Most running injuries can be traced to poor running form that is, in turn, caused by muscle imbalances. This is the message delivered by three sports medicine and fitness professionals — all runners themselves — who gave a presentation last Monday at the Ashland Family YMCA.
Running as the sole form of exercise tends to strengthen some muscles at the expense of others.
1. Runner's knee
How it feels: pain around and under the kneecap
What causes it: irritation under the kneecap caused by weak, inflexible quadriceps muscles
How to heal: massage the area with a foam roller, rest, ice it.
Strengthening exercises: squats
2. Achilles tendonitis
How it feels: tightness or pain from the top of the heel through the bottom of the calf. If serious, it may hurt to walk or stand on your toes.
What causes it: irritation of the Achilles tendon connecting the calf muscles to the heel, brought on by increased mileage or hilly terrain.
How to heal: rest, reduce mileage, avoid running hills, ice it. The tendon can rupture if you don't take it easy!
Strengthening exercises: calf raise/lower on a step, but only after the inflammation has subsided.
3. Plantar fasciitis
How it feels: ache on the bottom of the heel
What causes it: inflammation of the tendons on the bottom of the feet, due to tight and/or weak calf muscles, as well as weak foot muscles. It is often related to Achilles tendonitis, and can be brought on by increased mileage, improper footwear.
How to heal: ice and massage the heel, use a foam roller on the calf, avoid running hills, wear footwear with arch support.
Strengthening exercises: calf raise/lower on a step, toe scrunches.
4. Hamstring strain
How it feels: pain or ache in the back of the upper leg
What causes it: imbalance between (stronger) quadriceps and (weaker) hamstring.
How to heal: shorten your stride, avoid running fast, reduce mileage or rest.
Strengthening exercises: hip hinge — bend forward with a straight back and a slight bend in the knees until you feel the stretch.
5. Shin splints
How it feels: aching pain on shin, may go away after warming up. Shin is tender to touch.
What causes it: minor muscle tears: muscle fibers pulling away the shin bone, brought on by poor running form due to a weak hips and core, tight calves, increasing mileage too quickly, especially for beginning runners.
How to heal: rest a few days, reduce mileage, run on a softer surface, stretch and massage the calf muscles.
Strengthening exercises: heel walking (toes in the air), "pigeon-toed" calf raises
6. IT band syndrome
How it feels: pain in the side of the leg, often centered around the knee.
What causes it: a strain in the iliotibial band (connective tissue that runs between the shin and hip), caused by the IT band rubbing back and forth when hips are weak or tight.
How to heal: rest, check shoes for excessive wear. Shoes may also be inappropriate for your biomechanics.
Strengthening exercises: clamshell, sideways "crab walking" using a Thera-band for resistance.
7. Stress fracture
How it feels: sharp pain in foot or leg, less frequently in the hip, during weight-bearing activities.
What causes it: hairline fracture of a bone, after repeated/cumulative stress is transmitted improperly through the ground over several runs. This can be caused by poor running form, building mileage too quickly, improper footwear or slapping the ground with your feet as you run.
How to heal: rest for several weeks, depending on severity. Seek medical attention immediately for assessment and treatment. Avoid weight-bearing exercise until healed.
Strengthening exercises: wait until the bone has healed, then use conventional weight lifting to strengthen the bone. Strengthen the core with planks and hip raises, which will help stress to be distributed more evenly through the body.
"Most of us have strength imbalances. We're weak, inflexible, and most of us don't have great form," says Dr. Justin Adams. "A lot of it starts in our hips — weak abductors or adductors "Ľ and everything else falls apart from there down."
When injury does strike, there are two issues to be addressed.
"One is correcting what caused them to get injured in the first place, and that comes back to the gait, the strength imbalances," says Adams. "The other is whatever is injured, we have to get it healed."
Strength training is an essential ingredient for staying injury-free, says Mike Sotos, strength and fitness coach and owner of Rogue Valley Fitness Training.
"The general theme is building a stronger core, and also hips and legs," says Sotos. "You can say the upper body is important, too. If you have bad posture, that's going to throw off your running form, too."
Stress fractures of the foot or leg bones can be a symptom of a weak core, according to Sotos. He recommends a combination of front and side planks, combined with hip raises, as a way to help prevent this injury initially, and as part of the rehabilitation process.
Weak hips can also lead to iliotibial (IT) band syndrome, a painful condition on the outside of the leg caused by the IT band rubbing over the knee. For this problem, Sotos often suggests the clamshell exercise, which strengthens the gluteal muscles. In this exercise, the runner lies sidewise on the floor with bent knees and repeatedly lifts and lowers the top knee.
Self-assessment of running form is difficult, so Sotos often performs a visual analysis of the running form of his clients to help suggest the appropriate strength-training regimen.
When an injury is identified, it's usually best to cut back on mileage and intensity or even stop running to prevent the problem from worsening, says Ashland chiropractor Kelly Lange.
Lange uses standard chiropractic adjustments to jump start the healing process on some runner patients, but uses a variety of soft tissue techniques, as well. Stretching with the help of a foam roller can also help maintain flexibility and range of motion, she says, while foot exercises can help teach the body to redistribute weight during foot strike. Some of her treatment techniques may be new to runners, as well as their primary care physicians.
For foot injuries in particular, says Lange, "I want people to know there are options beyond surgery and orthotics."
With foot and joint problems, the site of the injury is often not the locus of the real problem.
"In my practice, eight or nine out of 10 knee problems are not really knee problems," says Lange. "It always comes back to the hip musculature."
Problems can be masked or exacerbated by the wrong choice of footwear, or in many cases, by running with no footwear at all.
"If we all ran well, if we all ran with perfect form, we wouldn't need shoes," says Adams. "If you want to run barefoot, ease into it slowly."
Though you'll have to learn to adjust your running form when you're footloose, the same fundamentals apply.
"To prevent injury, you want balanced strength, balanced flexibility and a good gait," says Adams. "All those things go hand in hand."
Daniel Newberry is a freelance writer living in the Applegate Valley. Email him at firstname.lastname@example.org