The Big 7 Body Breakdowns

How to avoid (and recover from) the most common running injuries

There are several very common injuries amongst runners, which you would do well to take steps to avoid. This post is all about how to do just that… or if you are unlucky enough to pick one up, what the best course of action is to make a good recovery.

In an ideal runner’s world, every step of every mile would be 100 percent pain-free. No aches, no twinges, no lingering soreness from yesterday’s workout. The reality is that many runners constantly deal with a slight (or not so slight) disturbance—a tender foot, a tight hamstring, a whiny knee. While these nagging issues often aren’t serious enough to require a time-out, they are annoying, especially when they don’t let you fully enjoy your time on the roads.

Think of running pains in terms of a spectrum. At one end you have severe, full-blown injuries—call it the red zone, which includes stress fractures that require time off. The other end, where you’re in top form, is the green zone. Mild, transient aches that bug you one day and disappear the next sit closer to the green end. Unfortunately, many runners get stuck in the middle—the not-quite-injured but not-quite-healthy yellow zone.

Whether you land in the red, linger in the yellow, or return to the green end of the spectrum depends largely on how you react when that first stab of pain hits, says Richard J. Price, M.D., a sports physician at Rocky Mountain Orthopedic Associates in Grand Junction, Colorado. “Often it comes down to whether you take a little time off now or a lot of time off later,” he says. You can reduce your risk of ending up in the red zone if at the first sign of an issue, you back off your mileage, reduce the intensity of your runs, start a treatment program, and develop a proactive long-term injury-prevention strategy, such as strength training, stretching, and regular foam-rolling. “Physical therapy is like homework,” Dr. Price says. “None of us likes having to do it, but if you don’t do it, the issue will come back.”

According to Price and a team of doctors and physical therapists consulted in the following pages, there are seven injury hotspots that most frequently plague runners. If you don’t get a handle on them, these issues can trap you in that nefarious yellow zone, or worse, turn into an acute injury that forces you to take a layoff. Here’s how you can keep annoying pains in check so you can move into—and, with hope, stay in—the green zone.

1. Runner’s Knee

Patellofemoral pain syndrome (PFPS), or “runner’s knee,” is the irritation of the cartilage on the underside of the patella (kneecap). About 40 percent of running injuries are knee injuries. And 13 percent of runners suffered knee pain in the past year, according to 4,500 respondents to a poll. PFPS typically flares up during or after long runs, after extended periods of sitting, or while descending hills and stairs.

Who’s at Risk?
Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, says Bryan Heiderscheit, Ph.D., P.T., director of the University of Wisconsin Runners’ Clinic. Risk factors include overpronation (excessive inward foot rolling) and weak quads, hips, or glutes.

Can You Run Through it?
Yes, but taking extra rest days and reducing your mileage is necessary. Run every other day and only as far as you can go without pain. Some runners find that uphill running is less painful, so Heiderscheit recommends simulating hills on a treadmill. Uphill running has the added value of working your glutes. Strong gluteal muscles help control hip and thigh movement, preventing the knees from turning inward. Avoid running downhill, which can exacerbate pain. Bicycling may speed your recovery by strengthening the quads. Elliptical training and swimming are other knee-friendly activities.

Check out the “Knee Injury Solution” for easy to follow knee exercises.

Rehab it: Strengthen weak hip and glute muscles with lateral side steps, says Charlie Merrill, M.S.P.T., a physical therapist at ALTA Physical Therapy in Boulder, Colorado. Place a loop of resistance band just above your ankles or your knees. Separate your feet and bend your knees, lowering down into a slightly crouched position. While staying in this position, walk sideways 10 to 15 steps, keeping your feet straight and your upper body still. Then reverse directions. Keep your feet separated to maintain band tension. When this becomes easy, try doing this on your toes with your heels off the ground. If there’s a problem in the way your kneecap tracks, athletic tape may reduce pain (Merrill demonstrates knee taping at Postrun icing also provides relief in the early stages of this injury. Heat works best once the injury is healing and no longer in an acute stage.

Prevent a Relapse: Heiderscheit recommends shortening your stride length and landing with the knee slightly bent, which can take up to 30 percent load off the joint. Count the number of steps you take per minute and increase by five to 10 percent per minute. Keep your knee tracking correctly by strengthening your knee’s support muscles like quads and glutes with exercises like lateral side steps and squats. It’s also important to stretch your hip flexors.

Elite Treatment: Marathon silver medalist Meb Keflezighi was building up for the 2010 Boston Marathon when he slipped on ice and tweaked his knee. He took two weeks off, ran only every other day for the next two weeks, and then decided not to run a half-marathon in March. The strategy worked: He was the second American at Boston in 2011, running a 2:09.

How to Proceed
Stop: Pain on the inside or outside of the knee immediately upon waking, which doesn’t go away as the day progresses.
With Caution: Twinges early in run, dissipate, come back after run. Bothersome after prolonged sitting.
Go Run: Completely pain-free even after sitting through a two-hour movie or after going on a hilly long run.

2. Achilles Tendonitis

The Achilles tendon connects the two major calf muscles to the back of the heel. Under too much stress, the tendon tightens and becomes irritated (tendinitis). It makes up 11 percent of all running injuries; eight percent of poll respondents dealt with it this past year.

Who’s at Risk?
Runners who dramatically increase training (especially hills and speedwork) and have tight, weak calves are vulnerable.

Can You Run Through it?
“If you have any pain during or after running, stop,” says Amol Saxena, D.P.M., a sports podiatrist in Palo Alto, California.

“This is not an injury to run through.” If you catch a minor strain early, a few days off might be sufficient healing time. If you keep running as usual, you could develop a serious case that may take six months to go away.

Rehab it: Five times a day, apply ice. Strengthen the calves with eccentric heel drops: Stand with the balls of your feet on a step. Rise up on both feet. Once up, take your stronger foot off the step. Lower down on your injured foot, dropping your heel below the step. Rise back up, return your other foot to the step. Do 20 reps. Pool-run, use an elliptical machine, and swim, but avoid cycling unless it’s not painful.

Prevent a Relapse: Strong calves protect your Achilles from flare-ups, Dr. Price says, so do heel drops daily. Avoid aggressive calf stretching and wearing flip-flops and high heels, all of which can irritate the Achilles.

Elite Treatment: Shannon Rowbury, 1500-meter bronze medalist (2009 World Championships), wears compression socks for hard workouts to relieve Achilles tightness. “It’s made a huge difference,” she says.

How to Proceed
Stop: Severe pain and swelling above your heel, even when not running. Standing up on your toes causes pain.
With Caution: Dull pain around your heel at the end of your run that lingers afterward but goes away when iced.
Go Run: No pain when you pinch the tendon, starting at the heel and working your way up toward your calf.

3. Hamstring Issues

Hamstring Stretch

Hamstring Stretch

The muscles that run down the back of our thighs bend our knees, extend our legs, drive us up hills, and power finish-line kicks. So when our hamstrings are too tight or weak to perform well, we notice it. Seven percent of poll respondents say their hamstrings have bugged them this past year.Who’s at Risk?
Hamstring issues usually arise because these muscles are weak—often from being too long or too short. Counterintuitive as it might seem, very flexible people are prone to hamstring problems because their overly stretched-out muscles are more vulnerable to damage. On the flip side, people who can barely touch their toes or who sit for long periods of time are also at risk. Tight, short muscles are under greater tension. Another factor is muscle imbalance: Many runners’ quadriceps overpower their hamstrings, which sets them up for injury.

Can You Run Through it?
If the pain comes on suddenly and strong and the area bruises, you may have a true pull and you’ll need extended rest—months—before you can run again. If it’s a less severe, chronic overuse injury, you can usually run, but it’ll take some time before you’re back in the green zone. “Hamstring issues stink,” Price says. “It takes a long time to heal them.” Running a slow, easy pace is usually less bothersome than attempting intervals or hill repeats. Bicycling, pool running, and swimming are good alternative activities.

Rehab it: Strengthen your hamstrings with one-legged deadlifts. Use a foam roller to alleviate tightness before and after a run, Merrill says. In chronic cases, active release technique (ART) and deep-tissue massage may be necessary.

Prevent a Relapse: Stay strong with bridges: Lie on your back with your feet on a chair or exercise ball. Raise your hips, then lift one leg into the air. Slowly lower your hips back down to the floor, using the supporting leg. Return that leg to the ball. Repeat with the other leg. Also, compression tights (see “Home Remedies,” below) during or after running can aid blood flow.

Elite Treatment: When U.S. champion miler David Torrence felt his hamstring tighten up, he took the next day off and went to his chiropractor. “My pelvis was misaligned, causing my hamstring to do extra work,” he says. “I took it easy for a few days, iced the hamstring four times throughout the day, and was improved within a week.”

How to Proceed
Stop: Sharp, sudden, strong pain and possibly even a snap or pop sound while running. The area is bruised.
With Caution: Chronic achiness and tightness that forces you to slow your pace and shorten your stride.
Go Run: Pain-free while climbing hills and doing speedwork, even after long periods of sitting.

Next:  Plantar Fasciitis