Picking up a physical activity, particularly running, is often high up on the list when it comes to setting New Year’s resolutions. Perhaps you’ve been persuaded to try your local parkrun, or taken the leap and signed up to a half-marathon or even a marathon, or you’ve simply been inspired by your runner friends to take it up. Whatever your motivation, running is one of the best ways to progress both your physical fitness and mental wellbeing.
My relationship with running dates back well over 30 years. I’ve had pretty much every injury a runner can have and so who better to give you some tips than a fellow runner who's also a physio.
Common running injuries and signs to watch out for
I’ve learnt over the years that you shouldn't fear injury and that an injury shouldn’t stop you. With support and education, you can overcome them.
Common complaints we see from runners in clinic include:
Patellofemoral Pain Syndrome (PFPS) - Characterised by pain around and under the kneecap (patella). This is the most common running injury we see in runners and is often referred to as ‘runner’s knee’.
Achilles tendinitis - A nagging, dull or sharp pain along the back of the heel where there is a thickened tendon. Limited ankle flexibility may also occur. A common symptom is stiffness, especially when you get up first thing in the morning, or when you move after periods of sitting or lying down.
Stress fractures - This is a small break or crack in the bone, commonly occurring in the shin (tibia), second toe (metatarsal) and around the ankle, but can also occur in the hip. There may be an area of bony tenderness which worsens on any weight bearing activity, especially on running, or a generalised ache that may become more localised over time. If your problems persist, even after a period of rest, it is important to seek medical advice.
Hamstring strain - A pain at the top of the hamstrings near the buttocks or in the middle of the back of the leg while running, particularly if you’re doing speedwork or running uphill.
Shin splints - A nagging pain focused on the front of your leg along the shin bone (tibia). A tell-tale sign is that it appears during and after exercise and when you press on the affected area on the lower leg.
ITB irritation - An aching, burning pain on the outside of the knee that sometimes radiates up the thigh to the hip. Pain will occur early on in every run, usually within the first 10 minutes.
Lateral ankle sprain - There are two types of lateral ankle sprains - mild and severe. Mild sprains cause moderate pain, swelling and some difficulty walking. Severe sprains bring on significant pain, swelling, bruising and joint instability.
Plantar fasciitis - A sharp stab or deep ache in the heel or along the arch of the foot, especially in the morning, after sitting for long periods of time, or during the push-off phase of your gait.
Read more about plantar fasciitis here.
Piriformis Syndrome - Pain, cramping and tingling in the glute muscles that may radiate down the back of the leg and into the foot.
Lower back pain - Muscle-related pain on either side of the lower part of your spine. You may feel spasms or pain on one side of your spine, especially when you twist or move.
Triggers of the above injuries can be caused by one or a combination of the following:
- Overtraining
- Increasing mileage too quickly
- Biomechanics and running gait
- Fatigue
- Poor footwear
- Intensity
- Frequency
- Failing to warm up or down correctly
While you can manage some injuries yourself at home, a number of running injuries will require more comprehensive rehabilitation. It’s key that the symptoms are treated, but it’s also important to take a step back and review the injury holistically to prevent future recurrence.
How to avoid a running injury and stay reasonably injury free
Running progression - A training plan with structured recovery built in is vital. The human body is robust and can adapt to manageable stress. However, any sudden changes in mileage and/or intensity can increase your risk of injury. A week-on-week increase of around 10-15% is the rough guide. As an example, if you run 5 miles in week one, increase this by 0.5 mills - 0.75 miles the following week. The same applies to intensity. You could explore using the heart rate monitors within smart watches. If you do want to increase intensity, do so one session at a time, and work on a lower overall mileage in that period. Most of your running should be at a fairly easy zone two pace, where you should be able to still maintain a conversation.
Strength – Carrying out strength and conditioning work that targets the main muscles required for running means that you’re far less likely to overload these muscles and end up having to seek medical attention. Physiotherapists can provide a weekly maintenance and strength programme as an aid to addressing some of the below niggles that runners face on a regular basis. This work will also help you to get faster.
Flexibility - Alongside running, consider taking up 10 to 15 minutes a week of Yoga or Pilates. Whilst several recent studies limit the benefits of stretching, from my experience as both as a physio and runner, those who commit to these activities experience less down-time due to injury.
Rest between sessions - If you have planned a hard session use the following session as a recovery one. Also take a well-earned day off, or a slow and relatively short recovery run. These should form the foundation of any good training programme.
Running fuel – Fuel is an overlooked aspect of being able to maintain running form and prevent injury. Starting a run dehydrated and with a poor diet potentially means poor decision making with reduced muscle energy. When you’re running, you’re loading at over three times your bodyweight. If you haven’t fuelled properly, you increase your chances of making technical errors or overworking an already fatigued muscle group, therefore increasing your risk of injury.
Find out how to fuel your body with a balanced diet by reading this article here.
Check your muscle imbalances – Most of us are either right or left side dominant. Whilst on a day-to-day basis this makes no odds as we simply adapt to having an imbalance, when we’re running our imbalances can impact our gait and lead to overuse injuries. A physiotherapist can play a role here in helping you to address some of these imbalances.
Be careful running when you haven’t recovered from a previous injury - Many runners return to training before they have fully recovered. This can lead to an injury returning within the first few runs, making it even harder to recover from. At Ascenti we use a clear return to running protocol which can help you to overcome this.
Warm up and cool downs - Warming up increases your heart rate and your blood flow. This facilitates more oxygen to reach your muscles. It also activates the connections between your nerve and muscles, which improves the efficiency of movement. You can complement this warm up with dynamic stretching. A cool down at the end of the run to reduce your heart rate will aid the process of recovery. Stretching each of the main muscle groups for 10 to 15 seconds can restore their length and bring your mind and body back to a resting state.
Can I run with an injury?
Running is a multifaceted activity using both upper and lower limb muscle groups. We’ve already discussed the risks of running having not recovered from a previous injury, but where is the line between a minor niggle that can be tolerated or something that might be more serious? Whilst quick fixes such as pain relief or taping can provide short-term aid, we want to provide a service for happy, healthy runners to have a long running lifespan.
There isn’t one single answer to the question of whether to run through an injury, but here are a few areas that should be considered:
Is your injury recent or a recurring chronic injury?
If you are in the first 14 days of an injury, rest would be the best solution. The risk of aggravating the condition is high and the benefit of continued running is low considering the time frame needed for most acute injuries to resolve.
When it comes to a chronic injury, the answer isn’t as straightforward – you’d need to weigh up the pros and cons. Some injuries take longer to heal and are best addressed with rest. We mentioned previously that it’s beneficial to mix up your training to prevent injuries - you may be able to perform alternative training activities to maintain your conditioning while reducing the training loads and stress on the healing tissues to an appropriate intensity. Your Ascenti physio can help here in providing guidance around this area.
Does your pain persist or improve with running?
It’s common to feel niggles or twinges as we return to running after an injury. There’s a low level of risk with niggles that resolve quickly and allow you to continue without ongoing symptoms overtly present. We can also modify our activity to decrease the level of risk.
We should never run through pain, especially if the pain is increasing. Your body uses pain as a signal and that signal should be respected.
Running modifications include altering surfaces, volume, cadence and gait. The evidence base shows that overstriding can lead to increased ground reaction forces and increased stress to the running muscles. Also by increasing cadence, shortening of your stride can have the potential to decrease ground reaction forces and symptoms.
Another method of reducing the ground reaction force includes altering the surface. A great example of this is in the use of a treadmill as you can control the pace and many treadmills also cushion the running surface area.
What if the pain persists?
If you are unable to tweak running modifications without continued pain, then you should stop running. If you’re feeling pain that’s around 6 or 7 out of 10, that’s impacting your daily life, or that lingers for more than 2 weeks, get yourself some help. This is an indication that you have an underlying condition which needs looking at, so at this point the role of a physiotherapist is vital. .
At Ascenti we would conduct an initial assessment to identify the source of your pain, and develop a treatment plan, including corrective exercises. Treatment may also include manual therapy, complimentary training or cross training to help you maintain aerobic fitness. We will use our award-winning patient app to provide you with exercise instructions and a treatment plan, where you will be able to access demo videos, track your progress and leave feedback for your physio to see. This is a great tool as it gives you 24/7 access to guidance and the confidence to know that you are doing your exercises correctly.
If you are an injured runner, I would encourage you to book into one of our clinics to get to the root of your problem, and get you back to doing what you enjoy.
