Running is great exercise, extremely accessible, and easy to do alone or with a crew. Runners are unique athletes and have their own challenges when it comes to injuries. Injuries are common and proper management is essential to limiting down time and achieving full recovery.
When people have an injury they often want to know what it is and how to fix it.
What is it?
Running most commonly results in lower body injuries such as hip, knee, ankle and lower back. Injuries can include tendon, ligament, and joint and muscle injuries.
You will often hear things like “tendonitis”, “bursitis”, “strain” or “sprain”. Basically, “itis” means inflammation, and strains and sprains are the tearing of muscles and ligament tissue. In most cases these will heal without surgery and the goal is to get things moving properly and be strong enough to support that movement, return to activity, and prevent future injury.
Is pain the problem or is pain the result of the problem?
The nature of the injury, is important, but why it happened is often more useful in terms of recovery and prevention. Naming it doesn’t fix it. It is important to recognize urgent injuries and those requiring surgical referral, but otherwise why something is happening is more helpful management wise. You already know your knee hurts. What you need is a solution.
If you have trochanteric bursitis or the outside of your hip hurts, does that distinction matter? You probably don’t have bursitis because it is Wednesday, or because you run. Most injuries are only on one side, and both sides are probably running the same amount. Usually the bursa is inflamed for a reason. Something is working too hard, too much, not getting enough recovery, or working inefficiently. If we can find out why it is inflamed, a long-term solution is more feasible.
Why running injuries happen falls mostly into two categories:
- Acute/traumatic injuries
- Repetitive overuse injuries.
These injuries are much more common with explosive movements like sprinting, but can also occur in endurance runners. A muscle strain would be the most common type of this injury and they tend to be posterior chain muscles like hamstrings and muscles of the calf. Things like rolled/sprained ankles are also very common.
Generally, having good functional mobility and strength should help prevent these injuries, but injuries do happen. In order to speed recovery, it is important to have someone who is knowledgeable about these type of injuries so they can help get you back up to speed quickly and as close to 100% as possible.
Repetitive Strain/Overuse Injuries
These are generally more common, especially with endurance running athletes. Small overuse adds up. Thousands and thousands of steps with a little mechanical error add up to tissue strain similar to an all in one acute injury.
A major difference is that these injuries tend to sneak up on you. They often start as a little pain/tightness at the start of a run or after the run and, if not taken care of, they tend to become more consistent and more severe.
How to fix it?
By the time the injury occurs, management is similar. We want to restore ideal motion and strength to the area. Typically, without major structural damage you want to get moving and keep moving right away. Maintaining strength and mobility will mean less work after healing and should also aid proper healing.
Rest, although possibly an important part of the treatment, typically will not correct a mechanical issue. Rest will allow tissue to heal, but it will not make you stronger or more flexible or improve mechanics. Rest is also something you can do on your own and probably don’t need to spend time and money for someone to tell you to do it. We see a lot of people that have tried only rest and while it relieves the pain, the issue just comes back upon return to activity.
Mechanical Injury Mechanical Solution
Joints and the muscles and ligaments around them are healthy when they are moving properly (not too little, not too much) and strong. To restore either of these things you usually need some mechanical intervention.
Typically in Canada this would include things like Physical Therapists who practice manual therapy, IMS or dry needling, Acupuncture, Massage Therapy, Chiropractic care, and manual osteopathy.
These types of practitioners can do a wide variety of things. Often you will get a referral to PT, Massage or Chiropractic, which could do any number of things. It is probably more reasonable to look for therapy type vs. practitioner. You could see a Physical Therapist who does primarily spinal manipulation or a Chiropractor who does mostly exercise instruction and soft tissue work.
I would look for some sort of hands on/manual therapy and exercise instruction as a minimum. That way you are working on moving better and being stronger, which is safe, and covers your bases for most injuries. Common therapy to look for would be various types of massage or myofascial work, Active Release Technique, Graston and other instrument assisted soft tissue therapies, joint manipulation or mobilization and exercise instruction.
Nutrition is obviously an important part of healing and should be considered, but is an article unto itself. Machines like shockwave and low level laser therapy can also be useful adjuncts for some patients.
When the most conservative therapies like these have failed, things like Prolotherapy or other injectables like cortisone or PRP (Platelet Rich Plasma) may be an option.
Prevention and Performance
Working just to limit the risk of injuries is often not satisfying for athletes. The goal is to keep tissues healthy, strong and moving properly, which should also help performance. Getting better vs. just working to stay the same is a big difference from a motivation perspective.
At home, mobility work like foam rolling and dynamic stretching/activation, as well as strength training put different stresses on the same tissues used when running.
Professional services like those mentioned above have similar goals as at home care, working on restoring or maintaining ideal mechanics, strength and movement. In my opinion, good therapy should complement what you can do at home, but do something that you can’t do on your own.
No one likes down time but with an effective plan you should be able to avoid many injuries and make a quick return when they do happen.
By Dr. Tyler Fix – Redefined Health