3 out of 4 runners will sustain a running related injury. These injuries typically develop slowly over a couple of weeks although may not become painful or limiting until tissue damage has occurred. Injuries to the runner are primarily due to the imbalance between a load capacity (resiliency of runners tissues) and a load force (runners ability to control forces applied to the lower limb with each stride of gait).

What can you do to save your running season from an acute injury? Let us help.

**Here are THE BIG 6**

Most common lower extremity running injuries and a few simple strategies to address overuse.

Patellofemoral Pain Syndrome

CAUSES
increased femoral internal rotation/adduction throughout gait cycle and decrease trunk lean during running gait.

DRILLS
1) leaning tower drill to increase hip moment and improve trunk lean.
2) Eccentric step downs (no greater than trace levels of discomfort)

GAIT MODIFICATIONS
Increased cadence training (180 steps per minute)

2. Iliotibial Band Syndrome (ITBS):

CAUSES
increased femoral internal rotation/adduction throughout gait cycle and decrease trunk lean during running gait.

increased femoral adduction/tibial internal rotation, impacting multiple sites of soft tissue insertion.

DRILLS
1) Single leg Clam Shell 2) Single leg side planks 3) Lateral Band Walk

GAIT MODIFICATIONS
Increase step width slightly (correcting scissoring gait). Increased cadence by 10% (this means increased step rate not increased split time) to improve gluteal activation and decreased strain to patellar tendon

3. Heel Pain (plantar fasciitis):

CAUSES
Many factors can contribute to heel pain but here are a few common causes.
Shoes with greater than 300 miles on them.
Limitations of ankle dorsiflexion and great toe extension.
Weakness of foot intrinsics.
Weak motors groups ie. gluteals, quads, or calf muscles. Contributing to aberrant force loads absorbed by the foot during running gait.

DRILLS
1) Foot intrinsic strengthening (towel scrunches/marble pick ups) 2) Foot doming in standing (“active foot posture”) 3) Single limb balance with toe spreading

GAIT MODIFICATIONS
Cadence manipulation increasing step rate to approx. 180 steps per minute. Barefoot running on grass to assist in changing strike pattern reducing heavy heel strike.

4. Shin Splints

CAUSES
Decreased step width (cross over sign), prolonged pronation and overstriding.

DRILLS
1) Stretch Soleus (calf stretch with knee slightly bent). 2) Active arch Drills with arch hollowing, toe spreading for great toe abduction. 3) Toe yoga 4) Curtsy Lunge

GAIT MODIFICATIONS
Use of temporary orthotics, increase step width, increased cadence (180 steps per minute), barefoot running with focus on “quiet running” (light heel strike, midfoot strike preferable)

5. Achilles Tendinopathy

CAUSES
Increased rearfoot eversion/pronation, decreased knee flexion, increased ankle dorsiflexion at midstance of running gait, insufficient for transfer through Achilles tendon at push off.

DRILLS
Eccentric heel lowers (can be performed off of step if tolerated) target both the gastroc (knee straight) and the soleus (knee bent). Perform 45x 2x/day

GAIT MODIFICATIONS
Cadence manipulation, temporary orthotic/heel lift, rearfoot or midfoot strike.

6. Bone Stress Injuries

CAUSES
increased supination, impaired tolerance to impact/loading, and peak tibial accelerations

DRILLS
Non-weight bearing if necessary, working toward pain free walking at a brisk pace 3x/wk for 60 min before progressing back into running.

GAIT MODIFICATIONS
“Soft Running” working on quieting your impact as your foot strikes the ground, increase cadence (180 steps per minute, optimal), changing strike pattern to midfoot.

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