Running-related injuries aren’t all equally prevalent for every runner.
Running injuries occur at all age ranges and skill levels, making them unique from patient to patient. Physical therapists aren’t just responsible for rehabilitating the injury itself. They also play a vital role in returning patients to pain-free running in the long term with preventative strategies. This article will outline common running injuries, how to assess them, risk factors, and rehabilitative strategies.
Recommended course: Running Injuries
Common running injuries
Many types of injuries can happen while running, affecting different structures (most commonly in the lower body):
- Patellar tendonitis: Inflammation of the patellar tendon is common in activities that require repetitive knee movement, like running.
- Plantar fasciitis: Inflammation and microtears in the plantar fascia has been linked to overuse stress.
- Shin splints: Repetitive stress on the shinbone and the surrounding tissues is common for new runners or those who suddenly change their running intensity.
- Patellofemoral Pain Syndrome (PFPS): An umbrella term for pain around the kneecap, PFPS is often associated with abnormal patellar tracking and muscle imbalances.
- Achilles tendonitis: Overuse or strain in the Achilles tendon leads to pain and stiffness in the back of the heel.
- Iliotibial Band Syndrome (ITBS): Irritation and inflammation of the ITB is linked to repetitive knee flexion in running.
Injuries by runner-type
Running-related injuries aren’t all equally prevalent for every runner. Novice runners have a significantly higher injury rate than experienced runners, with research following novice runners showing a proportion of injuries from 16-84.9%. Experienced runners had a proportion of 21.6-55.0%.
In fact, novice runners have an estimated 17.8 injuries per 1000 hours of running versus 7.7 injuries per 1000 hours of running in recreational runners, with ultramarathon runners experiencing even fewer injuries at 7.2 per 1000 hours.
Risk factors for common running injuries
Injuries due to running aren’t always clear-cut. Multiple factors often influence their development. Contributing risk factors include:
- Age: Increased age poses a greater risk of running injuries.
- Running volume: Amount of running per week and time/distance per run may be a risk factor, especially if increasing running intensity/volume suddenly.
- Running shoes: Using the wrong kind of running shoes for your foot type (e.g. looking at arches) may potentially increase risk of injury.
- Personal health history: A history of smoking and comorbidities may increase the risk of running injuries.
- Previous running injuries: Potentially one of the greatest risk factors is having previous running injuries.
- Body weight: Increased weight puts more strain on joints and tissues during runs.
It’s important to note that risk factors are unique to each patient, including their influences on each other in creating a multifaceted problem.
Physical therapy assessment for common running injuries
A thorough assessment requires both subjective and objective examination to understand the physical and psychological harm done due to the injury, and to discover the most optimal recovery plan.
Patient history
A detailed history will provide the physical therapist with clues as to the initial risk of the injury, the severity of it, the current restrictions it creates, and the patient’s goals. Include questions about:
- Previous injuries: Understanding the history of injury in the affected/surrounding area will help guide treatment and determine a prognosis.
- Initial care: Many patients will attempt recovery at home or go to the hospital before seeing a physical therapist.
- Activity: Is the patient a new or experienced runner? Do they participate in any other sports? Have they recently changed their running intensity/volume?
Postural observation
While there’s currently limited evidence suggesting that a runner’s posture is a risk factor, their alignment during walking, running, and static standing may indicate structural influences on their injury.
Physical therapists should closely and systematically observe patients’ postures from the front, back, and side. Ideally, the patient will be barefoot and wearing as little clothing as comfortable. This way, the rehab professional can clearly watch the posture both during standing and with movement. Things to be examined include:
- Standing alignment
- Right-to-left asymmetry
- Weight distribution
- Muscle tone
- Spinal curvatures
- Ankle pronation
Functional testing for running injury assessments
Running is a functional movement. The patient may subconsciously compensate for poor functional control in certain areas that require further investigation. Functional tests will better bring those issues to light. Watch for dynamic alignment, neuromuscular control, mobility, quality of movement, and right-to-left symmetry in the following movements:
- Single-leg squat: Provides immediate information on the patient’s movement patterns, including knee stability, hip strength, and ankle/knee mobility.
- Double-leg squat: Shows sagittal plane mobility at the ankle, knee, and hips, as well as trunk control. Can indicate mobility restrictions.
- Step-down: Like the single-leg squat, the step-down shows eccentric lower limb strength, lower leg joint stability, and mobility.
- Single-leg hop: Assess control during landing in the trunk, knee, and ankle, as well as vertical height and sound level upon landing.
- Single-heel raise: Indicates lower leg muscular endurance, ankle mobility, toe clawing, anterior weight shifting, accessory motion, and calf restrictions.
Physical examination
It’s important to remember that all physical tests are to be considered together, as they may greatly influence one another. For example, a lack of strength in the gastrocnemius may lead to increased calf tightness.
Testing for strength, mobility, and balance
These tests assess and grade strength in the:
- Glutes (all three parts)
- Quadriceps
- Hamstrings
- Calves (both gastrocnemius and soleus)
- Tibialis Anterior
- Core
- Mobility testing
A lack of mobility may cause unnecessary strain and wear on the affected structures. It may also be an indication of further strength deficits that the body is compensating for. The rehab professional should measure both passive and active range of motion in all appropriate joints, including thoracic mobility in addition to the lower limbs.
Balance testing
Taking a closer look at the patient’s proprioceptive skills may uncover issues in balance and joint stability and could provide an effective avenue of rehab.
Gait
Assess gait at both walking and running speeds (if possible), closely watching what the body does systematically. Start at the patient’s feet and observe upwards, or vice versa.
Rehabilitation strategies for common running injuries
Focus recovery on regaining the normal function before injury. It should also match the patient’s goals. Many running-related injuries happen during training, and many patients are keen on getting back as soon as possible.
Gait retraining
Gait retraining may be a great way to improve running mechanics, reduce pain, improve function, and address long-term issues the patient has faced from running. Visual and auditory feedback helps the patient dismantle old running habits and build new, improved ones. Feedback may be about:
- Heel vs forefoot striking
- Step rate
- Trunk position
- Step width, etc.
- Exercises
Strength, mobility, and balance work may improve both short and long-term outcomes, including a reduction in pain, increased confidence, improved neuromuscular efficiency, and stronger joint integrity. A progressive plan is optimal, with clear goals and milestones to ensure plan adherence and patient advancement.
Patient Education
Patients benefit from understanding how to:
- Manage their pain
- Modify their activities
- Follow their rehab plan
Teaching what the injury exactly is and the steps towards recovery will further improve plan adherence and make living with injury more manageable for the patient.
Activity modification
Modifying their training program, footwear, and daily activities may help the patient return to training quicker, even if at a lower training intensity. Modifications will heavily vary from patient-to-patient depending on their injury, lifestyle, and previous activities, so it’s important to understand each patient uniquely.
Individualized care and preventative strategies
Rehabilitation for running injuries requires a nuanced approach, and rehab professionals should focus on understanding how each patient’s injury affects their lives past the pain. Individualized care is key, and combining a progressive rehab plan with preventative strategies will contribute to successful recovery in both the short and long-term well-being of runners.