Running injuries

Although running is undoubtedly one of the best ways to keep fit, as a 'high impact' activity, it can cause injuries.

Running shoe

Any beginner is advised to start very gradually, thereby allowing both the cardiovascular system and the muscles and joints to become progressively used to the additional demands of running. Speed walking is a good way to start and then progress to walk/run intervals. 

Though direct treatment of an injury is, of course, paramount, establishing the 'cause' is vital if reoccurrence or 'chronic' conditions are to be avoided. Sometimes this is easy.However on many occasions the 'cause' is less obvious.

If despite 'starting gradually', 'training sensibly', 'using correct footwear and religiously 'warming up, cooling down and stretching', you still seem to suffer with more than your fair share of niggles and pains, there could be another source of your problem ie: faulty biomechanics. As faulty biomechanics can both compromise the efficiency of movement and be the cause of many sporting injuries, they should always be considered when trying to establish a 'cause

Prior to any treatment therefore, a physiotherapist would  carry out  a full assessment, to find any areas of the body which are not working at optimum efficiency. Lack of flexibility or strength in particular joints and muscles are highly suggestive of a problem. On occasions it maybe that there is insufficient strength to support excessively mobile joints. Sometimes it is the inherited body shape that creates problems.

The following, though by no means exhaustive, are just some of the things which commonly contribute to 'chronic' lower body injuries:

Static abnormalities

These are genetic characteristics and therefore cannot be altered eg:

  • leg length discrepancies
  • genu valgum or 'knock knees'
  • genu varum or 'bow legs

Functional abnormalities caused by

  • poor rehabilitation following injury
  • poor technique
  • developmental shortening of muscles

Abnormal lower limb biomechanics

The 'natural' method of running involves pronation of the foot. That is, after landing on the outside of the heel, body weight is transferred to the inside through a combination of eversion(turning outwards) and dorsiflexion(pulling up) of the ankle. During flight' the ankle is then supinated - (the opposite of pronation) ready to receive the next 'impact'.

Excessive pronation (rolling in on the mid foot)

This, unsurpringly, is when the  mid foot pronates (rolls over)excessively.  When the foot is in this 'weakened' position the impact  places extra stress on ligaments and muscles of the lower leg. This can cause an abnormal flattening of the medial longitudinal arch of the foot. This in turn may lead to increased strain on the plantar fascia which is in the sole of the foot. This structure is almost continuous with the achilles tendon which can then become inflamed - Achilles tendonitis - being the result.


Excessive supination (running with feet pointing together)

This could be due to weak peroneals / tibialis anterior ( muscles on the outer side of the shin) or tight calves leading to an inability to 'pick' the toes up between strides. This condition affects many runners when they tire toward the end of a run. Since a supinated foot is rigid, it possesses very poor shock absorption, inevitably leading to a risk of stress fractures

Abnormal pelvic mechanics

A certain amount of pelvic movement is essential in running, however poor control of the stabilising muscles can lead to excessive movement in any of the three anatomical planes (ie: sagittal, frontal, transverse).

Excessive anterior tilt

If abdominals or hip extensors(backside muscles) are weak, &/or the hip flexors ( muscle at front of hip) are tight, active hip extension ( taking the leg backwards) will place a strain on the lower back due to the inability to disassociate hip extension from pelvic movement (increased lumbar lordosis). This means that external hip rotators (eg: piriformis) work harder to help compensate and they too become tight. This can give pain in teh back, buttock or down the thigh

Excessive lateral tilt

Weak or tight hip abductors / adductors (muscles in the buttock & inside of thigh respectively) result in poor control of the leg whilst it is suspended ie: in the part of the stride whilst it leaves the ground. Strain is thereby placed on the lateral leg and knee structures.

Asymmetric pelvic movement

Both the above conditions can be bilateral or unilateral. Previous injury, tight / short muscles, inco-ordinate weak muscles, structural deformaties (eg: leg length discrepancy) may all be causes in asymmetrical pelvis movement . Running will invariably highlight any such problems and so anyone newly taking it up should be closely monitoring during their early stages

Static abnormalities

In addition to the above functional abnormalities there are also somestatic abnormalities which, though genetic and thereby cannot be altered, still merit some consideration:

Genu varum or 'bow legs'

Excessive pronation is required to allow the medial aspect of the foot to contact the ground, so see above for associated problems.

Genu valgum or 'knock knees'

Will place extra strain on all medial lower limb structures in much the same manner as excessive supination

Leg length differences

Often overlooked, since leg length effects both structure and function, any discrepancy can be the cause of all the problems already discussed.

Please note that although I have said that static abnormalities cannot be altered, they can be helped by properly fitted orthotics. A physiotherapist will be able to advise you whether a visit to a good podiatrist is necessary

Closing words

I hope that this chronicle of what can go wrong has not put you off running too much!

After all, would you consider jumping in a car that had previously been unused for years, and expect it to function trouble free, without first getting it checked over to see 'all was well'? Of course not. In much the same way as you get your car serviced, why not get a full body assessment to find out just how 'mechanically sound' and 'safe to use' your body really is, BEFORE it breaks down on the hard shoulder! When carried out sensibly and correctly, running is a superb way of exercising, keeping fit and having FUN.

Read about more common conditions, or contact us to find out how we can help.