Studies suggest if you’re a runner, you will likely get one of the following injuries (1).
- Medial tibial stress syndrome (shin splints)
- Achilles tendinopathy (pain, swelling, and impaired function of the achilles tendon)
- Plantar fasciitis (pain under the foot)
- Patellofemoral syndrome (pain in the front of and around kneecap).
This is a four part series to help you prevent these common running injuries. Note, these are prevention strategies not rehab strategies. If you already have one of the following injuries work with a specialist to rehab the injury correctly before returning to full training.
Medial tibial stress syndrome (Shin splints)
A large portion of blame for this injury comes from navicular drop (> 10mm) or In layman’s terms, week musculature in the foot/ankle complex. A prevention plan can attack this injury in two ways, strengthening the musculature of the foot/ankle complex and addressing poor biomechanics patterns.
Strengthening the musculature of the foot.
Perform the below exercises as a circuit, 3 times through 3 times a week.
Towel scrunch – Stand on the end of a towel barefoot, then scrunch the towel up by curling your toes, then extend the toes again before repeating the scrunch. Go until you have scrunched your way up the length of the towel!
Inversion/eversion foot roll - Split your stance so one foot is in front of the other and put your weight through your front foot. Slowly and with control shift your knee medially (inside) the line of your big toe so the arch of the foot flattens to the floor, then slowly and with control shift your knee laterally (outside) the line of your little toe, keeping all toes and your heel in contact with the floor but allowing the arch to lift. Perform 20 slow rolls on each foot.
Medial focused heel lift – Place a ball or similar between your heels and focus on squeezing your heels into the ball whole time. Then using a wall or solid object to aid balance, lift your heels off the floor by shifting your weight onto your toes and contracting the calf muscles. Hold at the top for 3 – 5 seconds the slowly lower back down before repeating. To get further range use a step or box for your feet and drop your heels below parallel. Perform 10 slow and controlled reps, if 10 is easy go for 15 or 20.
Resisted dorsiflexion – Place a band around the middle of your foot and secure the ends onto something that creates resistance against pulling your toes towards your shin. From a plantar flexed position (toes pointed) pull the toes back towards your shin (dorsiflexion) in a slow and controlled motion. Try to keep the toes relaxed and pull using the muscles at the front of your ankle and shin, you may want to cross the band over your feet in order to achieve this.
Biomechanical considerations to prevent shin splints.
Heel strike vs forefoot strike, an argument that will go on forever. There is no clear evidence a heel strike is worse or better than a forefoot strike. However one area to be mindful of is ground contact time, meaning how long your foot is in contact with the floor when running. A slower contact time has been associated with a higher risk of Medial tibial stress syndrome (2). A faster ground contact time has also been associated with a higher running economy (3).
In order to achieve a faster ground contact time some external cues can be bought into play, here are three to think about.
Landing the foot underneath the hips - this naturally positions the runners centre of mass in front of their centre of gravity, aiding the runner to generate greater forward momentum with less musculature effort.
Pulling the foot off the floor – this cue works particularly well for runners who over extend their leg at take off which can place the lower leg muscles under greater strain in order to create propulsion. Greater propulsion from larger muscles such as the quadriceps and gluteals is advantages and is created due to a greater contact force into the floor. While this seems counter intuitive, because the runner is thinking of a fast pull off they will naturally create a greater contact force into the floor. Think of this as the ’tennis ball drop’ If a tennis ball is just dropped into the floor it won’t bounce very high, if it is thrown into the floor it will bounce off the floor faster and higher.
Bow and arrow hips – a hip led take off creates a short stretch cycle in the hip flexors, this in turn creates a faster pull phase and decreases ground contact time. Think of this as a bow and arrow, the further the bow is pulled back the further the arrow flies (the bow being your hip flexors, the arrow being the runners knee or pull phase). A short stretch cycle happens only at high speed (< 2.5ms) so it’s important to set it up by incorporating the foot landing and foot pull points, once incorporated though, it makes the foot landing and foot pull points easier to maintain over longer distances.
The Biomechanical considerations require muscle patterns to be working optimally and to be strong enough to repeat the continuous pattern of running. These considerations should be implemented during all running types however when starting out, volume of running should be decreased in order to maintain good form and allow the muscles to adjust to a new stress. It must also be remembered runners with a history of shin splints are likely to get reoccurring shin split injuries, therefore run volume should be monitored closely along with session feedback.
We have developed a program to aid in running stronger for longer, called Run Strong. This program is built upon the principles that runners should maintain stability, posture, power and flexibility. Get it here www.innerfight.com/runstrong.
By: Tom Walker, Endurance Coach
(1). Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012;42(10):891-905.
(2). Gallo RA, Plakke M, Silvis ML. Common leg injuries of long-distance runners: anatomical and biomechanical approach. Sports Health. 2012;4(6):485-95.
(3). Moore IS. Is There an Economical Running Technique? A Review of Modifiable Biomechanical Factors Affecting Running Economy. Sports Med. 2016;46(6):793-807.