by Brian Schiff, PT, CSCS

As Spring is in full gear, and we inch closer to Summer, many recreational athletes begin running outdoors. While running is an excellent form of cardiovascular exercise, it often leads to musculotendinous and joint injuries in certain individuals. The primary factors causing injury are usually lack of appropriate footwear, inadequate training base, poor strength/flexibility and increasing mileage too quickly. Seasoned, experienced runners are well aware of these issues, but too often the novice who decides to take up running in order to shed some excess pounds encounters early problems. However, I have also seen many experienced marathoners with overuse injuries due to the extreme nature of the sport.

The most common injuries typically involve tendonitis, arch pain or shin splints. Tendonitis frequently occurs in the patella tendon, achilles tendon, or iliotibial band. This happens because the quadricep and calf muscles are responsible for absorbing the impact of your body weight as your foot strikes the ground repeatedly. Meanwhile, the iliotibial band runs from the hip to the knee joint along ther outside of the leg, and often becomes irritated due to repetitive friction during running. Without adequate strength, flexibility, and muscular endurance, many runners begin to experience inflammation in these areas. Arch pain may occur if an individual has an excessively flat or high arch. These feet (planus and cavus) contribute to abnormal force transmission from the foot all the way up through the knee and hip. People with flat feet often suffer from plantar fascitis or posterior tibialis tendonitis, as they overpronate during running. On the other hand, a person with a high arch may suffer from lateral ankle pain or soreness along the fifth metatarsal. Finally, people have to deal with the dreaded shin splints. These refer to soreness along the anterior or posterior shin muscles, which usually comes on quickly during running, and is often present in the initial training phases due to deconditioning.

Joint injuries with running typically involve the back, hip and knee. This pain often presents as localized aching along the lower spine, groin or behind the kneecap. Although these symptoms may occur more frequently in older runners or with higher mileage, they may also affect younger runners with poor form, abnormal biomechanics, decreased strength and especially those who are obese. The force on our joints increases significantly for every extra pound we carry. Runners also run the risk of encountering stress fractures, which may occur along the lower leg or in the feet. What about arthritis? Arthritis in a joint doesn’t necessarily mean you can’t run, but it certainly means you should avoid excessive pounding and allow pain to guide your mileage and running surface (treadmill/track vs. road/sidewalk). What if I am overweight? Begin slowly! I often suggest brisk walking for a few weeks prior to attempting jogging. Remember – the goal is safe and effective exercise to lose weight, while avoiding an injury, which may cause you to cease training altogether.

Now, here is some advice on how to avoid all of these nagging injuries that disrupt your running goals. First and foremost, I recommend performing routine strength training and flexibility exercises 2-3 times/week to condition the muscles and protect the joints from excessive compression and shear forces. Secondly, develop a plan to increase mileage gradually over a realistic time period to accomplish your desired level of running. Third, buy appropriate footwear that matches your foot structure and will help dissipate forces transferred to the rest of the leg. By the way, remember to change running shoes every 400-500 miles. Fourth, avoid running on heavy leg lifting days, as muscular fatigue may become a problem. Along with the previous principle, consider cross training (bike, elliptical trainer, swimming, etc.) to give the joints a break periodically and allow for recovery. Finally, utilize rest, ice and an anti-inflammatory medication if you begin to experience any of these problems. If pain persists, seek out your favorite orthopedic physician, because you may need examination and diagnostic testing, or even a course of physical therapy to resolve your symptoms. Good luck and happy running!