Five Common Running Injuries: Causes, Prevention and Treatment

Some runners are lucky and rarely suffer injuries, while others always seem to be battling various aches and pains. No matter which camp you fall into, remember that pain is your body's way of telling you there's a problem, so don't ignore it.

While virtually any type of injury can befall a runner, there are some that are particularly common. Here are five of them, and their causes, prevention and treatment:

• 1. Patello-femoral pain syndrome : Otherwise known as ‘runner's knee.' This manifests itself as pain felt in the front of one or both kneecaps. Some people with this problem actually hear clicking or crunching noises when the knee is moved.
  Causes: Muscle imbalance is often the culprit, particularly weakness in the inner quadriceps (thigh) and tightness of the outer quadriceps and the iliotibial tract, which is a fibrous band along the outside of the thigh.
  Unsupported flat feet or weakness of the outer hip muscles can also cause this problem. There's a theory that people with wider hips, e.g. women, are more prone to this problem because their legs ‘slant' from the hip to the knee area, thus putting more pressure on the knee.
  Prevention/Treatment: Stretch all outside hip muscle groups both before and after running (remember to warm up for a few minutes before your pre-run stretch) and make sure your inner quadriceps and hip muscles are as strong as possible. Ask a physiotherapist for specific exercises to strengthen this area. If flat feet are the problem, investigate arch supports/orthotics.
• 2. Shin splints : These are often stubborn and difficult to get rid of. The pain is felt on the front inside part of the shin. Shin splints result from a muscular imbalance between the front and back calf muscles. Left untreated they can even lead to a small tearing of the muscle away from the bone and develop into a stress fracture.
  Causes: Shin splints can be caused by biomechanical problems such as over-pronation (feet rolling inwards) or legs that are either too stiff or too loose, or such things as flat feet, switching too quickly between flat and hilly running, worn out shoes and/or inadequate stretching.
  Prevention/Treatment: Strengthen the muscle group at the front of the shin and make sure that you warm up and stretch adequately before running. Check your shoes and make sure you are replacing them often enough. If you do have an injury, apply ice, using a frozen bag of peas wrapped in a towel to the injured part for eight to10 minutes at a time. You can do this as often as you like, but wait 30 minutes between icing treatments. After 48 to 72 hours, the injured part should be feeling better.
  
• 3. Plantar fascitis: Pain felt in the arch or heel. The plantar fascia is a fibrous ligament covering the bottom of the foot. If strained, it can cause inflammation and pain.
  Causes: This problem can be caused by flat feet, over-pronation (feet rolling inwards), a tight Achilles' tendon, worn out shoes, sudden increases in mileage or changing running surfaces too suddenly, e.g. from pavement to sand.
  Prevention/Treatment: Forgive the repetition, but again, warming up and stretching are key, with a focus on stretching your calf muscles. If you develop a plantar fascitis problem, try massaging the arch of your foot with a frozen water bottle, or roll a golf ball in the arch of your foot to break up scar tissue.
• 4. Achilles tendonitis: Pain felt in Achilles' tendon due to repetitive stress or a single trauma to the area.
  Causes: Again, biomechanical problems of the leg or foot, such as over-pronation (feet rolling inwards), tightness of the calf muscles or poor footwear are the likely culprits.
  Prevention/treatment: More stretching! You may also need to try heel lifts in your shoes, a temporary reduction in mileage or no running at all for a period of time and application of ice. If it's caused by a biomechanical problem of the foot or leg, physiotherapy can address the root cause.
  
• 5. Iliotibial band syndrome: The iliotibial band is the fibrous band along the outside of the thigh. The syndrome involves pain felt on the outside of the hip, leg or outside of the knee.
  Causes: Once again, biomechanical problems such as over-pronation of the feet can cause this problem, as can weakness in the outer hip muscles, running on banked surfaces and lower back problems.
  Prevention/Treatment: You may be getting tired of hearing it, but stretching (always remembering to warm up before you stretch) will help both prevent and treat this problem. You will need to strengthen your hip muscles, and a physiotherapist can advise you on how to do this.
  

To sum up, let's borrow the lyrics from that old song, "Dem Bones":

"The foot bone connected to the leg bone,
The leg bone connected to the knee bone,
The knee bone connected to the thigh bone
The thigh bone connected to the back bone..." (etc.)

If running becomes painful, it's useful to remember this little song. While injuries may be just what they seem to be – in other words, a pain in your foot is a foot problem – they can just as easily be caused by biomechanical problems either above or below the actual site of the pain.

Let's review the advice that keeps coming up over and over again -

• Warm up and stretch thoroughly. Skip it and your body will pay the price.
• Change your shoes regularly, because running in worn out shoes will not give you the shock absorption you need.
• If you apply the preventive and treatment measures we've talked about in this article and you're still having problems, consider taking some time off from running and either cycling or running in water as an alternative exercise. In addition, you may want to seek professional help.
• It's true that some people are simply more vulnerable than others to the injuries described above and some become "former runners" as a result of chronic problems associated with these injuries. When you run, you are asking a lot of your body - don't forget to listen to it in return and pay attention to what it's telling you.

Laurie McLaughlin is owner/director of ProActive Physiotherapy ( Hamilton ) and ProActive Therapeutics ( Oakville ).