Running Injuries

Running Overview

Running physiotherapy focuses on the assessment, prevention, and rehabilitation of injuries specific to runners, as well as optimizing performance and maintaining overall physical health. Physiotherapists work with runners to ensure they recover from injuries, prevent future issues, and improve their running mechanics. Here's an in-depth look at the key aspects of running physiotherapy:

Common Running Injuries

Runners are prone to several injuries due to factors such as repetitive impact, overuse, and improper technique. Common running injuries include:

Patellofemoral Pain Syndrome (Runner's Knee): Pain around the kneecap, often caused by muscle imbalances or poor running mechanics.
Shin Splints (Medial Tibial Stress Syndrome): Pain along the shin, typically caused by sudden increases in running load and intensity or poor footwear.
Achilles Tendinopathy: Overuse or excessive load on the Achilles tendon, often from repetitive running and poor load management.
Iliotibial (IT) Band Syndrome: Pain on the outside of the knee, commonly caused by tightness or muscle imbalances in the hip and thigh.
Plantar Fasciitis: Inflammation of the plantar fascia, causing heel pain, typically seen in runners with poor foot mechanics or excessive mileage.
Hamstring Strain: A tear or strain in the hamstring muscles, often caused by tight muscles or inadequate warm-up.
Stress Fractures: Tiny cracks in bones, most often in the lower legs or feet, typically resulting from overuse or improper loading.
Ankle Sprains: Often caused by sudden changes in direction or running on uneven surfaces.

Musculoskeletal Assessment and Diagnosis

A comprehensive musculoskeletal assessment is vital in identifying the cause of pain, injury, or dysfunction. This typically includes:

History Taking: Understanding the runner’s training habits, injury history, running volume, footwear, and any other contributing factors.
Physical Assessment: Evaluating joint range of motion and muscle flexibility, particularly in the hips, knees, ankles, and lower back.
Strength Testing: Identifying weaknesses or imbalances in the main muscle groups that may be contributing to injury including the gluteals, quads, adductors, hamstrings and calves.
Diagnosis: With careful testing and palpation skills we provide a clear diagnosis and pathway going forwards for the athlete outlining all aspects of rehab and recovery.

Running Analysis

Running analysis can help identify mechanical inefficiencies that could lead to injuries. It typically includes:

Video Gait Analysis: Recording the runner’s movements to analyse stride length, foot strike pattern, and overall running mechanics.
Foot Strike Analysis: Determining whether the runner is a heel striker, midfoot striker, or forefoot striker and how this affects their biomechanics and injury risk.
Cadence and Step Rate: Analysing the number of steps taken per minute (cadence), as lower cadence is often associated with increased injury risk.
Postural Alignment: Assessing the runner’s posture, including head position, spinal alignment, and pelvic tilt during running.
Symmetry: Identifying any left-right imbalances in movement patterns, which can indicate underlying musculoskeletal issues.

Running-Specific Rehabilitation

Rehabilitation for running injuries typically includes:

Manual Therapy: Techniques such as massage, dry needling, or joint mobilization to reduce pain and improve movement.
Stretching and Mobility: Enhancing flexibility in tight muscles, like hip flexors and calves.
Strengthening Exercises: Targeting strengthening for the key muscle groups including the glutes, quadriceps and calves to restore strength and improve mechanical efficiency.
Stability Exercises: Strengthening the lateral hip region as well as the ankle for optimal stability and energy transfer, improving muscle efficiency and leading to improved running economy and prevention of injuries
Rest and Recovery: Allowing the injured area to heal before resuming activity, and providing an individualised return to running program when the athlete is ready to resume training.

Load Management

Proper load management is essential for preventing overuse injuries and ensuring recovery. This involves:

Training Load Monitoring: Keeping track of the amount of running an athlete is doing. We utilise tools like heart rate monitoring, GPS tracking, and perceived exertion to track frequency, intensity and duration of runs to avoid excessive strain on the body.
Progressive Overload: Gradually increasing intensity, volume, or frequency to allow adaptation without overwhelming tissues.
Recovery and Rest: Ensuring adequate rest between training sessions, particularly after long or intense runs, to allow the body to recover.
Cross-Training: Incorporating other forms of exercise, like cycling or swimming, to reduce the repetitive stress on running muscles.
Periodisation: Structuring the training program with appropriate phases of intensity, recovery, and tapering to peak for competitions and avoid burnout.

Injury Prevention

Proactive injury prevention strategies are key to keeping runners healthy and performing at their best:

Warm-up and Cool-down: A dynamic warm-up before running (e.g., leg swings, lunges) and a static cool-down afterward (e.g., calf stretches, hamstring stretches).
Flexibility and Mobility: Stretching and foam rolling to maintain flexibility and reduce muscle tightness.
Strength Training: Regular strengthening of key muscle groups that support running mechanics.
Footwear Selection: Ensuring the runner has appropriate shoes for their foot type and running style, as well as replacing shoes when they wear out.
Cross-Training: Encouraging other activities like swimming, cycling, or yoga to balance muscle development and reduce the risk of repetitive stress injuries.

Return to Sport Program

A structured return-to-sport program is essential for safely transitioning back into running after an injury. At Pro Perform Physiotherapy, our return to sport programs typically contain the following:

Functional Testing: Assessing strength, flexibility, and endurance to ensure the runner is ready to return to full activity.
Step-by-Step Progression: Gradually increasing running distance and intensity while monitoring symptoms to avoid re-injury.
Load Monitoring: Keeping track of the runner’s weekly training load to avoid sudden increases that could lead to reinjury.
Psychological Support: Helping athletes regain confidence and mental readiness after an injury.

Medical Management

In some cases, medical intervention may be necessary. Our physios can provide guidance on when medical intervention may be required and what specific intervention may be required:

Anti-Inflammatory Medications: To reduce swelling and pain.
Referral to Specialists: When necessary, referrals to orthopaedic surgeons, podiatrists, or sports medicine doctors may be required for more advanced treatment.

Liaise with Top-Grade Coaches

Collaborating with experienced running coaches ensures a comprehensive approach:

Physiotherapy Input: Sharing insights from our physiotherapy assessments of flexibility, strength and plyometric ability to ensure training is tailored to the runner’s current physical condition.
Training Program Design: Coaches help tailor a training plan that matches the athlete's goals and prevents overtraining.
Adjusting Training Load: We work with coaches to adjust training intensity and volume to prevent injuries and allow for recovery.
Psychological Support: Coaches and physios can help with mental preparation and motivation during the rehabilitation and recovery process.

Nutrition

Nutrition plays a key role in optimising performance and recovery:

Hydration: Ensuring adequate fluid intake before, during, and after runs.
Carbohydrate Intake: Fuelling correctly for low intensity and high intensity sessions, as well as post training recovery meals.
Protein: Consuming protein-rich meals post-exercise and steadily throughout the day enhances muscle repair and recovery.

Conclusion

Running physiotherapy is a comprehensive approach that combines injury prevention, rehabilitation, strengthening, and performance optimization. By addressing running-specific injuries, enhancing biomechanics, and collaborating with coaches, our physios can help runners stay healthy and perform at their best. Whether recovering from an injury or aiming to improve running efficiency, physiotherapy plays a vital role in a runner's overall training and performance journey.