New York City has one of the largest running communities in the world. Every year, the NYC marathon attracts tens of thousands of avid runners who travel through all five boroughs of the city. Some of the best running routes are easily accessible from the Upper West Side, including ones going through Central Park, Morningside Park, and Riverside Park. However, repeatedly running long distances with little rest days and muscle imbalances that result in creeping injuries that accumulate over the years. Professional physical therapists can help ease these injuries through exercises and sports massages that will get you back to doing what you love.
Over 80% of runners get injured. Yes, 80%. That’s a higher number than it should be, but if you are an avid runner then you probably get it. Running is addictive, empowering and gratifying. It doesn’t require any equipment or a big sports facility. It is a free sport, open to anyone who is interested. It is accessible to all and central to many.
It almost doesn’t make sense. Why should something that is free, that is accessible to all and that has so many benefits be so injury prone for so many? The simple and obvious answer is that running is high-impact and repetitive.
These two qualities predispose runners to a variety of injuries. Repetitive use of any kind, including typing, swinging a golf club, writing, lifting heavy weights, cycling and many other activities, put a lot of stress on the body. Certain muscle groups and joints get overused while others are neglected.
The inherent challenges of running, that is, repetition and high-impact, often exploit a person’s weaknesses. Any weakness, previous injury, asymmetry or compensation in the body will often get amplified when running. Because of this, it is extremely important to take precautions and be proactive with self-care, training protocols and running form to reduce the risk of getting injured.
What Causes Injuries?
There are several key factors that increase injury risk for runners. Any one of these factors alone may be enough to sideline a passionate runner from his or her running goals. And the combination of more than one of these will certainly lead to injuries, hence why over 80% of runners do get injured.
Previous Injury: The number one risk factor for injuries is, previous injury. More than any factor discussed below, this cannot be overlooked. If you have a history of orthopedic injuries and want to prolong your running days, it is key to correct the imbalances and contributing dynamics that led to the original injury.
Muscle Imbalances: Whether it is a weak, under-active muscle such as the gluteus medius or a shortened and inflexible muscle such as the soleus (calf) or hip flexor, muscle imbalances and weaknesses often play a huge role in running injuries. And it’s not just muscles in the foot and ankle but often in the hip and pelvis that are the problem.
For example, having overactive and shortened hip flexors such as the psoas, TFL and rectus femoris can compress the lumbar spine and lead to low back pain. It can also de-activate the gluteus maximus and thereby increase the risk of hamstring strains and low back issues. A similar dynamic can play out in the lower leg leading to shin splints or plantar fascitis.
Poor Biomechanics and Running Technique: This relates back to the issue of muscle imbalances. Just as with weight-lifting, pitching, a golf swing or playing basketball, technique and form matter with running. There are many factors that contribute to poor biomechanics, including the ones below. The bottom line is that staying injury-free requires optimal mechanics from the feet all the way up the body.
Overtraining: Doing too much too fast before the body is ready. Joints, muscles, tendons, fascia and ligaments need time to adapt to the stressors caused by running and too often runners don’t let that process take place. In addition, overtraining can also occur when runners do not take enough time off from running to let their bodies rest and recover. Whether it is weight lifting, playing professional baseball or boxing, your body needs time off. Running is no different, especially given the continuous and intense impact running creates.
Structural Factors: Whether it is a leg length discrepancy, flat feet, high arch or an increased Quadriceps angle (Q-angle), sometimes we just can’t control what we are born with. However in many cases we can work around these issues through orthotics, proper footwear, good running techniques, running on only certain surfaces, stretching, manual therapies, active release techniques, muscle activation and strength training.
Improper Footwear: Too often people don’t make the best running sneaker choices for a variety of reasons or they don’t change running shoes often enough. Over and over again people buy shoes at a running store after some random employee, who may have only taken a 2-hour training seminar, tells them that they ‘over-pronate’ and thus should buy this or that shoe. Foot shape, gait and running style are complex, detailed topics and you should only consult a true expert for advice. Be careful whom you take important advice from!
Most Common Running Injuries and How to Stop Them
According to Runner’s World Magazine and other sources, there are the “Big 7” most common injuries experienced by runners at all levels. Each can be painful, stubborn and season-ending but injury prevention measures can lower your risk and help you recover faster if they do arise.
Although these injuries each have their own particular risk factors, causes, treatments and prevention measures, they do share common injury prevention features as well. Thee will be discussed below.
Stress Fractures are not uncommon among runners. They usually result from overtraining with insufficient rest and recovery. They can be very painful and can require months of rest if they progress without early intervention.
One of the best way to prevent stress fractures is to make sure you have the proper footwear for your specific anatomy and running style. Find the right sneakers and inserts based on your unique foot shape, body type and running style.
Another way to avoid stress fractures is to adhere to a running program that includes proper rest and recovery time. This includes rest and recovery in between specific workouts and over the course of months and years. Given how addicting and important running is to so many people - casual, amateur and professional alike - this is an issue that many runners struggle with.
The third most effective way to avoid stress fractures is to incorporate strong running technique and form. Given the high-impact and repetitive nature of running, even small deficiencies in running form can have a cumulative and substantial impact over time. If you’re not sure about this, consider enlisting the help of a qualified running coach.
Hamstring Strains are one of the most stubborn musculoskeletal injuries in the entire body. While they are not usually that painful, they can drag on for seemingly endless amounts of time and can end even an elite athlete’s season.
The best way to prevent hamstring strains is to make sure that the Glute muscles are strong and that the hamstrings themselves are flexible but not too flexible. Too many people over-stretch their hamstrings because they think they need to. Remember, you only need to stretch muscles that do not have proper range of motion. It’s not necessary and can be detrimental to stretch every muscle without a specific plan or reason.
As with stress fractures and other running injuries, proper technique, appropriate footwear and adequate rest and recovery are very important for preventing hamstring strains.
Treatments if the injury does happen to you might include Glute muscle activation and strengthening, This is to ensure that the Glutes are doing their part, so to speak, so that the hamstrings are not overworking to perform hip extension.
Achilles Tendonitis and strains to the calf muscles are often the result of inflexible calf muscles and hypomobile (not enough) ankle joints. So your best injury prevention strategy is to make sure you have proper range of motion and mobility in the ankle and lower leg. It’s also important to make sure that there is proper balance, strength and flexibility up the kinetic chain, especially at the hips and pelvis, as issues in those areas can and often do negatively affect the foot, ankle and lower leg.
Treatments might include massage therapy, Active Release Techniques, stretching and ankle mobility exercises. The goals is to restore proper length while also treating the symptoms.
Iliotibial Band (ITB) Syndrome and Patellofemoral Pain Syndrome are preventable and treatable injuries but they can sideline runners for extended periods while causing chronic pain. They often times can occur simultaneously.
Injury prevention guidelines include those mentioned above. In addition , it is important to make sure that the VMO (inner quadricep muscle) is strong in order to prevent improper patella (knee cap) tracking. Moreover, since the ITB goes all the way up into the hip and indirectly to the lower back, it is important to maintain strength and flexibility in the Glute muscles.
Treatments for ITB and Patellofemoral Syndrome follow along the same lines as prevention here but also should include targeted deep tissue massage, Active Release Techniques, self-myofascial release and stretching focussed on the ITB, lateral quad and Glutes.
Plantar Fascitis is a nasty, utterly stubborn and often extremely painful injury. In short, you don’t want to get this one. It can feel like having a piece of glass stuck in your foot.
The best prevention strategy for Plantar Fascitis is to maintain optimal lower leg flexibility, incorporate proper running technique and wear the right sneakers for your feet.
Prevention should include deep tissue and especially Active Release techniques for the calves and plantar fascia. Be careful not to do any self-myofascial release directly onto the painful spot, as this can cause more pain, inflammation and even tearing. Custom-made orthotics and a night splint are also two very common and often helpful treatment strategies.
Shin Splints (Medial Tibial Stress Syndrome) is another very unpleasant injury. While it does not have the same sort of specific and sharp pain that Plantar Fascitis can have, shin splints can be very painful and debilitating. But shin splints are very preventable. Lower leg biomechanics are almost always at the heart of shin splints. So it is important to wear the right shoes, prioritize rest and recovery, maintain ankle mobility and be sure to strengthen the anterior lower leg muscles. I have found Active Release to be magic when it comes to shin splints.
Although it is one of the most painful areas in the body to have ART on, the results can be staggering and fast. Rest should also be a priority as should running on softer surfaces until your symptoms improve.
Perhaps find a running coach or personal trainer to guide you through the injury recovery process.
In summary, if you are a serious runner, there is a very good chance you will get injured. But if you take some basic injury prevention measures continuously, your risk of injury should decrease. It is equally important to address an injury as soon as it starts to surface. Running injuries can last months and even years once they arise, so be sure to get ahead of them with early and frequent treatments.
Mark Greenfield is a Licensed Massage Therapist and Certified Personal Trainer with 15 years of experience. He is a graduate of the world-renowned Swedish Institute in New York City and has master-level training in Active Release Techniques and Medical Massage. Mark has provided over 10,000 hours of massage therapy and personal training for clients seeking a wide range of fitness goals and injury recovery needs.