With the marathon only a couple of weeks away, and the weather finally starting to improve, it’s no wonder that I find myself treating an increasing number of running injuries!!
Below is a list of the most common in juries seen, and what to look for in the way of symptoms. If you have concerns that you are developing any of these, you should stop running until you have consulted a physiotherapist – the sooner, the better! Please note that the aim of this page is not to advise you on how to treat these conditions, but just to be aware that they exist and need addressing.
The Hip Region
This is inflammation of the pubic bone, commonly caused by overtraining and poor flexibility of the groin muscles. Pain is localised to the pubic bone and groin/inner thigh, and aggravated by repetitive impact or kicking. When left, the pain becomes more consistent and constant. This condition needs rest.
Piriformis is a deep buttock muscle. Tension can develop due to muscle imbalance, resulting from poor leg biomechanics/posture and a faulty running action. Pain can be referred to the back of the thigh and calf. If the condition is left, it can lead to compression of the sciatic nerve (especially when sitting). The muscle needs stretching, but it is advisable to get checked for muscle imbalance and biomechanical abnormalities which can be easily addressed by treatment and a possible need for a change in trainers or the use of orthotics.
The Knee Region
This is tension in the ilio-tibial band (ITB), which is a band of soft tissue running from the muscles that attach to the outside of the hip, to just below the knee joint. The tension is usually caused by overtraining and altered leg biomechanics (a tight piriformis muscle is common in conjunction with this). Pain can be anywhere along the band, but it is most common at the side of the knee, due to the repetitive bending that occurs during running. Hence the name of the condition.Unfortunately, as this band is not exactly a muscle, there are no good stretches for it. Treatment usually consists of reducing the symptoms together with addressing the biomechanical cause(s).
Anterior Knee Pain
Pain at the front of the knee can result from inflammation on the under surface of the kneecap (patella). Again, this is usually due to a biomechanical fault, where the patella is slightly out of position in the groove in which it sits, forcing part of the under surface to rub on the edge of the groove. Long distance, repetitive, and high impact training all exaggerate any muscle imbalances or faulty biomechanics, further aggravating this condition. This condition often goes hand in hand with ITB problems. Pain is reported during and after running, especially with long periods of sitting, and going up and down the stairs.
The patella tendon crosses the front of the knee, and is part of the quadriceps muscle (the large muscle at the front of the thigh). It attaches both to the patella and below the knee, and can become inflamed at either place due to overuse or fatigue from overtraining. Pain is local and will be present during and after repetitive impact. As the condition worsens, the time of onset during the run will reduce, and the length of time the pain continues after activity will increase. This condition requires rest and treatment.
The Calf Region
This is a term commonly given to shin pain, but can be caused by many different conditions, a few of which are mentioned below:
Tendinitis of the foot and ankle muscles that originate in the shin area. This especially affects the muscles responsible for flexing the foot up to enable the heel to strike the ground. The pain is usually localised to the particular tendon/muscle as it runs close to the shin bone (tibia). Pain will worsen during the run, and persist afterwards. The underlying cause may be faulty foot and ankle biomechanics which will require treating as well as the symptoms.
This results from weakening of the bone due to excess stress from repetitive impact, causing cracks to appear. Commonly affected sites are the tibia, ankle, and foot (2nd and 5th metatarsals). Sharp pain is local and is aggravated by weight bearing activities (even walking) and eased quickly by rest. Unfortunately, stress fractures do not often show on normal x-rays and there are no tell-tale signs such as swelling or bruising. Diagnosis is more likely to be made by a process of elimination. The best form of treatment is rest. Unfortunately if you develop a stress fracture this close to marathon day, you will not be participating.
This is also difficult to diagnose and presents like a stress fracture in that localised pain gradually worsens throughout the run, but eases quickly with rest. Similarly, there are no obvious signs such as swelling or bruising. The pain is caused by a build up of pressure within the muscle and can affect any of the muscles surrounding the shin. If left, this condition can be serious as the nerves and blood vessels can become compressed. It requires medical treatment.
The Foot and Ankle Region
As before, this is an overuse or fatigue injury, often related to faulty biomechanics. Commonly affected sites are the Achilles tendon, either where it joins the calf muscle above the ankle, or where it inserts into the back of the heel; top of the foot if the muscles are overworking to flex the foot for heel strike, or trying to control the foot’s position during the running action. These can be the same muscles/tendons as those affected in the shin, but presenting as foot pain instead of shin pain depending on the main aggravating action; heel or arch of the foot (commonly known as plantar fasciitis). Localised pain will respond as with tendonitis previously discussed.
Please see above.
Of course, don’t forget the more obvious and common injuries such as hamstring and calf strains, and ankle sprains!!
All these injuries can occur regardless of appropriate warm up regimes.
The advice is to stop running until you have consulted a physiotherapist or doctor and received treatment and advice about your training regime.