If you’re a runner, chances are you know a thing or two about pain. Whether it’s the pain of overtraining, the pain of a nagging injury, or the pain of missing a personal record (PR) by a few seconds, one thing is for sure: Regardless of its origin — your body, your soul, or you ego — it all hurts. The comforting news? You’re not alone. With running being the second most popular form of exercise in the world after walking, it’s no surprise that the prevalence of running injuries in the United States is between 19 and 79 percent. That’s a lot of people running around with some degree of “ouch” in their step!
While earning my Doctorate in Physical Therapy degree, a professor once told me, “Pain is a privilege.” While it may not always feel like it, pain is our body’s way of telling us that something isn’t right. Not everyone has the privilege of feeling this built-in warning system, so for those of us who are lucky enough to get the uncomfortable signals that something is wrong, I’d love to help you translate the message.
Despite all of us being unique snowflakes with our own imperfect biomechanics, here is a list of five common running pains that unite us, and how to avoid them. Because, let’s face it: being hurt can be… uhhh… a pain.
(Editor's note: These are very general guidelines. If you are in enough pain that it is affecting your daily life, or even just your running, go to a doctor or a physical therapist to get a full, more accurate, and more complete examination and diagnosis.)
1. Muscle Tightness
The pain: An achy and/or tight feeling anywhere along the muscle. It can feel like one part of your body is being pulled more on one side of your body, or like your alignment is slightly "off."
Why it’s happening: When muscles are tight, they are shortened, which means they are tugging more than they should on one of their attachment sites, such as the bones of the hip or the knee. This pull at the bone causes a slight change in alignment of the joints that, with constant repetitive movements, can lead to bigger problems up or down the kinetic chain. Bottom line: if it’s tight, stretch it!
How to avoid it: Stretch! Consider adding some downward dogs to your pre and post workout repertoire. Maybe even schedule a weekly yoga class, or get acquainted with a foam roller — it may just become your new best friend.
2. Patellofemoral Pain Syndrome (PFPS)
The pain: Unspecific, general and achy discomfort and/or irritation around the kneecap. Your pain gets worse with squats, descending stairs, and/or running.
What it is: Also known as “runner’s knee,” this pain is usually the result of muscle imbalances in your quadriceps. The pain occurs when the patella (AKA your kneecap) doesn’t track properly across the knee joint. It may be pulled a little more to the left, right, up or down, or is simply compressed into the joint in such a way that it is causing friction and irritation. Mild irritation, when not addressed, can feel more diffuse and become a generalized pain around the entire knee area —especially when running or going down stairs or a hill.
How to avoid it: Strengthen the quadriceps and hips (specifically, the gluteus medius muscles -- one of the most important "glute" muscles for runners because it helps stabilize your hips when you're standing on one leg (which is basically what happens most of the time when you're running). You can strengthen this special muscle with exercises such as side-lying straight leg raises or clamshells. And be sure to foam roll the heck out of your quads.
3. Plantar Fasciitis (PF)
The Pain: A dull ache, almost bruise-like. A feeling of tightness spreads along the bottom of foot, and you may feel pain at base of heel. Pain and/or stiffness is usually felt with the first few steps in the morning.
What it is: The plantar fascia is a band of fibrous tissue that runs from your heel to your toes. What most people with PF feel is a tightness along the bottom (or plantar surface) of their foot that gets worse with unsupportive shoes and/or long walks or runs. One often feels extra irritation at the heel, where the PF begins. The cardinal sign of PF pain is stiffness first thing in the morning. Note: Plantar fascia and achilles/calf tightness may go hand-in-hand.
How to avoid it: Stretch the calves using slant board or runner's lunge alternating 30- to 60-seconds with bent knees and straight knees to target both the gastrocnemius and soleus muscles (AKA the "calf muscles"), and strengthen the muscles within your foot with towel curls (scrunch a towel using just your toes for a few minutes every day). You can also self-massage by rolling your foot over a tennis or lacrosse ball, and decrease inflammation with an ice massage by freezing a water bottle and rolling your foot over the ice cold bottle. Even if you're not injured, a massage plus ice is the perfect way to end a long, hot run!
4. Shin Splints
The pain: A dull ache in the lower leg, along with extreme sensitivity to touch, pressure, and/or tapping along the line of the shin bone. During activity, you may feel a throbbing deep pain.
What it is: Shin splints occurs when the muscles around the “shin bone” (the tibia) are overused and under-rested, putting abnormal stress at their attachment site along the tibia. Small tears form along the border of the bone, which can cause a lot of pain in the lower leg, made worse with running. Shin splints are often the result of, “too much, too soon.” The dull ache anywhere along the lower leg tends to begin when a runner starts to increase his or her mileage a little too quickly. It can also be the result of weak hips (notice a trend?), tight muscles, or over-pronation of the foot.
How to avoid it: Stretch, stretch, stretch! Make sure those calves are nice and loose, but also make sure to keep them strong (with heel raises, for example). You should also strengthen your hips, make sure you have supportive footwear, and give your body the rest it needs. Shin splints tend to get worse with activity, so be sure to slow down and cut back on the running (temporarily!) before a small annoyance becomes a more chronic problem — or even a stress fracture. And consider buying new shoes -- sometimes, worn down shoes lose their ability to absorb shock, which causes extra stress along the tibia with each stride.
5. Iliotibial Band (ITB)
The pain: An ache in the hip, or bruise-like pain with pressure anywhere along the outer thigh and/or just above the outer knee where the IT band attaches to the femur.
What it is: ITB syndrome occurs when the glutes (specifically the gluteus medius -- remember this special glute muscle from the patellofemoral pain section?) are weak or overused, which causes them to not do their job as well. This puts a strain on the dynamic relationship between the hip and the knee. The gluteus medius is responsible for stabilizing the “stance leg” during gait, lifting the opposite hip, and separating the legs. When it is weak, the knees can end up closer together, which causes a harsher line of pull between the hip and the knee. This angle that is created puts extra strain on the muscles beneath this famous band of fascia, and -- yup, it doesn’t feel so good.
How to avoid it: If there was ever an area to foam roll, it’s the area along the IT band. Stretch the hamstrings and quads while strengthening the glutes, and be sure to wear good, supportive sneakers.
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