Running Injuries

Most running injuries occur as a result of overuse or inappropriate biomechanics. A good analogy is to think of a pulley system where the rope is your muscle and the pulley is the joint. If you have asymmetry in the way that you are pulling on the “rope”, you are not going to be able to glide it over the “pulley” without using excessive effort; it will become more difficult to lift the weight at the end, thus creating friction. This in turn heats up the "rope" and possibly, "SNAP"; you now have a tear. If you realign the rope and the way it travels over the pulley, via chiropractic and sports therapy treatments, the ease at which you can pull the weight up is greatly enhanced. One will then find that the energy required to complete your run is more efficiently used and your time will improve.

Some common running injuries:

Pronation Syndrome

Mechanical error whereby the foot is over pronated for too long in the stance phase, not held long enough throughout the phase, or the foot is pronated at the wrong time (i.e. should be supinated.)

It is very common!!!
60-75% of all runners
90% of all soft tissue problems concerning the foot.
Overuse injury

Overpronation Syndrome decreases shock absorption of the foot during the stance
Decreases foot stability during the stance phase
Decreases propulsion during the stance phase.

REMEMBER that if someone is flat footed, they are not necessarily overpronators!!!

Treatment of common conditions causing Pronation syndrome depends on the condition causing the Pronation.  Such conditions include:

1.Forefoot varus
2.Rearfoot varus
3.Tibia Varum
4.Genu Varum
5.Genu Valgum
6.Tricep Surae contractures

Forefoot Varus.  Inversion of the forefoot with the subtalar joint in neutral and the rearfoot parallel with the ground. Requires increased calcaneal eversion to establish full forefoot contact.

Treatment:

a. can not change structural defects
b. adjust fixations
c. stretch tibialis anterior
d. strengthen peroneals
e. Pronation control shoe
f. functional orthotics - medial forefoot posting

Rearfoot Varus.  Inversion of the rearfoot (calcaneus) when the subtalar joint is in neutral

Treatment:

a. adjust fixations - talus/calcaneus
b. stretch tricep surae
c. strengthen invertors
d. Pronation control shoe
e. orthotics with medial heel wedge (posting)

Tibia Varum.  Congenital error where the distal 1/3rd of the tibia is adducted (curved/bowed medially) in relationship to the proximal tibia causing varus foot in neutral.

Treatment:

a. Mild: shoe with medial rearfoot and forefoot posting- pronation control shoes
b. Severe: orthotics with varus wedge in rearfoot if not prolonged pronation; medial and posterior wedge if prolonged pronation.

Genu Varum.  Inward bending of the tibia (<5° at the knee); AKA "bow legged".

Treatment:

a. strengthen external tibial rotators
b. stretch internal tibial rotators and hamstrings
c. orthotics with medial posting (varus wedge)
d. adjust knee, hip, foot and low back.

Genu Valgum.  Excessive outward bending of the tibia (>15° at the knee); AKA "knock kneed."  This is very common.

Treatment:

a. pronation control shoe or orthotics with varus wedge
b. stretch hip extensors, knee rotators, and hamstrings.
c. strengthen hamstrings and quads.
d. adjust hip, knee, foot, and low back.

Tricep Surae Contracture.  Tight surae complex prohibiting adequate dorsiflexion (<5°) at the ankle joint, usually with a flexible flatfoot or valgus rearfoot.

Treatment:

a. avoid high heels
b. strengthen anterior leg muscles and invertors
c. soft tissue massage of the leg
d. contrast baths to calf muscle
e. adjust talar, subtalar (posterior calcalneus), or navicular (inferior).

Plantar Fascitis 

Definition.  Strain, inflammation and pain associated with the plantar aponeurosis and flexor digitorum brevis at their attachment to the anteroinferior aspect of the calcaneal tuberosity.

Onset.  Insidious onset quickly becoming chronic in nature with acute exacerbations. Plantar fascia: plays important role in the arch support as it is the “tie beam” One of the most common overuse injuries in athletes, especially distance runners and basketball players.

Treatment:

ACUTE
a. RICE
b. TENS
c. Soft tissue work- strip and stretch
d. adjust posterior calcalneus, medial talus, inferior navicular, and/or low back.
e. heel cup
f. home work: rub golf ball under arch 6-10 times

CHRONIC

a. orthotics control for pronation
b. stretch calf muscle
c. strengthen invertors
d. deep soft tissue massage
e. heel cup

Medial Tibial Stress Syndrome (Shin Splints)

Definition: muscle strain, tendonitis, and/or periostitis involving the tibialis posterior and/or soleus and presenting with pain along the posteromedial aspect of the middle 1/3rd of the tibia.

Etiology.  Repetitive impacts, most commonly in runners, aerobic dancers, or other high impact sports. Contributing factors that will exacerbate this condition: High mileage Hard surfaces Uneven surfaces Sudden changes in routine New activities Poor shoes

Signs and symptoms.  1.swelling
2.small lumps or nodules along the muscle attachments to the tibia
3.often the patient is an overpronators as well

Treatment:

ACUTE

a. ice massage
b. TENS
c. gentle stretching
d. gentle soft tissue work of the tibialis posterior
e. adjusting
f. change shoes

CHRONIC

a. continue adjusting
b. aggressive stretching
c. deep tissue massage
d. change exercise program
e. isometric/isotonic rehabilitation

Stress Fracture

Metatarsal Stress Fracture.  Often due to repetitive microtrauma; overuse as a result of excessive running, dancing, or jumping. It is a biomechanical fault that causes increased pronation or foot slap.

Osteoporosis- remember that an amenorrheic female athlete is at high risk for accelerating thsi process!!

Treatment:

a. rest for 2-3 weeks
b. TENS- low setting NOT to pain
c. semi rigid orthotics
d. ROM exercises
e. stretching and strengthening of intrinsic foot muscles

Iliotibial Band Syndrome

Definition.  Tendonitis along the iliotibial band causing pain along the lateral aspect of the knee.

Etiology.  Tight TFL Genu varum
Overuse: Most common:RUNNING!!!  Other contributing factors include over pronation, under pronation, poor shock absorption, and uneven surfaces.

Treatment.

a. soft tissue massage- strip and stretch
b. decrease mileage and avoid downhill running
c. orthotics
d. stretch hip abductors, hamstrings, and gluteal muscles
e. strengthen gluteals and other hip abductors

Trochanteric Bursitis 

Definition.  Inflammation of the large bursa that lies between the tendon of the insertion of the gluteus maximus and posterolateral prominence of the greater trochanter. Etiology: friction trauma from muscle hypertonicity and overuse (i.e. running with tight gluteals) Direct or micro trauma- pronation syndrome and/or a medial rotation stance.

Treatment:

a. electrical current for two weeks
b. ice if acute
c. soft tissue therapy- gluteals
d. stretch gluteals
e. adjust low back/ hip
f. avoid hills, stairs, and uneven surfaces

Iliopsoas Bursitis

Definition.  Inflammation of the bursa that lays between the iliopsoas muscle and the iliopectineal eminence; it overlies the anterior-medial capsule of the hip.

Treatment: as above