Running is cheap, popular, and a great way to get hurt if you’re not doing it right. Around 40,000,000 Americans run regularly, and that number climbs every year. About half of runners will injure themselves, and more often than not, it’s their own fault. Good shoes, reasonable mileage and avoiding drastic changes in training are the keys to staying healthy and staying on the road, trail, track or treadmill.
The most common injuries runners face have big fancy names like medial tibial stress syndrome, patellofemoral pain syndrome, and plantar fasciitis. All the big words translate to various parts of the lower body hurting because you’ve been mean to them.
Achilles tendinitis
The Achilles Tendon (Source: Wikimedia Commons)
Your Achilles tendon is the biggest, strongest tendon you’ve got, and it connects the back of your heel to your calf muscles. When those calf muscles contract, it pulls your heel up and gives you the "push-off" part of taking a step. Obviously, you use it a lot. When you use it too much, it fights back by getting inflamed, which hurts. Ignore it, and it can rupture. If walking is something you enjoy doing, you probably don’t want it to get to that point.
If you felt a sudden pop in your Achilles region or if you can’t point your foot or walk, stop reading. It’s doctor time. Those are signs you may have actually ruptured the tendon. If it’s just a creeping pain that’s snuck up on you, most of the time you can deal with it conservatively with some simple strategies.
— If it hurts, stop it. Sorry about your running — you won’t be doing it for a while. Get on the bike. Jump in the pool. Do something that takes the stress off the tendon.
— Reduce the inflammation. You’re going to be spending a lot more time with your old friends ice and NSAIDs (nonsteroidal anti-inflammatory medications like ibuprofen).
— Don’t suddenly increase your mileage or the number of days you run in a week. Slow (very slow) increases will help prevent you and your tendon from being miserable.
Iliotibial band syndrome
The IT Tract/Band (Source: Wikimedia Commons)
The IT band (or IT tract) is a fibrous strip of connective tissue that runs down the outside of your leg from the hip to just below the knee. It keeps your knee stable, and with the help of a few muscles in your hip/butt/pelvis area it abducts your leg (moves it sideways away from your body), and helps with bending and straightening the knee. Like the Achilles, you use it with every step you take. As the IT band rubs over the bottom of the femur, it can get inflamed and cause pain to the outside of the knee. It’s aggravated by constant flexion and extension of the knee, which as you’ve probably noticed is exactly what running is. Those folks you see using what looks like a foam rolling pin on the side of their thigh at the gym probably have IT band syndrome.
Like most running injuries, overuse is usually the cause of IT band syndrome. It can also have an anatomic component — legs of differing lengths, weak hip muscles, or constantly running on an uneven surface (like city streets, which are high in the middle to encourage runoff).
The treatment is almost identical to Achilles tendinitis — if it hurts to run, stop. And don’t replace it with another activity like biking, because in this case, it’s not about the impact, it’s about the constant knee motion. Ice it, take NSAIDs, and be smart about slowly increasing training. What about those foam rollers? That’s a surprisingly controversial treatment. You can find studies that say it helps, and ones that say it doesn’t. More research is needed, but the simple answer is that if you feel like it helps you, do it.
If the problem is anatomic, fix it. Different length legs? Get some custom orthotics for your shoes. Weak hip muscles? Strengthen them. And stop always running on the same side of uneven roads.
Medial tibial stress syndrome
The tibia, with muscle attachments noted in red (Source: Wikimedia Commons)
Sure, Medial tibial stress syndrome sounds exotic, but it’s just shin splints. Terrible, terrible, shin splints. A runner who’s never had shin splints is a rare beast. The pain along the front of the shin is thought to be caused by inflammation where the muscles of the lower leg attach to the bone, and as you can see by all the red outlines in the diagram, there’s quite a few of those.
You’ve probably already figured out that shin splints are associated with overuse, sudden increases in training duration or frequency, and repetitive stress — the sort of thing you can inflict on yourself by running on hard surfaces or in cruddy shoes.
The treatment is no surprise — cut down on activity, ice it, and run smart (I’m sensing a theme here).
Patellofemoral pain syndrome
The knee (Source: Wikimedia Commons)
Another big fancy term, another straightforward problem — pain behind the patella (kneecap). Experts have a hard time agreeing on what exactly causes this incredibly common problem, but the usual suspects are always mentioned — overuse and anatomy. The upshot is that the back of your kneecap gets inflamed and it hurts.
It’s more common in women and young people, and the management is the same as everything else, with the addition of some extra gear. Stop running for a while, ice your knees, and be smart about your mileage. Some people find knee braces or taping the kneecap into a certain position helpful. Strengthening the muscles that stabilize the knee (like the quads) is also helpful, and as with the IT band — if the foam roller feels good, do it.
Plantar fasciitis
The plantar fascia/aponeurosis (Source: Wikimedia Commons)
The plantar fascia (also known as the plantar aponeurosis) is a bunch of thick connective tissue that connects the heel to the toes. It’s also something you’re sick of hearing about if you know anyone who has problems with it. That's because it hurts, it’s hard to shake, and they looooooove to whine about it. Its job is to support the arch of your foot, and it stretches and contracts with every step.
The pain of plantar fasciitis (which is under the heel) is caused by tiny tears in the fascia itself from repetitive trauma. It’s more common in middle-aged people and those who put a lot of stress on their heels. Running? Well, that just happens to put a lot of stress on the heels.
The good news is it’ll usually go away on its own. The bad news is it can take a while — as long as six months to a year. Facilitate the process with ice, NSAIDs, stretches, strengthening the muscles of the lower leg and wearing goofy night splints that keep the plantar fascia in a stretched position while you sleep.
Night splint (Source: Amazon/Powerstep)
The moral of the story…
While you’re likely to have one or more of these issues if you’re a regular runner, you can do yourself a favor and modify what you’re doing to give yourself the best chance at legs that work.
— If it hurts, STOP.
— If it feels good, it’s probably okay.
— Replace your shoes after about 400 miles.
— Don’t suddenly increase your speed, your distance or the number of days you’re training per week.
— Run on forgiving surfaces like a treadmill, crushed gravel or rubber track.
— Incorporate strength training into your regimen — your feet, shins, knees and everything else will thank you.
— If you’ve already blown it and things are hurting — ice, NSAIDs, stretching and strengthening and don’t be in a hurry to get back on the pavement.
Jo Innes is a real-life doctor and contributor for Sporting News. Follow her on Twitter @JoNana.