So you have finally decided to follow through with one of those new year resolutions. After dusting off the running shoes the kilometers are slowly starting to pile up and things are taking shape for the up coming running season. Only you notice a niggle, a slight ache creeping into your daily movements. Here we outline 5 areas where pain shouldn't be ignored. If this sounds like you, check in with your physio or sports doctor who can shed some light as to its possible cause and how to resolve it.
1. Iliotibial Band (ITB) pain
Probably one of the most common running injuries. Why should we worry about ITB, or lateral (outside) knee pain? Lots of runners get into trouble when they push on with this problem. The ITB is a thick band of fascia that extends from the outer side of the hip and pelvis to the outside of the knee acting as a stabiliser for knee mechanics during activities such as running. It extends from the tensor fascia late (TFL) and superior gluteus maximus muscles. The quality of ITB pain is usually a relentlessly predictable pain on the outside of the knee which comes on every time you reach 'x' kilometers. It is pointless attempting to push on through the pain (many try and fail) and why should you when there is plenty you can do about it.
Using a foam roller, the go to treatment for this condition, is rarely enough. Most will often only roll the band itself without addressing the associated TFL or glute max tightness. It usually is a little more multifaceted where you may need gait retraining to change some non-optimal biomechanics. For example you might have:
- a stiff hip
- poorly utilised glutes
- reduced thoracic control and movement
- inappropriate foot wear
Many people have a gait pattern that is too narrow and their feet aren't widely spaced enough, this leads them to scissor across at the mid line during running resulting in a tightening of the this tissue. If there is a focal ITB problem (swelling or thickening), you might end up needing a ‘rescue injection’ just before that marathon (which still might not guarantee you’ll get around comfortably). This will require a visit to a qualified sports physician. The moral of the story is, get help early with an experienced running physiotherapist, who can help you make these changes.
2. Hip and Groin Pain
There is really no such thing as a “Groin Strain” and despite what we might be told, its actually not that common to have a true hip flexor problem. Groin pain often results from the many structures around the hip and pelvis. Whilst you might be tight in your hip flexors, more often pain at the front of the hip is due to hip impingement (a.k.a. ‘FAI’), overload of the pubic bone area or problems at the back of the pelvis at the sacroilliac joint (SIJ).
Probably the most serious cause of groin pain in runners is a stress fracture involving the neck of the femur. It can have disastrous consequences if not managed properly. You might have the beginnings of a stress fracture if:
- You can feel pain in the groin every time your foot strikes the ground
- You have ‘random’ pain which ‘comes and goes’ and seems to move around
- If you are “aware” of your niggle at night time.
It’s really important that you get checked out early, and you may need an MRI scan to do this. X-rays are not sufficient to detect stress fractures.
3. Foot pain
Metatarsal stress fractures are common in runners who present with foot pain, usually with a history of a gradual onset of symptoms that are slow to settle. Pain in the ball area of the foot might also be the result of a neuroma or sesamoiditis (inflammation of two pea sized bones under your big toe).
A neuroma feels like a lancing or knife like pain, between the heads of the metatarsal bones. It occurs when a nerve gets pinched, often between the 3rd and 4th toes, and results in a local swelling and inflammation around the nerve. It is often more common particularly if the arch across the front of your foot is flattening out. Neuromas can be made better with certain taping techniques, some appropriate orthotics from a podiatrist, alterations and gait pattern re-education. Some may even benefit from a cortisone steroid injection by a Sports Physician.
Sesamoiditis feels like an intense pain under the ball of your big toe felt at push off or in pivot sports such as golf. It is easily managed with so simple orthotics or padding to offload the effected area in combination with some load management strategies.
Running with a foot stress fracture (seen mostly in the navicular or head of the 5th toe) can grind you to a halt requiring an extended period of rest and possibly surgery. These injuries often require a period of rest (sometimes in a boot) to allow the bones to settle. Appropriate imaging is needed to get an accurate diagnosis to plan bow best to manage them.
Always seek a proper diagnosis with these symptoms. All may not be lost and seeking advice early is the best bet.
4. Heel pain
Sometimes plantar fasciitis isn’t plantar fasciitis! Sometimes pain in the area of your heel can be a calcaneal stress fracture or nerve irritation. Plantar fasciitis needs a proper biomechanical work up (usually from head to toe as the problem does not start in the foot but merely finishes there). Questions that should be asked include:
- Do you have a stiff ankle or foot, which reduces its ability to re-distribute ground reaction forces, which overloads the plantar fascia?
- Are your foot intrinsic muscles working correctly?
- Do you have a poorly functioning thoracic rotation movement pattern or reduced hip mobility?
- Do you have weak soleus calf muscles, or a tight calf complex?
- Maybe you simply need some different footwear or orthotics?
Shockwave therapy has been shown to be helpful in some resistant/specific cases of plantar fasciitis. Great Physiotherapy work will help you to resolve this more swiftly than you imagine, so don’t push on through the pain. Identifying where your body is failing to load correctly is often the most effective management strategy in the long term.
5. Shin splints
Particularly if these are severe you might actually be running the risk of a tibial stress fracture rather than just overload of the junction between the soft tissue and the bone. It is not uncommon to see patients post-marathon who actually have run (in agony) with a tibial stress fracture, whilst believing that they had simply a ‘bad case’ of shin splints. DON’T be tempted to run through this. It can end in a very, very length rehabilitation process (or even surgery) to fix the bone. Addressing poor foot intrinsic muscle function a control is a great place to start. Stand up and try to bend and flex your big toe in isolation from your other toes while standing... having trouble getting the message across?
Get proper physio advice for this and other intrinsic exercises is a good place to start managing painful shins. They can assess the injury to determine how to best manage such problems. If there is any doubt, they can then recommend you seek the specialist attention of a Sports Physician early on who can get appropriate imaging and blood tests to determine if there is an underlying cause.
All of these conditions, if given early attention, can typically be resolved swiftly and conclusively. So don’t grit your teeth and jog-on with pain. Get it sorted!
Note: This article was adapted with approval from a previous version written by Dr Cath Spencer-Smith - an Exercise and Sports Medicine Doctor based in London UK (more about Cath at http://www.sportdoclondon.co.uk/ )