Welcome to the second of my summer blogs following on from June’s blog on walking your way to fitness.
For this month’s article I’m going to up the ante a little, from walking to running.

The summer is full of running events, and Bristol, where we’re based, is full of runners jogging on the Downs and in the parks, making the most of our many green open spaces. In fact, Bristol has been named the running capital of the country!
Running is great, but, no surprise, can cause injuries. If you are a novice, make sure you build up slowly, with realistic targets – you can’t get to 10k without reaching 5k first. Suitable, supportive running shoes are vital; as are warming up, cooling down and stretching properly. If you are injured, or feel an old injury re-igniting, it’s important to stop and assess, instead of carrying on, potentially making it worse.
Here is a list of some of the most common (but not exhaustive) running-related injuries and their treatments. Physio is often very beneficial in treating running related conditions and in order to return to running as early as possible early intervention is advisable to prevent a chronic situation developing.

Shin splints
Feels like: Stiffness or pain in your shins
What it is: The strain and leg pain results from strong calves pulling repeatedly on weaker muscles near the shin. The muscles of the shin become larger with exercise and sometimes the sheath that surrounds the muscle does not stretch at the same rate putting pressure on the muscle – usually tibialis anterior – and causing pain. Running on concrete is likely to exacerbate the problem.
What to do about it: Cut back on your running for 3 to 8 weeks, depending on the severity, to give the tissues time to heal. You might need an anti-inflammatory medication, such as ibuprofen, or cold packs to reduce swelling and relieve pain. In the meantime, keep in shape by training with low-impact exercises such as swimming or cycling. You should also strengthen tibialis anterior to help prevent a recurrence, such as lifting your toes up towards your shins 20 times while standing, three times on each leg.
Physio can help to release the tight tissues, guide you with regard to appropriate stretches and acupuncture can help with symptom relief. Orthotics (insoles) are often also helpful to help unload the overactive muscles.

Trochanteric Bursitis
Feels like: Soreness on the outside of your hips
What it is: Although there are many potential causes of hip pain, it’s common for the fluid-filled sacs (bursae) that cushion the muscles on the side of the hips ,to become inflamed with repetitive stress. People with one leg slightly longer than the other may be more susceptible to this condition. Weak gluteal muscles and muscle imbalances around the pelvis can also cause more stress to the area, leading to inflammation and pain. Running without ensuring that you are engaging your gluteals well and without building your distance up slowly can predispose you to this condition.
What to do about it: Instead of running, ride a static bike, swim, or do some other non-weight-bearing activity for a few weeks. Strengthening your gluteals and other core muscles is essential. Start again gradually, building from a fast walk to a short jog before taking off on a 10k! Seek physio advice early to help release the tight overactive muscles which cause friction over the bursa and to show you how to strengthen the correct muscles.

Runner’s knee
Feels like: Throbbing either in front of your kneecap or to the side of or behind the knee.
What it is: Usually a low grade inflammation which is a result of friction between the layers of soft tissues (ligaments, tendons, muscles and fascia). This is often a result of some muscles and ligaments becoming tight – commonly the quadriceps and ilio-tibial band. This can also cause low grade inflammation behind the knee cap due to altered pressure between the knee cap and femur (patello-femoral joint). Runners with weak or imbalanced thigh muscles, weak core muscles or flat feet or high insteps, are at greater risk of runner’s knee. The knee pain may occur when you’re walking downhill, doing knee bends, or during or after sitting for a long period of time.
What to do about it: Reduce or stop running, particularly avoiding hills. Change to another type of exercise such as swimming until the symptoms subside. Seek physiotherapy early, for guidance regarding changing the muscle imbalance around your knee, thighs, calves and feet and to help release tight muscles which are causing the increased friction. Acupuncture can also help to settle symptoms. Orthotics (insoles) may be beneficial if you have particularly flat feet.

Muscle Tears
Feels like: Initially it may feel like cramp which you might try to run through or it may be sudden sharp pain which stops you in your tracks. Commonly the hamstrings (muscles behind the thigh) or gastrocnemius (calf muscle). There may be a warning from the muscle of fatigue prior to either of these sensations but not always. It may also occur with a sudden increase in speed if you’re not warmed up well or again if your muscles are fatiguing.
What it is: Tears occur in the muscle fibres and this needs time to heal.
What to do about it: Rest from running for 6-8 weeks depending on the severity of the tear. Ice x 10 minutes 4-5 times a day for the 1st few days. Taping to protect the muscle from further strain is often helpful. As the tear heals gentle stretching can begin to restore the muscle length and soft tissue release from a physiotherapist will help to ensure good structural healing of the muscle. Later rehab includes strengthening the affected muscle and also other muscles in the area which will have inevitably have weakened due to disuse. Building up and maintaining general  cardio-vascular fitness by swimming will also be helpful for a successful return to running. Initially this may only be confined upper body work to avoid re-injuring the muscle.
Seek Physio input early to help with this programme of rehabilitation.

Achilles Tendonitis
Feels like: Soreness, pain and stiffness in the tendon connecting your calf to your heel.
What it is: It is a tendinopathy which is likely to begin with inflammation around the tendon sheath.
What to do about it: Rest from running until symptoms settle. Ice the tendon for 10 minutes 4-5 times a day in the early days. Use a heel wedge to take the strain off the tendon – especially if you are experiencing symptoms when walking. Taping can also be useful to reduce the load on the tendon.
As symptoms settle it is important to begin a programme of graded stretching and strengthening of the tendon and muscle.Strengthening other muscle groups is also important – strong core muscles and gluteals are important as always to help to relieve the strain on the calf muscles by driving the body forward from the pelvis.
Seek physiotherapy early for guidance regarding appropriate rehab. for you. Soft tissue release, acupuncture and ultrasound can also be helpful to encourage good structural healing of the tissues.

Morton’s Neuroma
Feels like: Pain in the ball of your foot.
What it is: Probably the least common of the conditions here. If tissue surrounding a nerve near the base of the toes thickens, it can cause tingling, numbness, or pain that radiates to surrounding areas. It may feel as though you’re treading on a marble. This condition, known as Morton’s neuroma, usually develops between the base of the third and fourth toes. It’s up to 10 times more common in women than men, possibly because women’s feet are structured differently and because women tend to wear narrow, high shoes or very flat ones with poor support.
What to do about it: Treatment varies from simply wearing roomier shoes to surgery, depending upon the severity of the neuroma. Physio can be helpful in order to assess and address muscle imbalances around the foot and lower limb which can help to relieve the pressure. If problems continue custom made orthotics (insoles) or pads that relieve pressure and absorb shock may be helpful. Make sure that your walking and running shoes have a spacious toe box. Ladies -limit your time in high heels, and if you need to wear them, travel in comfortable shoes and then slip on the more stylish pair later.

Above all remember that given the numbers of people running these days injuries are relatively few and correct footwear and a steady graded running programme will go a long way to keeping you on track and injury free.

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