Running injuries fall into two major categories; acute and overuse.

1) Acute injury
Patient can usually recall the precise time at which the injury occurred.
An example is, "rolling" the ankle, resulting in a sprain.

Acute injury occurs when the force applied to skin, joint, muscle, ligament, or tendon, is
beyond the anatomic limits of that tissue.  

The pain of an acute injury is from tissue damage, bleeding, and inflammation.

                            The hallmark signs of inflammation are:
                                         Redness
                                         Swelling
                                         Heat
                                         Pain
                                         Loss of function

2) Repetitive strain (overuse) injury
**MOST COMMON**
An example is plantar fasciitis.

Overuse injuries occur when the repetitive trauma/stress to soft tissue or bone occurs
at a greater rate then healing.

The, "Terrible toos" are usually to blame:
 Too much
 Too fast
 Too soon
 Too often
 Too little attention to pain

Stages of repetitive strain injury:

  I.        Pain at beginning of run, goes away once warmed up.

 II.       Pain before run, goes away during run, may hurt following the run.

 III.      Pain felt throughout the run, altering gait and limiting run time.

 IV.     Pain during normal activities of daily living (Walking, stairs, etc.)

  The below information will focus on repetitive strain injuries.

Intrinsic factors- have to do with features of individual body type and anatomy
                                  
                                 Foot structure
                                         ex) overpronation or supination
                                
                                 Muscle imbalance or pronounced leg length discrepency
                                          ex) weak hip muscles, tight adductors
                                        
                                 Muscle flexibility
                                           ex) tight hamstrings, calves, adductors, or hip flexors
                                
                                 Previous injury
                                            ex) instability, scar tissue

                                 Bone density
                                             ex) susceptibility to stress fractures


 Extrinsic factors- modifiable factors, usually pertaining to training
                                  
                                 Poor footwear
                                         ex) worn heel, worn treads, decreased shock absorption

                                 Training errors
                                         ex) too much, too soon

                                 Improper warm up
                                         ex) lack of a dynamic stretching routine

                                 Surface/inclination
                                         ex) road pitch, hills when not ready

                                 Weight
                                           ex) more body weight = greater joint and soft tissue stress

I. Control pain and inflammation
Rest -- Ice -- Compression -- Elevation -- Rehab

Rest- With the exception of fractures and significant soft tissue trauma, injuries rarely need
absolute rest. Relative rest means that one should carry on with normal activities and exercises that do
not provoke symptoms.

 Ice helps control inflammation and is analgesic.

 Compression helps control swelling and pain.

 Elevation helps control excess fluid accumulation at the site of injury

Early and appropriate rehabilitation can begin soon after injury.

II. Modify training
 Don't run through pain that changes your form or gait.
See chart below for post-injury return to running suggestions.  

III. Address muscle imbalances
 Not everyone needs the same stretches and strengthening exercises. It is important to receive a
musculoskeletal assessment to determine what needs to be stretched and what needs to be
strengthened.  

IV. Core stabilization training
Core stability gives us the ability to control body position and motion based on strength and function of
the deep muscles of the low back, pelvis, and abdomen. Core stabilization  training allows us to control
body movement and withstand the forces placed on the body  by surface and external forces.
Core stability training is much more complex then performing crunches. A rehab specialist can guide you
through and appropriate routine.

V. Dynamic stretching
Dynamic stretching should be performed AFTER a brief warmup but BEFORE the
activity. The motions used should mimic the activity you are about to perform. Dynamic stretching for
runners includes hip swings, calf raises, spine twists, and skipping.  

VI. Address scar tissue / adhesions/ muscle tension - Active Release Techniques (ART)
Active Release Technique providers are trained to detect and treat soft tissue adhesions common to
repetitive strain injuries. These adhesions are often the culprit in slow or poorly healing injuries.
Most common
running injuries:

Knee pain
   -tendinopathies

Ankle sprains

Achilles / calf pain   

Tibial stress syndrome
   -"shin splints"

Metatarsal pain             

Thigh muscle strain
   hamstring
   quadriceps

Hip / groin pain              

Back pain

Plantar fascia/heel pain
                        Tips on Running Form
- “Run tall”
-Don’t lean back or forward, or twist to the side
-Don’t tense up
-Arms at sides, between waist and chest
-Limit side to side motion
-Breathing- mouth or mouth and nose, deep and regular
-Stride length- don’t overstride
-Uphills- slow up a bit and shorten your stride
-Down hills- careful and slow due to knee strain


ref: Stephen Pribut DPM
                           Post-injury return to run protocol:

-Warm up and stretch before run
-Static stretch after run
-Begin with walking only, up to 30 minutes, 3 x per week
-Begin running with walk-run intervals
-Continue to alternate walks and runs for a few weeks (2-3)
-Keep training sessions to 30 minutes
-10% rule:don't increase your mileage by more then 10% over the previous week
-Don’t run 2 days in a row
-Take 2-3 months to return to former mileage and intensity
-Don't run on uneven surfaces
-Cross train

-If symptoms return, stop. Revisit and address factors that may be
contributing to your injury.