Running injuries

Because running injuries affect a wide variety of muscles, bones, ligaments, tendons as well as other areas of the body, the symptoms are specific to the individual area, often characterized by

• Pain in the affected area
• Reduced range of movement of the affected region
• Swelling
• Discolouration or bruising

For instance, in the case of an ankle injury, the pain is located at the ankle and is amplified by swelling or discolouration of the affected part.

While there are many running injuries that affect people, they can be differentiated by the two primary reasons as to why they occur:

• Acute: An injury that occurs suddenly, like in the case of a fall or a twist and can result not only in bruises but fractures, tears as well as sprains.
• Chronic: This type of injury occurs due to the overuse of muscle groups during the repeated nature of the activity. A majority of running injuries are overuse injuries that accumulate over a period of time.

Here are a collection of injuries one should be wary of while running:

• Chafing: A common problem faced by long-distance runners and joggers is chafing, caused by friction of skin rubbing against skin, or an external item like clothing. The most common area where runners experience chafing is the inner thighs, but it can occur in the groin, the buttocks or even around the nipples. All of these can be painful and lead to bruising and bleeding.
• Blisters: Tiny sacs of fluid on the surface of the skin, called blisters, are a result of the friction created by the skin rubbing against another surface like shoes, socks and the like.
• Back pain: The repetitive stress of running long distances can put pressure on the lower back, because of which many runners complain of lower back pain. The pain of pre-existing conditions, like a herniated disc or sciatica, can be exacerbated by running.
• Shin splints: Those new to long-distance running or increasing the number of miles run can experience gradual to extreme pain in the shins called shin splints, which is also a common running injury. Pain is experienced on the inside of the calves around the shin bone (tibia, the long bone in the lower leg) due to overuse, leading to a strain or a tear in the tendons.
• Plantar fasciitis: A thick band of tissue connecting the heel to the toe can become inflamed due to sudden increase in workload while running, wearing improper footwear or even the natural structure of the individual’s foot. Pain during plantar fasciitis is usually experienced in the heel, or the sole of the injured foot.
• Achilles tendinitis: The Achilles tendon, present at the back of the foot just above the heel, connects the calf muscles to the heel bone. It can become inflamed due to strain or increased intensity while running. Achilles tendinitis leads to the individual finding it difficult to set off on the affected foot and not being able to put enough pressure on the affected foot as a result.
• Groin strain: Pain around the groin region, right from the pelvis down to the inner thighs, can be experienced by runners due to various reasons like a groin strain or deeper-lying conditions like a hernia. The injury, though not common, is caused by kicking movements, twisting, jumping or changing direction quickly while running.
• Pelvic pain: Runners can experience pain in the pelvic region due to overuse as the tendons around the pelvic joint become inflamed, leading to sharp pain. Women tend to experience this pain more than men.
• Hamstring strain: Though not common in long distance runners, hamstring injuries are very common among sprinters and athletes. Overstretching the muscles behind your thighs while running causes strains and tears.
• Runner's knee: Because our knees take quite a pounding while running, either long or short distances, the joint is prone to a variety of injuries and knee pain. A sprain in the knee is a common occurrence, caused by different conditions like Patellofemoral pain syndrome, injury to the anterior cruciate ligament, chondromalacia patella or iliotibial band syndrome - all given a collective title of runner’s knee.
• Meniscus tear: Another condition involving the knees, meniscus tear also affects the ligaments but the pain is experienced at the back of the knee, as opposed to the front of the knee in the case of a runner’s knee.
• Patellar tendonitis: Although similar to the runner’s knee, patellar tendonitis takes a different name, jumper’s knee, as it affects the tendon right at the front of the knee, and the pain tends to go down as you continue exercising, as opposed to the runner’s knee where the pain goes up. It can be caused not only by overuse but by a direct blow to the knee or landing on the knee.
• Calf strain: Increasing intensity of your daily run suddenly or a general increase in workload can lead to pain in the calf muscle. Calf strain can range from suffering cramps due to dehydration to sprains and muscle tears.
• Ankle injuries: An area of the body that is constantly used even when you’re not running is the ankle. The ankle joint takes up a tremendous load with the weight of the body as well as the daily tasks of moving around, and as a result, ankle injuries are common. Twisting an ankle is a common but painful experience. There are several other injuries that the ankle can suffer - right from a sprain, tendinitis, bursitis to even a fracture.
• IT band syndrome: The Iliotibial (IT) band, a long, thick band of tissue that runs right along the outside of the hip to the outside of the knee, can become inflamed due to overuse. It is a common running injury. Much like runner’s knee, IT band injury also affects the runner at the outside of the knee, causing pain that isn’t shooting but persistent.
• Hip pain: Hip pain is a common injury faced by runners. The above mentioned IT band syndrome is one of the factors, but as are strains, tendinitis, bursitis, stress fractures as well as osteoarthritis.
• Stress fractures: Severe bruising in the bone or small cracks develop over time due to overuse or excessive strain on particular bones and joints. While stress fractures can occur anywhere, the most common areas where runners experience them are in the shin (tibias), feet (metatarsals) and heels (calcaneus).
• Toe injuries: Though not common among runners as much as it is among other sportspersons, toe injuries can be wide-ranging as well. Bunions (hallux valgus), which is an articulation of the big toe, is usually due to the orientation of the big toe, which points inwards naturally, and can cause pain during running. Turf toe is another common occurrence that happens due to hyperextension of the ligaments in the big toe. Other conditions that can affect the toes are hallux rigidus, which is a type of arthritis of the toe, and stress fractures in the metatarsal bones, resulting in forefoot pain.
• Piriformis syndrome: Placed deep within the glutes, the piriformis is a small muscle but it acts as a stabilizer for the pelvis and allows the hips to rotate and balance. But because the sciatic nerve passes through this area, any compression of the nerve causes pain in the buttocks.

Running injuries are caused by a variety of factors that can either worsen an existing injury or lead to a new one.

• Fall: One of the common causes behind a running injury is a direct cause. A fall while running that makes one land awkwardly on any particular part of the body can result in an injury which may be worse than just a bruise. Sprains, fractures or ligament tears can be sustained as a result and put you out of action for a long time.

• Running on uneven surfaces: Running on surfaces that have undulations, pebbles and rocks, or a variation in gradient can be a contributing factor to your overuse injury.

• Fatigue: Not accounting for fatigue while you pursue long-distance running can be risky, as pushing yourself after having spent all your energies can lead to cramping, and in worse cases, long-term injuries.

• Increasing intensity: A gradual increase in the distances or speeds you run is helpful. But a sudden surge in your running patterns like an increase in speed, laps or distances can lead to stress-related injuries like sprains and stress fractures.

• Not warming up or stretching: One of the leading causes of your muscles contracting, spasming or cramping while running is the lack of warming up or stretching before going on a long run. An early morning run means your muscles are cold, and not warming them up or flexing them before a run can lead to injuries.

• Age: Older runners are more prone to suffering from injuries like calf strains as the muscles tend to wear with age.

• Greater pressure on muscles: Heavier people attempting to run faster or greater distances are likely to suffer from strains and injuries a lot more as they put more pressure on their bones and muscles.

• Dehydration: Not keeping your body sufficiently hydrated while on a long run or even during the course of the day leads to cramping at different places in the body, which can worsen with time.

Despite being as wide-ranging as they are debilitating, running injuries can be kept at bay or even avoided so long as you follow some simple routines along with your running programme.

• Strengthening leg muscles: A majority of the running injuries affect a runner’s legs, and it is imperative to strengthen the muscles in the legs to be able to stay injury-free. Simple strengthening exercises like squats, lunges, deadlifts (which strengthens the back as well), leg extensions and leg stretches must be performed interspersed with your running routine.
• Stretch and warm-up properly: Many of the injuries listed above are caused by the lack of conditioning of the particular muscle group that gets affected. This is because on a lot of occasions, runners tend to set off with cold muscles without warming up or stretching properly. Cold muscles tend to get injured quicker, which is why it is imperative to incorporate a warm-up routine before you go on a long run.
• Wear appropriate footwear: Ill-fitted or worn-out shoes can be a huge contributor to a runner suffering injuries. Identifying the right pair of shoes and not exceeding their life is a huge contributor to your overall fitness as a runner.
• Proper running technique: An incorrect running technique increases your chances of suffering from injuries right from the lower back and hips down to the feet. Make sure that you train with professional runners and try to employ the right posture so as to not put unnecessary pressure on any particular muscle group.
• Hydrate yourself: Ensure that you’re well-hydrated, drink more than your usual levels of fluids, especially on days you’re going on a run, and maintain your hydration levels throughout the week.
• Massage: Regular massaging of the leg and back muscles ensures that the tension in the muscles (that go through so much strain during a run) is eased up. Deep tissue massages help in blood circulation and keep the muscles relaxed and ready for your next week of running.
• Add variety to training: Just running long distances leads to overuse of muscles, and it is important to mix up your training routine to avoid such situations. Swimming, cycling, weight training or playing other sports can be helpful in keeping your leg muscles in good shape and prevent overuse injuries.
• Wear the right clothing: The choice of shoes and socks goes a long way in realising your running goals, as well as avoiding blisters and rashes on your feet. The right clothing includes light-weight, breathable fabrics that don’t stick to your body while running and allow for air to pass through to your body. The right pair of shorts and tights also help keep problems like chafing at bay.
• Stop when you feel pain: If you feel a stretch in a muscle, a twitch or something worse, it is always advisable to stop your running activity immediately and not aggravate it any further.

Because running injuries are so different and affect individuals differently, each condition or injury must be identified correctly, which means visiting a medical professional if the problem doesn’t go away. Here are a few steps that must be followed in the case of an injury:

• In the case of chafing, bruising or blisters, a doctor will look at the severity of the problem and advise medications to be applied to the affected area, along with oral medications depending on the severity of the injury.
• In the case of an acute injury like a fall or twist and an injury that is visible, the doctor will perform a physical exam to determine the extent of the injury and may ask for an X-ray to check for any fractures.
• The doctor will ask for imaging tests like X-ray, MRI or CT scans for persistent problems relating to strains in the tendons, muscles and ligaments to determine the exact cause.
• If you have flat feet and have been experiencing difficulty while running in your current footwear, a visit to a podiatrist can help in identifying the problem that it has resulted in, and advise the most suitable course of treatment.

Acute injuries like sudden falls are sometimes unavoidable, but ensuring you make the best out of each of your runs goes a long way in achieving your running goals.

• Pronation: The orientation of the base of your feet helps determine how comfortable you will be while running long distances. Having flat feet, for instance, puts you at a greater risk of suffering from injuries such as Achilles tendonitis, plantar fasciitis and various kinds of foot and ankle injuries.
• Wearing worn-out or ill-fitted shoes: It may seem innocuous but wearing the right kind of shoes goes a long way in keeping you injury-free and fresh for a run the next morning. Poorly-fitted shoes can cause your foot to land differently and lead to injuries over time, while worn-out shoes also put more pressure on the sole of your feet, especially if you’re used to running on hard surfaces like tarmac.
• Running on uneven surfaces: Those running on hard surfaces, tarmac, sandy surfaces or undulating surfaces in the hills also have a greater chance of injuring themselves while on a run.
• Poor running technique: Uneven running strides, swinging of the body or lack of coordination between the lower and upper body during a run are signs of using a poor running technique. It may look harmless at first, but can result in injuries with time.
• Dehydration: Dehydration is the leading cause of muscle cramps whether you’re out for a long run or playing a sport. Not consuming enough water, salts or minerals puts you at a greater risk of cramping up and, as a result, straining a muscle.
• Sleep: Not getting enough sleep can result in fatigue when you’re out for a long run, which means you will tire early and pushing yourself at that time can lead to injuries.
• Recovery: If you have been injured in the past, not completing your rehabilitation before returning to your regular running routine can be dangerous. 
• Warm-up: Above all, not warming up before a run indicates that you have been running and stretching cold muscles while on a run, which is a huge contributor to most injuries.

The degree or severity of the injury determines the time it will take to recover from it. Despite the differences in the muscle groups and areas of the body they affect a runner, approach to the treatment can be similar in nature, conservative at first and then looking at strengthening the affected area for rehabilitation.

• In the case of chafing and blisters, direct application of ointments for treatment and use of gels and creams to avoid recurrence is the favoured method.
• RICE therapy, involving a combination of rest, ice, compression and elevation goes a long way in relieving the initial pain, especially in the case of sprains in the ankles, knees and muscle strains in the hamstrings and calves.
• Stretching and gently massaging of the injured area are helpful measures, especially in the case of muscle and ligament related injuries.
• Use of pain-relieving medication, ranging from over-the-counter painkillers like ibuprofen to ones prescribed by your doctor help in bringing down the pain and swelling of the affected area.

It is never a good idea to push yourself when you’re in pain. Injuries in the tendons, ligaments, muscles and bones take notoriously long to recover from when they get worse, and it is always a good idea to stop if you feel even a slight sensation of pain.

Running may be one of the most favoured activities among fitness enthusiasts worldwide, as it is the most accessible once that can be performed without spending too much money. Injuries are also part of an active lifestyle, and one must exercise caution wherever possible, and play it safe.