Correcting Pain Caused by Running

Anyone who has set out for a run knows that injury happens. Whether from deconditioning, improper gear, or previous injury. In fact, some statistics say two of every three athletes will suffer at least one health issue each season. Most of these injuries won't be traumatic, but gradually develop. In this article, we'll identify common health issues and injuries that plague long-distance runners and recreational runners. Then we'll share the top corrective exercises fitness professionals use in case you or your client sustains an injury.

Common Health Issues for Runners

Any time someone laces their shoes for a training run or race, there is a chance they will end up with an acute injury. Blisters, sunburn, a rolled ankle, a pulled leg muscle, and dehydration are common acute injuries.

Chronic injuries are often the result of multiple acute injuries. They can also occur simply due to repeated stress on the body. For example, a rolled ankle may eventually lead to knee pain or hip pain if not properly rehabilitated before returning to the training program. Long-distance runners who get injured at the beginning of the race must choose to stop or continue and endure more pain and a potentially worsened injury.

Stress fractures are often the result of prolonged and repetitive training. Often the training program is not properly periodized or cross training is not used, causing overuse injuries.

Many runners experience these common running injuries:

• acute musculoskeletal injuries (muscle sprain)

• gastrointestinal issues

• dehydration or hyponatremia (imbalance of electrolytes)

• stress fracture

• Achilles tendinopathy

• blisters

• environmental injuries such as sunburn, heat exhaustion, frostbite, or hypothermia

Common Movement Issues for Runners

In addition to acute and chronic injuries, an athlete may develop muscular imbalances or improper movement patterns. These may include:

Runner's Knee

Runner's knee happens when the kneecap (patella) is out of alignment. According to Johns Hopkins Medicine, this may happen because of weak thigh muscles, tight hamstrings, tight Achilles tendons, ill-fit running shoes, overuse and overtraining, or prior injury.

Symptoms of runner's knee include:

• pain during activity

• pain after sitting for a long time

• a grinding or clicking sound in the knee

• sensitivity to touch (kneecap)

Shin Splints

The constant pounding of running can cause stress fractures in the tibia. Shin splints are a reaction to these minute cracks. Muscle weakness in the thighs or glutes and a lack of flexibility are common causes of shin splints. You may also develop shin splints if you have flat feet, run downhill, run on uneven surfaces, run on the street or sidewalks, or use old running shoes.

You may have shin splints if you feel:

• a dull ache in your lower leg

• pain on either side of the shin bone

• tenderness or have swelling in the lower leg

An athlete may also complain of numbness or weakness in the feet.

Plantar Fasciitis

Having tight calf muscles and high arches may make you more prone to suffering from plantar fasciitis. The plantar fascia is the largest ligament in the human body. It becomes injured over time, the cause of repetitive micro tears to the ligament. Symptoms that will clue you into this injury include:

• heel pain

• "stabbing" foot pain especially in the bottom of the foot or in the heel

• stiffness

• tenderness

Iliotibial (IT) Band Syndrome

The iliotibial band is a large tendon that runs along the lateral aspect of the upper leg from the iliac crest to the tibia. It crosses both the hip joint and knee joint. Runners most commonly develop iliotibial band syndrome if they do not adequately warm-up, cool-down, or stretch after training. Weakness in the hip abductors also contributes to injury. As with many common running injuries, overtraining, improper gear, and running surface may increase the risk of developing IT band syndrome.

Symptoms of IT band syndrome include:

• an aching or burning sensation on the lateral aspect of the knee

• feeling a pop or snap on the outside of the knee

• shooting pain that travels up and down the leg

• heat and redness on the outside of the knee

If you or your client think you may have iliotibial band syndrome, click here to find out more.

Corrective Exercises for Runners

Corrective exercises for running are necessary if an athlete has a muscular imbalance from overcompensation or poor posture. Functional training, including training movement patterns in novel ways, is a great way to prevent injury.

In a moment, we'll discuss how to design a program with the proper corrective running exercises. First, let's talk about some of the top corrective exercises for running.

Dynamic Warm-up

Corrective exercises include proper warm-up and stretching. Mobility training (covered in this article) is especially beneficial for runners. Exercises should be specific to the activity and be dynamic—not static—in nature. Some exercises to add to the warm-up include:

• walking butt kickers

• walking lunge with twist

• thoracic spine rotation (on all fours)

• leg swings

• clamshells

• butterfly hip thrust

Strength Training

Knee pain, hip pain, runner's knee, shin splints, and other common running injuries can be prevented by including functional strength training. Weak muscles are often the cause of injury. However, research suggests that the greatest risk factor for sustaining a running injury is a history of injury. Strength training can be both preventive and corrective.

Here are some exercises to include:

• leg curls

• Russian twists

• stability ball jack knife

• knee drives (with band)

• bird dogs

• fire hydrants

• split squats

Cross Training

Including cross-training into the training program helps avoid overuse injuries. When deciding which activities and exercises to use, consider how the movement patterns or energy systems used translate into running.

For example, swimming is an excellent way to increase cardiovascular endurance and overall muscle strength. The movement of swimming is not vastly different from running. And swimming is far gentler on joints, making it a great activity for runners who are rehabilitating an injury.

Another great cross-training exercise for running is cross-country skiing. During cold and snowy winter months, runners can use cross-country skiing to stay in shape. The movement patterns are nearly identical to running. However, the gliding motion of the feet over the snow reduces impact stresses and strengthens the joints.

How to Design a Corrective Exercise Program for Runners

Now that we've covered the corrective exercises for running, let's discuss the process for designing a training program.

Consult the Doctor

If clients are experiencing chronic, persistent pain with training, refer them to their primary care physician for additional diagnostics. Do not attempt to diagnose or treat injuries. Once they are cleared for exercise, start by conducting assessments.

Conduct Assessments

First, conduct movement screens. Use a movement screen that will identify imbalance and inefficiency. Two screens that have been found valuable for predicting injury in young male runners are the deep squat and active straight leg raise.

Postural assessments will also identify problem areas, such as lateral, posterior, or anterior pelvic tilt.

Specific Warm-ups

A slow jog around the track before going for a long run isn't sufficient to warm-up the body and prepare the joints for the workout ahead. Here are some specific movements to include in a functional training program that will help warm-up the muscles that support the ankles, knees, and hips.

• Ankle circles

• Knee circles

• High knees

• Hip circles

• Lateral leg swing

• Hip hinge

• Windmills

• Side lunge

• Single-leg walking deadlifts

Cross-training Exercises

Include exercises in the training program that use the same energy system and movement patterns as running. Include these in the off-season and to help clients get back into running after an injury. You can also use cross-training exercises during the "de-load" phase. Some workouts include swimming, cross-country skiing, elliptical machine, and cycling.

Strength Training

Strength training is critical for runners. Create a progressive program to strengthen the leg muscles and stabilize the joints. Stick with a repetition range that supports muscular endurance rather than hypertrophy.

Self-myofascial Release

Muscles are surrounded by a protective lining called fascia. Training can damage the fascia leading to tightness and reduced elasticity. Self-myofascial release helps reduce tightness and inflammation. Grab a foam-roller or tennis ball and roll out the following muscles:

• Soleus

• Gastrocnemius

• Tensor fascia latae

• IT band

• Quadriceps

• Adductors

• Piriformis

• Psoas

Ready to learn more about corrective exercise? Check out the ISSA's course on corrective exercise and get certified as a specialist. You'll learn to identify and correct the most common movement dysfunctions in your clients and you'll add another tool to your belt to boost your business as a fitness professional.

Click HERE to download this handout and share with your clients!