the physio corner!
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Welcome to physio corner! A page with information on some of the lower limb injuries commonly seen in runners. Written by a Chartered Physiotherapist with an interest in sports rehabilitation. It is intended to be for interest purposes only and by no means a substitute for a professional medical opinion when you sustain an injury. However I’m sure you’ll recognise some of these symptoms from you or your friends past injuries!
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HAMSTRING STRAINS
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Common in sprinters, hurdlers and other sports that involve sprinting e.g. hockey and football.
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KNEE PAIN
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There are many potential causes of knee pain, including ligament sprains or ruptures, cartilage problems, arthritis, patello-femoral instability (hyper mobile / lax knee cap), fat pad irritations and patella tendon pain (Jumpers knee). Here are two that are common to runners.
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PATELLO - FEMORAL PAIN SYNDROME
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Pain at the front of the knee, in and around the knee cap (patella). It is the most common cause of knee pain. Aggravated by walking or running long periods, stairs and squatting. It is thought that the pain is caused by a malalignment of the patella in the groove of the femur. This can bee due to lots of different factors, such as excessive pronation, wide pelvis, rotated hips, soft tissue tightness, particularly in the ileotibial band (ITB, which runs down the side of the thigh), gastrocnemius (calf muscle), hamstrings or hip flexors. Running excessive distances, lots of hills or stairs can aggravate symptoms. Treatment is by altering the above factors, looking at both biomechanics and training.
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LATERAL KNEE PAIN
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This is common amongst distance runners. The most common cause is Iliotibial band (ITB) friction syndrome. Where the tight ITB rubs against the prominent lateral epicondyle of the femur (thigh bone). Pain is normally described as an ache over the outside of the knee, aggravated by running. As in patello-femoral pain syndrome training problems and biomechanical abnormalities can predispose to this. Downhill running can aggravate this due to the reduced angle of the knee when the foot strikes the floor. Often the ITB is tight and the gluteal muscles (buttock muscles) are weak. Treatment may consist of ice, massage and stretches to reduce the tightness in the ITB and surrounding tissues, hip and core strengthening and stability exercises. If severe cortico-steroid injections can be used to reduce pain and if all else fails occasionally surgery can be indicated.
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SHIN PAIN
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Frequently seen in runners. There are 3 common causes:
1) Medial Tibial Stress Syndrome (MTSS) or inflammatory periostitis.
Pain is medial to the shin bone, normally comes on as you start running but eases as you continue.- 2) Stress fracture.
Pain is normally on the bottom third of the shin bone. It gets worse with continued exercise, is often worse after and you can get pain at night.
- 3) Chronic Compartment Syndrome.
Is increased pressure in one of the compartments of the lower leg, which can compress the nerves and veins. It can be caused by a sudden increase in muscle bulk. Pain and (possibly pins and needles) gets worse with continued exercise but normally eases quickly on rest.
Imaging (x-ray, MRI or ultrasound scan) is often required to confirm a diagnosis. Rest for varying periods is recommended in all cases. Massage, soft tissue release, acupuncture and taping can be helpful. Calf and hamstring stretches are normally necessary. Often a foot posture or podiatry assessment is required and good footwear is essential. -
ACHILLES PAIN
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The Achilles tendon in the heel is the thickest, strongest tendon in the body. An Achilles “tendinopathy” is very common in runners. It normally presents as a gradual onset of pain in the Achilles region. Pain and stiffness is worst on rising in the morning and on starting running and diminishes on walking or during the run.
Rupture of the Achilles is usually charictarised by a sudden, sharp pain in the heel area, like being “kicked” and an inability to point your toes. Contributing factors to Achilles Tendonopathies are years of running, an increase in activity (mileage, speed, gradient), reduced recovery time, change of surface or footwear. It is important that the predisposing factors are corrected in rehab. Treatment also consists of calf stretching and a specific tendon strengthening program. Often podiatry and orthoses may be required. Certainly good running shoes with rear foot control are essential. Return to running must be gradual and pain free. -
PLANTAR FASCITAS
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The plantar fascia is a strong band of tissue which runs along the sole of the foot. Plantar fascitis is an overuse condition which causes degeneration of the plantar fascia as it attaches to the heel bone. Pain is generally worse on rising in the morning and improves throughout the day. Calf, hamstring and plantar fascia stretches are recommended, soft tissue techniques, taping and acupuncture can help to settle the pain. Use of shoes with adequate support and flexibility is important. Plantar fascitis is often associated with excessive pronation, in which case anti-pronation running shoes may help. Often there is a history of other foot or lower leg injures, in which case physiotherapy and / or podiatry assessment may be required.