Addressing Common Running Injuries for PTs and PTAs

With warmer weather on the horizon, runners across the country are lacing up their outdoor shoes and trading treadmills for pavement.

Over 40 million Americans say they incorporate running as a part of their regular exercise. Of those, 17 million participate in distance races, from 5ks to full marathons, but as running's popularity increases, so, too, do running injuries.

These injuries can significantly disrupt a runner's regular physical activity and quality of life, presenting physical therapists and physical therapy assistants with a clinical challenge.

Who's at risk?

Novice runners experience injuries at a higher rate than experienced runners, with an estimated 17.8 injuries per 1,000 hours of running. Recreational runners average 7.7 injuries per 1,000 hours, while ultramarathon runners sustain the lowest rates of injury at 7.2 per 1,000 hours.

Overall, those with less than three years of running experience were twice as likely to experience an injury compared to those with greater experience.

Common running injuries

Unsurprisingly, most running injuries occur in the lower extremities. Knees take the brunt of the damage, accounting for between 7% and 50% of specific injuries. Also known as patellofemoral pain, “runner's knee” is the injury most physical therapy professionals are likely to encounter.

Iliotibial band syndrome, meniscal injuries, and patellar tendonitis are also high on the list of common injuries. Achilles tendonitis and medial tibial stress syndrome account for the bulk of diagnosed injuries of the lower leg and foot.

What impacts risk?

As a general rule, the factors contributing to running injuries fall into one of three categories: personal traits (sex, height, weight, etc.), training habits (running schedule, equipment, etc.), and health/lifestyle factors (smoking, comorbidities, previous injuries, etc.).

For women, studies show that the risk of injuries increases with age, previous participation in sports like cycling or swimming, running on concrete, and longer weekly running distances. Likewise, men run a higher risk of injury if they've restarted running after a history of previous injuries and average a distance of 39 miles (64km) each week.

In both men and women, previous running injuries proved to be the most important and predictive risk factors for future injuries.

Additionally, research suggests that distance and pace are key factors when determining the type of injury runners experience. Rapid changes in running volume are associated with proximal (e.g., hip, knee) lower-extremity injuries, whereas rapid changes in running speed have been linked to distal (e.g., shank, ankle, foot) lower-extremity injuries.

Evaluating running injuries

Critical elements of a physical therapy evaluation for runners cover a detailed patient history, structural alignment and assessment, and a gait analysis.

• Patient history. This includes their medical history, a complete account of past injuries, both related and unrelated to running, and their current training habits. Consider asking: What does their running schedule look like? Do they use orthotics or specialized running shoes? What do their post-run routines entail?
• Structural alignment and assessment. This can cover strength, flexibility, stability, and mobility and should be gathered via observation.
• Gait analysis. From initial contact to toe-off to terminal swing, a gait analysis via video capture (front view, side view, and posterior view) and naked eye observation can help a therapist pinpoint anomalies and critical gait events.

Clinical application

After observation and assessment, gait retraining may be necessary to reduce mechanical deviations and correct abnormal mechanics. Here are some possible clinical considerations for the most common running injuries.

• Patellofemoral pain: Consider increasing step rate, correcting overstriding, reducing impact loading, reducing hip adduction, correcting trunk position, and improving hip muscle performance.
• Iliotibial band syndrome: Consider reducing hip adduction, increasing step width (particularly if runner displays crossover gait), and improving hip muscle performance.
• Achilles tendinopathy: Consider correcting overstriding, increasing leg stiffness, transitioning away from forefoot strike pattern, and improving calf muscle performance.
• Tibial stress fracture or reaction: Consider correcting overstriding, reducing impact loading, reducing hip adduction, increasing step width, and transitioning away from rearfoot strike pattern.
• Medial tibial stress syndrome: Consider correcting overstriding, reducing impact loading, reducing hip adduction, increasing step width (eliminating crossover gait), and increasing intrinsic foot strength.
• Chronic exertional anterior compartment syndrome: Consider increasing step rate, correcting overstriding, and modifying foot strike pattern from rearfoot to a mid- or forefoot strike pattern.

This article is based on our sister company - Elite Learning's 4-hour Running Injuries physical therapy course, written by Cristine E. Agresta, MPT, PhD.