Common Running Injuries and How to Prevent, Treat Them

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December 9, 2021


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Running for exercise is an excellent way to maintain physical and mental health, but it can also be a source of injury. Maria Kyriacou, M.D., a primary care sports medicine physician at Miami Orthopedics & Sports Medicine Institute, discussed common running injuries, risk factors for these injuries and prevention and treatment strategies at a recent Live Healthy at Home virtual community health discussion.

Approximately 50 to 75 percent of running injuries are overuse injuries, which means that they happen over time through repetitive motion. The most common running injuries tend to occur in the knees (42 percent); feet and ankles (17 percent); lower leg/shins (13 percent); hip/pelvis (11 percent); and calf/Achilles (6 percent), says Dr. Kyriacou. Common injuries include:

  • Patellofemoral pain syndrome
  • Iliotibial band friction syndrome
  • Knee meniscus injury
  • Plantar fasciitis
  • Medial tibial stress syndrome


Maria Kyriacou, M.D., a primary care sports medicine physician at Miami Orthopedics & Sports Medicine Institute.

Patellofemoral pain syndrome

Also known as “runner’s knee,” patellofemoral pain syndrome (PFPS) originates between the kneecap (patella) and thighbone. Dr. Kyriacou says PFPS may be caused by abnormal tracking of the patella, which causes irritation of the surrounding structures. Another risk factor is weak core, glute and hip muscles, which may overload the quadricep muscles and cause uncomfortable tugging on the kneecap.Patellofemoral pain is aggravated by walking or running up stairs or uphill.

Iliotibial band friction syndrome

Pain from iliotibial band syndrome (ITBFS) occurs in the area just above or at the knobby outside of the knee. If the iliotibial band, which extends from the hip along the outside of the thigh and attaches to the top of the shinbone, becomes tight from strain or overuse, it can rub against the bulbous end of the femur and become inflamed, causing pain. Risk factors for ITBFS include weak glute and inner thigh muscles (hip adductors) or tight hamstrings, says Dr. Kyriacou. ITBFS is more noticeable by running downhill or on an uneven surface.

Knee Meniscus Injury

A torn meniscus, the C-shaped pad of cartilage that provides cushion and stability between the tibia and the femur, can cause knee pain, swelling and stiffness. In addition, the knee may give way or lock up if a piece of the torn meniscus prevents joint movement. Risk factors for a meniscus tear include advanced age, running on uneven surfaces and making sudden turns or stops. To prevent meniscus tears, Dr. Kyriacou recommends runners strengthen the glute muscles and leg muscles, including the quadriceps, hamstrings, abductors (outer thigh) and adductors (inner thigh).

Plantar fasciitis

If the plantar fascia, the thick band of fibrous tissue that runs along the bottom of the foot between the toes and heel, becomes inflamed, it can cause stabbing or dull heel pain. People who have flat feet, high arches, are overweight or on their feet a lot are at higher risk for plantar fasciitis. To ease pain and keep the condition from coming back, Dr. Kyriacou recommends stretching the calves, Achilles tendon and bottom of the foot and strengthening the lower leg and foot muscles. Plantar fasciitis pain may be worse when going up stairs or after prolonged standing or rest.

Medial Tibial Stress Syndrome

Medial tibial stress syndrome, commonly known as shin splints, causes pain and tenderness at the inside or front of the tibia (shin bone). Shin splints often occur at the start of a new training program when the lower leg is not properly conditioned and experiences repeated strain, Dr. Kyriacou says. “It’s important to adopt a new training regimen gradually and rest when increasing intensity or duration,” she explained.

Risk Factors

Dr. Kyriacou divides running injury risk factors into two categories: extrinsic and intrinsic. Extrinsic factors are related to:

  • Training errors, such as making an abrupt change in training technique or mileage;
  • Program errors, like running without a break or running too far too fast;
  • Footwear, which should offer appropriate support and be replaced every 300 to 500 miles; and
  • Running surface, which can increase a runner’s risk of injury if the surface is hard, uphill, downhill or uneven.  

“People who run one to three days a week and less than 20 miles per week are less likely to be injured,” added Dr. Kyriacou.

Intrinsic risk factors act from within an individual and include:  

  • Flexibility – Keep the major lower body muscles flexible.
  • Malalignment – A joint or stabilizer that is not strong enough or properly engaged causes the next one to be overworked and the entire chain of movement to be disrupted, Dr. Kyriacou says.
  • Muscle weakness and imbalance – Weaker muscles fatigue quicker and force other muscles to engage and overcompensate, leading to injuries. “Many muscle aches, strains, tendinopathies and joint injuries could be prevented with better strength training,” Dr. Kyriacou explained.
  • Gender – Females are at greater risk of injury due to their wider hips and larger “Q angle,” which can place greater stress on the knee and lower leg. 
  • Previous injury – Runners with previous injuries are at a 75% increased risk of sustaining another injury, warns Dr. Kyriacou. “Incomplete healing, uncorrected biomechanical healing and abnormal functioning of corrected tissue contribute to re-injury,” she said.

Prevention 

Dr. Kyriacou recommends runners take these steps to help minimize injuries:  

  • Wear proper footwear
  • Warm up before running
  • Add stretching and flexibility exercises to your routine
  • Increase training gradually
  • Incorporate strength training
  • Use proper running technique 
  • Run on dry, flat surfaces
  • Cross train and take breaks
  • Rest your muscles
  • Know your risk factors, especially if you have had a previous injury
  • Maintain a healthy body weight
  • Listen to your body

“A professional gait analysis, which focuses on the stride and how and where the feet land and absorb impact, can help a runner decide which type of shoe is best,” added Dr. Kyriacou. 

Treatment

In many cases, running injuries can be treated with conservative methods, including:

  • RICE
  • Rest—resting to give the injury proper time to heal
  • Ice—icing the affected area for short periods of time to reduce inflammation
  • Compression—wrapping the injured area to reduce swelling
  • Elevation—keeping the injured area elevated to reduce swelling and pain
  • Over-the-counter anti-inflammatory medications, if tolerated
  • Splint, cast or walking aids to immobilize the injury
  • Physical therapy to restore the alignment, improve flexibility and strengthen muscles
  • Soft tissue friction massage  
  • Cortisone injections to relieve inflammation and pain
  • Joint injections to help rebuild joints affected by degenerative disease

Running with an injury can exacerbate pain and further the injury. If a person rests the painful knee for a few weeks and still experiences pain, or if pain is severe, medical attention is warranted. “A primary care sports medicine physician can make a diagnosis and recommend treatment options,” Dr. Kyriacou said.

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