Prevention and Treatment of
the Most Common Running
Injuries
Post-Professional Residency Programs
Drew Grant, PT, DPT, ATC, CSCS
Sports Physical Therapy Resident
January 14, 2017
Objectives
At the conclusion of this presentation, the attendee will be able to:
• Describe the most common running injuries and their
associated signs and symptoms
• Identify common mechanisms for how and why these injuries
arise
• Select various treatment strategies for the most common
running injuries to reduce the severity of the symptoms
• Discuss ways to prevent the most common running injuries
Post-Professional Residency Programs
What are the most common running injuries?
• Medial Tibial Stress Syndrome
– “Shin Splints”
• Plantar Fasciitis
• Patellofemoral Pain Syndrome
– Runner’s Knee
• Patellar Tendinopathy
– Jumper’s Knee
• IT Band Syndrome
• Achilles Tendinopathy
Post-Professional Residency Programs
Medial Tibial Stress Syndrome (MTSS)
• What is it?
– Repetitive loading of the tibia (shin bone)
– Too much load with inadequate recovery time
• Causes
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–
–
–
–
Rapid changes in running technique (mileage, strike patterns)
Poor footwear and flat feet
Increased BMI; females
Lack of flexibility: hips, knees, and ankles
Previous history of MTSS
• Signs and Symptoms
– Dull aching pain in the middle of the shin bone
• Often comes at the start of the run, dissipates at the end of a run
• In severe cases, pain is constant throughout the day and night
– Tenderness to the touch over the shin bone
Post-Professional Residency Programs
Medial Tibial Stress Syndrome (MTSS)
• Treatment
– Rest (relative)
• Decrease volume or cessation until symptom resolution
• Cross training (low impact)
– Calf stretching and strengthening
– Shock absorbing insoles
– Physical Therapy
• Gait retraining to reduce the amount of force placed on the tibia
when running
• Prevention
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–
–
–
Graduated running programs
Shock absorbing insoles
Calf stretching and strengthening
Maintaining techniques to decrease
excessive loading
Post-Professional Residency Programs
Plantar Fasciitis
• What is it?
– Repetitive strain that leads to a chronic degenerative process in the
connective tissue on the bottom of the foot
• Causes
–
–
–
–
Long distance running
Female; ages 45-64; increased BMI
Flat feet or high arches
Prolonged standing
• Signs and Symptoms
– Pain on the inside of the foot in weight bearing
– Tenderness to the touch on the bottom of the foot
– Pain that is worse during the first few steps in the morning after
getting out of bed and usually improves with rest
Post-Professional Residency Programs
Plantar Fasciitis
• Treatment
– Calf stretching
• Runner’s stretch
– Foot and calf muscle strengthening
• Heel raises
– Physical Therapy
• Graston technique and massage
– Ice to the bottom of the foot
• Use of a frozen water bottle
– Rest
– Foot orthotics
• Prevention
– Calf stretching and strengthening
– Graduated running program
– Adequate footwear
Post-Professional Residency Programs
Patellofemoral Pain Syndrome
• What is it?
– Knee pain located around the knee cap that comes on with activity
– Usually a gradual onset caused by an unknown event
• Causes
–
–
–
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Overuse or direct trauma (uncommon)
Lower extremity strength imbalances and poor patellar tracking
Altered running mechanics
Females
• Signs and Symptoms
– Pain in the front of the knee
– Pain that gets worse with activity
• Especially stairs, squatting, kneeling, and running
– Cracking or popping sensation
Post-Professional Residency Programs
Patellofemoral Pain Syndrome
• Treatment
– Quadriceps, hip, and core strengthening
– Quad and hamstring stretching
– Physical therapy
•
•
•
•
•
Knee cap taping
Graded strengthening
Neuromuscular control
Gait retraining
Graston/STM to address flexibility
– Rest
– Foot orthotics or braces
• Prevention
–
–
–
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Quad, hip, and core strengthening
Quad and hamstring stretching
Graduated running program
Adequate footwear
Post-Professional Residency Programs
Strengthening
Hip
Quadriceps
Post-Professional Residency Programs
Patellar Tendinopathy
• What is it?
– Repetitive overload of the patellar tendon
– Weakening and degeneration of the tendon without adequate recovery
• Causes
–
–
–
–
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Increased BMI; males
Flat feet; leg length difference
Decreased quadriceps and hip strength
Decreased quadriceps and hamstring flexibility
Rapid increase in running mileage
• Signs and Symptoms
– Pain in the front of the knee below the knee cap that increases with
activities such as jumping and changing direction
– Pain with prolonged sitting, stairs, squatting, and after activity
Post-Professional Residency Programs
Patellar Tendinopathy
• Treatment
–
–
–
–
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Graduated knee loading program
Quadriceps and hip strengthening
Quadriceps and hamstring flexibility
Patellar tendon strap
Arch supports
Physical Therapy
• Graston/STM to tendon to promote healing
• Graded strength program
• Gait retraining
– Rest
• Prevention
– Graduated running program
– Quadriceps and hip strengthening
– Adequate footwear
Post-Professional Residency Programs
IT Band Syndrome
• What is it?
– Increased friction and
compression of the iliotibial band
with repetitive flexion and
extension activities
• Causes
– Running on the same side of the
road; hill running
– Weak hips; flat feet
– Rapid changes in running
routine
• Signs and Symptoms
– Pain and tightness on the
outside of the knee with activity
• May travel up to the hip
Post-Professional Residency Programs
IT Band Syndrome
• Treatment
–
–
–
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Rest
IT band “stretching”
Hip strengthening
Physical Therapy
• Graston/Soft tissue massage
• Gait retraining
• Graded strengthening
– Arch supports
• Prevention
– Graduated running program on
varying running surfaces
– Hip strengthening
– Adequate footwear
Post-Professional Residency Programs
Achilles Tendinopathy
• What is it?
– Repetitive overload of the Achilles tendon
– Weakening and degeneration of the tendon without adequate recovery
• Causes
–
–
–
–
Flat feet
Decreased strength: ankle and foot, hip and core
Decreased calf flexibility; limited ankle range of motion
High arch; increased BMI
• Signs and Symptoms
– Pain and stiffness in the back of the heel
• Worse during and after activity, in the morning, or when sitting for
long periods of time
Post-Professional Residency Programs
Achilles Tendinopathy
• Treatment
–
–
–
–
Calf stretching and strengthening
Hip strengthening
Heel lift
Physical Therapy
• Graston/STM
• Graded eccentric program
• Joint mobilizations and manual stretching
– Rest
• Prevention
–
–
–
–
Calf stretching and strengthening
Hip strengthening
Graduated running program
Adequate footwear
Post-Professional Residency Programs
Conclusion
• The most common injuries runners experience are a result
of overuse and lack of rest
• Rest and appropriate stretching and strengthening are often
indicated for treatment of running injuries
– If there is no improvement, consider making an appointment to see a
physical therapist
• A slow progression of running mileage and intensity as well
as appropriate footwear is important in the prevention of
running injuries
Post-Professional Residency Programs
Questions?
Thank You!
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