In a collaborative effort with Scott over at Straight to the Bar, we wrote about injuries for the month of November. This is the final article in the series. I will first explore why runners get injured, and then I will share some of the most common running injuries that you are likely to hear about or suffer.

Causes of Running Injuries

The vast majority of running related injuries are due to one of 3 things:

1. Poor biomechanics
2. Over training
3. Trauma

Poor biomechanics is caused by adopting a running gait that does not agree with your body. You can do this by trying to improperly emulate somebody else’s running style, or by wearing the wrong kind of shoes. Most people can wear most running shoes without hurting themselves too badly, but if you plan on running regularly you should first visit a specialty running store. I highly recommend that you seek the help of an expert when choosing your running shoes. Poor biomechanics can be exacerbated by inadequate flexibility or strength, even in muscles that do not seem to be related to running. While you can use different muscles to perform different actions, your body is really just one big, well-connected machine.

Over training can be broken out a little bit. Over training can be caused by increasing your mileage too fast and running more than your body is ready to handle. A safe way to increase your mileage is to try not to go up more than 10-15% or so each week from the week before, and to cut back at least 5% every 3 or 4 weeks. Over training can also be caused by running the same mileage, but increasing some other physical activity that can tire you out or make it easier to pull a muscle that will sideline you. And finally, the surface that you run on can lead to over training if you take too much of a pounding (or too little) no matter how much you increase or decrease your mileage.

Trauma is the sort of thing that can injure anybody at any time, whether they are running or not. It is caused by an external factor that causes you to hurt yourself such as falling down and breaking a bone, or twisting an ankle in a pot hole, or getting hit by a car. Injuries of this sort are usually pretty self evident and are outside of the scope of this article.

Common Running Injuries

These are the top 5 running injuries that you will hopefully manage to avoid:

1. Stress Fractures
2. Tendonitis
3. Plantar Fascitis
4. Runner’s Knee
5. Shin Splints

Stress Fractures
Stress fractures are cracks in the outer layer of a bone from repititive stress. It is most often caused through over training by increasing mileage at too rapid a rate. Stress fractures can be exacerbated by excessive pronation or supination, which is usually caused by wearing innapropriate shoes. Stress fractures will usually hurt in a very localized place and will begin as a dull ache that can easily be misinterpreted as a sore muscle. Rest is the best way to cure a stress fracture, although you may want to consider taking supplements with calcium and cutting back on diet soft drinks. They can inhibit your body from absorbing calcium. Be sure to keep adequate rest in your training plans and to follow a gradual schedule of increased mileage. If you suffer from frequent stress fractures, then you are either not allowing yourself enough time to heal (1 to 3 months) or else you may require custom orthotics in your shoes. Stress fractures can be easy to miss with a common x-ray and may require a bone scan to detect.

Tendonitis
Tendonitis is excessive inflammation in your tendons. The most common for runners is achilles tendonitis. It begins with a dull aching after you finish running, which gets worse if left untreated. The tendon will begin to ache first thing in the morning after getting out of bed, and then while you are in the act of running. The dull aching will become more acute, until you always feel at least the original dull pain even when you are not working out. Tendonitis is usually caused by running too far and too fast when your muscles are not flexible enough to support such a workout. The problem can be exacerbated by shoes that have worn out and cause excessive pronation. To avoid getting tendonitis, be sure to warm up before doing any speed work, do not raise your mileage too fast, and try to stretch when you are done with your workouts. You can treat tendonitis by icing after your workouts, taking small amounts of ibuprofen to reduce swelling, and taking time off from running. This is a perfect time to practice RID or RICE. Achilles tendonitis can be treated specifically by using small heel lifts until the pain subsides. Any acute pain, however, really needs to be checked out by a competent doctor.

Plantar Fascitis
Plantar fascitis is inflammation of the plantar fascia, or the bottom of your foot. This tendon is very hard, like a ligament, and connects the heel of your foot to the ball of your foot. Every stride that you take, whether walking or running, involves the stretching out of this tendon to absorb the impact of hitting the ground. Tight calf muscles can increase the stress on the tendon and cause increased microtrauma that can lead to inflammation. The first symptom of plantar fascitis is the feeling of a bruise on the bottom of your foot. Left untreated, it can become painful any time you walk or run about or stand for a long period of time. It will often hurt a lot first thing in the morning. Plantar fascitis is caused by over training and poor biomechanics. Icing, stretching, and replacing any worn shoes is very important in aiding the recovery process. Stretching should concentrate on the calves and on the foot. A hard, round ball with a bit of give can be rolled beneath your foot to stretch it out. You will need to decrease hill and speed work or take time off completely to allow plantar fascitis to heal. If it is left untreated for too long, you may require custom orthotics in order to do any serious training in the future.

Runner’s Knee
Runner’s knee refers to any pain in the knee cap and is usually the direct cause of over training and poor biomechanics. The two most common forms of runner’s knee are patellar tendonitis (the pain is localized to the tendon in your knee cap) and chondromalacia patella (scarring has occurred because the knee cap does not sit properly in its femoral groove, and the underside has worn down and become rough and deteriorated). This can be caused by a lack of flexibility in any or all of the quadriceps, hamstrings, or calves. Most often, however, it is caused by a problem with the foot or ankle, usually due to excessively worn shoes and over training. The problem can be exacerbated by excessive hill work. Runner’s knee begins (like most running injuries) as a dull pain after the run that gets worse over time. Treating it early is very important to prevent permanent damage. Stretching tight muscles after your workouts and icing frequently helps. I have found that an ice massage is especially effective.

Shin Splints
Shin splints are any pain in the shins and is usually tibial stress syndrome. There are two types of shin splits, anterior and posterior. Anterior shin splints are really an inflammation of the tendons that attach to the front of the shin bone to the outside. It begins as a dull ache on the outside of your shin bone as you run and can get worse until it is painful to walk. Posterior shin splints are an inflammation of the tendons that attach to the inner side of the shin bone and causes pain in the inner surface of your shin bone extending down to the arches in your feet. Shin splints can often mask an underlying stress fracture, especially when there is acute pain and swelling. Shin splints are rarely caused by too much mileage (unless it is really a stress fracture) but can be caused by too much hill work or speed work before you are ready for it. Tight calf muscles and excessively worn shoes are often the culprit. Stretching your calves several times a day and laying off of the speed work can usually make your shin splints go away in short order, and I recommend icing after every run while your shins hurt and for a few weeks after the pain has gone away.

Preventing Injuries

The reason that I explained the common reasons that runners get injured before describing some common injuries is that there are common themes amongst and between the different injuries. Diligence in identifying and treating an oncoming injury and some simple precautions can go a long way towards preventing the worst of the injuries from ever bothering you.

1. Replace worn shoes quickly. Better yet, use more than one pair of running shoes and rotate them often.
2. Ice Early, Ice Often.
3. Be careful about how fast you increase your mileage, as well as the duration and intensity and prevelance of any hill or speed work.
4. Warm up before workouts, and stretch your calves and any tight muscles after workouts.