Saturday 24 February 2018

Irish physiotherapists on the most common running injuries and how to avoid them

Thinking of running a marathon for charity or aiming for a 10k to get fit? Beware of the injuries runners are prone to - especially newcomers. Katie Byrne talks to physiotherapists about the most common ailments and how to avoid them

If running, invest in proper footwear
If running, invest in proper footwear
Physiotherapist Tomas O'Connell. Photo: Tony Gavin

Dublin-based physiotherapist Tomas O'Connell meets six to seven new patients suffering from running-related injuries in his Rathfarnham practice every week.

Some patients complain of pain in the knee: usually patellofemoral pain syndrome (aka runners' knee) or iliotibial band (ITB) issues.

Others report tenderness along the shin bone on the medial side above the ankle (usually shin splints), or tightening of the fascia that runs along the sole of the foot (usually plantar fascia).

This rise in running-related injuries, says O'Connell, is partly to do with the increasing popularity of the pastime, but mostly to do with the tendency for newcomers to do too much, too soon - especially while running on hard surfaces like pavements.

The strain that the repetitive impact of running on hard surfaces can place on joints has been the subject of countless studies. According to physical therapist Gerard Hartmann, who has treated 61 Olympic medal winners, the impact of running on hard surfaces is three times a person's body weight. "So for a 10-stone person, the impact transmission rate is about 30 stone on your body," he says.

Yet the problem isn't hard surfaces per se.

The human body is robust and the tendons act as natural shock absorbers. The problem, in most cases, is that runners don't take the time to condition their bodies before they train on hard surfaces, or vary their surfaces to reduce impact.

"People decide that they want to run a marathon for charity, and then they embark on an 18-22 week training plan," explains O'Connell.

"But if you're training for a marathon, you have to run four to five times a week, which means you only have three days off at most. Your muscles and your joints are being asked to do work that they are not used to and, for beginners, it's a huge incline in miles."

Physiotherapist Mark Kenneally, who competed in the 2012 Olympic Games men's marathon, agrees. "If someone is coming from a base of no running, mistakes get made," he says.

"Road running certainly exerts the most impact in terms of force, but we also have to look at three components: how often you run, how hard you run and how far you run. It's about getting the balance between those three factors right."

Kenneally, who works with The Performance Clinic in Dublin, also points out that while concrete exerts the most force, other surfaces can present their own issues. "Road running requires you to spend less time on the ground as you try to avoid those peak forces, whereas somebody running on grass would be making more contact with the ground, which would then open them up to being injured in a different way."

There is plenty of data available on the benefits and drawbacks of various running surfaces, but a lot is conflicting. That's why the experts tend to recommend that runners, beginners especially, vary their surfaces instead.

Hartmann advises all of his clients to do 80pc of their running on grass, which provides more shock absorption. Kenneally, meanwhile, says that runners who change their surface, distance and speed "will load different things in a different way".

"Softer and uneven surfaces have their problems as well," says O'Connell, "but for someone who isn't used to running, it is better to vary surfaces for the simple reason that your joints and muscles are working harder on harder surfaces. The pavement causes a lot of tension in the joints which can lead to overuse of the ankle and knee - predominately the knees."

Varying your surfaces may also help prevent injuries that can occur on an unrelenting, monotonous surface. "If you have some sort of predisposition, monotony will increase the chances of getting injured," adds Kenneally.

This means adding surfaces like grass to your programme if you tend to run predominately on concrete and asphalt.

However, newcomers are advised to avoid steep inclines and declines. "The patella tendon - the tendon underneath the kneecap - can get very tender when people start bringing in a few hills," explains O'Connell. "Usually they are not strong enough yet and that means the knee is a little out of line as they are climbing the hill, which sets off the tendon."

"Patellofemoral pain can be underneath or behind the kneecap and it can present as a popping or grating at times and comes from running on incline or decline," he adds.

Complementary strength training, which is an essential component of running, will help build the strength required for hill running, says O'Connell. The stronger the muscles, the less impact on the joints. It will also help prevent a multitude of potential injuries.

"So many people are training for marathons without doing any leg strengthening," he adds. "They think, 'Sure I'm cycling in and out of work so that should be enough', but it's not. Squats are brilliant. If done correctly, they get the knee in line and they work your quads and your glutes, which is huge for stability of the knee. You should also do a lot of work on your calves. So many people come in to me with calf tears, which is either from a lack of strength-training or a lack of stretching."

O'Connell advises his clients to perform dynamic rather than static stretching before a run. "An example of static stretching is when you work the hamstring by putting your leg up on a chair, bending down and holding for 20 or 30 seconds.

"But if you're going for a long run, research shows that you shouldn't put too much pressure on a tendon beforehand. You're better off doing dynamic stretching - like high knees or kicking your legs out. "Also, very few people stretch afterwards but it definitely helps - especially in the calves. When calves get tight, they are going to pull the joint and then you've got another issue. Even elevating the legs afterwards can help."

Stretching is especially important for people with sedentary, desk-bound jobs, he adds. "Some people are sitting slumped over for eight to 10 hours of each day. When they get up to run, they are putting their back into extension so if they don't stretch beforehand they'll get very tight glutes, hamstrings and lower back."

Running can also exacerbate pre-existing conditions - and hard surfaces don't help matters. "If we jump into a situation and start running all of sudden, there may be things that predispose you to certain injuries," says Kenneally.

O'Connell agrees. "A person might have an old injury from 10 years ago. What happens then is that the weakness in the ankle sets off a problem in the knee.

"It's one of the most common issues with people who don't have experience of running so we always look for a history of problems with the ankle. And every marathon training programme advises that people get checked out beforehand."

"There's plenty of support out there and a lot of running clubs these days are geared towards people who have never run before," concludes Kenneally. "What's important is that people plan out their programme very carefully and talk to serious runners and health professionals before they start."

See Siobhan Byrne's muscle strengthening exercises for runners on p12

ROAD WORTHY: HOW TO AVOID INJURIES WHEN RUNNING ON HARD SURFACES

1 Vary your surfaces: Avoid the repetitive strain of running on hard surfaces like concrete and asphalt by introducing surfaces like grass and natural trails to your training programme.

2 Introduce strength-training to your regime: Especially for the legs, glutes and hips. Flexibility training like Pilates and yoga is also helpful.

3 Don't ignore pain: Visit a GP or physiotherapist if you have a pre-existing injury or you experience any pain during or after running.

4 Avoid hills if you're a beginner: Steep inclines and declines can lead to injury if the muscles aren't strong enough to cope with the impact.

5 Invest in proper footwear: A specialist running shop will provide gait analysis.

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