5 Common Running Injuries and How a Physical Therapist Can Help You Treat Them

Running is a great sport, but it also comes with a 50% risk of sustaining at least one running injury per year! Of those injuries, 50-75% of them are overuse injuries¹. Despite these facts, you don’t need to hang up your running shoes! A physical therapist can help you address the underlying cause and help you get back to running!

The Two Main Reasons Why Runners Get Injured:

1. Structural Imbalances – Most often, the root cause of running injuries can be attributed to strength imbalances, compensations and altered running patterns. This increases the workload and stress in other areas of your body. This increase leads to pain and breakdown, and eventually shutting you down due to a chronic injury.
2. Training Volume & Stress – Exercise and running should be viewed as an activity “dose”. Your dose can be altered by how long, often, or fast you run, and what surface you run on. Commonly, when we treat runners with overuse running injuries, they are doing too much of one or more of these categories. The body likes gradual change. When you do too much too fast, the body will have the tendency to break down, causing pain.

Novice runners are more likely to experience an injury compared to veteran runners, and any runner with an injury history is twice as likely to experience the same injury again¹. A sad fact is that running injuries and pain with running are the biggest reason why someone gives up the sport. So, let’s break that cycle!

What Are the Most Common Running Injuries That a Physical Therapist Treats?

There is a wide variety of aches and pains that a runner endures. Many of these are not long lasting, especially when treated correctly. Here are some common running injuries that a physical therapist can help you better understand.

Plantar Fasciitis

Plantar fasciitis commonly presents as:

• Pain in the bottom of your foot, often where the arch meets the base of your heel or center of your arch
• Often will feel pain when the foot impacts the ground
• A hallmark sign is pain when you take your first step out of bed in the morning or after sitting for long periods of time

People often treat plantar fasciitis with orthotics, by rolling their foot on a frozen water bottle, or wearing a special sock at night. While these things might help at the time of application, they are often just a band aid. These short term solutions do not get at the root cause of why you are experiencing this pain. A physical therapist is a tissue and movement expert.

Here is what a PT can do to help:

• Assess your strength, movement patterns, and activity history to better understand why you are experiencing pain
• Create a plan to help address your strength and mobility deficits to rebuild tissue tolerance
• Use plyometric training to re-establish your foot’s tolerance for pounding
• Devise a return-to-activity plan with proper running progressions including key areas, such as time, intensity, and surface
• Help you with proper shoe selection to best fit your foot’s needs

Shin Splints

Shin splints (medial tibial stress syndrome) presents as:

• Pain and tenderness along the inside border of your bone and muscle at the lower part of your shin
• Pain can be described as anywhere from a deep ache to a sharp sensation along the inside of the shin
• The pain can be felt with impact and pushing off
• Pain may often be present at the start of the run, get slightly better during the run, and then return at the end
• Pain may linger following a run

Runners often manage shin splints with compression socks, anti-inflammatories, and ice. While these things might help manage the pain at the time, these too are just band aids. Listen to the term, medial tibial stress syndrome. There is no amount of socks, Advil, or ice that is going to change how you are stressing your body. That stress must stop to ultimately fix this problem. Commonly with shin splints, the lower leg is stressed due to altered running mechanics, which is rooted in decreased strength and tissue tolerance for what you are asking of your body.

Let’s talk about how a physical therapist can help you treat shin splints:

• Perform a biomechanics assessment to better understand how and why you are stressing your legs
• Address common strength deficits in areas such as your core, hips and legs to help improve your mechanics (Bonus: this can also help you run more easily and effectively!)
• Use plyometric training to re-establish your leg’s tolerance for pounding
• Help you understand how to manage your pain through proper activity and volume selection and progression

Shin splints are complex and are also often a precursor to a stress reaction. To take a deeper dive into what shin splints are, what causes them, and how to tell the difference between shin splints and a stress reaction, listen to our podcast with Dr. Sydney where she breaks all that down and more! Listen Here! 

Achilles “Tendonitis”

Tendon pain has been called many things over the years, tendonitis, tendinosis and more recently, tendinopathy. From the adult runner to the weekend warrior, tendon pain is very common in running injuries and can be a nuisance.

Common Achilles “tendonitis” symptoms include:

• Point specific pain in the back of the ankle, where the Achilles meets the heel, in the middle of the ropey area of the Achilles, or sometimes where the Achilles meets the bottom of your calf muscle
• The pain can sometimes also come with some mild swelling or redness in the painful area
• Pain commonly starts at the beginning of the run, might get better while running, and then come back at the end of or after a run
• Pain that comes on with increase in pace, distance, or running on inclines
• Pain with stretching

A classic experience with tendon pain is the pain will cause you to rest, and with rest it feels better. Then, with returning to running, the pain comes right back, and the cycle of pain and rest repeats itself. So how do we break this cycle?

Here’s how a physical therapist can help you break the tendon pain cycle:

• Help you identify why the tendon is not tolerating activity, whether it is due to strength discrepancies, mobility deficits, biomechanics, or a combination of these factors
• Address the findings from above
• Help you adjust footwear or temporarily use a heel lift to decrease stress on the Achilles
• Assist in proper return-to-activity progressions through pain reduction techniques, strength, plyometrics, and proper return-to-running volume progression
• This is a big one: finding ways to continue doing activity. It is important to find what you can do to keep you moving and help you build back up. Spoiler alert! Stopping all activity is one of the worst things you can do when treating tendon pain!

Clearly, treating tendon pain is somewhat complex and is very specific to each person. To learn more about tendon pain, check out one of our podcasts with Dr. Brett Ferstl. He breaks down what tendon pain is, what it feels like, when you should get help, myths surrounding tendon pain, how to treat it, and more!

Runner’s Knee

Runner’s knee (patellofemoral syndrome) is one of the most common running injuries.

Runner’s knee symptoms include:

• The pain is very broad and sometimes deep across the entire knee compared to a pinpoint spot
• Pain is often described as a deep ache/discomfort
• Pain is present with pounding/impact activities such as running, pain during activities with your knee in a deep bent position like squatting or lunging, and also commonly when going down the stairs or downhill
• A hallmark sign is pain while sitting for long periods of time

People who experience knee pain will commonly use knee braces, ice or rest to reduce their pain. But much like compression socks for shin splints, these tactics are only band aids. They might help temporarily address discomfort, but they will not get to the root cause of the problem. Runner’s Knee (patellofemoral syndrome) is common in running injuries and is driven by an imbalance of strength and mobility at the knee. This causes an altered running pattern that stresses and causes pain in the knee. 

How a physical therapist can help you fix your knee pain:

• Perform a biomechanics assessment to better understand how and why you are stressing your knee
• Address common strength deficits in areas such as your core, hips and legs to help improve your mechanics
• Help you understand how to manage your pain through proper activity selection and progression

IT Band Syndrome

IT Band Syndrome commonly presents as:

• Pain often described as tight, sharp, ripping, pulling, or stabbing pain on the outside of the knee or hip, especially when running down hills or going down the stairs
• Often times the patient will report a snapping on the outside of the knee when moving in and out of a bent knee position where the IT Band snaps over the outside structures of the knee
• Pain with running downhill, on a uneven/tilted or curved surface
• Pain that came on with training changes such as increased intensity or duration or runs
• Pain that sometimes improves with proper warm up before and cool down after runs

This is a tension-based issue that has multiple potential causes. The tension that occurs during IT Band Syndrome can create friction at bony areas on the outside of the knee or hip that will cause pain and discomfort as the tissue snaps over it while the leg is moving. Runners will often say, “But I stretch all the time, how can I be tight?” Tension is most often rooted in weakness. Changes in running, such as increased volume or intensity, as well as inclines or declines, require significant strength to withstand fatigue and increased demand on your body. It exposes your weakness (pun intended). When weakness is the driving cause, your body will rely on tension to get the job done. Thus, it is important to assess the cause of the pain to address the issue at hand to get you back to running pain free. 

Here’s how a physical therapist can help you treat your IT Band Syndrome:

• Perform an assessment to assess your mobility, strength, and mechanics to understand the root cause of your tension and pain
• They might prescribe some stretches specific to your needs
• Commonly patients with IT Band Syndrome will benefit from core, hip and leg strength
• Assess your shoe selection to determine if it was a contributing factor and help get you into the correct shoe for your needs
• Work with you to have a return to running plan with plyometric, running, and surface progressions to ensure your body is exposed to gradual change to limit recurrence of your pain

Often, I think people are nervous to see a physical therapist for their pain because they are concerned that they will be told that they have to stop running. Most times with running injuries, that is actually not true. It is our job to identify why you are experiencing your pain, and help you find what you can do. Staying active even in the face of an injury is one of the best things you can do. However, it comes with some parameters to ensure you don’t go further down the injury path.

Like I said earlier in the blog, physical therapists are tissue and movement experts! The more you regularly engage with them as a wellness resource, the more you can prevent big things from happening! Should something come up, addressing it sooner rather than later will likely ensure less time down from your sport and keep you doing what you love!

Seek help!

If you are a runner that has been dealing with any of these aches and pains, reach out to our office today to schedule a free consultation to better understand what is going on, and what can be done to get you back to running, pain free! At this 15-20 minute appointment, we will listen to your story, learn about your goals, take a quick look at you and get you pointed in the right direction to get back to enjoying running and being able to do it without pain!

Citations

1.       Van Mechelen W. Running injuries. A review of the epidemiological literature. Sports Med. 1992 Nov;14(5):320-35. doi: 10.2165/00007256-199214050-00004. PMID: 1439399.