Running injuries
If you are a runner, and unless you have been very lucky, you will most likely have experienced a running related injury. A quick Google search tells us that the most common running injuries are anterior (front of the) knee pain, Achilles tendon issues, ITB (Iliotibial Band) syndrome, shin splints, plantar fasciitis and stress fractures. Recognise some of these? Bring back painful memories?
These injuries are caused in as many ways as there are runners, and that doesn’t just mean the physical cause of the injury. Social, emotional, lifestyle, training plans, nutritional factors and maybe even Strava may also come into play when discussing injuries, their causes and prevention.
What Does the Science Tell Us?
As we can see, there is limited and inconsistent evidence for the suggested causes to many common running injuries. The evidence for the different causes of injuries is mixed. Injuries are as individual as the injured runner, so a “one size fits all” approach to cause and subsequent rehabilitation doesn’t necessarily work. What works for one person for an injury may not work for you. There are too many factors, although patterns will exist.
But They Are Due to Overloading Tissue Beyond its Tolerance Point
Running injuries are generally chronic and multifactorial. The repetition of continued load and strain on the body when running is what is leads to an injury. Bodies will have a tolerance what they can withstand, and once we go past that we are at risk of an injury. Bones and /or soft tissue, are affected, which is why biomechanical considerations, running technique and the type of running shoe are important considerations when dealing with an injury. This is what training does, it causes tissue damage. We then need the bodies own repair process to kick and repair the damage we have caused with training. When this breakdown / repair is not in favour of repair, we will break.
Why Recovery Is Important
In relation to injury prevention and recovery, it is important to understand the quality versus the quantity of our running. Are we training or racing? We need to understand load management throughout our running gait cycle. Other influences such as daily stress, nutrition, how well we breathe, and sleep will impact recovery times and general likelihood of injury. There are many stress factors that will affect our body, not just running. A busy hectic week with the family or work will have an impact on our training and recovery. A poor nights sleep, rushed meals, not enough fluids during a hectic day and our body is already under more stress than an easier day. This is often why elite runners can train so hard, all of the other stresses are very much reduced or taken care of. They just need to concentrate on the training.
Bone and Soft Tissue Injury
Our body is made up of bone and soft tissues – put very simply – but there are also different types of bone and soft tissues. Both will be subjected to loading stresses, but differently and will need a different approach to managing the injury. They are both repetitive strain injuries.
We suspect a bony injury when the onset is sudden, and it is too painful to run. Bone injury pain is often noticed after a short run that has followed a longer run. Unlike other running injuries, pain from bony injuries doesn’t ease up.
Soft tissues injuries are a little more subtle and therefore it can take longer for us to seek help and get treatment. Often, we can run through the injury, especially at first, and the running seems to ease the discomfort, but the pain will reappear following the run. Soft tissue injuries tend to follow the pattern of progressively coming on quicker during runs and then lasting longer afterwards. This slow progression of pain leads to us taking longer to stop running and seek treatment than the repetitive strain injuries or bony injuries.
Repetitive Strain – the curse of training
Running training is all about repetitive strain. Running is about doing the same thing over and over again. Repetitive strain Injuries occur when body has reached its capacity to absorb the load being applied. Basically, it is when we are over-working our body and tissues are damaged and not allowed time to repair, before we damage them again at the next session. When there is the pressure of training for specific events, or if we have particular race goals it can be tempting to ignore the niggles and “power through” even if something hurts.
Wearable data such as Strava could be a growing factor in this. The motivation of wanting to share running achievements or hit specific targets means that we might be pushing ourselves more than might be good for us. If we don’t give ourselves enough time to recover, this can lead to fatigue in muscles and joints, making them more susceptible to repetitive strain injury. Footwear is a vital link in staying well while running. Footwear needs to suitable for what we are doing and allow the body to move in an efficient way and is a very individual thing. Learn how and why you move as you do, then match a shoe to YOUR function.
Injury Progression – When do we call it
Injury progression is slightly different for each type of injury, but the general pattern can be seen in all types. Whenever we get injured, it takes a little while for our “running brain” to listen to our “pain brain”. At this point, we eventually realise that we have an injury and help is needed. The seemingly logical thing to do here is have a few weeks off running to rest and hope that the body will fix itself. Often this is followed by trying to start again, but with limited success because each time we start back running, the issue returns.
To recover successfully from injury, we need to take action at the first signs of injury. The very first thing we need to do is to reduce loading and reducing activity by 50% is a good plan. This is combined with looking at training plans to consider the injury and the goal, while encouraging recovery. Other factors such as external stresses need to be considered and reduced if possible. In terms of training and performance, the priority at his stage is recovery and rehabilitation. This can be a very frustrating time, especially for a very active person, but there’s no need to panic – this reduction in activity and load is a short-term change only, if done correctly.
Keeping on doing the same thing and expecting a different result is well used quote. We have to do something different so our body is not being subjected to the same damaging loads.
Bodies are trying to protect us – Pain guarding and Injury
Bodies are trying to protect us. Pain is used to alert us to something that isn’t right. Our bodies are often way ahead of us. They know when something is starting to go wrong, tissue is damaged and not being given enough time.
On a run where we experience pain either on or after is our bodies way of saying there is a problem starting here. We can get away with ignoring it for a bit, but if the problem is the same, or building then we have to act quickly. Stopping totally is often not the best way. As the body then thinks the problem has gone away. It hasn’t, we haven’t triggered enough of a load to cause the issue to be flagged up.
Also our repair system may also have switched off a bit. So then when we run again we trigger that system and pain and tightening of tissue is activated. But maybe at 8 miles rather than 10, the next time at 6 miles, then 5. The problem may not be getting worse but our body is getting better at protecting us. It knows there is going to be a problem unless it does something about it.
Pain is our bodies response to a perceived threat
Based on previous experience and is a learnt process. We are continually learning and so is our protection mechanism.
So What Can We Do?
During the recovery phase, we have decrease the damaging loads and encourage healing. That’s it really.
We can include stretching and mobility activities, specific strength exercises and changing activities to stay active but reduce the damage from specific loading patterns. Finally, the return to running should be gradual and monitored. It goes without saying that the return to running after an injury must be gradual, and that there will be some, if not a lot, of frustration. We must plan for between 4 and 8 weeks of consistent rehabilitation to get to the point where we can start to think about proper training. The issues is often our physiological health comes back faster than our tissue tolerance health. This means our lungs and heart fitness is far ahead of our body fitness. Injury return at this stage is a huge factor.
Certain people at certain times of life are more susceptible to injury. A big one, whose effects will be felt by more than half of the adult population, is the menopause. Due to the changes in hormone levels, the body starts responding differently and this affects all aspects of life. For runners, the impact that the menopause has on running can be unsettling and annoying. There are the various pains and aches, and changes to metabolism and body mass ratios associated with this time which affect the desire and ability to exercise. Proper nutrition, especially vitamin D is essential, as is good quality sleep. Many people find that HRT treatment can make huge differences.
What Can We Offer?
We have a variety of options to help you understand your injury and aim to diagnose the structure what is damaged and what is causing you the pain. Then aim to work out why it is happened. We discuss training, lifestyle, running goals, previous injury, other activities, footwear, day to day, anything and everything could be worth looking at.
Our assessment involves on the couch look at feet, legs, flexibility, strength. Standing to see how your feet respond to loading, arches, big toe joints, leg, knee, hip, pelvis and whole body position.
We look at you walk barefoot and video so we can show you what we see. We have a pressure plate you can stand and walk on. This shows how much pressure you put on each foot / leg and which part of your foot. A pelvis rotation can be often been seen by the way your body weight is distributed over your feet. Footscan and Phits Orthoses – Colpod therapy
We have a baiobit – a small device that fits on your pelvis when you walk. This tells us what your pelvis is doing, if your stride is equal, what the acceleration of each foot is and is linked to the footscan data.
If you are running we will video you running in your running shoes. This is crucial. We look at all of you, not just your heel. The aim is to see where your contact position is in relation to the rest of you, what happens to your foot, knee, hip, pelvis when you hit ground, move over your foot and as you move into the push off phase. We look for how your upper body and arms move. Your injury is caused by a specific movement / loading pattern. We aim to identify it.
Treat the Cause, not just the Symptoms
But most importantly, we need to know why this happening. This is the bit that needs treating. Your symptoms are the point where your body has broken down, the cause may be somewhere else. Treatment is often aimed at the symptoms (as it should be) but treatment has to address the cause and not just symptoms.
Treatment
Includes a discussion about what we think is going on and what needs to be done.
We advice on load management, different activities – we often want you to run again, but differently, with a different emphasis. There will probably be specific exercises for mobility and strength. Learning how to walk and run again is always a good discussion. We may carry out manual therapy and or shockwave to help the tissues relax and not be so helpful in their guarding patterns. We need to down regulate your very active nervous system that is on high alert. It needs to stop being so helpful at the slightest new thing.
Changing the Way you Move
This is important and it may be a big part of a long term plan. Reducing the specific damaging load is important and building tolerance into tissue is key. Knowing how you move is important and what to do about it . Making conscious changes are hard, but can be done with drills and running exercises.
Orthoses can also be helpful. We now use various 3D printing techniques for both design and print to ensure that orthoses are now designed to help you move in a different way. We very rarely talk about arch support, but look at how we can get your feet working again. Orthoses can be a really important part of this. All is explained. No one needs orthoses, but for some people they are the key to gets everything working again. They don’t need to be forever. They are there to do a specific job, to allow your body to move again.
What to do now
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