Sports Physiotherapy

Physiotherapy for runners

Why do running injuries occur?

Running injuries are amongst the most common sports injuries that we see as physiotherapists. The cause of injuries in running are multifactoral. They occur because of a combination of suboptimal biomechanics, muscle weakness, poor joint instability and training load. It is important to speak with a physiotherapist to be able to ascertain the main cause of the injury so that this can be rectified.

What increases your risk of a running injury?

The most common causes of running injuries are due to suboptimal biomechanics and training load. When you run your lower limb biomechanics can be affected by foot posture/stability (you may over pronate (flat feet) or less commonly you may not pronate enough), reduced joint range of movement (stiff joints or tight muscles) and joint instability (lax joints and poor muscle strength/control). When your biomechanics stray from the norm excessive stresses will be put on certain structures as a consequence which may lead to break down of the tissues and ultimately inflammation and pain.

For example, when a runner has flat feet and over pronates at their foot, it causes a bowing effect on the Achilles tendon. This creates asymmetrical loading to the tendon and increases their risk of Achilles tendonopathy. This can also be the cause of Tibialis Posterior tendonopathy, as with over pronation and weak foot arches, extra stress is put on the tibialis posterior muscle, resulting in tendonitis. Flat feet and lack of foot stability can also be the cause of shin splints. The exact definition of shin splints differs throughout the literature, however the nature of the condition relates to overuse of the lower leg and ankle musculature. With increased training load and poor foot and ankle stability/control there is increased risk of shin splints which will cause increased pain and reduced function to the lower leg.

Commonly, runners will report injuries after a change in training load. They may have increased the mileage they are doing per week or may have introduced intervals or hill sessions to prepare for an event. In this situation the injury (stress fracture, tendonitis, muscle tear, ligament strain, bursitis, shin splints) has occurred because the tissues are not resilient enough to cope with the increased training load.

How can physiotherapy help my running injury?

Your physiotherapist will complete a thorough assessment and will then ascertain the cause of the injury. Depending on the nature of the injury, the physiotherapist will then be able to provide a combination of manual therapy, a program of stretches and strengthening exercises. These will improve your biomechanics and joint range of movement helping reduce pain and promoting healing in the injured tissues. The physiotherapist may also address any biomechanical issues with the aid of foot orthotics, manual therapy and exercises.

As part of the biomechanical assessment the physiotherapist can also complete a podiatry assessment by carrying out a foot posture index, as well as assessing your footwear to ensure they are providing your foot and ankle with sufficient support. These assessments are vital in getting to the route of your injury. If further assessment is needed from a qualified podiatrist then a referral can be made.

Can physiotherapy help with my calf strain?

Yes. Muscle strains fall into 3 broad categories which are differentiated by how many muscle fibres are injured.

A grade 1 muscle strain is the least severe and only involves a few muscle fibres. You should ice your calf every 2 hours and will need to rest from running for a couple of weeks. Your physiotherapist will be able to apply deep tissue massage and advise you on stretches and strength exercises to assist with tissue healing.

A grade 2 muscle strain involves more muscle fibres and you are likely to have experienced some bruising and general discomfort with walking and climbing stairs. You will also need to apply ice to the calf every 2 hours but you are likely to need to rest for 3-4 weeks. Your physiotherapist can use manual therapy and exercises to optimise the healing process and ensure that return to running without any ongoing problems.

Grade 3 strains involve tearing of the majority of the muscle fibres if not a complete rupture. Healing time for a grade 3 strain can be over 3 months and may require surgery. However the majority of time this can be managed with physiotherapy alone as previously mentioned.

Can physiotherapy help with my illiotibial band (ITB) syndrome?

Yes, ITB friction syndrome (ITBFS) is caused when the ITB (a band of connective tissue that passes down the outside of your thigh from your pelvis to your knee) rubs against the bony prominences at the knee or hip when you run. It is almost always caused as the result of poor biomechanics and can be the result of over pronation of the foot or poor strength in your pelvis and hips. Your physiotherapist can provide deep tissue massage to the ITB and surrounding muscles to reduce pain in the ITB and can prescribe a program of strengthening exercises and stretches to address the biomechanical cause of the problem. Acupuncture can also be used to help ease the tension in the fascia and surrounding muscles which will reduce pain levels.

Can physiotherapy help with my knee pain?

Knee pain in runners occurs most commonly at the patellofemoral joint (between the knee cap and the knee), often labelled as patellofemoral pain syndrome (PFPS). A lot of stress is placed on the patellofemoral joint during running and as a very mobile joint it is very susceptible to the effects of poor biomechanics. As a result, this form of knee pain can be caused by over pronation of the feet, tightness in the calves, quadriceps or hamstring muscles, or weakness in the pelvis and trunk (core muscles).

Your physiotherapist will be able to provide manual therapy to reduce your pain and may tape the knee cap to enable increased pain free activity and a return to training. Your treatment program may also include orthotics and an exercise program to address the biomechanical causes of the problem.

If you would like to discuss your problem before booking an appointment please give our physiotherapy team a call, we will do our best to help.