Why they happen and how to prevent them – by Osteopath Lachlan Buckley

Running injuries pop up when we least expect them – some are the result of overuse and a bit of abuse, others are
preventable, and some will require total rest (and a whole lot of ice). No matter how or why running injuries happen,
it’s the worst. Let’s explore the most common injuries that affect runners.

INJURY 1: PATELLOFEMORAL PAIN SYNDROME (RUNNER’S KNEE)

WHAT? Knee pain that can result from improper tracking of the patella on the femur WHERE? The anterior-
inferior/lateral knee

WHY? Muscular imbalances during a repetitive activity – like running – can cause asymmetric pulling of the patella
to the superior/lateral direction, causing it to track over the femur improperly. That causes friction, which leads to
inflammation, which leads to pain.

HOW TO RECOVER? I prefer to assess the muscular imbalances from an activation standpoint so I can find out
which muscles aren’t pulling their weight or if it’s a biomechanical problem in the gait cycle. Typically, the quadriceps
are overused and the adductors and gluteus medius and minimus are not properly being accessed during weight
bearing and offloading. A well-rounded leg-strengthening routine – one that hits all three planes of motion, plus
single-leg exercises – will help you maintain overall strength in order to offset the overuse during the repetitiveness
of running.

HOW TO PREVENT THE INJURY? Don’t skip leg day! During the off-season, build strength by adding load and velocity work three to four times per week. Maintain that strength during a training cycle by committing to leg-
strengthening exercises two times per week. Foam rolling is also an excellent way to soften tissue – especially the quadriceps – and reduce tension.

INJURY 2: FEMORAL ACETABULAR IMPINGEMENT

WHAT? In the hip joint, where the femur articulates with the hip – that’s called the femoral acetabulum. There’s
cartilage in the joint for smooth motion, a suction effect, and some load transfer. If one or both of the surfaces of the
bones is misshapen or doesn’t match up to the other side, the joint won’t move smoothly and can grind away at the
cartilage. This can also happen artificially if muscles that move the hip are tight, causing an asymmetrical grinding of
the joint. (Translation: ouch.)

WHERE? It’s typically a deep rear glute pain that can radiate throughout the hip. It may feel painful to sit, climb
stairs, or cross your legs, and may hurt when squatting or lunging.

WHY? It can be a congenital malformation, or a result of muscular imbalances that no longer support the joint.

HOW TO RECOVER? Conservative care is to help rehab the movements and weaknesses that aren’t allowing the
joint to glide properly. This can include manual distraction, soft-tissue work, strengthening, and rest. The grinding
can cause inflammation, and if there’s a tear, you’ll need to do some work before getting into training again.

HOW TO PREVENT THE INJURY? If there’s a congenital malformation, there’s nothing to do to prevent it – it’s
something you’re born with. Supporting the joint with a comprehensive strength training and stretching routine is the
best way to prevent overuse.

INJURY 3: PLANTAR FASCIITIS

WHAT? Inflammation of the connective tissue on the plantar (underside) surface of the foot.

WHERE? The heel when you stand up after sitting. It usually gets better after taking a few steps.

WHY? Overuse

HOW TO RECOVER? Inflammation requires rest. Swimming or cycling as an alternative to running can help you
keep training while you determine the root cause. Strengthening the hips, core, and lower leg and monitoring the
biomechanics for abnormalities are key to rehabbing plantar fasciitis.

HOW TO PREVENT THE INJURY? It’s often improper load transfer and lack of strength in the hips and glutes that
cause the smaller muscles and soft tissue in the foot and lower leg to work too hard.

INJURY 4: GLUTEUS MEDIUS TENDINOSIS

WHAT? Inflammation of the proximal and/or distal attachment of the gluteus medius muscle

WHERE? Usually the lateral side of the hip when you’re standing or stepping on the affected leg. It can also feel
tender along the sacrum. As you jump from one leg to the other, one hip may drop and not remain level.

WHY? Lack of strength in the glues and core or altered body mechanics during the gait cycle, which cause the hip
abductors to work too hard and the tendons to become inflamed.

HOW TO RECOVER? Good old hip, glute, and core strengthening, especially in single-leg stance, and working on
your running form.

HOW TO PREVENT THE INJURY? Hip and glute strengthening is the key. So many runners only work in the
sagittal plane, doing things like squats and lunges, and they don’t spend enough time in the frontal or transverse
planes. You have to strengthen all three planes in order to have maximum support.

INJURY 5: STRESS FRACTURE OR REACTION

WHAT? A stress reaction is inflammation in the bone without evidence of a fracture. A stress fracture is the next
level up: inflammation with a fracture.

WHERE? The most common sites for runners are the fifth metatarsal (pinky toe), tibia (like radiating shin splints),
femur (anywhere in the upper leg), and pelvis or sacrum (pain when sitting or standing). The pain gets worse with
activity, often radiates, and isn’t relieved with short bouts of rest or soft-tissue work.

WHY? Strength and load transfer can play a role, but another key factor is diet – restricting calories can lead to
decreased bone density.

HOW TO RECOVER? Rest, a nutritional evaluation, and an examination of hormone levels through blood work. You
have to stop the inflammatory response, which happens through rest, before attempting to increase density in the
form of strength training.

HOW TO PREVENT THE INJURY? Overtraining can definitely be a culprit here, especially in small bones like the
foot or tibia. When large bones and pelvic bones are concerned, it’s usually more complicated. (So avoid the
temptation to visit Dr. Google, and definitely seek out a sports medicine doctor in person.)