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.
The Achilles tendon connects the calf muscles in the lower leg to the heel bone of the foot. It is responsible for plantar flexing the foot (pointing the toes down) making it vital to run mechanics. The achilles most common injury is via tendinitis (pain and swelling) but can be more severely injured via a rupture (tear or complete detachment).
The cause of achilles injuries is thought to be bifold, biomechanical loading (as with most run injuries) and poor activation of key stabilising muscles (2). The Achilles tendon has been measured to take forces of up to 6 - 8 times body weight during running (3), for a 75kg runner that is 450 - 600kg each time the foot lands. If a poor loading pattern and / or poor muscular activation is present a gradual onset of pain and tenderness is likely to occur, if further ignored or poorly treated, a tear or rupture is likely.
Improving loading patterns
In part 1 of this series shin splints were discussed. This is a another injury caused by poor biomechanics of the lower leg and to save repeating myself I suggest you head over to read the biomechanical considerations section. Essentially it comes down to two factors, placement of foot strike and utilising stored energy. Furthermore, over pronation of the foot was found to be present in runners with achilles injuries compared to non achilles injured runners (4), for those who have read part 1 you will know this can be prevented through foot strength, which is also discussed in Part 1.
The large muscle groups of the leg and torso play a big role in looking after the lower leg. Any disfunction in the kinetic chain must be made up for elsewhere, this is why many run injuries occur as repetitive strain injuries. It is also why they seem minor at first, usually ignored, and then grow to be something more serious. Glute maximus, hamstrings and the tibialis anterior muscles have been shown to have lower activity in runners with achilles injuries (2). These large muscle groups should act as shock absorbers during the loading phase of running, whether or not they are active has no effect on the amount of load but does effect how the load is dispersed. When under-active muscles struggle to deal with the load correctly it carries through to the smaller tendons and joints which aren’t designed to take the higher force. An example of this could be a runner with weak glutes, the glute muscles if working correctly should stop the knee from collapsing in during stance phase, if unable to do so the knee will fall inwards followed by internal rotation of the tibia (shin bone) which in turn causes over pronation at the foot and ankle. As we know from the loading patterns paragraph and Part 1, over pronation is part of a poor loading pattern.
Returning to running post injury
If injured seek medical advice from a professional. Ice and gentle stretching will help in aiding minor injuries but rest is most commonly needed in order to fully reduce pain.
Once pain and swelling has disappeared a return to run protocol should be followed. A run/walk program is usually the safest way to do this and allows for gradual loading and conditioning of the tendon and surrounding muscles to happen. A strict rehab protocol should be put into place, this program should include posterior chain activation work such as glute bridges, lateral squat patterns and balance work. Our Run Strong program contains all of these focus areas. To add strength back into the achilles tendon and calf muscle, an eccentric calf drop can be used. This eccentric loading exercise lengthens the muscle fibres as the load is applied which is the strongest way for the muscle to work and mimics the loading pattern during running.
Our Run Strong program comes with video demos and tutorials. It is designed to make you run faster, for longer. 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). Azevedo LB, Lambert MI, Vaughan CL, O'Connor CM, Schwellnus MP. Biomechanical variables associated with Achilles tendinopathy in runners. Br J Sports Med. 2009 Apr;43(4):288-92
(3). Kader D, Saxena A, Movin T, et al. Achilles tendinopathy: some aspects of basicscience and clinical management. Br J Sports Med 2002;36:239–49.
(4) McCrory JL, Martin DF, Lowery RB, et al. Etiologic factors associated with Achilles tendinitis in runners. Med Sci Sports Exerc 1999;31:1374–81.