Treatment for Running Injuries

Matthew Gordon, PT, DPT talks about treatments for common running injuries.

Today we are going to be talking about common injuries that people sustain while they are preparing for a race. Matthew what is one of the major reasons why people get injured while running?
One of the best statements I have seen recently is that while running your body has to absorb 1.5-3 times your body weight as the foot contacts the ground. They went on to say that, in a typical mile we strike the ground 1000 times. This means for a 125 pound person their body may have to absorb more than 180 tons worth of force over just one mile. It is the combination of the amount of force and abnormal mechanics that lead to injury.

Now that we know why we get injured lets start from the bottom up and discuss common foot injuries.
Plantar fasciitis is one of the most common foot injuries we see. It is an overuse injury that for some is the result of abnormal mechanics due to weakness and or decreased flexibility of the calf muscles. But for those who are preparing for an upcoming run the increase in training and abnormal mechanics can lead to irritation of the fascia and lead to pain. For example tightness in the calf muscles and weakness in the muscles that control the arch can lead to a decreased ability of the muscles to absorb force while running. This results in an increased load into the fascia which over time will lead to irritation, pain, and injury if not corrected.

What are treatment options for plantar fasciitis?
Two things you have to address are the painful tissue in the sole of the foot and the causes of the abnormal mechanics. Message, stretching, and Astym are great treatments to directly effect the tissue on the sole of the foot. Performing specific calf stretches and strengthening of the muscles of the arch are also ways that can alleviate causative factors. Lastly, you must look up the chain to the knee and hip in order to properly treat plantar fasciitis.

Runners can complain of pain in their shins – what causes this pain?
Oftentimes pain that is located in the shin is known as shin splints. The pain of shin splints is the result of overuse and inadequate recovery time. Also, running while fatigued can result in the force being absorbed where the tendon inserts into the bone – as this continues, the forces can cause the outer layer of the bone to be pulled off. This is what leads to the pain not only with activity but while at rest also.

What is the treatment for this kind of injury?
Initially, activities need to be modified to allow for increased recovery time. Next you need to address the flexibility of muscles in the calf and shin. Also, strength and endurance of these muscles need to be addressed. As I mentioned, if a person is running while fatigued, the forces will not be absorbed by the muscles, but by bone and this is why strength and endurance is a key to rehab.

Next let’s move up to the knee and talk about common running injuries there?
One of the more common complaints people have in regards to their knee is pain at the front of the knee – or just behind the kneecap – this is known as patellofemoral pain. The pain is typically caused by abnormal alignment and gliding of the kneecap as it moves on top the femur during walking and running. Typically, it is the result of weakness in the muscles of the hip and ankle or unequal strength in the sides of the quads. As with the foot – weakness and decreased flexibility lead to altered mechanics and when this is combined with the increased force and repeated stresses associated with running, injuries are likely to ensue.

What are treatments for patellofemoral pain?
Assessing for muscle imbalances, tightness, and weakness at the hip, knee, and ankle are the first steps in determining how to best treat a patient. Oftentimes, weakness in the hips leads to the knee dropping down and in during running and as a result causes abnormal tracking of the kneecap. As this abnormal tracking continues it will result in stress on the surrounding tissues and then can lead to irritation, inflammation, and pain of the knee. Thus very often knee pain is originating from the hip.

Let’s talk about the hip – what is one of the more common hip injuries seen in people as they prepare for the race?
In regards to the hip, typical injuries include strains to the muscles that control the hip. These muscles include the quads, hamstrings, and muscles of the gluts. Strains are the result of micro-damage and is typically the result of overstretching the muscle or overuse.

What is the common treatment for a strained muscle?
Initially, you want to allow the muscle time to heal. You also need to be stretching the tissue to reduce strain in the muscles once you return to activity. Lastly, working the strength and endurance of the muscle is very important because it will reduce the risk of future strains.

What is an important thing to remember about treating a strain?
One of the most important things to keep in mind when you have a strain is that you need to properly rehab it. While the muscle does have an ability to heal on its own, it does not always properly heal. This is when you need a physical therapist to help the muscle lay down new tissue that is properly aligned and thus will improve the function of the muscle. It is also important to remember that when a muscle is not properly rehabbed – compensations will occur. And as we have mentioned multiple times, compensations can and do lead injury. Our body is like a car, if we take care of our body now it will last longer and run better. That is what the Doctors of Physical therapy at Mettler are here to help you do. We are here to help you run better and to get the most out of your body.

I heard you had an injury – how has that affected your participation in the race?
I did have an injury that resulted in my back muscles going into spasm for about three weeks. It was extremely hard to bend let alone run. During this time, I was not able to run, but I am now back and progressing well. But I had to follow the advice we have been discussing today.

What if someone has one of the injuries we discussed or a different injury?
If someone listening has an injury that is affecting their ability to participate in their training or like my injury has completely stopped you in your tracks – the next step is to come to Mettler. Our skilled Physical Therapists will assess how you move and create a plan that is specific to you. As I stated last time, the therapists at the Mettler Center are here to help you achieve your goals and help you do so while functioning at your best.

Lastly, with the race less than two months away - is it too late to start training for the race?
People still have time to train for the shorter distances, but the half and full marathons would be tough if you are not already regularly participating in running.  I do want to encourage people overall to become more active. The American Heart Association recommends that adults get 30 minutes of continuous activity five days a week. If you are unsure of how to start an exercise program to help you achieve this – I encourage you to come in and see the facilities we have at the Mettler center. Our physical therapists and personal trainers can help create specific exercises programs for you that are focused on achieving your goals.