Four ways to prevent your next running injury. Part 3.

Studies suggest if you’re a runner, you will likely get one of the following injuries (1).
  1. Medial tibial stress syndrome (shin splints)
  2. Achilles tendinopathy (pain, swelling, and impaired function of the achilles tendon)
  3. Plantar fasciitis (pain under the foot)
  4. 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. Part 3. Plantar fasciitis Three distinct bands of dense connective tissue make up the plantar fascia of the foot which supports the foot arch. Plantar fasciitis is commonly defined as an inflammatory injury due to micro trauma and micro tears in areas of the plantar fascia. Up to a quarter of running populations suffer with the injury (2). The primary complaint of runners suffering with plantar fasciitis is a pain in the arch of the foot when weight baring and symptoms subside when rest is taken. Symptoms tend to occur in runners who have one or more of the following; Obesity, shortened or tight achilles tendons, high arches, flat feet and decreased range in ankle flexion (1). Prevention is better than cure. Due to the micro trauma caused to the plantar fascia from repetitive strains (running) a thickening of the tissue happens. This is the bodies way of preventing larger trauma, however this is what causes pain through a reduction in blood flow, metaplasia and a hardening of the tissue. When the fascia is loaded, the tissue isn’t supple and reactive as it should be and as load increases further tears occur. To prevent plantar fasciitis is the key, as when it has developed resting it is the major factor to reduce the pain, E.g; No Running! So to prevent this repetitive strain injury means learning to repeatedly load correctly. This leads to, you guessed it, correct loading patterns! I’m assuming if you are reading this you have read Part 1 and Part 2 which both discuss the other most common run injuries, shin splits and achilles tendon pain. These injuries are not exclusive of each other and usually a combination of all three is happening. So by performing much of the advice given in those articles you will get a head start on preventing plantar fasciitis. Practical advice Above basically tells you what the injury is, how its caused and redirects you back to two other articles to read. So here comes some practical advice for you. Run consciously. A Forefoot strike combined with increased step rate can lead to lowered impact loading rates, and rearfoot strike combined with anterior trunk lean can lead to higher impact loading rates. High loading rates of the foot have been linked to plantar fasciitis (3). So running upright with a slight forward lean, landing the foot neutrally under the hips which should naturally increase your step rate (run cadence, rpm) will help reduce this injury. If you struggle with a forefoot strike you likely suffer with a low step rate too. Increasing the step rate is an excellent way of improving foot strike. If you naturally run at a low cadence around 155 - 165 spm try to increase this rate by around 10% until you can comfortable run at 175 - 185 spm. This may take a few weeks to become unconsciously competent at it, so in the mean time be consciously competent of it! Try counting your step rate on every 5th minute when running, this will keep you actively aware of it and also present minded in your running too. Once finished analyse your run data to see what your average cadence was. Foot fascia care. Keeping the fascia healthy and reactive means keeping it active! This doesn’t mean more running, it means some simple manual therapy treatment you can do on your own. Rolling the foot over a hard ball or bar with some added pressure can help to break down scar tissue and the hardening properties discussed earlier and increase blood flow in the area. Do 30s each on up/down, side to side, heel to big toe and heel to little toe with a ball or bar twice through before and after your run sessions. You can also do exercises to increase range of ankle flexion and achilles length by following our Lower leg maintenance routine pre and post run. As this article series unfolds you should be seeing the pattern occurring. Common run injuries can be prevented through run biomechanics and strength work. Our Run Strong program comes with video demos and tutorials. It is designed to make you run faster, for longer. Get it here By: Tom Walker, Endurance Coach Got a question? Email or message on instagram @Tomwalkerfitness (1) Gill LH. Plantar fasciitis: diagnosis and conservative manage- ment. J Am Acad Orthop Surg 1997;5:109e17. (2) Whittaker, G.A.; Munteanu, S.E.; Menz, H.B.; Tan, J.M.; Rabusin, C.L.; Landorf, K.B. Foot orthoses for plantar heel pain: A systematic review and meta-analysis. Br. J. Sports Med. 2018, 52, 322–328. (3)Y. Huang, H. Xia, G. Chen, S. Cheng, R.T.H. Cheung, P.B. Shull, Foot Strike Pattern, Step Rate, and Trunk Posture Combined Gait Modifications to Reduce Impact Loading during Running, Journal of Biomechanics (2019)