As promised here is part 2 of our common running injury blog. Part 1 concerning knee injuries can be found here.
Beyond the knee, it is also very common to have tendon related pain on the outside of your hip (gluteal tendinopathy) or the back of your heel (Achilles tendinopathy).
These will follow a similar pattern to the patella tendon (See management here). Discomfort before you exercise, which reduces during, to return afterwards, sometimes with some added stiffness (sounds fun doesn’t it?). Similarly, if you have a poke into the respective regions (the outside of your hip, and along your Achilles) you will probably find some tender areas.
Tendons can also become irritated by compressive loads. These are slightly different to the longitudinal loading which cause movement of the limbs. Many of you will have heard of (and probably foam rolled) the Iliotibial band or ITB/IT band. This is a good example, it passes over the top of the Glute tendon, so in certain positions it increases the amount of pressure it places on it. As a result, in gluteal tendinopathies things like sitting with crossed legs can cause an increase in symptoms. Other aggravating activities to look out for in gluteal tendinopathies are lying on either side in bed, standing on one leg to dress and walking or running uphill/upstairs.
Morning stiffness is a more frequent feature in the Achilles than in other tendinopathies, but most other aggravating factors are similar and simply surround increasing the tendon load (prolonged running, faster running, jumping, hopping).
As previously discussed, loading is VITAL for improvements. Initially some isometric exercises are useful. Isometric glute abduction against a wall and heel raise wall squats are respectively good places to start. This can then progress into some kind of bridging movement for the gluteal tendon, and some heel raises for the Achilles. When conducting the exercises, remember to consider what was previously mentioned about managing pain!
Medial Tibial Stress Syndrome AKA Shin Splints
So, this is yet another condition that is primarily due to an overload of tissues (maybe you guys should run less, or maybe not?). Although the exact pathology unclear, what we know is it is an exertional pain syndrome related to some kind of bone stress reaction.
Often there will be some tenderness down the front of the shin which can remain for several days after exercise, and pain that’s worse on impact. These symptoms are often accompanied by a change in activity or training. This could include increase in distance, duration or intensity of running, doing more hill work, or running on heavier surfaces (through muddy fields etc).
If you are only suffering a mild discomfort when you are running, simply giving yourself a couple of days off, reducing your mileage, increasing your cadence (as discussed previously) and perhaps running on a more forgiving surface will be enough to eradicate symptoms. However, if the pain persists for a couple of days after exercise, then it may be worth seeing a professional. This is because MTSS can closely mimic stress fractures (these won’t respond well to online help videos titled ‘get rid of your shin splints’).
Should you have mild symptoms it is also worth considering buying new running shoes – as after 250 miles they will be up to 60% less shock absorbent. So, if your shoes seem to have lost their spring or support, its probably time to replace them.
Muscle tightness can contribute to the bone stress reaction, so some stretching can be useful. However, it is best to be guided by a profession through this as stretching and foam rolling too early in the recovery process can be detrimental.
A safer alternative would be doing some strengthening work. This can address movement control and improve force absorption. Once again, this would be most effective guided by a professional who can assess which areas need strengthening, but as a general rule of thumb, working on the calf muscles is a solid place to start. Working to fatigue doing some calf raises (single or double leg depending on your strength) and knee bent calf raises certainly won’t do any harm then progressing to working through some running specific strengthening (obviously).
For more on shin splints visit our youtube shin splints masterclass here.
Plantarfasciitis (PF) or simply Plantar fascia pain
This particular issue is pretty characteristic in its presentation. Most individuals describe a sharp pain in the sole of their foot during their first steps in the morning, often resembling treading on glass or a sharp pebble. So, if you meet someone suffering with PF and they are a little grumpy, give them a break. Imagine waking up and stepping on your children’s Lego every morning.
In addition to this unique feature the foot pain will usually be worse when climbing stairs, walking barefoot on hard surfaces and wearing shoes that have no arch support, or have particularly unsupportive soles (daps, plimsoles, flats etc).
Once again there is usually some change in exercise intensity, frequency or duration (again runners, just run less!), or a sudden change in footwear. The latter is becoming a more and more common cause, with barefoot footwear becoming fashionable in the fitness industry. Feel free to skip over this next slightly boring biomechanical explanation of why this occurs. Barefoot or minimalist shoe running tends to cause a sudden bias towards forefoot strike. This combined with the increase in toe dorsiflexion increases the load on the plantar fascia.
Therefore, it can useful to look at your choice of running shoes. Essentially you want a shoe that has a fairly firm toe section that doesn’t bend too much (the movement or pointing your toes towards the sky loads up the plantar fascia), mid-section with cushioned arch support (firm arch can aggravate symptoms, but some form of arch support can reduce symptoms) and a heel with at least 10mm heel toe drop. Got all that? Good.
Insoles can also be useful in terms of providing some kind of heel elevation, and arch support, thus offloading the structures in the short term. Trying some off the shelf insoles will rarely cause any harm, but if you see no improvement it can be useful to visit a professional to see what your ankle and foot mechanics will benefit from.
Long term, a pretty effective exercise protocol has been developed. It uses a variation of a calf raise, where you place your big toe on top of a rolled-up towel. Each repetition should be performed slowly (3 secs up, 2 secs pause at top, 3 secs down) and as always, the load should be progressed to promote positive change.
Today, we have included just a collection of ideas to get you started in your injury management journey, should you wish to discuss this further with a member of our team you can do so here.
Thanks for taking the time to read.