Running Injuries

We are currently the only Chartered Physiotherapist in Sussex offering a specialist service for running injuries and running gait analysis.
Unlike other video analysis packages, we combine hi-tech video analysis with a physiotherapists' understanding of how the body moves and the latest clinical research findings, to give you a complete running improvement and injury prevention package.

Research has shown that 65% of runners will get an injury in the average year. That is estimated to be 40 million running related injuries a year worldwide!

So why the injuries? Research looking at triathletes is very revealing; 15% get injured swimming, 25% get injured on the bike and 75% get injured running. Yet, it is one of the most natural and economical ways to get fit. It is the impact, not the repetitive nature of running, that causes problems. Research has shown that when running the forces around the knee can reach seven times the body weight.

What few people realise is that running doesn’t have to be just something you do - it is a skill that can be improved year on year to increase efficiency and speed, reduce your chances of injury and give you more control over your training.

Why running causes problems

Correctly treating running injuries can be complex and there are many factors to consider and address within the treatment program. Problems occur due to a combination of the following;

• Following generic programs without scope for individual adaption
• Technical faults
• Abnormal movement patterns during the running gait
• Unresolved injuries
• Overtraining (or wrong training!) – often increasing volume and speed at the expense of form
• Excessive stiffness in specific areas
• Insufficient strength and endurance – particularly the lower abdominal and gluteal muscles

How treatment can help

There's no point looking at any of the above factors in isolation, which is where a lot of generic treatments or analysis techniques go wrong. To make a real difference long term, and help you regain the joy you once felt at moving freely, treatment for runners must concentrate on investigating and treating each of these factors.

An initial consultation ascertains which problems need addressing first and highlights possible issues with training schedules, and video analysis shows up any technical factors. Once any injuries or muscle imbalances have been treated (using manual therapy and exercise programme to increase endurance and flexibility), runners often return for video analysis every few months to keep on top of any emerging problems and fine tune their technique.

The following images are the same runner before and after a a 20 minute session of running drills addressing technique – the improvements in technique are noticeable, and will result in improved speed, efficiency and enjoyment.

Do you have abnormal movement patterns in your running gait?

If you have a history of running related injury there may well be some significant problems with your technique. These are easy to spot with a video camera and frame by frame analysis of your gait.

There are several major biomechanical problems related to running. For example; if you run with external tibial rotation of around 15 degrees (see left) this causes a dramatic increase the compressive forces underneath the kneecap, leading to tissue overload and pain. Analysis of your gait combined with a physical examination of your pelvis, hips and knees will determine the exact nature of this motor control problem and identify a corrective strategy.

Could you benefit from changing your technique?

If you have spent countless hours running with little improvement it may be time to take a look at your technique.
In recent years, many people have studied running and although there are some controversial topics (e.g. forefoot landing) there are many areas of agreement relating to optimal technique for speed and injury prevention.

Good running posture/technique includes:

• Strong upright trunk with a forward lean
• High cadence
• Reduced / minimal heel strike
• Reduced contact timev
• Reducing knee extension of trail leg at toe off
• Reducing knee extension at heel strike

These components when done well result in
• Excellent engagement of the abdominal wall and gluteal muscles.
• A reduction the amount vertical movement in running – which is a huge energy cost as we are trying to move in a horizontal direction not a vertical one.
• Reduced shock through hip and knee joints/tendons/muscles
• Reduced pain
• Increased running distance
• Increased running speed

Let’s have a look at how correcting technique can improve running form. Heavy heel strike (below) creates high impact; note that the knee is straight and therefore cannot absorb shock, the angle of heel strike is 65 degrees – a vertical heel strike is desirable; closer to 90 degrees the better.



Compare these with the angle of heel strike in the image below - notice the foot is landing closer to the body and the knee is slightly flexed to absorb shock, which will result in less impact and less likelihood of injury.

Our trunk should be still, with a slight forward lean; this engages the trunk and gluteal muscles. This image (right) shows a runner who is extending his low back every time he extends his hip (about 8000 times every run). This was overloading his spine, causing back pain. He was able to run pain free after addressing this problem with a series of corrective drills over a two month period.

Below are examples of common errors relating to the trail leg. Correcting these leads to faster running pace and less impact through the leading foot as the gait becomes more balanced.

Previous injuries could be causing you problems...

Previous injuries could be causing you problems, even if the injuries themselves are no longer an issue

Consideration must be given to areas of previous injury to ensure there is adequate flexibility, strength, muscular endurance and control of that area and the surrounding body regions. There are commonly residual problems related to previous injuries and if this is the weak link problems often arise as training increases.

Why overtraining could be limiting your progress

When we stress our bodies with exercise we create microscopic areas of tissue damage – this may sound alarming, but it is this microscopic injury that stimulates the body to repair itself following exercise. This repair process strengthens our bones, muscles and tendons. It is called ‘adaptive remodeling’ and it explains how, over years of training, our bodies can become strong enough to do amazing things – think about a karate expert breaking concrete with his fist, or an ultramarathon runner.

Provided the training stimulus is optimal your body will adapt and strengthen. If, however, the training stress is too great, your body will be unable to repair itself sufficiently between runs and will break down, resulting in injury. Increasing volume or speed of running, often as a result of following a 'generic' training programme for an event, is the biggest error leading to overtraining problems. There are many running programmes available and these are good to use as a guideline, but they are not designed for individuals. Everyone’s body is different, and by following a specifically tailored running programme, you can give your body a chance to engage its natural healing and strengthening mechanisms.

Is insufficient flexibility holding you back?

Improving flexibility is a bit like oiling a machine. When we are running, we are moving all our limbs repeatedly through their range, so if our limbs are stiffer more energy will be required to move them - and we will tire more quickly. The more fluid and flexible we are, the better our machine will run. Stiffness can also increase compressive forces on joints and tendons; for example, traction through the iliotibial band (which occurs when it gets stiff) causes a lateral shift, a rotation and a tilt of the patella, in turn causing an increase in the compressive forces underneath the kneecap and resulting in – you guessed it - pain.

The right amount of flexibility in the right areas:

• reduces the likelihood of injury
• improves running technique
• improves running performance

Or are you suffering from insufficient strength?

Substantial strength is required in the abdominal and gluteal muscles in order to stabilise the trunk while the arms and legs generate force for forward propulsion. If the trunk muscles are not doing their job, lots of extraneous movements will occur. These can cause overload to tissues in the back and hip, resulting in pain, as well as reducing the running efficiency and causing fatigue. Strength and endurance exercises will increase running ability and reduce the risk of injury.