Advice from an Expert Who Runs: Managing Common Injuries

With marathon season rolling around whippets start testing their limits with tougher workouts and more mileage in search of a PR this fall, aches and pains may start to show up. We’ve found that Google can be a scary place, convincing you that you’re either totally fine to run with a stress fracture or that your merely tight IT band requires full knee replacement. Instead listen to the experts!

We asked Emmi Aguillard, a member of the Dashing Whippets and Physical Therapist at Finish Line Physical Therapy, to round up and explain some of the injuries she sees most frequently in patients. We hope this article helps keep you injury free and on the road to that PR.

As PT, I deal with a LOT of running injuries day in and day out. Googling is often our go-to when we feel some discomfort pop up, but can oftentimes lead us down a rabbit hole, or provide less than accurate information. Here is a summary of a few very common injuries that I see, and the basics of what to do about each. Just a note, if you are experiencing any injury lasting more than a week, it’s always best to check in with your physical therapist or physician to make sure that everything is OK!

THE KNEE

This is one of the most common body parts where runners experience pain. Many things can contribute —  from your sneakers, to the surface that you are running on, to tightness in other areas of the body. A good rule of thumb for this joint is: “It’s never the knee’s fault”– that is, pain here usually stems from a restriction or dysfunction either at the hip or ankle. The knee is a simple joint – it is just meant to bend and straighten. Tightness in our hip flexors from too much time at our desk and calf tightness are two BIG underlying factors for knee pain.

• Runner’s Knee
  • Many of y’all have probably been to see a doctor for knee pain, and gotten the lovely diagnosis of “Runner’s Knee” or “Patellofemoral pain syndrome.” Patellofemoral pain syndrome is an umbrella term, and we need to look at the whole system to figure out why the knee is taking on more forces than it should, therefore causing pain. It oftentimes develops from overuse of the quads compared to the glutes, or a restriction in the hip or ankle causing increased rotational forces and inflammation in the knee.
  • Rehab Tips: Foam roll quads and calves, stretch hip flexors, glute activation (and strengthening!)
• IT-Band Syndrome
  • One of the primary symptoms of IT-band syndrome is pain on the outside of the knee, closer to the knee joint. You may notice this pain more when you are going up and down stairs, and it is usually a sharper pain than “runner’s knee.” Fellow FLPT therapist Brendan calls it a “toothache of the lateral knee.”
  • You might also notice increased tightness on the outside of the hip (gluteus medius or tensor fascia latae muscles). Restrictions here can increase your risk for developing IT-band syndrome
  • Rehab Tip: Foam roll lateral quads and the top/side of your hip. It’s actually not necessary to roll directly on the IT band itself as it takes over 2000 lbs of force to change the structure of this tissue; you’ll get much more bang for your buck by focusing on the lateral quad. If it’s still feeling tight, hamstring restrictions can also contribute to ITB pain, you could try foam rolling the length of your hamstring. Finally, glute activation, glute strength/endurance, and learning how to properly load and engage your glutes while running is essential for keeping IT-band pain from reoccurring.
• Shoe Tip: If you are having increased knee pain when running AND you notice that your knees seem to be diving in a lot when you land (known in the rehab world as “knee valgus”), you may also benefit from shoes with a little bit of support or stability. This will help to control that inward motion from the bottom up. Not sure if you fit this profile? Check with your PT or a running shoe specialty store for an assessment by a professional!

THE FOOT AND ANKLE

Two of the most common overuse related injuries that I see in runners in the lower part of the body are plantar fasciitis and achilles tendinitis, which actually have a lot in common, and can stem from overworking of the calf and foot due to decreased hip extension or even lack of core stability. Both of these areas can be tricky because of the lack of blood flow to these tendinous structures, so healing time can take what feels like forever. Modalities and exercises targeting increasing blood flow to the inflamed tissue are an essential part of rehab.

• Plantar Fasciitis
  • This injury can stem from both a flat foot or an arch that is too high; With a flatter arch, the tissue is being overstressed and overworked; with a higher arch, the rigidness of the arch prevents the proper pronation (arch collapse) and load during gait, so forces are not being distributed evenly across the arch.
  • Rehab Tip: Trigger point work or lacrosse ball to bottom of foot and calves, wearing proper running footwear to help offload the plantar fascia and control the inflammation (be sure it is the proper type of support for your foot type, as a “stability shoe” may cause increased supination (outward movement of the foot)  in a rigid foot.) Day to day walking, etc, make sure you’re in something comfortable: no crocs or flat sandals!

• Achilles Tendinitis
  • This is often the result of tight calves; another contributing factor could be decreased hip extension and glute engagement during running – the runner is getting all of their push-off from the calf and the glute isn’t kicking in enough to aid in forward propulsion.
  • Rehab tips: foam roll calves, stretch calves, stretch hip flexors to allow for more hip extension in gait; a shoe with a greater heel-toe drop can also be helpful to offload the achilles.
  • Research also supports the use of compression socks aiding in pain relief for Achilles tendinitis. If all else fails, try sleeping in a night splint or strassburg sock to keep the calf lengthened overnight.
  • Red flag: the lower down the pain is, the more severe the tendinitis is – the closer to the calf muscle, usually healing time is a little faster
• Shin Splints
  • Can stem from many different factors, but often times an increased heel strike, or simply being new to running and mileage can be a big factor
  • Rehab tip: foam roll calves; compression socks, make an effort to get to a soft surface for your runs (bridal path, track, treadmill, black-top instead of cement)
  • Red flag: stress fracture

THE HIP

One of the most complex of all of the body parts where runners can experience overuse injuries, pain or discomfort here should be treated a little more seriously than in the lower extremities. Additionally, seeking treatment here sooner rather than later can save you a LOT of recovery time in the long run. I would encourage you to consult with a medical professional sooner rather than later if you experience acute pain in the hip that lasts for over a week.

STRESS FRACTURES

This is a RED FLAG for runners — an injury that you absolutely do not want to run through, as it may results in a broken bone, crutches and recovery time of 4-6 months. Stress fractures are a spectrum, and the sooner they are caught, the faster they heal. A stress reaction is inflammation within the bone – think “bony swelling.” If a bone is swollen, the structural integrity is compromised so the risk for fracture increases dramatically. A stress fracture is when the bone actually develops a crack, but is much less severe than a full-on bone fracture. Here are some warning signs to look out for:

• Pelvic
  • Pain when shifting onto affected leg (increased weight bearing)
  • Vague inner thigh pain or tightness
  • Painful to put on pants
  • General weakness in affected leg
• Tibial:
  • Pain with hopping (landing), VERY tender in one spot
• Foot:
  • Can be a little harder to diagnosis, but you may also see pain with hopping
• If you are experiencing any of these symptoms, check in with your PT or Orthopedist ASAP!

If you are experiencing any of these symptoms, or have questions in general always feel free to reach me via email: . Running consistently is really the key to long-term success in this sport, and being on the sideline BLOWS. Happy trails!

— Emmi