Wellness Articles

Running Injuries

Running Injury Prevention and Treatment by Vancouver Chiropractor

Most running injuries occur as a result of overuse or inappropriate biomechanics. A good analogy is to think of a pulley system where the rope is your muscle and the pulley is the joint. If you have asymmetry in the way you are pulling on the “rope”, you are not going to be able to glide it over the “pulley” without using excessive effort; it will become more difficult to lift the weight at the end, thus creating friction. This in turn heats up the rope and possibly, SNAP; you now have a tear. If you realign the rope and the way it travels over the pulley, via chiropractic and sports therapy treatments, the ease at which you can pull the weight up is greatly enhanced. One will then find the energy required to complete your run is more efficiently used and your time will improve.

Here is a breakdown of some common running injuries:

Pronation Syndrome
Is a mechanical error whereby the foot is over pronated for too long in the stance phase, not held long enough throughout the phase, or the foot is pronated at the wrong time (i.e. should be supinated.) It is an all too common complaint in my practice! 60-75% of all runners have approximately 90% of their soft tissue problems associated with the foot.  Typically, portion syndrome is an overuse injury as it develops over time, resulting in decreased shock absorption of the foot during the stance, decreased foot stability during the stance phase, and decreased propulsion during the stance phase.

REMEMBER if someone is flat footed, they may not necessarily overpronate.

Treatment of the common conditions causing pronation syndrome depends on the condition causing the pronation.  Such conditions include:
1. Forefoot varus
2. Rearfoot varus
3. Tibia Varum
4. Genu Varum
5. Genu Valgum
6. Tricep Surae contractures

Forefoot Varus
Inversion of the forefoot with the subtalar joint in neutral and the rearfoot parallel with the ground. Requires increased calcaneal eversion to establish full forefoot contact.

Treatment:
a. can not change structural defects
b. adjust fixations, especially of the subtalar joint
c. stretch tibialis anterior strengthen the peroneal muscles
d. pronation control shoe
e. functional orthotics – medial forefoot posting if the condition does not improve with a pronation control shoe.

Rearfoot Varus
Inversion of the rearfoot (calcaneus) when the subtalar joint is in neutral.

Treatment:
a. adjust fixations – talus and subtalar
b. stretch tricep surae (calf muscles)
c. strengthen the muscles involved with inversion
d. pronation control shoe
e. orthotics with medial heel wedge (posting) if the condition does not improve with a pronation control shoe.

Tibia Varum
Congenital error where the distal 1/3rd of the tibia is adducted (curved/bowed medially) in relationship to the proximal tibia causing a varus foot in neutral.

Treatment:
a. Mild: shoe with medial rearfoot and forefoot posting- pronation control shoes
b. Severe: orthotics with varus wedge in rearfoot if not prolonged pronation; medial and posterior wedge if prolonged pronation.

Genu Varum
Inward bending of the tibia (>5° at the knee); AKA bow legged

Treatment:
a. strengthen external tibial rotators
b. stretch internal tibial rotators and hamstrings
c. orthotics with medial posting (varus wedge)
d. adjustments to the knee, hip, foot, and low back.

Genu Valgum
Excessive outward bending of the tibia (15° at the knee); AKA knock kneed.

Treatment:
a. pronation control shoe or orthotics with varus wedge
b. stretch hip extensors, knee rotators, and hamstrings.
c. strengthen hamstrings and quads.
d. adjustments to the hip, knee, foot, and low back.

Tricep Surae Contracture 
Occurs when tight surae complex prohibit adequate dorsiflexion (>5°) at the ankle joint, usually with a flexible flatfoot or valgus rearfoot.

Treatment:
a. avoid high heels
b. strengthen anterior leg muscles and inverters
c. soft tissue work to the leg
d. contrast soaks to calf muscle
e. adjustments to talar, subtalar (posterior calcalneus), and navicular (inferior).

Plantar Fascitis 
Definition: Strain, inflammation and pain associated with the plantar aponeurosis and flexor digitorum brevis at their attachment to the anteroinferior aspect of the calcaneal tuberosity.

Etiology (onset)- Insidious onset quickly becoming chronic in nature with acute exacerbations. Plantar fascia plays an important role in the arch support as it is the “tie beam”.  Plantar fascitis is one of the most common overuse injuries in athletes, especially distance runners, basketball players, and dancers.

Treatment:
ACUTE
a. RICE
b. IFC, U/S or TENS
c. Soft tissue work- MRT and strip and bow
d. adjustments to the posterior calcalneus, medial talus, inferior navicular, and/or low back.
e. heel cup
f. home care: roll golf ball under arch 6-10 times followed by an ice massage.

CHRONIC
a. orthotics control for pronation
b. stretch calf muscles
c. strengthen muscles involved with invertion
d. deep soft tissue massage
e. heel cup

Medial Tibial Stress Syndrome (Shin Splints)
Definition: Muscle strain, tendonitis, and/or periostitis involving the tibialis posterior and/or soleus and presenting with pain along the posteromedial aspect of the middle 1/3rd of the tibia.

Etiology: Repetitive impact and most commonly occurs in runners, aerobic dancers, or other high impact sport athletes.
Contributing factors that will exacerbate this condition:
High mileage
Hard surfaces
Uneven surfaces
Sudden changes in routine
New activities
Poor shoes

Signs and Symptoms:
1. swelling
2. small lumps or nodules along the muscle attachments to the tibia
3. often the patient overpronates as well

Treatment:
ACUTE
a. ice massage
b. IFC, U/S, or TENS
c. gentle stretching
d. gentle soft tissue work of the tibialis posterior
e. adjustments to talar joint and knee
f. change shoes

CHRONIC
a. continue adjusting
b. aggressive stretching
c. deep tissue massage
d. modify exercise program
e. isometric/isotonic rehabilitation

Stress Fracture
Metatarsal Stress Fracture: Often due to repetitive microtrauma; overuse as a result of excessive running, dancing, or jumping. It is a biomechanical fault that causes increased pronation or foot slap. Osteoporosis- remember an amenorrheic (non menstruating) female athlete is at high risk for accelerating this process.

Treatment:
a. rest for 2-3 weeks
b. IFC and U/S- low setting NOT to pain
c. orthotics (usually semi-rgid, shock, or sport)
d. ROM exercises
e. stretching and strengthening of intrinsic foot muscles

Iliotibial Band Syndrome
Definition: Tendonitis along the iliotibial band causing pain along the lateral aspect of the knee.
Overuse: Most commonly due to continuing to run or cycle when symptoms are already present.  Other contributing factors include over pronation, under pronation, poor shock absorption, and uneven surfaces.

Treatment:
a. soft tissue massage- MRT and strip and bow
b. decrease mileage and avoid downhill running
c. orthotics
d. stretch hip abductors, hamstrings, and gluteal muscles
e. strengthen gluteals and other hip abductors

Trochanteric Bursitis 
Definition: Inflammation of the large bursa that lies between the tendon of the insertion of the gluteus maximus and posterolateral prominence of the greater trochanter.

Etiology: friction trauma from muscle hypertonicity and overuse (i.e. running with tight gluteals).  Direct or micro trauma usually resulting from pronation syndrome and/or a medial rotation stance.

Treatment:
a. electrical current for two weeks
b. ice massage if acute
c. soft tissue therapy- gluteals
d. stretch gluteals
e. adjustments to the low back, SI joint, and hip
f. modify activity- avoid hills, stairs, and uneven surfaces

Iliopsoas Bursitis
Definition: Inflammation of the bursa that lays between the iliopsoas muscle and the iliopectineal eminence; it overlies the anterior-medial capsule of the hip.

Treatment: as above

Have a great day,
Dr. Crysta Serné
Vancouver Chiropractor and owner of Vitality Clinic



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