Congratulations. If you’re reading this, you have decided to tackle the experience of running a race. Unfortunately, many of you are likely to encounter some sort of injury along the way. You need to pay attention to your body, be mindful of some of the most common injuries and know what to look for to avoid doing further damage. Be a smarter runner by learning about common running injuries you are likely to face during your training.
- Femoral neck stress fracture: This is a serious cause of anterior groin pain in runners. Usually worse with activity such as running or walking and better when not weight bearing on the hip, femoral neckstress fracture is caused by repeated stress on a bone which causes a small crack to develop. This can occur after increased training loads when runners increase their volume. It may not be visible on an x-ray, and a physician should evaluate persistent groin pain, as more advanced imaging such as an MRI may be needed to diagnose. This type of injury requires prolonged rest from running to heal. Lack of treatment can prevent proper healing of the bone in the femoral neck.
- Iliotibial band syndrome: This is a very common type of injury that runners experience. The iliotibial band is the large ligament that extends from the hip to the lateral knee. Runners commonly mistake this pain for a knee injury. It is typically felt as pain on the outside of the knee as the IT band tightens and causes friction against the lateral knee. IT band pain can also be felt anywhere along the IT band all the way to the hip. Just like femoral neck stress fractures, it is an overuse injury caused by too much mileage, over-pronation, running on uneven surface, or worn out running shoes. You may need to rest once you notice pain to your IT band. Look at your running shoes and make sure they are evenly worn, as over-pronation may cause more stress on your IT band. Try to run on even surfaces. If you run on a track, make sure to switch directions every few laps. Self-foam rolling is key in treating IT band syndrome as it stretches the IT band.
- Runner’s knee: Runners knee encompasses a term for any pain in, around or under the kneecap. It can be caused by malalignment of the kneecap or chondromalacia. Chondromalacia is softening of the cartilages under the kneecap where it deteriorates and causes pain. Chondromalacia pain is often worse when going up or down stairs. Imbalances in muscles can also cause abnormal tracking of the kneecap over the femur, causing pain. These muscles can be strengthened by performing Vastus Medialis Oblique or VMO exercises<https://youtu.be/vynEuGZKDEc>. This strengthens the quadriceps muscle so that the patella tracks normally over the distal femur. Runner’s knee injuries may require a reduction in training volume.
- Shin splints: Otherwise known as medial tibial stress syndrome, the cause is thought to be small tears of the muscle fibers near the tibia or inflammation of the periosteum (outer bone lining). Shin splints cause medial shin pain with impact and running. Stress fractures also cause shin pain. With stress fractures, pain is more localized as opposed to diffuse. If shin pain does not go away with rest, seek medical attention to rule out stress fracture. Runners with shin splints can still run but may need to reduce total mileage as shins heal. Ice shins after each run. Strengthening of the anterior tibialis muscle (in front of leg) is a key component of treating shin splints. Do this by performing dorsiflexion exercises with<https://www.youtube.com/watch?v=ElkXCO7IsgU&feature=youtu.be> and without a resistance band or weight<https://youtu.be/jwxugMF0iSk>.
- Stress fracture: Fractures of the metatarsals are common sources of pain that require medical attention and rest from running to heal. Persistent pain to the metatarsals should be evaluated by a physician.
- Plantar fasciitis: Plantar fasciitis is common for runners and presents with pain on the bottom of the foot occurring anywhere from the heel to the forefoot. The large fibrous band that stretches across the bottom of the foot can become inflamed with repeat pounding the pavement. As a runner, you must stretch this fibrous band regularly. A good way to do this is by rolling a tennis ball under your foot to stretch the fibrous tissues.
- Tarsal tunnel syndrome: This type of foot pain occurs as the nerve that courses behind the inner ankle bone becomes compressed. Compression of this nerve results in arch pain and sometimes, pain in the heel and toes, numbness and tingling. This syndrome is usually caused by over pronation. You may need to see a
physical therapist or podiatrist to assist with stretching or biomechanical issues. - Achilles tendonitis: Overuse can cause inflammation of the Achilles tendon, which can result in pain in the back of the distal leg just above the heel, and can go into the calf. Runners experiencing this should consider taking time off from running to let the tendon heal as it can develop into a chronic tendonitis. Heel drop exercises performed on stairs (eccentric stretching exercises where you stand on your toes while on the stairs and slowly let your heels drop down) may help, along with calf stretching exercises. Strengthening of the calf muscle with calf raises is important as well. Self-massage of the Achilles tendon either by hand or with self-massage stick may also provide relief.
Listen to your body. Dealing with an injury does not mean you have to lose fitness. Consider swimming, biking or performing some other non-weight bearing activity as you recover from some of these injuries.
Always remember to ice and don’t hesitate to seek help from a medical professional for persistent injuries.
Dr. Michael Hartmann
Race Medical Director, Healthy Driven Naperville Half Marathon & 5K
Emergency Room physician, Edward Hospital