Whether you’re a long-time runner or it’s a new addition to your exercise routine, injuries are a risk. And, just like any form of exercise, there are a few injuries that are more common than others.
Here, we discuss the three most common injuries sustained by runners, how to diagnose them, how they are caused, and how you can treat them.
Anterior knee pain
Sometimes referred to as ‘runner’s knee’, anterior knee pain is usually characterised by discomfort or pain in the outside-half or middle of the knee, around the kneecap (patella). It is a common injury among runners, with between 28% and 30% experiencing this type of pain.
You could experience the pain while running, or when:
- Using the stairs.
- Keeping the knee bent for a sustained period.
- Sitting up or down.
The pain can be linked to a variety of conditions, including anterior knee pain syndrome, patellofemoral pain syndrome, patellofemoral malalignment, chondromalacia patella, and iliotibial band syndrome (IT band syndrome).
What does this all mean? Knee pain isn’t straightforward, so as a runner, you can better protect yourself from injury by learning how to avoid it.
Overuse is one of the most common causes of anterior knee pain, especially for new runners or those who have begun running more often. If you tend to run until you’re exhausted, or try to run through pain, you’re also at higher risk.
Anterior knee pain can also be caused by:
- Patellofemoral malalignment — When the kneecap has deviated from its position at the centre of the knee joint.
- An increased or decreased Q angle — The Q angle is the difference in angle between the upper leg and the lower leg when they meet at the kneecap. If this angle is above or below average, it places increased pressure on the knee.
- Low dynamic stability — The knee is not sufficiently stabilised by the ligaments when put under pressure by dynamic movements.
- Poor range of hip and ankle movement — When movement is limited at the hip or ankle, impacting on the pressure being exerted on the knee.
- Increased hip adduction during running — When the leg moves inwards when running.
Running less regularly, or for shorter periods of time, will help to reduce the pressure on your knee and prevent anterior knee pain caused by overuse. There are also a number of additional changes you can make, including:
- Increasing our step rate — Taking shorter and more regular steps while running reduces the load on your knee. To begin, count how many steps you take in a minute. Alternatively, if you have a Garmin or Polar watch, it will measure this as ‘cadence’. Increasing this step rate by 7.5% to 10% has shown to be beneficial in taking pressure off the knee.
- Changing your foot strike pattern — Your foot strike pattern is determined by which part of your foot lands first. A forefoot strike, which involves landing on the balls of your feet, will lower the pressure exerted on the knee. Changing this pattern can be a slow transition, but it is effective, especially when accompanied with strength training.
- Undertaking corrective strength training (proximal to distal) — Improving the strength of the body parts used in running, starting closer to the body and working outward, e.g. from hip to knee to foot.
- Improving your range of hip and ankle movement — Use a range of exercises and stretches to increase how much your hip and ankle can move.
- Plantar fascia pain
The plantar fascia is the ligament-like tissue on the bottom of your foot that runs from the heel to the toes. It helps you to walk and run by supporting the arch of your foot and absorbing the impact of your foot hitting the floor.
When you experience pain in your heel or on the bottom of your foot after running, it is likely that the plantar fascia is irritated or inflamed. In most cases, the pain will usually occur after running or exercise, rather than during it.
In general terms, pregnant women, those with a high BMI, and people whose jobs involve walking on hard surfaces are at an increased risk of experiencing plantar fascia pain. However it is also very common among the general running population.
Pain in the feet after running can also be caused by:
- Increased foot pronation — Pronation occurs when the foot rolls inwards toward the centre of the body, which places strain on the arch of the foot.
- Increased training load (speed or volume) — Foot pain can occur when you start running considerably more regularly, further, or faster, rather than increasing the load slowly and gradually.
- A change in foot striking pattern — As previously mentioned, a foot strike pattern refers to which part of your foot lands first when running. Changing this can be beneficial, but it can also result in pain on the bottom of the foot.
- Inappropriate footwear — Wearing shoes that aren’t designed for running, or that don’t fit your feet, can result in plantar fascia pain.
- Limited range of big toe or ankle movement — Limited movement in the big toe (including hallux rigidus, the name given to arthritis of the big toe) or ankle increases pressure on the plantar fascia when running, causing irritation or inflammation.
If your foot pain is down to a high BMI, losing weight and reducing your BMI will ease the strain on your plantar fascia. In terms of rehabilitation, there are a variety of options:
- Strength training — Carrying out training exercises focused on increasing the strength of your hips, knees, and feet.
- Orthotics — Placing an orthotic insert inside your footwear to support the bottom of your foot while running.
- Corrective footwear — Using shoes that are specially designed to provide more support for your plantar fascia.
- NSAIDS — Taking nonsteroidal anti-inflammatory drugs (NSAIDS) to reduce the inflammation of your plantar fascia, which eases the strain on the ligament during exercise.
- Shockwave therapy — This highly effective treatment can be used to reduce the discomfort of plantar fascia pain.
- Steroid injections and exercise — Combining the use of steroid injections with exercise has proven to be more effective in alleviating foot pain than exercise alone.
- Running gait re-education — Your running gait is the way your foot strikes and leaves the floor with each stride. This can be changed to reduce strain on your foot and prevent damage from excessive foot pronation.
Achilles or patellar tendinopathy
Tendinopathy, also referred to as tendonitis, is a condition that represents physiological change within a tendon. While you can experience tendonitis in any of your body’s tendons, it is the patellar and achilles tendons that are the most commonly affected for runners.
Achilles tendinopathy is characterised by pain at the top of the heel and just above, in the achilles. This may be at its worst in the morning or after exercise, or get worse during the day or during exercise. A swollen achilles is also a sign of tendonitis.
The primary symptom of patellar tendinopathy is pain in the knee at the base of the kneecap. You may also experience swelling around the area and a burning feeling in the kneecap.
The achilles and patellar tendons are force-producing tendons. They absorb load and use the stored energy to propel the body in the opposite direction. While they are two of the strongest tendons in the body, they can be worn down by overuse or spikes in training load.
Overuse and substantial increases in load are the primary causes of tendinopathy. However, there are additional risk factors that increase the chances of experiencing tendinopathy. As you age, you become more susceptible to tendinopathy due to the reduced elasticity of your tendons. Those with a high BMI are also more likely to suffer from tendinopathy as their increased body weight puts more strain on the tendons.
The most effective way to avoid tendinopathy is to increase your training load in small increments. Increasing how often you run or how far you run by 10-15% per week is a safe way to do more without running the risk of damaging your achilles or patellar tendon.
Tendinopathy worsens over time. Initial damage is usually categorised as reactive tendinopathy, with further damage leading to tendon dysrepair and eventually degenerative tendinopathy. The severity of the tendinopathy you experience will determine the direction of your rehabilitation.
As a runner who has recently increased their load, it is more than likely you are experiencing reactive tendinopathy. In this case, treatment should comprise:
- Rest — In the immediate term, you should stop running. As the pain subsides, you should consider some light exercises.
- NSAIDS — If the tendinopathy is causing significant pain, take a non-steroidal anti-inflammatory drug, such as ibuprofen or paracetamol. However, you shouldn’t take NSAIDS for longer than 7 to 14 days.
- Exercises — Strengthening the tendon is important in treating tendinopathy. Completing light exercises designed to aid in tendinopathy recovery every day will help control pain.
- Progressive loading — As your recovery progresses, slowly increasing the load on your achilles or patellar tendon will aid in your recovery. It is also essential to preventing relapse that you apply training that replicates running, as it will ensure your knee is strong enough.
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