Running Injuries

Overview

Injuries are very common for runners and can cause them to discontinue the activity. Understanding the nature of the injuries and how to prevent them, as well as possible treatment, is essential.
Six common running injuries include:
  • Stress fractures of the hip or leg: A stress fracture is a microscopic break within the bone that has not progressed to a full fracture. In runners, stress fractures commonly occur within the femoral neck (hip bone), tibia (shin bone), or fibula (bone on the lateral side of tibia).
  • Hamstring strains or other pulled muscles: Whether the hamstring, quadriceps or another muscle, pulls can result from not being flexible enough and from sudden overexertion.
  • Patellofemoral pain syndrome: Patellofemoral pain syndrome is a common condition in which pain emerges around the knee cap. The condition involves how the kneecap moves in relation to the femur (thigh bone).
  • Iliotibial (IT) band syndrome: The iliotibial band is a fibrous strap of tissue originating at the pelvis, extending down the thigh and to the lateral tibia (outside of the knee). Repeated movements, such as with running, can cause a sharp, burning pain in knees and hips. The condition is more common among distance runners.
  • Shin splints: Common shin splints stem from inflammation of the periostium (a sheath of tissue) on the tibia. The injury has many potential causes, but commonly results from overtraining or a biomechanical flaw in the foot.
  • Plantar fasciitis: Plantar fasciitis is experienced as heel pain, generally worse upon getting out of bed in the morning or rising after a prolonged sit. The condition is due to a degenerative tear in the fascia (tissue running from heel to toes on the bottom of the foot).

Symptoms

  • Stress fractures of the hip’s femoral neck: Stress fractures often create pain in the groin, anterior thigh or side of the hip. It worsens with activity or weight-bearing and improves with rest.
  • Hamstring strains: A sudden onset of pain in the back of the thigh often stems from moving from a standstill to a sprint (e.g., starting from a runner’s block). Patients frequently report a “popping” feeling with the strain and sometimes bluish or purple bruise is visible.
  • Patellofemoral pain syndrome: Patients usually describe an aching pain under the kneecap that increases with weight-bearing, kneeling, squatting, stair-climbing or running.
  • Iliotibial (IT) band syndrome: Symptoms frequently include a sharp, burning pain and irritation at the front or side of the knee that worsens with running, especially downhill, and hurts most as the foot hits the ground. IT band syndrome pain usually improves with rest.
  • Shin splints: Symptoms of shin splints include pain in the front of the shin (the inner or outer side of the tibia) near the foot. Pain usually worsens with activity.
  • Plantar fasciitis: Irritation and swelling occurs in the thick tissue on the bottom of the foot. The fascia can become inflamed and painful, making walking difficult.

Causes

In general, the causes of the most common injuries experienced by runners include overuse or overtraining, or abnormal biomechanics (poor technique or when the runner has asymmetric muscles so some muscles are weaker than others). In some injuries, such as stress fractures, hormonal imbalances, poor nutrition and osteoporosis can be contributing factors. Obesity or sudden weight gain may increase the stress of running to bones and joints and may make increase likelihood of all injuries referenced here. In athletes with poor nutrition or eating disorders, bones may be osteopenic (lack density) and weaker than usual, and more likely to suffer from a stress fracture.

Risk Factors

  • Overuse or improper training, such as increasing distance too quickly
  • Poor biomechanics (mechanics of movement)
  • Weakness of specific muscles
  • Obesity
  • Improperly fitting or old, worn out shoes
  • Bad habits (e.g., wearing cleats rather than running shoes while running distances)
  • Poor nutrition
  • Hormone imbalance
  • Osteoporosis

Diagnosis

Typical diagnosis of running injuries involves a qualified physician (such as a physiatrist specializing in sports medicine) obtaining a complete patient history and thorough physical exam, which may reveal tenderness at the injury site. Diagnostic tests may include an X-ray and/or bone scan (with injected dye to determine precise location of injury). In addition, an MRI (magnetic resonance imaging) may be performed for a specific diagnosis or to rule out other causes.

Complications

If not treated, running injuries often continue to cause pain. This can ultimately lead to reduced or complete stoppage of the activity. In some cases, lack of treatment may also cause a complete fracture or displacement of the bone; this can lead to progressive deformity and osteonecrosis (loss of blood supply to the bone, causing the bone to decay or die).

Recovery

Patients with running injuries should apply the rest, icing, compression and elevation (RICE regimen). They should follow their physician’s and/or physical therapist’s instructions, especially regarding weight-bearing guidelines, such as using a brace. They should take oral medications as directed. Patients can help themselves by avoiding specific activities that cause pain and by examining their workouts and habits to ensure they build strength and stamina incrementally.

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