The 5 Most Common Running Injuries - ABD Chiropractic & Sports Wellness

Here are the 5 most common running injuries a runner will potentially face during their running career. These are the highlights of what the injury is, what symptoms you’ll experience as a result, the cause of the problem, how to do some self treatment, medical treatment, alternative exercises to do while you’re healing from the injury and also some preventative measures. These really are the basics though, I encourage you to see professional care if you feel that you are experiencing any of the following.

Achilles Tendonitis

Definition: Starts as inflammation of the Achilles tendon. The Achilles is the large tendon that anchors the major calf muscles, gastrocnemius & soleus, to the back of the heel bone. Under too much stress, the tendon has to work too hard causing it to become inflamed. If this continues for a long period of time, the body can produce a covering of scar tissue, which is not as flexible as the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Symptoms: Dull or sharp pain along the tendon but typically close to the heel. Limited ankle flexibility. Redness, heat & possible swelling over the painful area. May have a nodule (scar tissue) that can be felt on the tendon. May produce a cracking sound (scar tissue rubbing against the tendon) with ankle movement. No bruising.

Causes: Tight or fatigued calf muscles cause more stress to be placed on the tendon during activity. This can be due to poor warm up, increasing distance too rapidly, or over-training excessive hill running or speed work, both of which stress the Achilles more than other types of running (more on your toes). Runners who overpronate (feet roll in too far on impact) are most susceptible to tendonitis.

Self-Treatment: Rest – stop running or at least slow to a walking pace for a while. Ice the Achilles for up to 20 minutes or once skin is numb (will feel cold, burning, relief & then numbness). Wait at least 60 minutes before icing again (allows skin to re-warm itself). Self-massage with arnica, biofreeze or some other anti-inflammatory gel in semi-circles away from nodule up to 3 times per day until nodule is gone. Do gentle stretches of the calf muscle. Avoid running until you can do heel raises & jumping exercises without pain. Return to running gradually. Typical recovery time is 6-8 weeks.

Medical Treatment: If injury doesn’t respond to self-treatment in 2 weeks, see a sports certified chiropractor (CCSP or DACBSP), MAT (Muscle Activation Techniques) therapist or other alternative health care provider first. Then upon his/her recommendation, see a physiotherapist or orthopedic surgeon. These doctors have access to several modalities to aid the healing process & further evaluate the severity of the condition.

Alternative Exercises: Swimming, pool running, cycling (in low gear) “spinning”. Avoid of do very little weight-bearing exercises.

Iliotibial Band (ITB) Syndrome

Definition: Pain & inflammation of the outside portion of the knee, where the iliotibial band attaches to the knee. Friction occurs between the ITB & the femur (long bone of thigh), which can result in producing inflammation & pain.

Symptoms: Initially, a dull ache 1-2 kilometers into a run, with pain remaining for the duration of the run. The pain disappears soon after you stop running. Later on, severe, sharp pain which prevents running occurs. Pain is typically worse running downhills or on cambered surfaces. It may be present when walking up or downstairs. There is local tenderness & inflammation on the outer portion of the knee.

Causes: Tight & weak gluteals (the muscles of your bottom). Overtraining with high amounts of hill training (especially downhill) or training on hard surfaces along with cambered surfaces. Overpronation (where the foot rolls in too much), poor shock absorption of shoes or worn shoes. Bicycle seat set too high, improper adjusted bike pedals. Leg length asymmetry.

Self-Treatment: Mild pain, modify workout routine by reducing training load & intensity & avoid running downhills or on cambered surfaces. Severe pain, stop running all together. Start taking a natural anti-inflammatory supplement (i.e. Bromelain, MSM, etc). Apply ice to the knee until skin is numb (approximately 20 minutes) & then take a 60 minute break before repeating. This helps to reduce the inflammation. Self-massage, using arnica, biofreeze or an anti-inflammatory gel, to the muscle & the band (along the outside of the thigh only, not down the side of the knee where you feel the pain as this will only aggravate the problem). Stretching the ITB: Stand with the right leg crossed in the back of the left leg. Extend the left arm against a wall/pole/chair/other stable object. Lean your weight against the object while pushing your right hip in the opposite direction. Keep your right foot anchored while allowing your left knee to flex. You should feel the stretch in the ITB muscle in the right hip and along the outside of the right thigh. Hold for 30 sec. Relax slowly. Repeat to opposite side. Repeat stretch 2-3 times per day. Return to running gradually. Full recovery is usually between 3-6 weeks. Get proper fitting shoes (go to running store & have the gait analysis done).

Medical Treatment: If your injury doesn’t respond within 2 weeks, go see a sports certified chiropractor (CCSP or DACBSP), MAT (Muscle Activation Techniques) therapist or physiotherapist. Then upon his/her recommendation, see a physiotherapist or orthopedic surgeon. These doctors have access to several modalities to aid the healing process & further evaluate the severity of the condition.

Alternative Exercises: Swimming, pool running, cycling (in low gear) “spinning”. Avoid any exercise that places straining onto the ITB, in particular, avoid stair-climbing.

Preventative Measures: Strengthen the hip adductors/abductors (inner thigh & out thigh respectively), hamstrings, quadriceps & calf muscles. Appropriate shoes, have them fitted for you (involves gait analysis).

Runner’s Knee

Definition: Inflammation of the infrapatellar tendon (portion of tendon below the knee). This condition is also known as infrapatellar tendonitis, patellofemoral pain syndrome & jumper’s knee.

Symptoms: Discomfort around the knee, mainly below the knee but is also poorly localized. May experience increased pain during &/or after strenuous activity (going up & down hills, especially down). May also have an increase of pain after prolonged periods of sitting with knees flexed. This pain is relieved by straightening the leg. May also have pain when standing up from a seated position. Swelling is typically rare for this condition.

Causes: Overpronation (feet rotate too far inward on impact), which can cause the kneecap to twist sideways. Knee instability, genu valgum (knock-kneed), tight gastrocs & soleus muscles, or leg length asymmetry. Muscular imbalances: tight hip flexors, knee extensors, hamstrings, ITB & gastrocs; weak paraspinals (muscles that run right along the spine), abdominals, quadriceps & tibialis anterior. Training faults: running on a cambered surface (creates a leg length asymmetry), improper/worn out shoes, cycling with improperly adjusted toe clips, increased mileage too rapidly (10% rule = don’t increase mileage more than 10% per week), hill training – especially downhill & stair climbing, repetitive jumping, excessive sprinting or stop & go, hard surfaces, & weight lifting – squats or repetitive deep knee bends.

Self-Treatment: Rest: 1-2 weeks; avoid offending activity – hills, cambered surface, jumping, heavy lifting, squats, stop & go (line drills) & inappropriate shoes; pool exercises with Aquajogger is a good way to continue aerobic low impact exercises; running in the shallow end of the pool is another alternative; note that the treadmill is also lower impact than running outdoors; return to walking program first and then proceed to running. Ice 15-20 minutes or until the skin is numb 3 times per day & after activities/training. You can also wear an elastic knee brace with a cutout to help with support for the knee. Self-massage with arnica, biofreeze or another anti-inflammatory lotion on all the sore spots around the knee. Once pain-free, start strengthening the quadriceps muscles. Exercises include: 1) Place pillow under knee, tighten quadriceps, push knee down into pillow and lift foot up 20 times & then do on other leg. 2) Repeat exercise as above with foot turned out in order to strengthen the inside of the quadriceps muscle. Repeat exercise 20 times for each leg. 3) Squats. Perform with back against physioball placed against a wall. Bend knees slowly to between 45 – 60 degrees. Ensure that knee travels over line between big & second toes. Hold for a count of 5 seconds. Relax slowly. Do one set of 20 reps. 4) Step-downs. Stand on step or box. Tighten quadriceps and lower opposite leg slowly to the ground. Ensure that knee travels over line and between big and second toes. Then raise the leg up onto the step, relax. Repeat 20 times for each leg. Increase the number of repetitions in increments of 5 every two days, all the way up to 60 reps. Full recovery is usually between 4-6 weeks.

Alternative Exercises: Swimming, pool running, cycling (in low gear) “spinning”. Avoid or do very little weight-bearing exercises.

Preventative Exercises: Proper warm up, microprogress your way into your activity (i.e. if you’re going to be running, start first with walking, then jogging, then running). Light stretching after running of the quadriceps, hamstring, ITB & gluteals muscles. Have your shoes fitted (someone who will do a gait analysis, put you on a treadmill, etc. Gradual progression of your training program & incorporate rest time into your training program as well. Avoid excessive hill training & speed work.

Shin Splints

Definition: Inflammation of the muscle attachments and interosseous membranes to the tibia (shin bone) on the inside of the front of the lower leg. Note: “shin splints” is a very widely used phrase and can refer to several lower leg injuries. It’s a generic catchall term referring to leg pain brought on by any running or jumping activity. “Shin splints” is more of a symptom than a diagnosis. The focus of this description is specifically on the inflammation described above.

Symptoms: Pain or tenderness along the inside of the shin that occurs during specific activity & increases during the activity. Initially the pain is relieved with rest, as the condition worsens the pain becomes constant & can even occur at night. Pain on palpation (touch) of the shin & with passive (someone/something else doing the stretch) stretching. Pain is most severe at the start of a run but may disappear during the run as the muscles loosen up. This is different from a stress fracture where the pain will be continuous throughout weight-bearing activities (walking, running). Swelling is rare. Small lumps or nodules along the muscle attachment to the tibia may be present & could be an indication of a more severe situation (compartment syndrome).

Causes: Repetitive impacts, most commonly in a runner, aerobic dancer, or other running/jumping sports, gymnastics, volleyball, basketball. Running long distances, hills, on hard &/or uneven surfaces, changes in routine or new activity, poor shoes, poor conditioning or inadequate warm up can also cause this problem to occur. Overpronation (feet roll inward too much upon impact) & overuse leads to increased stresses on muscles & connective tissues in the muscle/tendon/bone complex, which causes myofascitis (inflammation of muscles), tendinitis (inflammation of tendons), and periositis (inflammation of bone covering) & ultimately results in pain. Also can occur from weak tibialis anterior, tight gastrocnemius/soleus, tight or weak quads or hamstrings.

Self-Treatment: If pain is mild, reduce high impact mileage, hills & intensity. If the pain is severe, stop running for a 1-2 week period & then resume training gradually. Apply ice to the shin area for 15-20 minutes or until the skin first feels numb every 2 hours & after activity to help reduce inflammation. Self-massage with arnica, biofreeze or another anti-inflammatory lotion to the muscle only (along side of the shin). Gentle stretching of the calf muscles. Get appropriately fitted shoes (involves gait analysis). Wear lycra/polypropylene tights or some other form of elastic compression while performing activity. Return to training gradually. Full recovery is usually between 2-4 weeks.

Alternative Exercises: Swimming, pool running, cycling (in low gear) “spinning”. Avoid or do very little weight-bearing exercises.

Preventative Measures: Proper warm up, microprogress your way into your activity (i.e. If you’re going to be running, start first with walking, then jogging, then running). Light stretching after running of the gastrocs (keep knee straight) & of the soleus (keep the knee bent) will aid in keeping the muscles loose. Have your shoes fit (someone who will do a gait analysis, put you on a treadmill, etc). Strengthening of foot & calf muscles: 1) Place a weight around the foot & move foot up & down from the ankle, with no movement in the rest of the leg. Or use a partner to grasp the foot and provide manual resistance. 2) Band exercises. Anchor one end of an exercise band (i.e. inner tubing of bicycle) to a heavy object, such as the leg of a couch. Loop the other end around the foot. Move the foot up, down, & from side to side against the band’s resistance to exercise different muscle groups. Gradual progression of your training program & incorporate rest time into your training program as well. Avoid excessive hill training & speed work.

Plantar Fascitis

Definition: Inflammation of the plantar fascia, which is the thick band of connective tissue that spans the bottom of the foot from the heel to the base of the toes. When this tissue is placed under too much stress, the plantar fascia stretches too far & results in microtears, which then leads to inflammation of the fascia & surrounding tissues. These tears are covered with scar tissue, which is less flexible than the fascia & only aggravates the problem.

Symptoms: Pain present for several days at the base of the heel most commonly. No history of a traumatic incident to cause the pain. An increase in pain with initial standing, walking, running. The pain seems to improve as the activity continues, then gets worse at the end of the day again. Tired achy feet at the end of the day; foot cramps. Improves with rest (long cessation of high impact activity). Worse after short periods of rest (several hours); often worse when first bearing weight after a night of sleeping; subsides within approximately 5 minutes of walking around.

Causes: Stress, tension pulling on the plantar fascia. Inflexible calf muscles & tight Achilles tendons, which place more stress on the plantar fascia. Overpronation (feet roll inward too much upon impact). High arches & rigid feet, which are not as good at absorbing shock. Improper or worn shoes. Overtraining.

Self-Treatment: If pain is mild, reduce training load & intensity. If the pain is severe, stop running or performing the offending activity for 1-2 weeks. Apply ice to the plantar fascia for 10-15 minutes every 2 hours & after activity in order to reduce the inflammation. Works well to freeze a water bottle & roll bottom of foot along it. Self-massage with hands or use a golf ball with arnica, biofreeze or another anti-inflammatory lotion to the plantar fascia. Exert enough pressure with the golf ball to feel a little tenderness while moving it back & forth under your foot. Strengthen the muscles in your feet by placing a towel/cloth on the floor & scrunching it up with your toes towards you. Grab some of the towel with your toes & pull the towel towards you & repeat. Return to training program gradually. Full recovery is usually between 6-8 weeks.

Alternative Exercises: Swimming, pool running, cycling (in low gear) “spinning”. Avoid or do very little weight-bearing exercises.

Preventative Measures: Proper warm up, microprogress your way into your activity (i.e. If you’re going to be running, start first with walking, then jogging, then running). Light stretching after running of the gastrocs (keep knee straight) & of the soleus (keep the knee bent) will aid in keeping the muscles loose. Have your shoes fit (someone who will do a gait analysis, put you on a treadmill, etc). Women should avoid wearing high heels on a regular basis as this shortens the muscle, which increases the stress on the tendon when wearing regular shoes & also flattens the arches in the feet that are necessary to keep tension off of the plantar fascia. Gradual progression of your training program & incorporate rest time into your training program as well. Avoid excessive hill training & speed work.