RUNNING RELATED INJURIES: WHAT ACTUALLY HELPS?

The sun is shining more frequently, the temperatures are rising, and more and more people are lacing up their sneakers and pounding the pavement.  As we inch our way out of the winter here in Portland, OR the number of runners out in the city seems to be increasing exponentially. One famous event here in the city to help usher in the spring season is the annual Shamrock Run.  As excited as we are about the increase in physical activity within the community we also want to shed some light on the the topic of running related injuries and what the science says about which injuries are most common, what their implications are, and what really makes a difference when it comes to managing running related injuries.  

How often do runners get hurt?

Statistically speaking anywhere from 20% to 80% of runners are dealing with some sort of running related injury at any given time (van Gent et al).  Injury rates tend to be higher amongst short distance sprinters and ultra-marathoners (Kluitenberg et al).  The suspicion is that these two sub-groups tend to exhibit either the highest amount of ground reaction forces or total training volume. 

While the running community, including the footwear industry, has tried to pinpoint the cause of most running injuries on either poor footwear or poor running technique the data suggests that neither of the two play a significant role in reducing the risk of injury (Nielsen et al).  As a matter of fact, the greatest predictor of a running related injury is whether or not you have sustained a running related injury in the 12 months prior to your current injury (Saragiotto et al).  While this may seem like a frustrating statistic, it should help us narrow down the playing field in regards to what we really need to focus on when dealing with an injury.  

What kind of injuries are we talking about?

First things first, the scope of this article does not include traumatic (read: freak accident) injuries.  We are speaking in regards to injuries that seem to be training related.  

Tendinopathy

Tendinopathy is a degeneration of the collagen that makes up a tendon.  Now, while degeneration of tendons and joint surfaces is a normal occurrence in all human bodies and does not automatically equate to pain and dysfunction, the truth is that tendons need time to acclimate to physiological stresses placed upon them and sometimes we can overshoot.  In other words, sharp increases in weekly mileage, a drastic change from shod running shoes to zero drop shoes, or the sudden addition of plyometric work in one’s training program without gradual introduction can contribute to such issues as achilles tendinopathies, shin splints, and plantar fasciitis.  

Strains

Strains are muscle injuries and occur when the forces placed upon the muscle are greater than the muscle is able to withstand.  Examples of muscle strains may include quad injuries after a significant period of downhill running at the end of a long race or hamstring strains midway through a 100 meter sprint.  In both of these cases the muscle tissue was being asked of more than it was able to deliver.  

Knee Pain

Commonly diagnosed as Patellofemoral Pain Syndrome (PFPS), knee pain is one of the most common complaints amongst runners.  PFPS is typically classified as such because there is no direct tissue degeneration that correlates with this diagnosis, however interesting finds are that lateral hip and quadriceps weakness tend to coincide with generalized knee pain.  As far as whether the hip and quadricep strength discrepancy precedes the knee pain or is a sequelae of it is yet to be determined.  

Bone Stress Injuries

Bone stress injuries (e.g. stress reactions and stress fractures) are another common injury type and often misdiagnosed.  Typically bone stress injuries (BSI) are found in the tibia and the femoral head/neck. Bony tissue is constantly undergoing a metabolic process of some sort with osteoclasts and osteoblasts perpetually absorbing and reforming bony matrix tissue.  Individuals at risk for BSI’s tend to have higher osteoclast activity than osteoblast activity and are subsequently categorized as osteopenic or osteoporotic, depending on severity of clinical findings. Currently, the lack of weight bearing activity (think resistance training using external resistance) and malnutrition are the most prominent modifiable (i.e. things you can control) risk factors for bone stress injuries.  

So what should you do about your running related injury?

It would be easy (and somewhat expected) for us to just say, “The answer is to just get stronger.”  However, it isn’t so simple. The problem is that a “runner” can be defined a million and one ways from recreational, to competitive, to elite, to long distance, to short distance, and all the distances in between.  

Programming for any athletic endeavor can never be done in a cookie cutter fashion.  Each athlete, along with his or her current injury status, needs to be assessed in a holistic and complex fashion because...well...that’s what we are as humans.  

What’s your injury status? 

What’s your injury history? 

What’s your training program and what is your training history?  

What are your goals?  

How much time is at your disposal for rehab?  

What actions are you actually willing to take to get better?  

What about the rest of your recovery?  Are you eating enough and sleeping well?

Sure, every runner would be well served to participate in more resistance training protocols, but running related injuries require more than a sheet of paper that says “squat and deadlift”.  

If you are a runner suffering from a training related injury that is keeping you from reaching your goals don’t hesitate to contact us to help you craft a personalized plan to get you back to doing the activity you love most.  Click the button below to get an email or phone call from one of our doctors of physical therapy.