Why do running injuries occur?
Running related injuries generally result from relative over-stress to the body tissues from repetitive motion of running. The overload to the tissues may be caused by:
Training error- increasing mileage or intensity faster than the body can keep up with. The repetitive stress breaks down body tissue at a higher rate than the body can repair the tissue. Read more about avoiding training error in this blog post written by Anya. Here is a link to another post Anya wrote on injury prevention through training load management. It is more focused on cyclists and triathletes, but the concepts are very applicable to runners.
Weakness/relative low load tolerance- In addition to muscle strength, running requires relatively high demands of load to other tissues such as bone, tendon, and cartilage. All of these tissues must be adequately strong enough to meet the demands of the desired running quantity and intensity in order to avoid injury.
Musculoskelital imbalance- Sometimes certain muscles become overdeveloped, while others become underdeveloped. This can often lead to movement patterns that overload certain tissues
how do we rehabilitate running injuries and prevent them from reOCCURRING?
Comprehensive subjective and physical assessment
In order to treat a running injury, your physical therapist must first understand why it occurred in the first place. We will spend as much time as necessary to understand your training habits, shoe selection, and personal running goals. We will then perform a physical exam in order to determine 1) the specific tissue that is injured; 2) the probably cause of injury (training error, weakness, muscle imbalance etc.); 3) any current habits that may be preventing the injury from healing. The examination will likely include specific strength testing using hand-held dynamometer, mobility assessment, and running gait analysis.
running gait analysis
If it is appropriate, your physical therapist will perform a video gait assessment in order to capture your gait pattern. This may help identify movement patterns that contributed to your injury and may also reveal areas where you may be able to improve efficiency and performance quality. At Endurance Physio, we use a 2D video assessment tool along with RunScribe wearable device that captures the following data. We are particularly concerned with identifying the following:
How well to you currently tolerate (or not tolerate) running. This will help determine a timeline and program to return to the desired running volume
Is there a characteristic of your selected gait pattern that could be altered to allow you to better tolerate running
treatment approaches
Your physical therapist will educate you on any impairments found in the initial exam. You and your PT will discuss treatment options and devise a plan to address the relative issues in the least amount of visits with the most amount of success. In general, treatment consists of the following:
Education on training, cross training, and relative rest
Muscle activation and progressive loading/strengthening program to improve your tissues load capacity to better withstand the load demands of running
Gait retraining. If it is indicated, your physical therapist may provide cuing to alter your running gait in order to decrease pain, decrease loading of injured tissue, improve running tolerance, and/or improve running economy and performance quality.
Education on home exercise program. At Endurance Physio, we highly value your treatment success. In order for you to overcome your injury, we will work with develop a plan so you may perform as many exercises and drills on your own as you feel able to do and as we see relevant and safe for you to do.
Guidance on returning to running. On of the trickiest parts of rehab is how to get back to running without re-injuring yourself. Your physical therapist will help you come up with a plan to get you back on the trails/roads as quickly as possible without risking re-injury.
Taping, education on ideal footwear and/or orthoses. Your physical therapist may use taping techniques to improve alignment, offload injured tissues, an decrease pain. You may also be educated on change in footwear or use of foot orthoses if appropriate
Manual therapy. In order to aide in pain relief, improved mobility, improved muscle activation, and muscle down-training (decreasing activation to overactive muscle groups), you may receive any of the following manual therapy treatments if needed:
Functional Dry Needling
Instrument Assisted Soft Tissue Mobilization and Soft Tissue Mobilization
Muscle Energy Techniques (MET)
Joint Mobilization
