Running becomes more popular every year as a way people use to get back in shape and improve overall health. It is a great way to improve aerobic capacity, cardiovascular health, metabolic fitness and has even shown to increase longevity. Despite these amazing benefits, distance running can also lead to pain and injury. Studies show that anywhere from 65-80% of runners in a given year will experience some sort of injury or persistent pain. For those who have experienced this, you know that trying to keep up with a running regimen while dealing with pain or injury can be very frustrating. As PTs, we frequently work with runners in recovering from pain, preventing injury, and improving overall performance. So with such high injury rates, why do people still run?
Benefits of Running
Health Benefits – as stated above, countless studies have shown that cardio training can improve cardiovascular health. Running can help control blood pressure and reduce cholesterol levels, allowing more efficient blood flow throughout your body
Weight Loss – running certainly can have an effect on weight loss as you will burn calories fast and get your heart rate up. Though it shouldn’t be the primary route of losing weight, it can be an effective add-in for a program if dosed properly and safely.
Goal Setting – whether it’s training for a competition or setting personal goals, running can be a great way to achieve goals. Some runners work to reduce their mile-times, some focus solely on increasing distance, and some work on both. Setting and achieving these goals can be great for overall mental health and sense of well-being.
Reducing Stress – running can be a great way to get the “mental escape” and clear your thoughts. On top of that, you get that “runners high” which is where chemicals are released in your brain that can result in feelings of euphoria after long-distance running. This is often why people feel a lot better overall after they run
Getting Back in a Routine After the Winter Months
As we get through the winter months and get ready for Spring, some of you may be getting ready to kick start a running routine once the weather clears. For those in warmer weather, you may already be on a running regimen. Regardless of whether you are getting ready to start or working to maintain, there are a few important things to consider:
Recognize the importance of rest days and getting a full night of sleep. When planning your training schedule, make sure you include rest days to let your body recover. Utilizing these rest days is essential for your long-term success, especially if you are dealing with any aches or pains. Also understand that our body heals when we sleep, and if you are not getting 7+hours, you may be overstressing your body.
Cross Train. For an effective running regimen and to help prevent injury, you must be incorporating some sort of strength training program. This is especially important when starting a routine. Aerobic capacity can improve faster than strength gains; so just because you are not as tired at the end of a 3mile run, doesn’t mean that your boy is ready for a jump to 4-5 miles. Frequently, we see runners pick up their distance too fast early and don’t reinforce with strengthening. This will result in burnout and eventually injury.
Eat Healthily. Following a balanced diet will help you feel energized and motivated each day. Consulting with a nutritionist and getting on a specific diet plan can be a key factor in achieving your goals.
Find Appropriate Footwear. This is a factor that I found to be very frustrating for runners, as they hear many different opinions on the best kind of footwear. Whether it’s firm arch support, soft arch support, “barefoot” shoes, etc. It is important to understand that you know your body best, and whatever feels best for you is probably the correct choice. No foot is the same, and just because you have flat feet or high arches, doesn’t mean that a specific shoe is right for you!
How Can a Physical Therapist Help?
Consulting with a PT before starting a training plan would be extremely beneficial for any and all runners out there. As PTs, we can identify biomechanical errors, muscle weaknesses, and mobility impairments; while also developing a comprehensive home exercise program that will treat those impairments. PTs will also be able to identify the roots of pain and prescribe strategies that you can use to eliminate those symptoms. It is important to realize that just because your knee hurts, it doesn’t mean it is a problem with your knee itself. In fact, we often find that knee pain is the result of stiffness and/or weakness in either your hips or ankles.
Common Injuries in Runners and Treatments
Injuries experienced with running can occur anywhere in the body from neck to toe. However, it has been found that the most common injuries in runners are Achilles tendinopathy, plantar fasciitis, patellofemoral pain syndrome, and medial tibial stress syndrome (Lopes, Hesphanol, Yueng, Costa).
Achilles Tendinopathy – your Achilles tendon is what attaches your calf muscles to your heel. With overuse, the tendon becomes irritated from excessive compression and lengthening. Often, we find that runners overuse their calf muscles and are not engaging the rest of their posterior chain. Tendinopathy can be a very debilitating condition depending on the severity and proper maintenance with exercise is essential to keep the pain at bay.
Plantar Fasciitis – your plantar fascia is the thick, fibrous tissue that runs from your heel to your toes on the bottom of your foot. Symptoms normally involve pain on the underside of your heel and are aggravated with increased activity. Similar to Achilles tendinopathy, we find that plantar pain can sometimes develop with a lack of posterior chain recruitment or lengthening (glutes, hamstring, calf).
Patellofemoral Pain Syndrome – your patella is your knee cap, and it sits in a groove created by your femur (thigh bone) and tibia (shin bone). Many different muscles pull on the patella and if there is dysfunction in any of them, it can pull on the kneecap in abnormal ways resulting in friction with your femur. Often we find the quadriceps excessively tight, whether it’s due to overuse or weakness. Other times it can be your IT band, which would present as pain on the outside of your knee. Regardless of what the cause is, patellofemoral pain is treated with gluteal, quad, and hamstrings strengthening, as well as mobility work to the entire leg. Studies have shown that strengthening your gluteal muscles can be more effective in treating PFPS, than just quad and hamstring strengthening. (Ferber, Earl-Boehm, Emery).
Medial Tibial Stress Syndrome (Shin Splints) – this occurs with repetitive overuse of the tibia and/or surrounding musculature. Typically, the tibialis anterior, tibialis posterior, and soleus muscles are involved. If you do not have sufficient control of your ankle complex with distance running, the tibia will bend too much and can irritate the tissues around, or even the bone itself.
For each of these conditions, many studies have shown that footwear can be a correlating factor. For example, a recent study has shown that barefoot or “minimal shoe” results in higher tendon loading of the Achilles, which will increase the risk for Achilles tendinopathy. So if you are planning to switch to barefoot or minimal support shoes, make sure you slowly progress into it (Rice H, Patel M).
To combat these injuries, it would be best for you to consult with a PT to quickly get the solution to your problem. Many runners are shocked at how quickly PTs can identify the roots of their pain and realize the benefits therapy can have for compliance. A big myth we hear a lot is the “no pain, no game” approach. Though aches and pain will happen with distance running, and pain does not always mean harm; it does not mean you should ignore it. I recommend the use of the traffic light system for pain: Green is 1-2/10 pain which you should be aware of but can work through, Yellow is 3-6/10 which is when you should be more cautious of pain and recognize that you should ease the intensity and Red is 7-10 where you should stop immediately. Book an appointment now with one of our physical therapists for your individual assessment and plan of care.
All in all, I believe running is a great form of exercise and movement training. The overall health benefits are undeniable and most runners can agree that it can be great for mental health. The goal of this post was not to discourage people from distance running to avoid injury, but just to make sure that runners are aware of the potential injury risks. To achieve your running goals without harm, it is necessary to take a global approach by addressing sleep, diet, cross-training, and most importantly listening to your body. Runners often say that they love the mental escape or the ability to zone out during a run; and though this may help with stress, it is also critical to be aware of your body when you run. Take moments to think about your form, what muscles are working, and how your breathing feels. If you listen to your body and become honest with what your body can accomplish on a day-to-day basis, I believe that you will be better equipped to achieve your goals!
Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012 Oct 1;42(10):891-905. doi: 10.1007/BF03262301. PMID: 22827721; PMCID: PMC4269925.
Ferber R, Bolgla L, Earl-Boehm JE, Emery C, Hamstra-Wright K. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial. J Athl Train. 2015 Apr;50(4):366-77. doi: 10.4085/1062-6050-49.3.70. Epub 2014 Nov 3. PMID: 25365133; PMCID: PMC4560005.
Rice, H, Patel M, 2017. Manipulation of Foot Strike and Footwear Increased Achilles Tendon Loading During Running. Am J Sp Med.