Going the extra mile: the most common running injuries, their causes and symptoms, and how to help yourself - part 1


Marathon season is upon us, so now is as good a time as any to review the most common running injuries and the best course of action for their management. Of course, this isn't just aimed at those of you who will try to run 26.2 miles in the coming weeks, it is also relevant for anyone trying to lose weight or tone up.

Whatever the reason behind an increase in physical activity, running is the backbone of many people’s exercise regime - but this ramping up of miles on the body’s odometer does not usually happen without some tweaks, sprains and strains along the way.

This is the first part of my guide to the most common running injuries I see at my clinic. I'll start with the back and work down to the knee.

Non-specific lower back pain in runners

Location of the pain:
The lower back.

A pain and/or stiffness in the lower back that often comes on after running for 10 minutes. The pain may refer into the buttock, but does not extend below the knee and there is no no pins and needles or numbness in the legs. Pain is generally worse for bending backwards or sideways, although simple tasks such as putting your shoes on may be uncomfortable. Stiffness and a sense of vulnerability can also be felt at times when not running.

The detail:
Non-specific lower back pain is a diagnosis frequently given for people with lower back pain when the precise tissue causing the pain is not known. The facet joints of the spine, the intrinsic spinal ligaments and muscles, the large paraspinal muscles, as well as the sacroiliac joints, may be implicated. 

In runners we often see a similar problem. After all, runners often complain lower back pain is stopping them from running, but they don’t see it as an injury caused by running, like they would a muscle strain or ligament sprain in the leg. However, this is misguided, because if you accept your back pain is a running injury, you can make adjustments to your running style, duration and frequency that will be an important step towards curing your back pain.

Ice the area - there is likely to be inflammation and irritation of the facet joints.

Attend to your core strength - the muscles that surround the lower back are frequently neglected by runners. These muscles act as a corset of sorts and provide increased stability for the lower back.

Attend to any other niggles in the legs you may have - these could be causing you to compensate through your pelvis and lower back.

Reduce hill running - the downhill sections will bring the joints of the spine closer together.

Use a foam roller or tennis ball to work on the myofascial trigger points (hyper-irritable spots in the fascia surrounding skeletal muscle) of the muscles on each side of your spine.


Gluteus medius tendinopathy

Location of the pain:
Hip and gluteal muscles

Commonly an aching pain and stiffness around the outer hip. Often there will be no discomfort in the early stages, but the pain will increase with the length of the run. Other symptoms may include: inflammation, heat or redness of the local area, pain and stiffness when first waking, tenderness of the immediate area.

The detail:
Gluteus medius tendinopathy is commonly an overuse injury rather than a result of direct trauma. The tendon of this muscle attaches to the hip bone, and like all tendons it is a rough fibrous tissue and therefore when subjected to repetitive actions (such as running long distances) it can develop micro tears that have difficulty fully recovering without an adequate healing period.

Ice the local area after a run.

Space out runs to give the tendon time to recover. Better still, rest from running completely until symptoms reduce substantially.

Sit on a tennis ball, with the ball under your buttock muscle (you can use a harder ball of similar size, but it will hurt more) to give yourself a trigger point massage.

Hamstring tendinopathy

Location of the pain:
On and just below the ‘sitting bone’ of the lower buttock.

Pain and aching deep in the buttock and sometimes down the back of the thigh. Other symptoms include; pain when sitting on a hard surface, pain and stiffness when first waking, increased discomfort in the area when doing regular hamstring stretching.

The detail:
The hamstring group is comprised of three muscles. They attach to the leg bones beyond the knee and span the length of the thigh attaching to ischial tuberosity, often know as the ‘sitting bone’. When the hamstrings become overused and thus overstressed it is often the tendon or the musculotendinous junction that suffers from micro tears or strains. This is particularly seen where there has been a quick increase in intensity or length of activity.

Tendon strains will cause localised pain and inflammation and should not be ignored. They are a symptom of an overuse injury and unless appropriate action is taken the tendinopathy will become a chronic problem and will be far harder to rectify.

Ice the area in the early stages of the injury - place the ice on and just under the ‘sitting bone’.

Use trigger point massage and foam-rolling to decrease the muscular tone of the hamstrings.

Avoid using the classic method of stretching the hamstrings (leg straight and bending forward) as this will just create further stress on the tendinous attachment.

Iliotibial band syndrome

Location of the pain:
Outer side of the knee.

Pain on the outside of the knee that increases with persistent bending and straightening of the joint. There may even be popping or snapping from the outer knee. This is often noticeably worse with heel strike. There may be localised swelling and redness.

The detail:
The iliotibial band, often called the IT band, runs from the area of your hip to the fibula bone in the lower leg. It is made up of extremely strong tissue and its purpose is to stabilise the knee throughout its whole range of motion. However it can with increased activity friction against the protuberance on the outer edge of the femur (thigh bone). This can result in localised inflammation and pain.

Apply ice to the local area to manage inflammation.

Use a foam roller on the outer thigh in order to target the IT band itself as well as adjoining muscle groups; quadriceps, hamstrings and gluteals.

Rest the problem and manage it before it becomes chronic and persistent.

Patellofemoral pain syndrome

Location of the pain:
Below and around the kneecap

Discomfort and tightness around or deep to your patella (kneecap). It can also be felt as a sharp pain. Discomfort often disappears quickly with lack of movement of the knee (although the tightness may remain). Symptoms may be more obvious when running uphill, going up and down stairs and when sitting for long periods. There may be an increase in grinding of the patella.

The detail:
In a healthy knee the patella moves smoothly with relative contraction and relaxation of the large quadricep muscles. With patellofemoral pain syndrome, or ‘runner’s knee’ the patella can move inappropriately with a deviation towards the outer knee. This is thought to be due to a muscular imbalance of the large quadriceps muscles. The upshot is irritation and damage to tissues beneath and local to the patella.

Due to the fact that muscular imbalances within the thigh muscles are a causative factor it is important to reduce tone in vastus lateralis (outer front thigh muscle) with liberal foam rolling and stretching.

Equally vastus medialis and vastus medialis obliqus (inner front thigh muscles) should be strengthened with appropriate exercises to counteract vastus lateralis.

Taping of the knee can be introduced to encourage patella alignment.

If your symptoms seem to match any of these injuries, try to apply some of the self-management techniques.

This list is far from exhaustive, but it gives an idea of what I see most frequently. Why not call for an appointment - we can take a look at the problem and I can advise on the best treatment and management approach for you. It could save you a great deal of pain and time away from running.

In the next instalment, I will look at common running injuries below the knee.