Running dates back to more than 10,000 years ago, with Persian Pheidippides completing the Marathon of Sparta. With long-distance running comes niggling pains that oftentimes lead to debilitating injuries due to a lack of training structure, not taking time to recover, and weak muscles and imbalances.
Throughout the past couple of months, our clinicians have seen a host of patients enter our sports physiotherapy clinic doors with a variety of running injuries — from hip flexor sprains to runner’s knee, shin splints, and heel pain — so we thought we would explore the most common running injuries and how to prevent them from a sports physiotherapy perspective.
Anyone training for a marathon can develop an overuse injury due to increasing strain by placing a lot of repetitive motions on the lower extremities. This fact alone can cause all sorts of issues. When you combine the basics of repetitive movements with improper training techniques, and not enough rest, the outcome can be painful — and mentally wearing — as an injury may speed away all of those months of training.
So, we’ll first discuss the common running injuries we’re starting to treat at our clinic as clients increase their mileage.
Does Running Really Wreck Your Knees?
Clients often come in complaining about knee running pain is wrecking their training. However, clinical research actually shows the opposite effect — distance running fortifies the strength around our knee joints and protects against degenerative knee conditions like osteoarthritis. With proper, consistent training, our knee’s cartilage becomes more robust, and major muscles are strengthened to support the knee.
Do check out a few of our recent articles about running injury prevention and musculoskeletal dysfunctions:
- The Truth About Knee Pain and Running: Common Knee Injuries
- Runner’s Knee: Debunking the Myth that Patellofemoral Pain More Common in Women
- Prevalence of Hip Osteoarthritis in Athletes
How to Stay Injury-Free: Running Rules & Training Tips
HelloPhysio’s team of physiotherapists and instructors has decades of training and experience, both in the clinic and on the roads. If you’re a beginner looking to get from the couch to that first 10k, or training hard to finish the full Standard Chartered Singapore Marathon, our team has a few tips to share to help you reach the finish line strong and without injuries:
- No more than a 10 percent increase per week rule. Your muscles need time to strengthen, and even if you’re feeling enthused and full of energy, the steadfast 10 percent over the previous week’s mileage is a time-honored principle when it comes to training for a marathon and injury-free running. As a vast majority of running injuries are due to overuse and imbalances, this core tenant will help your body gradually adapt to the increased stress and prevent injuries to get you across the finish line.
- Dynamic stretches versus static stretches. Muscles are strongest when at resting length. Like a rubberband, static stretches decrease muscle elasticity and turn those connective tissues into loose rubber bands, deforming tendons and ligaments. Instead, you’ll want to mimic the movement of the activity you want to do in order to actively move joints and muscles to target the muscle groups that can help to jettison performance even before you get out running.
- Consistency trumps volume. Remember that training is cumulative, and each training cycle benefits from rest and recovery days. Consistency is key, so try to get out there a minimum of 3 times per week to provide yourself with adequate rest days and recovery time for more intensive sessions.
- Keep muscles supple. Recovery is part of strength training and of utmost importance when it comes to running injury prevention. Core Pilates stretching exercises regularly not only help to keep your muscles supple and improve your overall flexibility, but it also relieves muscle tension which is one of the main culprits of common running injuries. Use a simple massage roller or work in a sports massage therapy session each week to help relieve these tensions.
- Plyometrics improves speed. Vertical and horizontal training movements teach your muscles how to work together efficiently and strengthen tendons and muscle tissue. Beyond making your strides more powerful and stored energy efficient, these exercises will also help your brain and muscle fibers communicate and simultaneously activate to increase motor firing rate; hence, improving speeds.
“Sporting injuries caused by running are common, mostly at the lower proximity but can be prevented,” says David Shum, sports therapist and running coach at HelloPhysio. “Be realistic on the short and long-term goals. And, when in doubt, seek out a certified running coach with a proven track record to design an appropriate running program leading to a specific race.”
Common Lower Leg Running Injuries Associated with Marathon Training
Consistency trumps volume when it comes to improving your speed and optimizing performance when it comes to running. Most new runners will push themselves beyond their body’s ability to build muscle to offset imbalances and weaknesses.
Add improper running techniques to the mix — bouncing up and down too much, overstriding, not using hamstrings/glutes enough, landing on feet too heavily, not using your arms, twisting the midriff side-to-side while running, bending the head and upper body forward and jogging slower than you can walk — and we have the recipe for the top 5 running injuries we’ve been treating at the clinic in the past few weeks.
Common Running Injury 1
Hip Flexor Strain
Hip flexor strain, attributed to the hip flexor muscles responsible for the running movement of bringing your knee closer to your chest, can be torn or ruptured with anterior hip pain during the swing phase of your running gait cycle. If you haven’t warmed up with dynamic stretching before a run, there’s a chance that you’re putting additional strain on your hip flexor muscles.
Running injury treatment may include soft tissue sports massage and low back and hip joint mobilization exercises or dry needling to release taut muscle fibers to improve strength and range of motion to get you running again after injury.
Common Running Injury 2
Patellofemoral Pain Syndrome
Patellofemoral pain syndrome, a degenerative condition of cartilage underneath the kneecap, is one of the most common causes of knee pain and is often referred to as ‘runner’s knee’, which leads to inflammation.
To alleviate the pain, our physiotherapists may prescribe a combination of exercises to strengthen the core muscles, the hip flexor, trunk, or the knee, and muscle recovery therapies at home between long runs with a Theragun percussive massage gun or stretching with a foam roller.
Common Running Injury 3
Iliotibial Band syndrome
Iliotibial band syndrome, an inflammation of connective tissues that runs down the outside of the thigh due to hip abduction weakness, presents as intense lateral hip and glute pain that can also be experienced in the thigh and knee areas. It’s one of the most common lower leg running injuries among endurance athletes, especially those training for marathons, as the repetitive motions for the iliotibial band irritate the tissue beneath it to cause pain.
Running injury treatment of ITB syndrome with INDIBA Activ can help reduce inflammation with noninvasive radiofrequency to stimulate tissue repair.
Common Running Injury 4
Anterior and Posterior Shin Splints
Anterior and posterior shin splints, or medial tibial stress syndrome, affect up to 35 percent of long-distance runners, especially new athletes training for a marathon. Pain can be stabbingly painful on the outside or inside of your shin bone whenever you move your ankle during the running gait swing phase, and often results in lengthy disruption to all of that hard training that you’ve been doing.
Treatment begins with a bit of rest and ice in the acute stage, and thereafter rehabilitative and strengthening exercises as with Clinical Pilates sessions. Adjunctive treatments, like Shockwave Therapy, can also help to reduce the recovery time by stimulating the repair of the musculoskeletal system and tendon structures, thereby improving the density and strength of newly formed ligament fibers.
Common Running Injury 5
Plantar fasciitis, one of the most common running foot injuries, is a collagen degenerative disease of fibroblast cells instead of inflammation typically seen in acute conditions like Achilles tendinitis.
Plantar fascia running foot injuries occur at the medial calcaneal tubercle half-bone closest to the heel, and as the collagen degenerates due to overload strain, it creates repetitive microtears. This is why runners often experience stabbing pain in the bottom of the foot and heel area. Comorbidities may include insanely tight calf muscles and decreased angel flexibility.
As the condition isn’t an inflammatory response but rather is degenerative, the treatment plan works to address root anatomical issues like overpronation or excessive tibial or femoral anteversion with Clinical Pilates stretching and strengthening programs, dry needling trigger point release, or the use of orthoses to address biomechanical imbalances.
One of the simplest ways to prevent all of these injuries caused by running is proper training.
“It doesn’t matter if today is your first day or if you’ve been running for two decades. There is no test to pass on how fast or far you need to run. There is no membership card to get started. Just run!” shares Jenny Huang, founding physiotherapist at HelloPhysio and podium-placing elite runner.
If you’ve been suffering from a running injury for more than two weeks, then it’s time to schedule a consultation with our running physiotherapists and trainers at HelloPhysio sports injury clinic in Singapore.
Jenny continues, “If you’re just starting out running again after an injury, you’ll want to progressively manage your running load to prevent further comorbid injuries down the line.”
Continuing to overtrain and push through the pain will likely result in more serious complications even before you can get to the finish line to reap all the endorphin rewards for all of that hard training. The Standard Chartered Singapore Marathon is right around the corner. Stay 100% injury-free and healthy in time for race day by scheduling a consultation with one of our leading sports physiotherapists and trainers today.