel pain in runners and can be caused by any of the reasons listed in the introduction above as well as obesity and poor ankle flexibility. It is a degenerative condition in which the tissue breaks down and can be associated with inflammation. Runners presenting to a medical practitioner with this can expect a clinical evaluation to confirm the diagnosis and elicit the cause. This could be supplemented with investigations such as Ultrasound and MRI scanning. Treatment options include, Physiotherapy, Orthotics assessment, shockwave therapy, anti-Inflammatory medication and sometimes injections.

Achilles Tendinitis (Achilles Tendinopathy)

The Achilles Tendon runs from the end of the calf muscles at the back of the lower leg to its insertion into the base of the heel bone. Inflammation of the Achilles Tendon either at its insertion or more commonly in its mid-substance, leads to pain at the back of the lower leg near the heel. Additional to the causes listed above, tight muscles in the calf complex can also lead to this condition. Much like Plantar Fasciitis runners presenting to a medical practitioner with this can expect a clinical evaluation to confirm the diagnosis after a thorough questioning about the condition. This could be supplemented with investigations such as Ultrasound and MRI scanning. Treatment options include, Physiotherapy, Orthotics assessment, shockwave therapy, anti-Inflammatory medication and sometimes injections.

For more information on tendinopathies see our What should I do for tendon pain? article from Alastair written earlier this month.

Medial Tibial Stress Syndrome (Shin Splints)

Runners with “Shin splints” experience pain down the inside of the shinbone, usually nearer the bottom than the top. This is caused by inflammation to structures in this area. Runners often complain of pain that builds during exercise and eases with rest. It is a direct result of high impact exercise overloading the tibia (such as running on concrete) along with certain predisposing biomechanical factors. An MRI scan may be requested to help confirm the diagnosis and shed light on what may be driving the symptoms, your physician may also perform some blood tests to look at things such as calcium and Vitamin D. Treatment involves, rest, Physiotherapy to strengthen the lower limb and core, possible Orthotics assessment and a careful, graduated re-introduction to running program.

Stress Fractures

A stress fracture is caused by repeated micro-trauma over time. Much like Medial Tibial Stress Syndrome, runners complain of pain that builds during exercise and eases with rest (there may even be some pain at night). It is a direct result of repeated high impact exercise along with certain predisposing biomechanical factors. The common bones affected by stress fractures are the tibia, fibula, metatarsals, and navicular (one of the small foot bones). Diagnosis is confirmed with clinical evaluation and MRI scanning. It is also very likely blood tests will be needed to rule out other causes of stress fractures. Treatment includes rest and immobilisation for a period and then Physiotherapy to strengthen the lower limb and core, possible Orthotics assessment, possible medical therapies if abnormalities are detected on blood tests and a careful, graduated re-introduction to running program.

Patellofemoral Pain Syndrome (Runner’s Knee)

This is pain around the front of the knee. A direct result of repetitive load in certain biomechanically pre-disposed people. It has multiple causes and careful clinical evaluation is needed to elicit the correct diagnosis. Some causes may need further investigation to help guide treatment. Treatment often involves Physiotherapy to strengthen lower limb and core muscles. It may also be necessary to obtain an Orthotics assessment. Education about running technique and frequency is also essential. Occasionally certain injections can be performed which can prove helpful in the right patient group.

Iliotibial Band (ITB) Syndrome

The ITB is a very strong piece of connective tissue that runs from the outside of the pelvis to the outside of the tibia below the knee. ITB Syndrome is inflammation resulting from the band rubbing against the lateral femoral condyle of the knee joint (large piece of bone at the end of the thigh bone). The pain around the outside of the knee builds during exercise and eases with rest. ITB Syndrome can be persistent and stubborn to treat, and has a habit of recurring after resolution. Diagnosis is usually made from accurate clinical evaluation and occasionally ultrasound or MRI scanning. Treatment options include Physiotherapy, anti-Inflammatory medications, and sometimes guided injections into the area to reduce inflammation. The runner often benefits from running education to help prevent recurring episodes.

Conclusion

There are multiple common overuse injuries that can affect runners. As with all persistent injuries it is crucial to get an accurate diagnosis and treatment plan in order to return to running as safely and as speedily as possible.

To find out whether we think your issue is likely to be an overuse injury related to running and therefore whether a doctor like Alastair can help then simply fill in your clinical details for free on our online form and let us help get you on the road to recovery.