WHAT ARE THE TOP RUNNING INJURIES?

Runners of all abilities and ages get injured. Earlier this year I completed a clinical audit of the runners I looked after from January to March to assess what injuries I was seeing and where to plan my professional development over the next few years. This made me look into the research to see if the trends I was seeing was the same as being reported.

I found “A Systematic Review of Running-Related Musculoskeletal Injuries in Runners” which was published in 2021. I’ve made up the infographic below for you. I won’t talk about my own audit as I would require consent from my patients.

SYSTEMATIC REVIEW OF RUNNING-RELATED MUSCULOSKELETAL INJURIES IN RUNNERS.

(KAKOURIS ET AL 2021).

The chart shows that Achilles tendinopathy had the highest incidence, followed by shin splints, plantar-fasciitis, patella-femoral pain (knee pain) and the dreaded ITB related pain. Most runners will have heard of these and even more will have experienced pain in one of these areas.
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You'll notice that the numbers do not add up to 100%. This is due to a small number of injuries not included. However if you read the study they are fully reported.
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📌70% of all injuries reported were down to overuse!

🧠This is massive but it’s also encouraging. We can have a big intervention on overuse injuries with their treatment, management and PREVENTION. Sometimes this can be through looking over a plan for trends and sudden increases in one type of running. It might be looking at where and how you recover. It might also be measuring muscle force or endurance and looking at weak points.

📌The majority of injuries were reported below the knee.

🧠This might because the propulsion phase in the running gait is generated from the foot and the lower limb muscles and bones, which leads to increased load on these structures. This could also be why so much research is coming out about how to strengthen the lower limb in runners.
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🏃‍♀️The authors recommend injury prevention measures to these area's to reduce the high incidence of injuries.
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🙋🏻‍♂️In all of my sessions with runners 🏃🏿 I try to implement education on load management and how to safely increase mileage, interval and hill training. I teach you how to analyse your training plan so you reduce the risk of making a training error and cause an overuse injury. I’m a huge believer in learning how to strength train for injury prevention and increased performance.
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I’m starting a new service where I’m offering online strength training for runners and triathletes. If you’re interested in learning how to implement strength training as part of your training to improve performance and reduce injuries then please reach out to me.

To book an appointment with me you can call my online secretary 07900363938 or email info@shauntyler.com.

Reference and read what I've read 📚
Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522. doi: 10.1016/j.jshs.2021.04.001. Epub 2021 Apr 20. PMID: 33862272; PMCID: PMC8500811.

I treat lots of runners in my Colchester osteopathy and running clinic. They range from people of all ages and abilities. I really like the challenge of each runner with the pressure of getting someone ready for an event combined with their unique biomechanics and training methods.

Over time I have seen patterns in new runners. I see the same mistakes being made repeatedly causing injury, pain, and time away from running. Here’s my top four mistakes that new runners are making.

1. TOO MUCH TOO SOON

New and experienced runners are guilty of this. You get the runners high, the more you run the better you feel. It can be intoxicating. But I will let you into a secret. 99% of running injuries I see in my clinic are from doing too much too soon. I performed an audit for 2021 and I saw one runner who was injured because of an accident and that was twisting their ankle in a pothole. Every other runner was direct result of a training error.

Whether you’re trying to increase your long run and weekly mileage, interval training or hill sprints - introduce them gradually. Yes, you might be able to complete the session, but can your body recover and adapt from it? For instance, did you know it takes tendons three times longer to recover than muscles? While there is nothing like looking back on a good training week and counting the miles make sure you plan recovery. Take time to assess your body and note how it feels. A niggle might be the start of something not having enough time to adapt.

Employ the 10% rule. If your goal is to increase your long run or your weekly mileage try not to exceed more than 10% of the previous week’s volume.

2. RUNNING THROUGH THE PAIN

While a little pain is good for us and strengthens us physically and mentally, it’s important to differentiate between a “working” pain and a “hurting” pain. The working pain might be your thighs burning while running up a long hill. We kind of expect this pain if we want to get better at running. A hurting pain might be a joint or tissue that gets sore the more you run and inevitably worse when you stop running especially 24hours afterwards.

3. NOT WEARING RUNNING SHOES

Running is a repetitive and high impact activity. If you’re new to running then your bones, joints, muscles, tendons, and other connective tissue will not be used to these high levels of impact and force. You need to get the right tools for the job. They will help cushion your feet and joints from the impact. Good quality running shoes help reduce your risk of pain and injury - meaning you’ll have a longer running career.

Get a pair of running shoes. They don’t have to be the most expensive pair on the shelf, and you probably don’t need a gait analysis for now. I advise using www.sportsshoes.com as they have shoes for anyone’s budget.

https://www.sportsshoes.com/running/

4. NOT TAKING REST DAYS

Running will absolutely improve your cardiovascular health, improve endurance, tone you up, help manage your weight and do wonders for your mental health. But let’s make one point clear. You’re not getting fitter during your run. All that’s happening is you’re stimulating your body and overloading your tissues whether that be the heart and lungs or muscles and tendons. Your body gets fitter after the run if you have enough rest. New runners should probably not run-on consecutive days to avoid overtraining and breaking down tissue. Think about creating the best environment for your body to recover. Good hydration, a healthy diet with plenty of fruit and vegetables and lean protein and prioritise sleep.

I hope you found these tips useful. Feel free to leave a comment if you have any tips to add.

I love treating runners. They are without a doubt my favourite patients. Probably because I’m an ex-runner myself. I say ex-runner, as I’ve had two knee replacements and dare not run anymore. I know the joy of getting out the front door and onto the road and what it can do to your mental health. I’m also more than aware of how dispiriting it is not being able to run due to pain and injury. I am passionate about running, running training, and running injuries and I make it my business to stay up to date. 

So, what is my philosophy of treating runners and how can osteopathy help? 

One of the key concepts of osteopathy is to treat every patient as an individual. I don’t care whether you’re a seasoned club runner or you’re two sessions in on the Couch25K plan. To me you’re a runner and you’re an athlete so you deserve to be treated like one with the best care in the area. I know you are at your happiest when you can run so I will do everything I can to keep you running. 

On the initial session I will take a full medical history and ask plenty of questions about your training (or lack of!). This might include, how long you’ve been running for? What are you last six weeks of training? How quickly have you increased your mileage? I will ask questions about your injury like, does your injury swell? Is it worse in the morning? Is it worse at the start or end of a run? Have you had it before? 

I will assess you biomechanically looking at posture, gait, joint range of motion and muscle balance. This will include single limb strength, quadricep to hamstring strength ratio. I will assess your joint mobility. This might include the flexion and extension of your big toe. How much dorsiflexion you have and explain to you how this relates to the Windlass mechanism and your running gait. I will try to explain things, so you understand and educate you as much as possible.

Once I’ve given you a diagnosis, we will BOTH agree on a treatment plan. Not only will this include treatment on the couch but a full progressive rehabilitation plan including strength training. We may have to talk about modifying your running frequency and intensity. 

On the couch you might be offered massage and osteopathic techniques such as mobilisation, manipulation, and neuromuscular stretching as well as dry needling and acupuncture. If you have a tricky tendon or plantar fasciitis there is access to shockwave therapy. 

Proper rehabilitation is key. We may need to implement simple exercises you can do for five minutes per day. If it’s more complex, then you might have to follow a progressive strength training plan. This is where follow up sessions come in. We’ll need to measure your progress whether it be increased strength, power endurance or increased range of motion in a joint. I will use this information to optimize and progress your current plan. 

My primary goal is to get you back on your feet and running as soon as possible. 

My secondary goal is to make you stronger, so you don’t have to come back for the same injury.

Once your injury free I have links with running coaches and clubs in the Colchester area. This can help increase your fun and commitment to running. You never know you might get a new PB!

If you consider yourself a runner and you’re experiencing pain, then it’s important to get your advice from a healthcare professional. I see so many runners of all abilities who have been in pain for months or made an injury worse as they’ve been listening to Barry the bricklayer give his “expert” advice on what worked for him when he self-diagnosed his own shin splints. Every onset of running injury is different just like we all have our own running style and DNA. Therefore, it’s important for a full assessment to be performed so we can get to the root of the problem and address it quickly. 

GET IN TOUCH

If you want to work with a friendly and knowledgeable local osteopath, then please get in touch to book and appointment. 

Call: 07900363938 or email info@shauntyler.com

Do you always have a niggly calf?

Are you always “pulling” the same calf?

Are you a runner based in Colchester, Essex?

Often when I see a runner from Colchester with a calf strain they will present with a sharp pain or a “tight” feeling. I once heard a runner say that “it felt like I’d been shot!” If you runr and you’re always pulling the same calf muscle then read on as I’ve got some advice for you.

Most calf injuries occur in the medial head of the gastrocnemius. This is the inside of the upper calf. It’s the third most common site for muscle strains in elite athletes. The second most common site is near where the two muscles in the back of your calf blend into the Achilles tendon. This is called the musclo-tendinous-junction or MTJ for short. Lastly and less common is the lateral gastrocnemius, or the outside of the calf that can also be injured.

The gastrocnemius is the chunkier muscle in your calf. It’s a biarticular muscle meaning it connects over two joints, the knee and the ankle. It has a high density of fast twitch muscle fibres. Most injuries are more acute and the runner will experience a sharp pain or tight calf muscle. This might be from increasing interval training or speed work into their training too quickly. Imagine driving off your back leg during your stride, up on your toes with your knee extended. This puts stress through the gastrocnemius and this is where the “pull” happens. It’s a bit like cracking a whip.

The soleus is the slimmer muscle lower down the leg just above the Achilles. It’s a mono-articular muscle meaning it only attaches over one joint. It attaches onto the fibula and the tibia bones then into the Achilles tendon onto the heel. It’s made up of predominantly slow twitch muscle fibres. Injuries to this muscle are more sub acute or chronic. The mechanism of injury is similar to running uphill. The foot is dorsi-flexed (pulled upwards) and the knee is bent so there is stretch across the soleus. Injuries to this muscle often occur when a runner has increased their mileage, they’re doing lots of hill work.

Here’s a list of the main causes of recurrent calf strains in runners.

Lack of Tissue Capacity

One of the problems I see with a lot of runners is that their calf muscles aren’t able to cope wit the amount of training and miles they put their legs through. Your calf muscles and Achilles tendons absorb up to 9 x bodyweight with each stride. It stands to reason that you may want to pay some special attention to your calves. It might be even more prudent to see if the side you keep injuring is as strong as the good side. Adding in a couple of short strength sessions that include some calf raises, hops and plyometrics can really go a long way to increasing tissue capacity so you can adapt and recover from your runs.

Training Error

It’s been reported in studies that 60-70% of all running related injuries are caused from training errors. This means you’re probably running too much or too fast with too little recovery or after doing too little for too long. Keeping a training diary and recording any niggles can help you manage your training and recovery. If you’ve just started hill training and you’re getting a pain in the soleus and it’s getting worse with each session then you’ve got some objective data to inform your decision making. As an osteopath it’s also really helpful when a runner brings their training diary as I can identify trends and spikes in load.

Could it be a nerve?

Sometimes a recurrent calf strain can be caused by an irritated nerve. The calf is supplied by the tibial nerve. Symptoms are almost the same. A tight calf, pain on movement andpossibly weak. The nerves can become compressed and inflamed causing a lot of discomfort. Sometimes it can cause cramping. This is often misdiagnosed as a calf strain. It’s important to see a health professional to make a diagnosis and treatment plan. Often the nerve pain can be coming from another area of the back. If it is from the back that is a sign of L5 radiculopathy and must be assessed and managed as a matter of urgency.

Impaired Biomechanics

As a registered osteopath I take an interest in the biomechanics of the muscles and joints. Runners with recurrent calf strains usually have a tight calf complex causing a lack of dorsiflexion. This can be from high arches, bone anatomy, plantar-fascia problems, osteoarthritis of the big toe or a lack of big toe extension. Every person is different this is why having a bespoke assessment that takes into account biomechanics, training experience, current training plan, past history of injuries and even medication can save time, money and get you back running as quickly as possible.

Worn Out Shoes

I know you love your current running shoes but let’s be honest, how many miles have they done? Do they make your foot feel stable and supported? Has the grip worn away and you’re sometimes slipping in the wet? When you put them on do you feel like you’re standing on the sides of your feet? If you’re nodding side to side at this moment then it’s time you changed them for a newer model. Your shoe is the first point of contact with the ground and if it’s not doing its job then your biomechanics and shock absorbing properties will be below optimal. If you feel you require a gait assessment then please get in touch as I work with an amazing podiatrist at Colchester at Reflex 18 Injury Hub.

If you’re based in Colchester and would like to see me face to face to discuss your calf strain then please drop me a line or give me a call. Not only will I make you better, I will make you better than you were before.

Email: info@shauntyler.com Telephone: 07900363938

A study followed 264 recreational runners over a 22 week period. They uploaded their physical activity to an online platform where scientists analyzed the data to assess for running related injuries.

The researchers defined a running related injury (RRI) as "a physical pain or complaint located at the lower limbs or lower back region, sustained during or as a result of running practice and impeding planned running activity for at least 1 day."

87 of the recreational runners (about a third of the cohort) reported at least one injury over the 22 weeks.

The researchers concluded that the participants who rotated two or more pairs of shoes in parallel had a protective effect against running related injuries. This might be because there's a slightly different distribution of load with each pair of shoes, therefore changing the stress on the musculoskeletal system.

This is a fairly cheap way of trying to reduce your risk of an injury. It can take up to 48hours for the foam in the training shoes to decompress. EVA foam that is commonly used in running shoes is known to compress over time and shorten the life of the shoe. We know there are high loads when running so it’s imperative the shoe has time to “recover.” If we think about when we have a gait analysis we are dealing with tiny movements often measured in mm so a compressed sole could have an effect on your foot posture as well as the shock absorbing ability of the shoe.

If you are going to start to rotate shoes then I would advise trying to stick to the same model that works for you. This will allow continuity for your foot and running style especially if you’re training for something like a marathon, triathlon or Ironman.

If you do decide to choose different shoes for different runs then I would advise using the same principles as you would with your training. You’d integrate a new training technique slowly into your current regime and that should be the same with your training shoes.

Obviously there are more productive ways to manage running injuries such as monitoring training load, recovery and some strength training. However, if your budget stretches to I would advise investing in an extra pair of shoes. It’s about marginal gains and sometimes these small changes can go a long way to creating a more productive training environment.

If you need help with a running injury please get in touch:

07900363938

info@shauntyler.com

shauntyler.com

Reference:

Malisoux L, Ramesh J, Mann R, Seil R, Urhausen A, Theisen D. Can parallel use of different running shoes decrease running-related injury risk? Scand J Med Sci Sports. 2015 Feb;25(1):110-5. doi: 10.1111/sms.12154. Epub 2013 Nov 28. PMID: 24286345.

A systematic review published in 2012 investigated the available scientific literature to identify what were the main causes of injury in runners.

The evidence suggested 60-70% of all injuries were a result of training errors. The main causes were

- Excessive mileage (total weekly mileage).

- Increased frequency of sessions (more sessions per week).

- Increases in speed (interva / tempol training / sprints / hills).

- Changes in terrain (changes from flat to hill work or cross country / off road).

An interesting comment caught my attention "In a review of the etiology and prevention of and intervention for overuse injuries in runners, Hreljac (2005) concluded that the causes of all overuse running injuries could be classified as trainiing errors, and thus, all overuse running injuries should be preventable". 

In simple terms the authors believe overuse injuries are completely preventable. This is an absolutely massive statement. 

A simple strategy that I’ve found helps is keeping a training diary and knowing how to analyse the weekly workload. Look for increases in the training errors above as well as cross referencing for any pain, aches or niggles. This is one of the most important tools in injury prevention for the average runner. 

References: 

Rasmus Oestergaard Nielsen, PT, Ida Buist, PhD,Henrik Sørensen, PhD, Martin Lind, PhD,Sten Rasmussen, MD.
Training Errors And Running Related Injuries: A Systematic Review. The International Journal of Sports Physical Therapy. Vol 7, No 1: 58-71. 

Hreljac A. Etiology, prevention, and early intervention of overuse injuries in runners: A biomechanical perspective. Phys Med Rehabil Clin N Am. 2005;16(3):651-67, vi.