Running Injury Prevention: Common Conditions

Achilles Tendonitis Treatment

The Achilles tendon is a very thick, strong structure that can absorb and transfer a lot of force. Running puts a large amount of force onto the body and this tendon. Your body’s ability to accept this force can improve with time if you increase your training load gradually.

What Causes Achilles Tendonitis?

Many times Achilles tendon pain will come from increasing mileage too fast or adding in speed workouts, which the tendon is not strong enough to tolerate. Another possible cause of pain in the Achilles tendon is if the runner changes to a more minimalist shoe with a reduced ramp or drop.

Ramp is a measurement of how much drop the shoe creates in the sole from the heel to the toes. The minimalist running movement has caused a decrease in shoe ramp from as much as 14mm to as little as 0mm, dropping the heel down closer to the level of the toes. A lower ramp shoe will increase strain to the Achilles tendon.

If you have changed running shoes to a pair with significantly lower ramp but continued training at the same volume, you may increase the load on your Achilles tendon too fast.

Achilles Tendonitis Treatment

In the Running Clinic, through the support of instrument-assisted soft-tissue mobilization, we can strengthen the tissue of the tendon. We also work to develop a safe progression of increased volume to reduce the likelihood of tendonitis.

Two things to try at home for Achilles tendon pain:

  1. Eccentric heel raises
    • Stand on a step with both balls of the feet on the step and the heel off the step.
    • Raise all the way up into a heel raise with both feet.
    • Take the non-painful foot off the step and slowly lower the heel all the way down on just the affected side.
    • Do three sets of 15 reps daily.

Do on both sides if the pain is on both Achilles tendons.

  1. Soleus calf stretch
    • Stand with one leg on a stair with just the ball of the foot.
    • Let the heel drop down slightly.
    • Bend your knee forward, stretching the lower calf region.
    • Hold for 30 seconds.
    • Repeat two times.

Calf Muscle Pull

Your calf muscles produce power when your foot is pushing off the ground before it begins to swing. The calves also work to control your shinbone from falling forward while you are loading it with your weight. Because of this, your calf can become strained during the push-off phase of running.

The butt muscles and hamstrings work together with the calf during this phase. If these muscles are weak or their contraction timing is delayed or impaired, then your calf can become overloaded and more prone to strain.

Another factor that can affect whether your butt can contract correctly is the hip extension range of motion. If your hip cannot move past the body during the push off phase, then your butt can’t contract, which in turn overloads the calf again.

In the Running Clinic we use slow motion capture cameras to see when your running mechanics are impaired. We also have can see when a muscle is contracting during the running cycle to make sure muscles are working at the right time.

Calf Muscle Pain Exercises

Two things to try at home for calf muscle pain:

  1. Calf stretches
    • Stand with hands against a wall and one leg behind you.
    • While keeping the heel of the back leg pressured into the ground, push hips forward until a stretch is felt in the back of the lower leg.
    • Hold 30 seconds.
    • Repeat two times on both sides.
  2. Bench hamstrings:
    • Lie on your back with your heels on the seat of a chair or bench. Your hips and knees should be bent to 90 degrees (knees right over hips).
    • Push your hips into the air until your hips are in a plank with your knees and hips.
    • Squeeze your glutes at the top; then roll back down.
    • Work up to three sets of 20 reps.

Hip Flexor Pain & Groin Pull

Hip flexor injuries cause back hip pain and may spread to the upper quad/thigh area. Typically, you would feel this pain while running when the leg is extended behind and as you swing your leg forward. After straining the hip flexor, pain may also happen when you lift your thigh (getting out of a car) or stand up from a seated position.

Many runners are tight in the hip flexor muscles, and sitting for long hours reduces flexibility in the anterior hip region.

Causes for Hip Flexor Strain

Typical causes for a hip flexor strain are large increases in running volume, running hills, and increases in speed workouts. Tempo runs and interval work increase the demand on hip motion and increase the demand of the hip flexor muscles, which results in injury if the demand is too much for your present fitness level.

Groin Pull

A groin pull can feel like a hip flexor strain, with the location of pain being more on the inside of the thigh towards the groin region. If pain lasts longer than a typical muscle strain, see your physician to rule out other possibilities, like a hernia.

Hip Flexor Pain Treatment

Two things to try for back hip or groin pain: 

  1. Prone planks
    • Come into a plank position either on your elbows and toes or elbows and knees.
    • Make sure you engage your core to stabilize a neutral spine and squeeze glutes together.
    • Progressively add hold time as you get stronger, up to two x 90 seconds.

Once your hip is pain free begin #2: hip flexor strengthening.

  1. Begin hip flexor strengthening
    • Tie two loops at either end of a Theraband.
    • Secure one end to a stable pole (or behind a shut door) and place the other end around your ankle.
    • With the resistance pulling from behind you, swing your leg forward with a straight leg using your upper thigh to flex your leg forward.
    • Slowly bring your leg back to the starting position. As always, engage your core to keep your trunk stable.
    • Start with two sets of 10, slowly progressing reps to 20.
    • Do this exercise four to five times per week.

Hamstring Strain

The hamstring is a group of three muscles on the back of the thigh that work to pull the leg back and slow down the leg before it contacts the ground again. The hamstring group works with the buttock muscles during both parts of the running cycle. If the buttocks muscles are weak, it can overload the hamstrings, which causes strain or inflammation. In addition, if the hamstrings are weak or not contracting at the correct time, this can also cause strain or inflammation.

Hamstring Strain Cause: Sprinting

The hamstrings have a low blood supply and require more time than other muscles to heal. Sprinting has a higher rate of hamstrings strains because of the large increase in demand on the hamstring muscle.

In the Runner’s Clinic we use tools (sEMG) to see when the muscles are contracting during running. This allows us to identify the source of the problem. We also use these same tools to find the perfect exercises specifically for you to gain the most muscle strength and control.

Hamstring Injury Exercises

Two things to try at home for hamstrings strain:

  1. Clamshells
    • Lie on one side with your hips and knees bent 45 degrees, legs stacked. Keep your feet together and your top hip just forward of your bottom hip.
    • Raise your upper knee as high as you can without moving your pelvis.
    • Pause, then return to the starting position.
    • Do 20 reps per side.
    • Repeat two times.

Add in resistance band around both knees as you get stronger.

  1. Bench hamstrings
    • Lie on your back with your heels on the seat of a chair or bench. Your hips and knees should be bent to 90 degrees (knees right over hips).
    • Push your hips into the air until your hips are in a plank with your knees and hips.
    • Squeeze your glutes at the top.
    • Roll back down.
    • Work up to three sets of 20 reps.

Iliotibial Band Syndrome

The Iliotibial band, or IT band as it is more commonly known, runs from the outside of the hip to the outside of the knee, attaching onto the tibia. This band crosses both the hip and the knee, and its primary function is to stabilize the knee. The IT band is a thick strand of connective tissue that encloses a small muscle called the tensor fascia latae (TFL) that anchors this muscle into the iliac crest, as well as most of the tendon from the gluteus maximus.

Causes of IT Band Syndrome

IT band syndrome has been linked to weak gluteal muscle strength, which is important for stability of the pelvis and lower leg. If the gluteal muscles are not working while the leg is on the ground, then the alignment of the pelvis and the knee become impaired. This puts more tension onto the IT band. Over time this impairment continues to increase strain on the IT band, which can cause it to become irritated.

Strengthening the muscles around the hip, butt, and abdominals can help improve the alignment. Also, working on your body’s awareness of its alignment so that the muscles contract at the right time is a very useful tool to produce long-term changes.

In the Runner’s Clinic we utilize slow motion capture cameras, along with a force-plated treadmill to help improve body alignment.

IT Band Syndrome Exercises

Two things to try at home for lateral knee pain:

  1. Foam roller release
    • Place the foam roller perpendicular to your body.
    • Lie on the foam roller with your lateral thigh on the roller (this leg is straight), your other foot flat on the ground in front of you (knee bent), and both hands on the ground for support.
    • Roll up and down from just above your knee to just below your hip. Make sure you get both the quad/anterior side and the hamstring/posterior side of the ITB.

Do this for five minutes daily.

  1. Lateral walking with resistance band
    • Loop the resistance band around both ankles.
    • Walk to one side for 15–20 steps and then back to your starting position while keeping your feet pointing forward, a slight bend in both the hips and knees, and your back stable.
    • Repeat two to three times.

Lower Back Pain While Running

Lower back pain while running can happen for multiple reasons. Your abdominal muscles may not be strong enough and you may not be running with proper posture. If your abdominal muscles are not engaged while your run, your lower back arch, or extension, can increase. this forces the ligaments or joints of the spine to take the load.

Another factor that can cause back pain while running is hip range of motion and running form. If you don’t have good hip extension when your toe is about to push off the ground, then your back will arch to make up for the motion. Over time this can cause back pain.

One thing to focus on while running is having a tall spine while holding your abdominals tense. In the Runner’s Clinic we specifically focus on mobility and strengthening that will help improve your body’s ability to keep a neutral spine while running.

Strengthening Exercises for Lower Back Pain

Two things to try at home for lower back pain associated with running:

  1. Prone planks:
    • Come into a plank position either on your elbows and toes, or elbows and knees. Make sure you engage your core to stabilize a neutral spine and squeeze glutes together.
    • Add hold time as you get stronger, up to two x 90 seconds.
  1. Hip flexor stretch:
    • In a half kneeling position, keep a tall spine and tuck your butt under.
    • Slowly push your targeted side hip forward till a stretch is felt to the front of your hip and upper quad.
    • Do two per side for 30 seconds each.

Piriformis Syndrome/Gluteal Pain

The piriformis is a muscle in the buttocks that stretches from the sacrum to the outside of the hip on the femur. This muscle helps to stabilize the pelvis, as well as rotate and extend the leg out and back. This muscle can become overused by muscle weakness within the bigger muscles of the buttocks (gluteus maximus) or from instability of the pelvis due to lack of abdominal strength.

Causes of Piriformis Syndrome

When this muscle becomes overused, it can become tight and tender. Not only will this cause pain in the buttocks, but it can also restrict the movement of the sciatic nerve traveling down the leg causing radiating leg pain. Mobility and strengthening are important for each individual with piriformis syndrome.

In addition, running form can be an important component to analyze and address, which the Runner’s Clinic does with slow motion capture analysis.

Piriformis Syndrome Exercises to Try at Home

Two things to try at home for piriformis/ gluteal pain:

  1. Piriformis stretch:
    • Lie on your back with both feet flat on the floor and knees bent.
    • Put the ankle of the right leg over the knee of the left leg.
    • Pull the left thigh in towards your chest and hold the stretch, which will be felt in the glutes of the right side.
    • Hold 30 seconds.
    • Repeat two times for each side.
  1. Fire hydrants:
    • Start in a quadruped position (on hands and knees) with back flat and parallel to the ground.
    • Keeping your pelvis level, raise one knee out to the side (and slightly back) trying to get the knee parallel with your hip.
    • Then lower the knee to the starting position. Keep your back and pelvis flat and neutral the whole time.
    • Do two to three sets of 15, progressing the reps as you get stronger.

Plantar Fasciitis/Heel Pain

Plantar fasciitis is a common injury that affects runners in the arch of their foot, or, more commonly, in the heel. Pain in the bottom of the heel after sitting is characteristic, especially with the first few steps getting up in the morning.

The plantar fascia tissue can get inflamed when you increase your activity, especially if you your shoes provide poor support. The symptoms of this injury can be tight calves, calcaneal bone spurs, micro tears where the tissue in the foot attaches to the heel, and increased weight gain.

Treatment for Plantar Fasciitis Running Pain

Many runners with acute injury may benefit from taping or temporary orthotics to help support and offload the arch. In the Runner’s Clinic we will help to improve cadence and work on running mechanics to decrease the force in the foot as the runner strikes the ground.

Try these two things for plantar fascia pain:

  1. Soleus calf stretch
    • Stand with one leg on a stair with just the ball of the foot, letting the heel drop down slightly.
    • Bend your knee forward, stretching the lower calf region.
    • Hold for 30 seconds.
    • Repeat two times.
  1. Single leg, heel raises
    • Stand on one leg either on flat ground or with the ball of the foot on a stair.
    • Slowly raise the heel up as far as you can go while keeping your knee straight.
    • Slowly lower back down.
    • Start with two sets of 15 and work up to three x 15 per side.

Runner's Knee (Patellofemoral Pain Syndrome) Runner's Knee (Patellofemoral Pain Syndrome)

The kneecap helps stabilize the knee while running. It is shaped to fit within the grooves of the thighbone, so when it moves up or down the force from running is distributed evenly over an area. If the butt muscles, hip muscles, abdominals, or quads are weak and cannot control the pelvis and lower leg, the knee cap will shift to the inside or the outside of the knee joint. This will increase pinpoint pressures on the underside of the kneecap causing pain over time.

This pain is very sharp and will quickly reduce your ability to enjoy running. It’s important to focus on strengthening weak muscles that help to control leg alignment. You should also improve your body awareness contracting the right muscles at the right time.

Treatment for Runner’s Knee

In the Runner’s Clinic, we use slow motion capture cameras to see when running mechanics are impaired. We can see when a muscle is contracting during the cycle, to make sure muscles are working at the right time.

Exercises for Sore Knees From Running

Two things to try at home for anterior knee pain:

  1. Quad and hip flexor stretch
    • Using a chair with a padded seat, place one foot on the back of the chair and the knee on the padded seat. The other leg will be on the side of the chair slightly in front.
    • Stand up tall and tuck your butt under.
    • Slowly push your hip forward until you feel an anterior hip and quad stretch down the leg on the chair.
    • Repeat two times for 30 seconds on each side.
  1. Glute squats with resistance band around knees
    • Place a tighter resistance loop around both knees, preferably above the knees.
    • Squat down starting with bending at your hips like you are sitting down into a chair far behind you. Make sure you keep your knees in alignment with your ankles and hips by pushing into the band, but keeping your feet flat on the ground.
    • Repeat 20 times, adding three to four sets as you get stronger.

Stop if pain increases to your knees or lower back.

Shin Splints

Shin splints can occur in two different locations on the lower leg, in the front of the shinbone and on the inside of the shinbone. Even though the problem can occur at two different locations, the most common cause of this problem is that you have ramped up your training volume too quickly or you have a slow cadence (cadence is the number of steps a person takes per minute).

If you have a cadence slower than 160–170, you typically have a longer stride length and land with a straighter, more rigid leg. Landing with a straight leg is not as effective at absorbing impact forces, increasing demand onto the muscles and bones of the lower leg.

By increasing your cadence by five to 10 percent, you can reduce the loading rate and impact forces on the body, especially the knee and hip joints. In the Runner’s Clinic we use a force-plated treadmill to analyze loading impacts and cadence.

It is important to note that increasing your self-selected cadence by more than 10 percent at any one time will increase your energy demands, so you should increase your cadence slowly over time.

Shin Pain Exercises to Do at Home

Two things to try at home for shin pain:

  1. Single leg heel raises
    • Stand on one leg either on flat ground or with the ball of the foot on a stair.
    • Slowly raise the heel up as far as you can go while keeping your knee straight.
    • Slowly lower back down.

Start with two sets of 15 and work up to three x 15 per side.

  1. Increase your cadence while running by five to 10 percent:
    • Count your self-selected (normal) cadence by counting how many times one foot lands on the ground for 30 seconds.
    • Multiply this by number by four. This is your cadence (or steps per minute) at that speed.
Without increasing your speed, try increasing your cadence by no more than 10 percent by using a metronome or a metronome app on your phone to get the targeted stepping rate.