Common running injuries

Common running injuries.

This blog will highlight the common running injuries in both our long distance runners and our sprinters. We will look at why these might occur, the risk factors, prehab and rehab. Our main aim is to give you enough guidance on preventatives of these injuries and what to do if you might already have this injury.

Long distance running

With long distance running there are many common injuries, but here are a few we see quite regularly…

• Lateral knee pain (pain on the outside of your knee)
• Achilles tendinopathy (formerly known as tendinitis)
• Patella tendinopathy

Lateral knee pain

Due to repeated knee flexion to extension whilst clocking up the miles when running certain structures of the knee can become aggravated, for example our iliotibial band (ITB) which can lead to iliotibial band friction syndrome. This is where the ITB rubs against our lateral epicondyle (side of our knee) causing friction and pain to be present on the outside aspect of our knee. This usually occurs when an athlete’s foot contacts the floor when running.

Risk factors:

• Overuse
• Downhill running
• Poor hip stability potentially due to weakness in glutes

Symptoms: An athlete with this injury will complain of an ache/sharp pain on the outside aspect of the knee which is made worse by running.

Management

Rehab/prehab:

• Decrease load and address what might have caused the lateral knee pain- overuse? Poor hip stability?
• Glute stretching
• Hip strength work
• Hip control work
• Massage/foam rolling to symptomatic trigger points

(Brukner and Khan)

An example of a hip strengthening exercise would be clams as shown in the picture below. With this you need to ensure the hip does not role backwards.

Achilles Tendinopathy

A runner with Achilles tendinopathy will notice a gradual onset of pain and stiffness in the achilles, especially in the morning. When running the pain will decrease as the tendon becomes nice and warm to only return post exercise with a vengeance.

Risk factors:

• Changes in training patterns for example sudden increased loading
• Poor calf flexibility
• Ankle weakness/stiffness
• Poor technique

(Kader et al)

Management

Prehab:

• Biomechanical screening is a great way to allow any biomechanical issues to be highlighted to decrease the risks of developing achilles tendinopathy. For example, poor motion of the foot can increase stress put through the achilles tendon therefore, this would be highlighted and individualised strengthening/mobility would be given to the athlete
• Calf stretching
• Calf strengthening
• Ankle strengthening, this can be performed by bringing in balance work such as single leg balance into your warm up, jumping activities such as hopping on one leg and double legged jumping

Rehab:

Rehabilitation should focus on increasing strength and flexibility of Achilles and surrounding areas. The athlete should decrease their load in training such as decreasing the amount of training a week, duration and intensity. Tendon healing can be slow; therefore, stopping exercise totally will hinder the healing process due to the Achilles poor blood supply and low metabolic rate (Findley 2006).

The Alfreson protocol is a good protocol to follow which is an exercise which uses eccentric loading (Contraction with lengthening of tendon) with slight discomfort in the achilles to increase strength and flexibility of the achilles to allow healing to take place (Alfredson 2007). In Rehab don’t fully unload the tendon when the injury occurs, unload at the beginning then gradually progress. Only eccentrically load the achilles tendon post 10 days after injury.

See link below for eccentric loading of Achilles.

https://www.youtube.com/watch?v=78KxJJzVsXk

Patella tendinopathy

With this injury patients generally complain of anterior knee pain aggravated by movements involving more impact such as jumping. This pain is normally felt underneath the knee cap. Pain can develop due to repeated trauma to the knee, it is an area which is commonly overused as the patella tendon is used to transfer forces from the quadriceps muscle group to extend the knee. Pain is usually felt in exercises involving knee bending.

Risk factors:

• Tightness in quadriceps and hamstrings
• Lower limb weaknesses-Calf, glutes, quadriceps and hamstrings
• Changes in training patterns for example sudden increased loading

Management

Prehab/rehab:

• Decrease running distances
• Correct weakness in lower limb-quads, hamstrings and calves to spread forces through the knees evenly (Brukner and Khan)
• Improve hip stability and strength by bringing in some glute work
• Improve mobility of quadriceps, hamstring and calves

Rehab:

Similar to Achilles tendinopathy where we use eccentric loading to help rehabilitate the tendon we do this with the patellar tendon too. Check out the video below to see how this can be performed.

https://www.youtube.com/watch?v=Q8b7xEZmWo0

Sprinters

In sprinters hamstring injuries are very high and are one of the most commonly injured and REINJURED areas. For example in one sprint season every second injury is a hamstring injury! Scary huh? The hamstring is a two joint muscle that allows the knee to bend and the hip to extend therefore, a very important muscle when it comes to sprinting.

Mechanism of injury in Sprinting:

In sprinting our hamstring is placed through some high eccentric (lengthening of the muscle) and concentric (shortening of the muscle) loads, which you can see in the picture below showing each phase of running.

In the Swing phases which is shown in the picture above when the athlete goes from mid-swing to terminal swing the knee is being forced into sudden extension. This is when the hamstring is becoming eccentrically loaded as the hamstring is being lengthened and loaded at the same time. This part of the phase is when athletes are most likely to sustain a hamstring injury due to very high forces going through the hamstring at this phase to decelerate the leg to allow a heel strike as shown in the image below.

Risk factors:

• Previous hamstring injury
• Weak glutes- glutes help to maintain pelvic stability so are key in reducing injury
• Tightness in hip flexors- will pull pelvis forwards which will be putting more stress on hamstrings
• Age- older athletes are shown to be at higher risk
• Ineffective hamstrings- poor strength and lack of endurance
• Inadequate warm up

(Alexander et al)

Management

Prehab: You might not currently have hamstring pain however, a study by Gabbe et al showed that athletes with previous history of hamstring injury is a predictor of future hamstring problems. Therefore, it is important that prehab is used as a preventive of hamstring injuries.

With prehab we need to make sure you are keeping the hamstring nice and mobile and strong.

Example of exercises for prehab:

1. Romanian deadlifts- two and one legged
2. Good morning- Two and one legged
3. Hip flexor stretching
4. Hamstring stretching

(Palmer et al)

Check out the video below for examples of more exercises for rapid eccentric to concentric movements

https://www.youtube.com/watch?v=Ln3_YEOXbTc

Rehab:

We are all humans therefore, there isn’t a one size fits all method as we are all different.

Straight after a hamstring strain the athlete should follow the protocol- REST, ICE, COMPRESSION, ELEVATION for the first 48hours. If bruising is evident and the athlete is unable to walk they should then seek further medical attention.

After 48hours the athlete should perform pain free hamstring stretching and movement work, once this has been achieved hamstring strengthening can then be performed. Due to the high risk of hamstring re injury seeking further Sports Therapy attention might be needed to fully assess the injury to individualise the rehab program.

Thank you for reading.

Happy running!

If you have any questions please feel free to get in touch.

Jessica Woodhouse

BSc Sports Therapy MSST