Season of Running and Injury

Illinois MarathonIn April, the Boston Marathon kicks off yet another season of running. Whether it is 5k or a Marathon, from April to October running enthusiasts have no trouble finding a running event to participate in. Here in my town of Champaign, some 20,000 participate in one of the Illinois Marathon events. With these races comes training and where there is training, you can find injury close by.

Runners are a rare breed. You cannot keep them down. A runner’s passion for sport, resilience to challenge, and unique characteristic to rise above is unparalleled by any other athlete. Running is one of the most popular recreational sports in the US. Some estimates say 20% of the population are runners and 10% of these people participate in race events. Combine the intense pre-marathon training and a runner’s very nature–the unwillingness to stop–and you get a recipe for injury.

Running injuries are multifactorial; neuromuscular imbalance, poor arthrokinematics and other things such as age, nutritional status and environment are to blame. Some of the more common injuries are Patellofemoral Syndrome, Iliotibial Band Syndrome (runner’s knee), Medial Tibial Stress Syndrome (Shin splints) / Tibial Stress Fracture, Achilles Tendinitis, Plantar Fasciitis, and Sacroiliac Joint Pain. What is interesting is that all of these injuries can be caused by biomechanical breakdown and kinetic inefficiency. The good is the dysfunctional patterns are identifiable, preventable, and correctable. The table below highlights some of the common arthrokinematics and neuromuscular dysfunctions found in runners.


Limited Motion Excessive Motion Weak Muscles

Overactive Muscles

Ankle dorsflexion

Forefoot pronantion and rearfoot valgus Medial calf (gastrocnemius, post/ant. Tibialis) Lateral calf and peroneals

Knee extension

SI joint / Pelvis (anterior innominate rotation) Medial hamstrings

Biceps femoris

Hip extension Scapulothoracic abduction Adductor magnus

Anterior Adductor group (not magnus)

Thoracic Spine rotation

Lumbar spine extension Gluteal group (maximus/medius /minimus)

Hip flexors

Lumbar spine
Cervical spine extension Transverse abdominus

Rectus abdominus

Glenohumeral Internal rotation

1st Rib Right external oblique and left internal oblique Quadratus Lumborum
Rhomboid/middle/lower trapezius

Pec major & pec minor

Serratus Anterior

Levator scapula and upper trapezius

Deep cervical flexors

Scalenes / sternocleidomastoid

A simple plan is to turn off the overactive and turn on the underactive muscles. This will bring the joints into proper alignment and allow for proper muscular efficiency, ultimately preventing injury and improving performance. Below is a sample injury prevention program that will keep most runners free of common injuries.

Step 1: Decrease neurological drive to hypertonic tissue

  • Self-Myofascial Release (foam roll or ball) – (60 seconds per muscle)
    • Gastrocnemius/Soleus
    • Adductors
    • Hip Flexor
    • TFL/IT-band

Step 2: Lengthen hypertonic muscle or joint tissue

  • Static stretch – (perform 1 set for 30 seconds to each muscle)
    • Gastrocnemius/Soleus Stretch
    • Adductor stretch
    • Kneeling Hip Flexor Stretch
    • TFL/IT Band Stretch

Step 3: Activate weak or underactive muscles

  • Exercise: Isolated Strengthening – (2 sets x 15 reps, done slowly)
    • Single leg calf raise (toes in)
    • Fire Hydrants
    • Clams
    • Resisted Hip Extension

Step 4: Integrated Dynamic Strength Movement – (2 sets x 15 reps, done slowly)

  • Single leg RDL with curl to overhead dumbbell press

*Disclaimer: This program is simple and generic. Doing this program 3 -5 times per week will prevent many injuries, however, each person and every injury is unique. To get specific guidelines for injury prevention, a detailed movement assessment should be done. If you need help with a specific injury please contact me.

Beyond the correction of movement dysfunction there are alternatives to treat running injuries which are effective and gaining popularity. This table highlights a few. While these therapies are well supported in literature, they are costly and do have side effects. The problem with these treatments is that they are treatments. If an injury is caused by dysfunctional movement patterns and those patterns are not corrected, it is likely other issues will arise because the true problem was not fixed. It is my opinion the following should serve as a last resort and be done only if a comprehensive rehabilitation program has failed.

Prolotherapy This has been around since the late 1800’s, but has recently become popular. The basis of prolotherapy is that it expedites healing by increasing fibroblastic activity and collagen repair.
Autologous Blood Blood is the medium that carries tissue repairing materials to injury sites. However, sometimes blood cannot deliver adequate amounts of material to the injured area. Thus, injections directed right at the injury site deliver tissue repairing material.
Platelet Rich Plasma (PRP) Like autologous blood, PRP is injection of a concentrated mix of tissue repairing blood components, specifically platelets, which facilitate tissue repair healing.
Bone Marrow Aspirate Concentrate Despite the negative press and belief that stem cells are only derived from an unborn fetus, stem cells do come from other sources, such as bone marrow. Taking stem cells from bone marrow and injecting into damaged areas will facilitate tissue repair.
ESWT Extracorporeal Shock Wave Therapy is commonly known as lithotripsy. Lithotripsy is a procedure in which sound waves blast and destroy kidney stones. ESWT is the use of sound waves to destroy calcific tendons and ligaments.

Runners are the most stubborn and prideful athletes. No means yes, and yes means do more. Nine out of every 10 clients I work with have underlying dysfunctional movement patterns. This is ever so true in runners due to the repetitive nature of the sport. Correcting the neuromuscular inefficiencies and dysfunctional movement patterns will go a long way in preventing injury.


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