Running Injuries

Running Injuries

Running injuries are usually overuse injuries of the foot, lower leg, knee, and hip. View the most common injuries here:

Below are some of the more common injuries which affect runners.

Foot and heel

Lower leg and ankle

Knee

Thigh

Hip & groin

Lower back

Should I seek professional treatment?

If you have any of the following symptoms you should seek further medical assistance.

  • Severe pain, especially on walking
  • Severe swelling (oedema)
  • Altered sensation in the foot – such as a feeling of “pins and needles” (paresthesia) or a “loss of feeling” (anaesthesia).
  • Unable to complete normal daily activities after the initial 72 hours.

Further medical assistance can be sought through either your local GP or a private clinician such as a podiatrist, physiotherapist, sports therapist, osteopath or chiropractor. If you have followed the P.R.I.C.E. principles (see below) and are still unable to walk after 72 hours or still have severe pain that is not subsiding after the first 72 hours you should visit your local A&E department for further assessment.

Secondly, if you have applied for P.R.I.C.E. principles and still have weakness that lasts a long time (more than 2 weeks) or have ongoing discomfort in your foot or heel, you are highly recommended to seek advice from a specialist expert - such as a podiatrist or physiotherapist, osteopath, or chiropractor - who can provide you with advice and an appropriate and effective recovery and rehabilitation program.

Immediate first aid for acute running injuries

The PRICE principles are the gold standard set for treating acute sports injuries. The acronym stands for Protection, Rest, Ice, Compression and Elevation and should be applied as early as possible and continued for at least the first 24-72 hours.

Protection

Protection of the damaged tissue is vital to prevent further damage and enable the healing process to start efficiently and effectively. There are a number of ways to protect the injured area all with the same aim of limiting further movement and use of the joint/muscle/ligament/tendon. One way this can be achieved is by using a support or splint.

Rest

In the early stages, rest is one of the most important components of the P.R.I.C.E principle but is often neglected or ignored. It does not only refer to the prolonged period of time that the athlete will be out of action but also to the immediate period after the injury.

An athlete must know when to stop training and allow the injured area to heal otherwise repetitive minor injuries can often result in a more severe injury that keeps the athlete out for much longer.

If an injury is sustained during sporting activity some athletes have a tendency to 'run it off'. This implies that by continuing to participate in the exercise, the injury will simply go away. In fact, in the majority of cases, this is not true and is not advisable.

Ice

Ice therapy, also known as cryotherapy, is one of the most widely known and used treatment modalities for acute sports injuries. It is cheap, easy to use and requires very little time to or expertise to prepare.

The application of ice to an injury, in the acute phase, can substantially decrease the extent of the damage. It achieves this in a number of different ways:

  • Decreases the amount of bleeding by closing down the blood vessels (called vasoconstriction).

  • Reduces pain (pain gate theory)

  • Reduces muscle spasm

  • Reduces the risk of cell death (also called necrosis) by decreasing the rate of metabolism

Ice is usually applied to the injured site by means of a bag filled with crushed ice which is wrapped in a damp towel. The damp towel is essential as it forms a barrier between the bag of ice and the skin and reduces the risk of an “ice burn”. DO NOT leave the ice on for more than 15 minutes as you could cause an “ice burn”.

There are a small number of areas that you should not apply ice to which include the neck, the outside bone of the elbow, the collar bone (upper end), the front of the hip (bony part) and the outer bone of the knee. The reason for this is there is a superficial nerve just below the skin in these areas that can be damaged by applying ice to it. Always check for contraindications.

Compression

Applying compression to an injured area minimises the amount of swelling that forms after an injury in two ways and should be applied for the first 24 to 72 hours from the onset of injury. Compression can be applied through a number of methods. The most effective of these is by using a compression bandage which is an elasticated bandage that simply fits around the affected limb.

Elevation

Elevation of the injured limb is the final principle of PRICE but is equally as important as the other 4. Elevation allows gravity to drain the fluid away from the injured site. This aids in decreasing the swelling which in turn may decrease the pain associated with the oedema (swelling).

Read more on PRICE principles

Race Day Tips

Former Elite Marathon runner Paul Evans gives his inside hints and tips of how to make the most of race day for any big city marathon including the London Marathon.

Transcript: Make sure you get there in plenty of time, make sure you know where you're going, make sure you know where your start is, especially if it's a big city marathon because there are going to the thirty-five thousand other people who are going to be there on the day. Make sure you know where your start is and you're not rushing around with your heart rate already up. Don't do anything different on race day which you haven't done in training, ie, don't wear new shoes, don't wear new kit because it could rub and be very painful. Don't experiment with any drinks that you haven't tried. That is the key one. So many people I mean I know at London will have their drinks sponsors, make sure you've used that drink in your training runs because there's nothing worse than getting an upset stomach at 21, 22 miles and ending up sitting at the side of the road.

Always take loads of warm clothes because you never know, if you're talking about London, any big city marathon, any marathon, come to that, it could be cold and it's always best to have too many clothes because you can take them off, I mean even if it's gloves and hats, to begin with, you can always peel them off as you start the race. So, I wouldn't stand there in a vest shivering, you know, even if it's having a long sleeve T-shirt and cutting the hole so that your numbers sticking out, you know, there's all sorts of things like that that you can do.

Make sure you don't run the first few miles too quick. Because it's very very easy to do because you've just had a week of training, you haven't done any training, it's the day of the race, you're all excited or what have you, that gun goes and it's so, so easy to get caught up in somebody else's race, somebody else's pace and believe me it will find you out somewhere along the line.

From Tower Bridge going right out to Canary Wharf which I always used to call, I think it was Eamonn Martin used to call the dead zone. Because you're running away from the finish, it's where the crowds get a little bit thinner and it's a time in the race where, you know, if you're going to lose it, mentally that's where you're going to lose it. I used to have to really concentrate for that six miles and it used to be really really tough because if it's going to fall apart, that's where it's going to fall apart.

It's very very important that you drink early on in a marathon, if you don't, a lot of people leave it until they're thirsty, it's too late by then, you're dehydrated. the best thing to do is always drink little and often. So at your first drink station take a drink. Make sure you're well hydrated before the race, and obviously the night before as well. Just make sure you're drinking loads the three days leading up to the marathon.

My diet used to be about eighty-five percent carbohydrate. So I would just make sure, the evening before the race I would have a little bit more carbohydrate than I would normally have as well. So you're standing on the start line, it doesn't matter if you're standing on the start line and you feel about a pound over weight, it doesn't matter at all, in fact, the sign is it's a good way to be.

You do lots of your training during your long runs too, so you can actually try, train your body, to actually keep going when you do hit that wall. There are lots of drinks, lots of isotonic drinks, you've all heard about the pasta parties and things like that, that all helps, because it gives you glycogen which your body uses as fuel anyway. You run out of glycogen, your muscles run out of glycogen is when you hit the wall. So you can stand on that start line really loaded up with glycogen and drink, some good fuel and hopefully that will take you through the twenty-six mile.

I just used to write my splits on my arms, so I went through at five k, I knew what I wanted to go through at five k and ten k and if you went through a bit quicker you could slow it down.

I think everybody should do the London Marathon at least once in their life because it's such a fantastic experience. Yes it is a long way, it's twenty-six miles but you know it's just the camaraderie is just absolutely fantastic between the athletes and every mile there are bands playing, it's really a lot of fun. And crossing that line is just a unique experience whether you're running two hours six minutes or you're running six hours it doesn't matter. New York's the same, New York, you go to New York and the atmosphere there is absolutely unbelievable as well and to run around one of the major cities in the world. Yeah, Big City Marathons are very very special.


Barefoot Running

Across the running community, people are beginning to ditch their expensive, high-tec running shoes in favor of taking to the streets barefoot (or the closest alternative). But why is this and what do they hope to gain from doing it?

Why Run Barefoot?

People have been running barefoot for as long as they have been present on this earth. Many tribes in Africa and South America in particular, have continued to do this. Others wear very minimally supportive footwear such as moccasins or sandals. Interestingly, these populations do not suffer from the slew of running-related injuries that are often blamed on ‘the wrong trainers’ or ‘worn-out trainers’ in western society.

Nike developed the first modern running shoe, the Cortez, back in the early 70’s. Before that, runners wore very thin, racing flats. Nike’s idea behind developing the Cortez was that running with a thicker, cushioned sole and the heel raised up would stop the foot from tiring and propel the athlete forwards. The huge popularity of the Cortez spawned the modern running shoe industry we have today. This is a $20 billion industry where companies such as Nike, Adidas, Asics, Saucony and New Balance to name only a few, compete to produce the ideal running shoe for each ‘type’ of runner (i.e. overpronators, oversupinators and neutral runners). They all claim to use the latest technology to produce shoes which will improve performance and comfort as well as decrease injury rates. So, with all of this money, research, and technology, surely the rate of running injuries is decreasing? Unfortunately, this is not the case.
Last year, in a paper in the British Journal of Sports Medicine, Dr. Craig Richards revealed there are no evidence-based studies that demonstrate running shoes make you less prone to injury.

Similarly, Dr. Daniel Liebermann, professor of biological anthropology at Harvard University, who has been studying the increase in running injuries, claims that many modern running shoes, in fact, make our feet weaker and this contributes to the development of many common running injuries such as shin splints and plantar fasciitis.

Is Running Barefoot Actually Better for us?

The barefoot devotee's claim that running barefoot is more economical and improves technique and performance, thus allowing us to run faster, and most importantly, avoid injuries! These are big claims that were until recently, largely unsubstantiated.

Liebermann and his group of researchers have investigated the 'Foot strike patterns and collision forces in habitually barefoot versus shod runners'. Their findings demonstrate that those who run barefoot, use more of a mid-foot, or fore-foot strike. 75% of runners who wear modern running shoes demonstrate a prominent heel strike. It is this heel strike which is thought to contribute to increased injury risks due to the massive shock put through the heel with each step. Those runners who run barefoot, have a lighter, more springy step. Forefoot strikers have far more range of motion in the foot, their feet flex, spread, splay and grip the surface, reducing the amount of pronation and more evenly distributing pressure.

In theory, this all sounds great. However, people tempted to convert to barefoot running should be cautious and introduce it into their routine very gradually. Running barefoot uses different muscles to running in trainers. The calf and foot muscles must work harder and so as with any exercise, a slow build up should be used to avoid injuries.


Choosing running shoes

Running shoes are, without a doubt, the most important piece of equipment a runner will ever purchase. We take a look at the different types of shoes available.

 

Their most obvious function is in protecting the foot, however getting the right shoes will also help to prevent injuries, improve comfort and possibility even enhance performance!

Not all Running Shoes are the Same

The right shoes for one person, will more than likely not be the right shoes for someone else! There are many different shoe manufacturers out there, with many different models. How do you know which one is right for you? Well, the most important thing is to know what kind of runner you are and what foot type you have.

When it comes to buying running shoes, you will no doubt hear the words pronation and supination. These are natural movements of the foot, which everyone does to some extent when they run and walk. The problem comes when the foot over-pronates, or over-supinates (sometimes known as under-pronates).

Pronation is where the arch of the foot flattens and the foot rolls inwards as you walk or run. Over-pronation means that too much of this motion occurs. Excessive pronation also causes an excessive inward rotation of the lower leg, knee, and even upper leg, possibly causing overuse injuries such as Achilles tendinopathies, plantar fasciitis and shin splints.

Supination is the opposite movement to pronation, causing the arch to rise and foot to roll outwards. Over-supination can also cause injuries, mostly because this causes the foot to be very rigid and so lacking in shock absorbing capabilities.

When in the market for running shoes, especially your first pair, you need to determine what happens at your feet when you run. There are many ways of doing this, but the best bet is to have a gait analysis. This involves a trained individual observing your feet and how you move, sometimes filming it so they can slow it right down!

So, now you know what foot type you have, but where does this come in when buying your running shoes? Well, different shoes are available to meet the requirements of different runners.

Types of Running Shoes

Motion Control Shoes

Motion control shoes are designed for people who overpronate. They are heavier and have a rigid arch support to help decrease movement of the foot.

Cushioned Shoes

Cushioned running shoes are designed for the runner with a neutral foot. This means they do not excessively pronate or supinate. These shoes provide a mix of arch support and cushioning.

Stability shoes

Stability running shoes are designed for people who oversupinate, as they provide the extra cushioning and shock absorbing that this particularly rigid foot requires.

Other Considerations

Of course, there are other things to consider when buying a running shoe. Width, fit and comfort are probably the most important. The general advice is to buy a pair of shoes half a size larger than your normal shoe size to allow the foot to move. However, this will vary slightly as sizes are different from one manufacturer to another.

Similarly, some manufacturers produce wider shoes than others and so if you know you have a wide foot, make sure you have enough room. Try lots of different brands and choose the best fit. Often, when you have found the right shoe for you, you will stick with this brand in the future!


Gait Analysis

Gait is the way in which we move our whole body from one point to another. Most often, this is done by walking, although we may also run, skip, hop etc. Gait analysis is a method used to assess the way we walk or run to highlight biomechanical abnormalities.

What are Biomechanical abnormalities?

Being able to move efficiently is important in avoiding injuries. Having joints capable of providing sufficient movement and muscles capable of producing sufficient force is vital to generate an efficient gait cycle. If joints are stiff (usually caused by muscle tightness), limiting the range of motion, or muscles are weak, the body must find ways of compensating for the problem, leading to biomechanical abnormalities.

Examples of biomechanical abnormalities include:

  • Overpronation
  • Oversupination
  • Increased Q angle
  • Hip hiking (or hitching) - lifting the hip on one side
  • Ankle equinus - limited ankle dorsiflexion
  • Pelvic tilt - can be either anterior, posterior or lateral

Biomechanical problems such as these are usually caused by muscular imbalances (tight muscles working against weak muscles), although they can sometimes be caused by structural problems, such as leg length discrepancies resulting in hip hiking.