Injury Prevention for Runners

written by Physiotherapist Sarah Hull

As the weather is finally warming up, I have been starting to see a lot more running injuries in the clinic. Running injuries are very common and often occur in the hip, knee and/or ankle.  


During a running stride, your two feet are never in contact with the ground at the same time. That means you are always relying on single leg balance for stability and power throughout your run. Making sure you are strong and steady in a single leg stance is imperative for injury prevention. On average, men and women ages 18-39 should be able to hold a single legged stance with eyes open for 44 seconds, eyes closed for 15s, that number slowly decreases with age (1). Are you within those limits? If you are not, it may be due to weakness in some of the muscles that support your hips and ankles during single legged stance like your gluteus medius and tibialis posterior. During a physiotherapy assessment, we are checking your single legged stance along with other biomechanical movements that make up your running sequence and address potential areas of weakness.

Most running injuries are overuse injuries due to increasing mileage or introducing new shoes or terrain too quickly. It’s often because of muscle imbalances in the lower extremity. These imbalances compromise proper technique and running form that is more evident as you fatigue in your run. 


I wanted to discuss the three most common lower body running injuries I see in clinic. 

PATELLOFEMORAL PAIN 
Slower onset of pain that is under or around the knee cap often described as a sharp, grinding pain.

The pain is aggravated by:

  • Running – up and/or down stairs
  • Standing up after prolonged sitting
  • Lower extremity exercises such as squats and lunges
  • Jumpling / plyometric activity


Caused by: 

  • Poor running form (misalignment of knee cap through femoral groove putting more pressure on the edge of the patella causing inflammation)
  • Weakness in the hip 
  • Weakness in the ankle (flat feet, previous ankle injury) 

For this injury, alignment corrections are integral for recovery. Often patellar support through tapes and or braces can be helpful. 


ITB SYNDROME
Pain on the outer edge of the knee that can travel towards the hip. The pain often has a slow onset during the run progressing to a point where you need to stop running. 


The pain is aggravated by: 

  • running- up/down stairs
  • crossed legs while sitting 


Caused by:

  • Training errors in running (progress too quickly)
  • Weak hip abductors and extensors
  • Tight hip flexors/TFL/lateral quad
  • Poor running form (often knee is falling to adduction too much)

For this injury, foam rolling the tight muscles, NOT directly over ITB, is very important for recovery. 

SHIN SPLINTS
Pain on the front or inside of your shin while running. Can become persistent. 

The pain is aggravated by:

  • Running
  • Jumping/plyometrics 

Caused by:

  • Poor footwear (poor cushioning)
  • Patients who are “heavy on their feet”
  • Poor running form (heavy heel strike  = unable to dissipate forces well)
  • High arches/flat feet
  • Training error (progressing too quickly)
  • Tight calves 

For this injury, adequate rest and appropriate footwear is very important. 

These injuries are some of the most commonly treated running associated injuries that we see in clinic. If you are noticing symptoms, please make sure to stop in so we can get you back running as soon as possible! 

(1) Springer, B. A., Marin, R., Cyhan, T., Roberts, H., & Gill, N. W. (2007). Normative values for the unipedal stance test with eyes open and closed. Journal of geriatric physical therapy30(1), 8-15.

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