1. Iliotibial Band Syndrome
This is the most common source of pain for runners. The iliotibial band is thick connective tissue (fascia) which runs up the outside of your thigh from your knee to your outer hip. Iliotibial band syndrome will usually start as a niggle and then develop into an irritation that makes you want to give up running forever! It will cause pain on the outside of the hip and knee and will make you go upstairs backwards to try and avoid putting tension through it. It’s important to find out why the iliotibial band is being overloaded in the first place in order to banish it.
The iliotibial band itself is inelastic but tension can be caused by tight or poorly functioning glute muscles which attach into the band at the hip. The Glute Medius muscle is one of the muscles that turns your leg outwards so if your leg has a tendency to rotate inwards, and your medial arch is collapsing (i.e. you’re prone to pronating!) your knee rolling inwards may create excessive stress through the ITB.
To resolve this issue, you need to address the strength and tension through Glute Medius. Some people also find it helpful to torture themselves with a foam roller, however the jury is out on whether this actually helps given the inelastic quality of the iliotibial band
2. Plantar Fasciitis (“PLAN-ter fash-ee-EYE-tus”)
I secretly quite enjoy hearing the various pronounciations of this one when patients tell me they’ve had issues with it in the past (“Fashiateetus”, Fasheetus”, “Fa-shite-ius”!) Whilst it may sound like a comic book evil villain it is in fact a very sore foot. It usually manifests as pain pain in the heel or sole of the foot that creates a sensation of running on hot coals. Most people report pain under their foot after resting – for example sitting down for a while or when they first get out of bed.
As with Iliotibial Band (ITB) pain it usually slaps you in the foot right when you’re trying to increase your distance and push yourself. As with ITB pain, it’s caused by tension through the body’s fascia. Fascia is the slimy connective tissue you see when dissecting a chicken between the skin and the meat and it covers the whole body (I really hope I’m not the only one who dissects chickens to learn about anatomy…).
Overstretching can cause inflammation of the fascia and this is what is primarily behind plantar fasciitis, typically in someone with pronating foot action. This is because they will be repeatedly loading the fascia on the sole of the foot when the foot rolls over.
The current guidelines for the treatment of plantar fasciitis recommend rest, using cold therapy, wearing supportive shoes with a good medial arch support and consider wearing an orthotic if your foot is really pronating. From patients I’ve seen it’s also worth looking at muscle tension through the calf and how the ankle and foot are moving in order to help the foot function as it wants to.
3. Achilles Tendonopathy
This used to be called “tendonitis” denoting inflammation but now it’s understood that it actually involves physiological changes in the Achilles tendon caused by repetitive overloading rather than inflammation. This means that the tendon itself goes from being nice and malleable to considerably more stiff, this is a problem when you need it to be nice and boingy to run. Again, looking at the biomechanics of your foot and ankle is a good place to start in resolving this issue. Unfortunately running “through” the injury isn’t going to help, even though increasing the blood flow through this area might feel good in the short term.
Treatment after a period of rest is usually aimed at loading the tendon in a strategic way to stimulate the tendon to reorganise in a healthy way. Eccentric contraction of the calf muscles is suggested, which is where the calf is stretched whilst being lengthened (e.g. weight bearing whilst dropping the heel off of a step).
4. Piriformis syndrome
Also known as “a massive pain in the butt”. Piriformis is small muscle which sits deep in the buttock and runs over the Sciatic nerve, which can sometimes get compressed if someone is suffering from an overactive piriformis. In 10% of the population the Sciatic nerve actually runs THROUGH the piriformis muscle. It feels a bit like someone just jabbed a red hot poker into your buttock, and the location of the pain can be quite difficult to indicate other than jumping up from your chair, spinning around, pointing to your bum and saying “it hurts! In there!”
In the short term you can usually get some relief by positioning a tennis ball underneath the area and sitting on it! But long term you need to identify why it’s caused an issue which is usually something to do with how the pelvis is functioning, or indeed if the biomechanics of the leg is less than ideal.
5. Ankle Sprain
There’s not much you can do to avoid “going over” on your ankle except for looking where you’re going… having sprained my ankle in the past after being knocked off my scooter I can vouch for how much a ligamentous/soft tissue injury can really hurt. I was taken to A&E and when the XRAY came back clear and the nurse told me to stand up and put weight on my foot I thought that she’d LOST HER MIND.
Of course she was right. Initially you want to follow the rest, ice, compression, elevation procedure to allow the inflammation and swelling to go down but after that you need to load the foot and ankle in order to put stress through the soft tissues to stop the scar tissue causing them to contract. If you’ve done major injury to the ligaments/tendons of the ankle you’ll see some pretty dramatic bruising and swelling.
Soft tissues including ligaments have a big role in proprioception (helping our brain to work out what our body parts are), therefore if you have had an ankle sprain it’s important to rehabilitate the ankle properly in order to regain full proprioceptive ability.
That’s right…I said top 5. That’s because this isn’t an injury, it is really annoying though and no one is quite sure why it happens – they think it’s most likely due to a spasm through the diaphragm. The best thing you can do is practice your lower rib breathing by exhaling fully and trying to limit tension through the diaphragm.
If you’re interested in getting to the bottom of your running injury, or would like to get some advice – call/email me on 07534933516 or firstname.lastname@example.org to find out about how osteopathy might help you.