Health & Safety Resources

RUNNING RELATED INJURIES

Introduction

Running is a popular sport worldwide, both recreationally and competitively, and is practiced by all ages, year round. An estimated 40-50 million Americans run several times a week. Running helps to maintain fitness level, and health benefits include decrease in the risk of cardiovascular disease and cancer.

Along with the benefits of running, are the risks of running related injuries. Factors contributing to running injuries depend on age, experience, type of running, running surface, and gait imbalances. The majority of running injuries are related to overuse and training errors. Often athletes try to accomplish too much too fast and set unrealistic goals.

Higher injury rates are associated with prior injury, running more than 40 miles a week, and running seven days a week without a rest day. Studies have shown that runners who do not take rest days are injured more often than those who take rest days.

Intrinsic and extrinsic factors can lead to running injuries as well. Intrinsic factors include foot arch anatomy, gait imbalances, leg length discrepancy, and pelvis and lower extremity alignment. Extrinsic factors include footwear, arch supports, and types of running surfaces. Selecting proper footwear with appropriate support, cushioning, and stability is important in injury prevention. 

History taking is the key to determining overuse issues and whether training errors are a contributing factor. Injury risk assessment should be based on the individual athlete. Valuable information can be obtained from reviewing training logs.

Common training principles include increasing weekly mileage by no more than 10%,  not exceeding 30% of total weekly mileage on long runs, and when returning from an injury, resuming at a decreased pace, at no more than 50% of normal training mileage.

Types of injuries

The highest frequency of running injuries occurs in the knee, lower leg, ankle and foot. Lower frequency of injuries occurs in the hip, thigh, and lower back. The most common injury is patellofemoral stress syndrome, followed in no particular order by iliotibial band friction syndrome, medial tibial stress syndrome, Achilles tendinitis, plantar fasciitis, and patellar tendinitis. Other injuries include metatarsalgia, hamstring injuries, stress fractures, and ankle sprains.

Patellofemoral stress syndrome: Anterior knee pain, due to variety of biomechanical factors

Patellar tendinitis (“jumper’s knee”): Anterior knee pain over the inferior patella (the lower part of the knee cap) and patellar tendon, typically worse after exercise

Iliotibial band friction syndrome: Pain at the lateral knee (outside of knee). Due to iliotibial band friction over the lateral femoral condyle (outside of knee joint) during knee flexion

Medial tibial stress syndrome (“shin splints”): Pain at the junction of the medial and distal tibia (lower shin), typically relieved by rest

Tibial stress fracture: Anterior tibial (shin) pain that persists, with rest, and can occur at night

Achilles tendinitis: Tenderness at the Achilles tendon and /or at the insertion onto the calcaneus (heel), +/- swelling

Plantar fasciitis: Medial heel pain at the insertion of the plantar fascia onto calcaneus (heel), worst during first step out of bed in the morning

Hamstring injuries: Tenderness at the hamstring, decreased strength and flexibility. Occur after inadequate warm up, when hamstring contracts

Metatarsalgia: Pain at plantar surface of foot, proximal to second–fourth metatarsal heads (base of second – fourth toes). Primarily at second toe.

Diagnosis

Diagnosis is primary made by a careful history and physical examination. Sometimes imaging studies may be necessary to determine the extent of an injury.

Treatment

Most running injuries can be treated conservatively with rest, ice, short course of NSAIDs, bracing as needed, local modalities, and targeted rehabilitative exercises and stretching techniques. Important components of treatment are assessment of training errors and potential overuse, biomechanics, footwear, and instituting formal physical therapy as necessary. If pain or limitation in activity level persist beyond an acceptable time frame, further reassessment by a physician is recommended. Communication amongst the athlete, athletic trainer, coaches, family, physical therapist, and physician is important in achieving optimal results. The goal is to allow athletic participation in a safe and effective manner, making training modifications as necessary, with an emphasis on injury prevention.

Prevention Tips

• Adequate warm-up and stretching routine before and after running
• Adequate time to rest after competitions to allow healing process
• Listen to your body (do not push too fast, too far, and beyond pain level)
• Setting realistic goals
• Paying attention to running surface
• Injury specific rehabilitative exercises; modification of workout regimen (ie- swimming, elliptical) to prevent de-conditioning
• Proper footwear (shoe wear; orthotics if necessary)
• Regular follow-up with athletic trainer and physician

For further information on this article or for priority appointments for sports injuries please contact Henry Ford Center for Athletic Medicine at 313-972-4216.

Written by: Melissa Nayak, M.D., Henry Ford Center for Athletic Medicine

Henry Ford Health System’s Center for Athletic Medicine offers a comprehensive approach to sports medicine, including surgical and non-surgical care, sports rehabilitation, injury prevention, and performance enhancement programs.  The HFHS treatment team includes sports medicine fellowship trained orthopedic surgeons, sports medicine fellowship trained primary care physicians, as well as certified athletic trainers and physical therapists.  These health care professionals are supported by the HFHS nationally recognized bone and joint research facility, including the prestigious Herrick Davis Motion Analysis Lab.  HFHS is proud to be health care providers to the Detroit area’s premier sports programs including professional, collegiate, and high school athletes.