As stated in the previous article, running- while great for your overall health and a viable option for most people, does tend to lead to a high rate of injury; 27% in novice runners, 32% in long distance runners, and 52% in marathon runners. (1)
To recap, running related injuries most commonly affect the knee (28% prevalence), foot and ankle(21-38% prevalence) and hamstring (19% prevalence) according to the above study. Our experience anecdotally supports that. So what can be done about it?
There is level A (consistent, good quality patient-oriented) evidence for the following treatments:
-eccentric exercises (other research says eccentric and concentric are equally valuable) for patellar and Achilles tendinopathies
-exercise therapy for patellofemoral pain, consisting of core and leg strengthening as well as leg flexibility exercises
-functional bracing while running for 6-12 months after an ankle sprain to improve stability and prevent recurrence (we personally feel this seems excessive)
-foot orthoses are beneficial for plantar fasciopathy. No evidence that custom orthoses are superior to off the shelf
Level B (inconsistent or limited-quality patient-oriented) evidence
-Exercise therapy for IT band syndrome should consist of hip abductor strengthening and hamstring and IT band stretching (stretch the muscles connecting to the IT band, as you will not actually stretch the IT band, it is way to strong)
Level C (consensus, disease-oriented evidence, usually practice, expert opinion, or case series)
-eccentric exercises should be considered for treatment of hamstring tendinopathy (this is less studied at the time but makes logical sense)
Notice that there is a lot of talk about strengthening and stretching… and not any mention of injections, surgeries, or imaging.
So what is recommended AGAINST?
-Do not routinely order x-rays for diagnosis of plantar fasciitis/heel pain in those who stand or walk at work.
-Avoid ordering knee MRIs for those with anterior knee pain without mechanical symptoms (consistent painful clicking) or swelling unless they have not improved following completion of an appropriate functional rehabilitation program (American Medical Society for Sports Medicine).
-Do not perform surgery for plantar fasciitis before trying six months of non-operative care (this is from the American Orthopaedic Foot and Ankle Society, mind you)
SO what SPECIFIC exercises can be used for these injuries? In short:
Achilles- progression of heel raises
Hamstring- single leg squats, lunges, Nordic curls
Patellar- decline knee bends, keeping trunk more upright to focus on quads/patellar tendon instead of glutes.
As a rough guideline, you want to be able to perform 2-3 sets of 10🡪15 repetitions of the exercise 2x/day as long as it does not significantly increase pain or lead to increased pain the next day.
Once the initial pain is alleviated, a specific strength training and stretching program can help decrease risk of future re-injury and pain.
(.....That's where we come in)
1) Arnold MJ, Moody AL. Common Running Injuries: Evaluation and Management. Am Fam Physician. 2018 Apr 15;97(8):510-516. PMID: 29671490