Make no bones (or muscles or tendons) about it: Start running, and there’s a good chance injury may follow. Some estimate that nearly 80 percent of runners are injured each year. (They don’t tell you that before joining the track team.) Most injuries are caused by overuse—applying repeated force over a prolonged period of time. Sudden changes in training volume, whether a newbie or a vet, can also do some damage. Here are 12 of the most common ailmentsthat plague those who hit the pavement, along with a few ways to stop the pain.
Running Ragged—The Need-to-Know
- Runner’s knee. Experiencing a tender pain around or behind the patella (or kneecap) is a sure sign of patellofemoral pain syndrome, a fancy term for runner’s knee. (And yep, this ailment is so common among runners it was named after them.) Find relief: The repetitive force of pounding on the pavement, downhill running, muscle imbalances, and weak hips can put extra stress on the patella, so stick to flat or uphill terrain,and opt for softer running surfaces when or wherever possible. To treat the pain, some experts suggest knee taping and/or braces, anti-inflammatory medications, and cutting back on the mileage Runner's knee: what is it and what helps? Arroll, B., Edwards, A. The British Journal of General Practice, 1999 February; 49(439): 92–93..
- Achilles tendinitis. The swelling of the Achilles, the tissues that connect the heel to lower-leg muscles, can be the result of many finicky factors: rapid mileage increase, improper footwear, tight calf muscles, or even having a naturally flat foot Achilles tendinitis in running athletes. Nichols, A.W. The Journal of the American Board of Family Medicine, 1989 Jul-Sep;2(3):196-203.. Prevent the pain: To help sidestep this pesky pain, make sure to always stretch the calf muscles post-workout, and wear supportive shoes. Also, chill out on all the hill climbing, which puts extra stress on tendons. Anti-inflammatories, stretching, and the ol’ R.I.C.E strategy (rest, ice, compression, and elevation) are the best ways to get back on the path to recovery.
- Plantar fasciitis. This tricky-to-pronounce pain is due to the inflammation, irritation, or tearing of the plantar fascia—tissue on the bottom of the foot Plantar fasciitis in runners. Treatment and prevention. Warren, B.L. Department of Human Performance and Health Promotion, University of New Orleans, Louisiana. Sports Medicine, 1990 Nov;10(5):338-45.. Just some of the causes include excess pounding on the roads or strapping on unsupportive footwear (read: flip-flops) to go the distance The result: extreme stiffness, or a stabbing pain in the arch of the foot (sounds like fun right?). Soothe the sole: Wearing shoes with extra cushion, stretching and rolling a tennis ball over the heel, and getting ample rest can help dull the pain. If the problem persists, doctors recommend wearing custom-made orthotics, a night splint, or in some cases getting a steroid shot into the heel (ouch!) to speed up recovery and keep on keepin’ on.
- Shin splints. If you’re a runner who’s never experienced that aching, stabbing sensation in the shin, please tell us your secret! Among the most nagging of injuries, shin splints occur when the muscles and tendons covering the shinbone become inflamed. Stop the stabbing: Try icing the shins for 15-20 minutes and keeping them elevated at night to reduce swelling. Prevention is a liiiittle trickier, but some researchers find shock-absorbing insoles that support the arch may help The prevention of shin splints in sports: a systematic review of literature. Thacker, S.B., Gilchrist, J., Stroup, D.F., et al. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA. Medicine and Science in Sports and Exercise, 2002 Jan;34(1):32-40.. Also make sure those sneaks are the right fit for the foot, and stick to running on softer grounds whenever possible. Avoid hills, too, which put extra force on the shin’s tibialis muscle.
- Iliotibial band syndrome. Distance runners take note: This injury is not your friend. ITBS triggers pain on the outside of the knee, due to the inflammation of the Iliotibial band, a thick tendon that stretches from the pelvic pone down the tibia (the bone that runs down the thigh). Common culprits include increased mileage (half-marathon training, anyone?), downhill running, or weak hips Iliotibial band syndrome in runners: innovations in treatment. Fredericson, M., Wolf, C. Stanford University School of Medicine, and Stanford University Cross-Country and Track Teams, Stanford, California. Sports Medicine, 2005;35(5):451-9.. Ease the ache: Give those muscles some love. Specific stretches, along with foam rolling, may decrease inflammation and help reduce pain.
- Stress fracture. Non-contact sports can have some bone breaks, too. Stress fractures are tiny cracks in the bone caused by repeatedly pounding greater amounts of force than the leg bones can bear. Find time to chill: Taking some time off is a must and usually involves some crutches with a side of physical therapy. And in some cases, an x-ray may reveal it’s time to go under the knife (yikes!). To avoid the sidelines, make cross-training your BFF to avoid overuse, wear proper shoes, and get enough calcium to keep bones strong.
- Patellar tendinitis. It’s often referred to as “jumper’s knee,” but this is one injury that’s just as common among distance runners Recalcitrant Infrapatellar Tendinitis and Surgical Outcome in a Collegiate Basketball Player: A Case Report. Klucinec, B. Journal of Athletic Training, 2001 Apr-Jun; 36(2): 174–181.. Patellar tendinitis strikes when overuse (sensing a pattern here?) leads to tiny tears in the patellar tendon (the tendon that connects the kneecap to the shinbone). Overpronation, over-training, and too many hill repeats are likely causes. Tenderize it: To reduce the risk of patellar tendinitis, strengthen the hamstrings and quads (at the gym or at home!), and ice the knee at the onset of pain. Doctors also recommend physical therapy to help soothe and strengthen the tendon.
- Ankle sprain. A sprain occurs when the ankle rolls in or outward, stretching the ligament (and causing some serious pain). Curbs, potholes, tree branches (or just an unfortunate landing) can be just a few of the unfortunate culprits. Straighten Out: Recovery may be a little shaky at first, but many experts suggest doing balance exercises (like single-legged squats) to strengthen the muscles around the ankle Balance training improves function and postural control in those with chronic ankle instability. McKeon, P.O. Ingersoll, C.D., Kerrigan, D.C., et al. College of Health Sciences, University of Kentucky, Lexington, KY. Medicine and Science in Sports and Exercise, 2008 Oct;40(10):1810-9.. Stick to some solid rest after the sprain occurs; how long depends on the sprain’s severity, so see a doc for a more specific game plan. They might also recommend an ankle brace or air cast, and taping it up when you’re ready to get back out there to prevent re-twisting.
- Pulled muscles. When a muscle is overstretched, fibers and tendons can tear and cause a pulled muscle. (The calf and hamstring are common muscle pulls among runners! The management of hamstring injury--Part 1: Issues in diagnosis. Hoskins, W., Pollard, H. Macquarie Injury Management Group, Macquarie University, Sydney, Australia. Manual Therapy, 2005 May;10(2):96-107.). Overuse, inflexibility, and forgetting to warm-up are a few possible causes. Prevent the pull: A proper warm-up, cool-down, and dynamic stretching pre-workout is the best way to avoid a pesky pull. While the pain persists, lay off (up to five days!), and stick to gentle stretching and icing the muscle.
- Blisters. More annoying than a younger brother, blisters can pop up when we least expect it. As the heel rubs against the shoe, the top layer of skin can tear, leaving a bubble between the layers of skin. Stop it or pop it: The best way to beat ‘em is prevention: Make sure the shoe (literally) fits, and wear a good pair of synthetic socks Managing blisters in competitive athletes. Brennan, F.H. Primary Care Sports Medicine, Dewitt Army Community Hospital, Fort Belvoir, VA. Current Sports Medicine Reports, 2002 Dec;1(6):319-22.. If a blister still appears, cover it up with special Band-Aids, moleskins, or gels.
- Chafing. For most, there’s no escaping it. When skin rubs against skin (we’re looking at you, thighs), the skin can become angry and irritated. Stop the sting: Avoid those short-shorts and throw on a pair of longer running shorts or capris to avoid that skin-on-skin action. When in doubt, there are also products like body-glide to keep things moving.
- Side stitch. Ever get that awful pain on the side of the stomach? Formally called exercise-related transient abdominal pain (ETAP), side stitches can really creep up—affecting nearly 70 percent of runners. Many experts believe the pain is caused by the diaphragm beginning to spasm from being overworked and suggest poor running posture could be to blame. Nix the stitch: Remember to stand up straight to help prevent a stitch. If it strikes, try bending forward and tightening the core, or breathing with pursed lips to help ease pain Investigation of the side pain "stitch" induced by running after fluid ingestion. Plunkett, B.T., Hopskins, W.G. Department of Physiology and School of Physical Education, University of Otago, Dunedin, New Zealand. Medicine and Science in Sports and Exercise, 1999 Aug;31(8):1169-75. Influence of posture and body type on the experience of exercise-related transient abdominal pain. Morton, D.P. Callister, R. Faculty of Education, Avondale College, Australia. Journal of Science and Medicine in Sport, 2010 Sep;13(5):485-8..
Just Beat It—Your Action Plan
Still hell-bent on racking up the miles? (Yeah, most runners are.) Remember there’s a fine line between pushing through and pushing your luck—and only you (and your doctor) will know what’s best when the running gets rough. To minimize the aches and pains, though, consider these general tips to help stay on the safe side:
- Stick to the 10 percent rule. Don't increase mileage by more than 10 percent each week. Upping those miles unexpectedly is a major reason overuse injuries occur!
- Warm up and cool down. Heading for an intense run? Remember to warm up and cool down to ease the body in and out of a workout. This will help keep injuries at bay Prevention of running injuries by warm-up, cool-down, and stretching exercises. Van Mechelen, W., Hlobil, H., Kemper, H.C., et al. Department of Health Science, Faculty of Human Movement Sciences, Vrije Universiteit, Amsterdam, The Netherlands. American Journal of Sports Medicine, 1993 Sep-Oct;21(5):711-9..
- Fix your form. Smooth and efficient is the key. Not only will poor form hinder performance, it could lead to unnecessary pain. So make sure to use correct running technique to prevent injuries, especially shin splints and back aches. Imbalances in the body can also lead to problems down the road, and it never hurts to visit a skilled physical therapist who can help identify and address any biomechanical issues.
- Replace the sneaks. Keep track of how many miles those shoes have logged, and replace them every 600 miles—if not sooner! It’s also worth swinging by a specialty running shoe store, where they can help you figure out which shoe is the perfect fit.
- Keep it even. Avoid running on uneven surfaces that put unnecessary stress on ligaments. And while off-roading is a fun change of pace, rough terrain may make it easier to twist an ankle—so be extra careful on the trails.
- Strength train. Don’t disregard those dumbbells, even if running’s your main gig. Lifting can increase structural fitness—which helps bones, ligaments, tendons, and muscles endure all that pounding. Pay special attention to strengthening hips, too, since weak hips are linked to higher rates of injury Hip muscle weakness and overuse injuries in recreational runners. Niemuth, P.E., Johnson, R.J., Myers, M.J., et al. Rocky Mountain University of Health Professions, Provo, UT. Clinical Journal of Sports Medicine, 2005 Jan;15(1):14-21..
- Know your limit. Shocker: Overtraining can cause overuse injuries. Make sure to take at least one day off per week, and mix up those fartleks and hill-repeats with some easier recovery runs. Don’t forget to pencil in regular rest days, too. You (and your body) deserve it!
Disclaimer: Remember that none of this information should substitute professional medical advice. Definitely check with a doctor or physical therapist first once those aches and pains arise!
Illustration by Bob Al-Greene