Running has one of the largest participation rates in Australia. However, running can cause many injuries, often due to over training.

People doing too much, too soon and not gradually progressing their exercise. Up to 70% of recreational and competitive runners sustain overuse injuries during any 12-month period. Overuse/chronic injuries are far more common that acute injuries.

Here are the 6 most common running injuries we deal:

1 Shin Splints (medial tibial stress syndrome - MTSS)

Shin splints is often thought of as a diagnosis – it isn’t! Shin splints is an umbrella term used to describe pain along the shin (tibia) bone. The medical term for shin splints is medial tibial stress syndrome (MTSS). People who participate in sports that includes a lot of running, sprinting, jumping are more prone to developing MTSS.

Think of shin splint pain as a continuum, ranging from mild irritation of the shin bone to potential fracture of the shin bone. Often this bone pain is felt towards the ankle over the lower part of the shin bone. Here the bone is susceptible to more stress as the cross- sectional area is lower, compared to the top near the knee.

People often will first complain of pain in the muscle belly of the tibialis anterior (see photo) near the top 1/3rd of the knee. If treatment is not sought, eventually this may develop into MTSS. Other symptoms may include throbbing of the shin, particularly at night and during or after exercise.

The cause of shin splints is multifactorial in nature, however at the centre of the cause, is chronic overload. Often pain is caused by an increase in training load (doing too much too soon with no graduated training program) with inadequate rest periods. In laymen’s terms, if you do too much too soon, your bone will either:

a: Get stressed, however you pull back on the training and the bone has time to adapt and repair, becoming more robust and stronger for next time.

b: Get stressed, however you don’t pull back on training, and the bone’s repair mechanisms do not have enough time to heal the bone because you’re still loading the bone/participating in the aggravating activity. This is when it becomes an issue because the rate of bone breakdown exceeds bone repair.

Other factors that may contribute include increased BMI, tight and weak calf muscles, excessive pronation (low arch) and poor foot biomechanics. It is also believed there is some evidence for poor footwear selection, running technique/biomechanics (e.g – excessive heel striking or over striding) and strength deficits further up the kinetic chain (e.g – gluteal muscles) may contribute to developing MTSS.

2 Achilles Tendinopathy

Achilles tendinopathy is pain felt along the tendon at the back of the heel. It is very common in activities or sports that require a lot of repetitive jumping and running. 30% of runners experience achilles tendinopathy at one point. Pain is often aggravated by increased training load and demand on the achilles tendon and calf musculature (gastrocnemius, soleus and plantaris).

Inadequate rest periods and poor sleep patterns also reduce the tendon’s ability to remodel and adapt to the training stimulus. Did you know that the achilles tendon is the largest tendon in the body and the soleus takes 6-8x your body weight per step when you run! That means your soleus must be pretty strong to withstand those loads!

There are 2 types of achilles tendinopathy and often that may have to be treated initially differently.
Midportion (55-66% of cases) Insertional (sometimes has a compressive factor due to the tendon compressing on the heel and may also cause bursitis of the retrocalcaneal bursa – (i.e inflammation of a fluid filled sac that sits between your tendon and your heel bone)

People will complain of pain around the back of the ankle/heel, often report recent changes in training frequency/duration or load and localised swelling. People will often report pain on climbing up/down stairs, walking or raising up onto their toes.

High blood pressure and BMI, cholesterol levels, diabetes family history and use of corticosteroid and some anti biotics may put you at further risk. Sometimes over pronation, weakness in calf muscles and other muscles further up the chain (e.g - quads, glutes, core), reduced ankle range and calf flexibility may increase your risk.

Tendons are not very vascular, meaning they don’t have very good blood supply, so their potential to heal is quite slow. Sometimes tendon pain can take up to a year to resolve!

Make sure you don’t wait to see a physio!

Evidence shows that achilles tendinopathy responds extremely well to a progressive strengthening and loading program.

3 Plantar fasciitis

Plantar fasciitis is described as inflammation of a fascia located on the sole of your foot. This fascia attaches from the heel bone to the tendons of the forefoot. Research shows that the structure of the plantar fascia is very similar to tendons – in the sense that it is very good at absorbing and transferring load. The plantar fascia plays an important role in supporting the arch of the foot and stabilising the foot during landing and push off, when walking and even more so when running 1/10 people experience heel pain at some point in their lives. 4.5-10% of runners are affected by plantar fasciitis.

People will often describe pain either along the inside arch of their foot or the heel bone, however some people also complain of pain over the lateral (outside) aspect of the under-surface of their foot. Often, they will describe pain on their first step out of bed in the morning. The pain described varies vastly, ranging from mild pain in the morning to inability to walk and potentially needing a period of unloading in a moonboot.

Whilst acute (rupture or tear) injuries of the plantar fascia can occur, the majority of cases are caused by chronic overload. Plantar fasciitis is often caused by an increase in training load (doing too much too soon with no graduated training program) with inadequate rest periods.

Other risk factors include increased BMI, excessive pronation (low arch), excessive supination (high arch) poor foot biomechanics, reduced calf strength, big toe and ankle range of motion. High blood pressure, cholesterol levels, diabetes family history and use of corticosteroid and some anti biotics may put you at further risk. It is also believed there is some evidence for poor footwear selection, running technique/biomechanics (e.g – excessive heel striking) and strength deficits further up the kinetic chain (e.g – gluteal muscles) may contribute to developing planta fasciitis.

Treatment involves determining which of these factors (or all of them) is most likely contributing to your pain. Often, educating and managing training load is the number one treatment. Evidence shows that plantar fasciitis also responds extremely well to a progressive strengthening and loading program. There is also evidence for use of shockwave therapy and orthotics, which Jannali Physio provide! Corticosteroid injections have also been proven to be helpful for those really stubborn plantar fasciitis cases!

4 Runners Knee (patellofemoral pain syndrome - PFPS)

PFPS is described as pain felt on, behind or around the knee cap. Often pain is aggravated by climbing up/down stairs, downhill running, squatting, kneeling, jumping, running.

An increase in training load (doing too much too soon with no graduated training program) with inadequate rest periods and poo sleep patterns can put you at an increased risk for developing PFPS.

The knee cap sits in a little groove and is influenced by muscles and ligaments attaching onto it. If there is an imbalance in the muscles attaching onto the knee cap, it may result in mal-tracking of the patella. Pain can also be secondary to excessive compression on the knee cap.

A physio can assess why this may be occurring. Sometimes weak quads, glutes, calves, ITB, quads and hamstrings may contribute. Hip pathology, runners who predominantly heel strike and poor landing/jumping mechanics may also contribute. Sometimes if your kneecap sits too high or lateral, or if the groove that the knee cap sits in is too shallow it may contribute. The anatomy of your thigh bone (if thigh bones twists in) and low foot arches may also influence pain.

Treatment involves determining which of these factors (or all of them) is most likely contributing to your pain. Often, educating and managing training load is the number one treatment. Evidence shows that PFPS also responds extremely well to a progressive strengthening and loading program, emphasising adequate pelvic, hip and knee control during these exercises. Massage and other passive modalities can be used to SUPPORT treatment if needed (taping, dry needling etc). Running and movement analysis is also very important.

5 Patella tendinopathy (Jumper’s knee)

Patella tendinopathy also known as Jumpers knee is pain and dysfunction in the patella tendon and is very common in activities or sports that require a lot of repetitive jumping and running such as netball, basketball and running. Pain is often aggravated with increased training load and demand on the quadricep muscle/tendon. Doing too much too soon with no graduated training program, can cause structural tendon changes Inadequate rest periods and poor sleep patterns also reduce the tendon’s ability to remodel and adapt to the training stimulus.

We want our tendons to feel like a trampoline – very extensible and pliable. When they are like this, they are able to absorb and transfer the load placed on them. Unfortunately, if the tendon gets stressed, in undergoes many structural changes where it becomes thickened and is no longer extensible and pliable like a trampoline. When the tendon is in this state it is unable to absorb and transfer load adequately.

It can potentially be a devastating condition, if not diagnosed and managed early. 1/3 of people with patella tendinopathy were unable to return to sport within 6 months of injury.

People will complain of anterior (front) knee pain, usually below or on the knee cap. The will report it as a gradual onset and pain can often occur as soon as exercise/loading commences, however eases with activity (warm up phenomenon). Night pain may be present and reports of pain ascending or descending stairs, squatting, prolonged sitting, bending the knee too far is common. It is more common among males and an increase in BMI can put you at a further risk for developing patella tendinopathy. High blood pressure, cholesterol levels, diabetes family history and use of corticosteroid and some anti biotics may put you at further risk. Sometimes over pronation and excessive hill training can also increase your risk.

To reduce the risk of patella tendinopathy, strengthen your quads, glutes and hamstrings. Ensure that you have good ankle range of motion and hip/knee control is adequate. Make sure that you aren’t doing too much too soon and your training is progressively loaded.

Tendons are not very vascular, meaning they don’t have very good blood supply, so their potential to heal is quite slow. Sometimes tendon pain can take up to a year to resolve! Make sure you don’t wait to see a physio!

6 Ilio-tibial band friction syndrome (ITBFS)

The ilio-tibial band is a connective tissue that connects from the outside of your hip to the outside of your knee. A bursa (fluid filled sac) helps to cushion where the band attaches onto the knee and this helps to reduce the amount of friction/rubbing occurring as the knee bends and straightens.

This band also has attachments onto the Tensor fascia latae (TFL) and glute max muscle and plays a role in stabilising the pelvis, hip and knee.

However, there are other muscles (gluteal, abdominal, hip rotators, quads) that are better at stabilising the pelvis/knee area, therefore if those muscles are weak and/or ineffective, then added stress/load may be placed on the ITB – load and stress that is not its job!

With repetitive bending and straightening of the knee (e.g – running, stairs, cycling), sometimes the band can get irritated at the knee causing pain on the outside of the knee. People may also describe this as a clicking on snapping sensation on the outside of the knee. Often as this ‘snapping’ occurs, it can also irritate the bursa lying underneath, causing swelling and inflammation.

An increase in training load (doing too much too soon with no graduated training program) with inadequate rest periods and poo sleep patterns can put you at an increased risk for developing ITBFS. Activities (such as running - particularly downhill and cycling) that involve repetitive knee bending and straightening can increase your risk of developing ITBFS. Weak hip abductors and lack of pelvic control have been linked to ITBFS. Often people will come into the practice and they are unable to keep their hips level and their knee caves in quite a bit during functional tasks (see photo).

Patient who had ITBFS of the left knee. Ideally, we would like:

  • Trunk to be straight (no sideways lean). Small angle. Less than 15 deg isn’t too bad.
  • Hips level (not popping hip out to side). Yellow line to be straight.
  • Knee roughly in line with 3rd toe. Red angle to be as close to 180 as possible. 150 is too low.

Other contributing factors include poor biomechanics, foot pronation, incorrect cycling set-up, repetitive training on hard surfaces.

All of these factors combined with an increase in training load, volume and/or intensity = higher risk of ITBFS.

Here at Jannali Physio, we will determine which of these factors (or all of them) is most likely contributing to your pain. We will look at the way you move and run/do the aggravating activity and prescribe exercises and advice to correct the cause.