It has been observed that while starting a new exercise regimen, most individuals prefer the relatively conventional exercise, which is running. In addition, almost all types of sports or physical training demand some form of running activity. Research and clinical data suggests that moderate physical activity is helpful in maintaining healthy gut metabolism and digestive functions, mobilization of fat, weight loss, hormonal stability, maintenance of good mood, smoking cessation and bone remodeling processes. Needless to say that running is one of the most effective forms of physical activity that can help in maintaining a healthy lifestyle and optimal wellness.
However, poorly coordinated exercise regimens and running activities can also increase the risk of varying degree of injuries that may require serious medical intervention. In recent years, there are numerous comments or feedback on the benefits of physical therapy for running injuries other than conventional treatments.
According to a recent study, the prevalence of running injuries in professional athletes range from 11 – 85%. The risk of injury increases proportionately with the number of running hours. Based on the statistics reported in the International Journal of Sports Medicine, scientists reported that for every 1000 running hours, the rate of injury ranges between 2.5 to 38 episodes.
What are common factors that may contribute to running injuries?
Research published in the British Journal of Sports Medicine suggested that 60 to 70% of all the injuries are caused by training errors and are preventable in most cases. Clinical data suggests that running injuries are most frequently reported in following settings:
- If running is performed without proper warm-up exercises (or performed on ‘cold muscles’).
- Overexertion or vigorous training without developing adequate stamina.
- Running injuries are also likely to occur when a person resumes running after a very long time or after a recent trivial injury.
- It is also likely that injuries may occur if the running routine is changed suddenly, such as lengthening the running distance and increasing the pace.
- A change in the running surface or environment can also provoke an injury or tissue damage For instance, if you shift from a plane surface to a slope, it will stress the calf muscles more and can increase the chance of inflammation or tearing of connective tissue elements.
- It is very important to wear the right shaped and right sized shoes while running. It has been observed that the risk of running injuries can increase 15 to 25% with the use of improper gear as it adds further stress to your joints and musculo-skeletal elements.
Running injuries most frequently involve highly mobile joints such as the knees, ankle and pelvic joint. However, smaller and less frequently joints or tissues can also undergo injury (especially in athletes or dynamic individuals). In addition, ligament and muscle injuries are also likely to occur if the runner does not take adequate rest and relaxation between running sessions.
On an average, healthcare providers suggest that even a professional athlete should not run for more than 8 miles per day as it can immensely increase the risk of muscle injuries.
You should speak to an expert to learn more about the cautions and care that can be taken to prevent injuries, if you are experiencing warning signs like:
- Persistent leg pain that last for days after initial running activity.
- Frequent episodes of muscle pulling while running.
- Swelling of feet and legs or difficulty in walking.
General classification of running injuries
- Hip injury: The bursa of the hip can be damaged, which usually results in sharp pain while walking. Other forms of hip injury are, dislocation, inflammation, arthritis, tearing of supporting ligaments.
- Knee injuries: Knee injuries are caused by overworking of the thigh muscles, which pulls the ligaments near the knees and results in injury and pain. Other causes include osteoarthritis or other forms of inflammatory joint conditions. Sprains are also very common in the knee area. The knees are supported by three ligaments which are the medial and lateral menisci as well as cruciate ligaments that are often implicated in knee abuse or overuse injuries. Pain is also persistently felt in addition to swelling. If, the running routine is not altered, permanent damage can result.
- Iliotibial band syndrome: iliotibial ligaments are responsible for supporting the ankles and run along the thigh muscles. When injury occurs, this ligamentous band swells up to make walking a difficult and painful process.
- Painful shins: This is mostly reported by runners who have recently adopted running as a physical activity. Improper warm up and stretching can lead to muscle pulls and injuries in the thigh and shin region of the legs. In addition, working out excessively and not taking proper rests in between, can also trigger such injuries. Wearing proper shoes, starting with a low-key workout and taking adequate rests between runs can help prevent this injury.
Based on the data analysis of 28 randomized controlled trials, it was observed that the prevalence of most popular running injuries in runners is:
- Medial tibial stress syndrome (9.5% of the athletes)
- Achilles tendinopathy – reported in 6.2% to 9.5%
- Plantar fasciitis 5.2% to 17.5% runners
- Patellofemoral syndrome (affects about 7.4% to 15.6% of the marathon runners)
Why should you consider physical therapy for the management of running injuries?
Running injuries are usually discomforting (at times for a significant period of time). There are a number of reasons why you should consider physical therapy for running injuries in the resolution of your symptoms.
- Physical therapy is a holistic method of care that does not involve painful and costly surgeries to manage an overuse or abuse injury. Most surgeries are hazardous in the long term and can affect the integrity of tissues and muscles.
- Physical therapy helps in stabilizing and strengthening the core anatomical architecture of the body. Needless to say that appropriate training and muscle stabilization reduces the risk of recurrent injuries.
Physical therapist utilize an organic approach to identify and address the pathogenesis of running injuries. Most practitioners conduct a detailed physical examination to:
- Suggest a change in running routine.
- Advice appropriate exercises that can help in enhancing the repair and regeneration of injured tissues.
- Advice regarding the rest and activity duration and spacing.
- Provide important information and guidance regarding maintenance of appropriate posture, physiological integrity and strength.
- Besides posture modification, physical therapists also provide valuable information regarding therapeutic management of the injuries and ailments.
Physical Therapy Interventions For Management of Running Injuries
Sometimes, changing the running machine and adjusting the pace is sufficient to treat a person, while at other times specific treatment regimens are needed. Running injuries can be managed and treated by a number of modalities. Depending upon the nature of injury, your doctor may advise rest (or only mild activity) for a significant period of time. Other interventions that are most frequently advised by physical therapists are:
#1: Massage Therapy
Massaging is one of the most recommended and ancient method of care for the management of sore muscles and inflamed tissues. Massage therapy performs several functions in the setting of running injuries such as:
- Circulation: Inflamed tissues are usually swollen due to changes in the circulatory forces. Massage therapy helps in promoting the flow of blood across the inflamed and swollen tissues.
- Detoxification: Massaging helps in excretion of inflammatory chemicals and breakdown products of hormones, mediators and inflammatory blood cells.
- Soothing sensation: Indeed massaging helps in the release of relaxation inducing chemicals and mediators that help in promoting the overall sense of well being.
There are several modalities of massage such as deep tissue massage and Swedish massage. Study conducted by Crane and associates concluded:
“When administered to skeletal muscle that has been acutely damaged through exercise, massage therapy appears to be clinically beneficial by reducing inflammation and promoting mitochondrial biogenesis”
#2: Feet And Pelvic Support
In case of an acute or moderately severe injury, physical therapists also advise implants to support the feet and other joints of the limb. Study reported in the peer reviewed Journal of Orthopedic and Sport Medicine suggests that non-elastic ankle tape in professional athletes can help a great deal in reducing the risk of ankle sprain by supporting the key muscle ‘fibularis longus’.
Study concluded that a moderately higher muscle activity is reported after the application of nonelastic tape on the ankles, suggesting a better performance with minimal risk of injury. In more severe cases, bracing can also be used to support the inflamed or torn ligaments.
#3: Icing, Hot Or Cold Compresses
Application of ice is needed to numb severe swelling, inflammatory redness or pain in case of an acute injury. Periodic icing reduces the requirement and dependency on the pain-killers and analgesics. For sprains and sprains, alternate hot and cold compressions are advised to improve the tissue mobility by reducing swelling and inflammation.
#4: Ultrasound And Laser Therapy
Physical therapists use ultrasonic radiations to alleviate tissue inflammation and swelling. Study published in the accredited journal Photomedicine and Laser Surgery suggested that low level laser therapy (LLLT) as well as Low-Intensity Pulsed Ultrasound are both effective after an acute skeletal tissue injury in the setting of exercise or trauma. Not only does these modalities improve the flow of blood across damaged tissues, but also stimulate regeneration and healing by stimulating specialized cells.
According to another study conducted by Raquel Agnelli Mesquita-Ferrari and associates, low level laser therapy performed in the hands of an expert physical therapist can alter the expression of inflammatory mediators like TNF-α and TGF-β after an acute running or traumatic injury. These mediators delay the regeneration and repair mechanisms within the body and produce pain, swelling and discomfort. Study conducted on animal subjects suggested that the positive results in the repair of skeletal tissues can be observed within a few days of initiating low level laser therapy.
#5: Strengthening Exercises
Stabilizing and strengthening exercises are added to the overall exercise regimen in order to condition damaged and degenerated tissue fibers. There are several other benefits of strengthening exercises:
- Improvement in the overall range of motion of joints
- Enhancement of stamina and athletic endurance
Study conducted by Reed suggested that core strengthening exercises improve athletic performance within a few weeks when compared to control population. Most effective measures of athletic endurance include vertical leap and maximum squat load.
Physical therapists also advise lifestyle modifications by:
- Providing guidance regarding the choice of appropriate footwear.
- Posture regulation to reduce the stress and strain on the muscles and connective tissues.
- Exercises (both active and passive) to retrain receptors and ligaments.
- Physical therapy also reduces the pace of tissue degeneration in the setting of osteoarthritis.
If you are experiencing recurrent episodes of running injuries, you may require expert’s opinion regarding the health and stability of your joints and muscular components. Other than relying on oral pain medications to ease the symptoms, you should consider the various benefits of physical therapy for running injuries as mentioned above.