The running community make up a relatively large percentage of our patients at Hardiman Performance. This means one of two things, either Luton, Hitchin and the surrounding areas are all extremely keen runners, or those of you who do run, do a terrible job and keep getting yourself injured (joking!).
The aim of this blog is to try and address some of the more common running injuries and see if we can provide some advice on how to manage your own pain. However, there should still be emphasis placed upon visiting a professional to gain an accurate diagnosis, and to ensure appropriate management if you aren’t able to improve your symptoms.
I’d firstly like to clear up that the old cliché that ‘running is bad for your knees’, is NOT true. It’s just a coincidence I am starting with knee pain, honest!
Patellofemoral pain syndrome (PFP) AKA “runners’ knee”
As the name suggests, this is an umbrella term for pain arising from the structures and soft tissues adjacent to the patellofemoral joint (under the kneecap). It often has a multifactorial aetiology (caused by several different things) which can include relative muscle weakness, overloading the internal structures of the knee or anatomical abnormalities.
PFP can be a little confusing as its often poorly localised, and symptoms can sometimes jump around. Commonly it feels pretty dull and achy, and usually is painful when the knee is loaded in a bent position. It can also be uncomfortable after prolonged periods of sitting, especially if you sit with your feet tucked under your chair (knees in that same bent position).
Unfortunately for you fitness-crazed runners, management can sometimes require a short period of rest where you may have to stop running (if particularly bad) or reduce your running training! Essentially this just allows time for some of these sensitised structures within the knee, to calm down a little bit. In the meantime, however, you can be getting on with some different exercises. These will target the relative muscle weaknesses often present in PFP. Some hip strengthening work is often useful, where you focus on building up glute strength, alongside some quadricep work. Initially your therapist may get you working in a slightly reduced range, to limit any aggravation of the joint.
When you return to running it’s important to gradually increase your mileage. 10% per run is often a good place to start but this is highly dependant on training level and what you can tolerate. Sometimes much more or less than this is advised.
Additionally, it is worth looking at your cadence or steps per minute. In this day and age if you’re into your running, chances are, you’ll have some kind of fitness tracker. Increasing your cadence has been shown to be pretty effective with the “ideal” cadence being somewhere between 160 and 180 for recreational runners and 180+ for seasoned professionals.
Some useful exercises to start with include, side lying hip abductions, isometric hip abductions and fire hydrants.
Patella Tendinopathy AKA “jumpers knee”
The latter name was initially coined as this condition was commonly found in individuals who participated in sports which required repeated high velocity loading of the patella tendon (long jump, triple jump, high jump, volleyball, basketball). However, it is just as common in the running community.
As with any tendinopathy, it is usually associated with an increase in load, one that the tendon isn’t capable of adapting too. This, amongst other things, could include an increase in running distance, an increase in running speed or decreased rest between runs.
The pain is far more localised than in PFP. If you press onto the tendon (just below where the bottom of the kneecap is) it will often feel tender. Similarly, to PFP, any kind of loading will usually aggravate the pain (running, walking up/downstairs).
Most tendinopathies follow a pretty similar pattern. The area will feel uncomfortable before you exercise, but once you get going, the pain tends to ease, returning afterwards. Following this you will often get increased discomfort for the next 24-48 hours, sometimes with some stiffness, particularly prevalent first thing in the morning.
Once again, management may start with a period of rest/relative rest followed by some progressive strengthening work. The latter is very important in tendinopathies with symptom improvement unlikely without it. Any symptom reduction requires an improvement in the capacity of the tendon to absorb load and store and release force.
A good place to start is with isometric exercises (exercises where you are working the muscle without it changing length). These have been shown to decrease pain and start a positive remodelling process within the tendon. A wall squat at around 70 degrees is a good place to start. Once symptoms have reduced, a more progressive strength programme should be completed, based around your individual requirements as a runner (e.g. walking lunges, step ups).
Finally, when suffering with tendinopathy it is OK to feel some discomfort throughout your exercises. However, this should be manageable and SHOULD NOT cause you to be in more discomfort the next time you get round to doing your exercises (some aching in the hours after completing the exercises is ok).
We go over some more common running injuries including Achilles pain, shin splints and plantar fascia pain in part 2 of this blog. Stay tuned.
Osteo Jake (osteo_jake)