Rajat Chauhan, Elemention’s running expert columninst, is an ultra marathon runner and a doctor specializing in sports and exercise medicine and musculoskeletal medicine, and founder of Back 2 Fitness. He is also associate editor, British Journal of Sports Medicine, and a Mint columnist.
Madhav Kumar twisted his right knee a few weeks before he was supposed to join the Indian Army’s Officers Training Academy in Chennai. For the 24-year-old fitness buff, this was a big blow—he had wanted to join the army for as long as he could remember. A scan revealed a tear in the medial meniscus, a cartilage that stabilizes the knee joint, reduces friction during movement, and absorbs impact. The knee was swollen, painful and stiff. A surgery was recommended, but that would prevent Kumar from joining the programme—in a month’s time he was expected to run 2.5km in 9 minutes, followed by 25km cross-country race that has to be done in under 3 hours.
Was there a way out for Kumar? Yes—three weeks of intense physical therapy not just to rehabilitate the knee, but also to correct other muscular imbalances in the body, and learn a running technique that would put less pressure on the knees. Kumar was sceptical at first, but gave in since this seemed like the best option. In two weeks, he was almost on his way to recovering to full fitness. The last week was spent on running technique, on reducing his stride length without affecting the speed. At the end of the month, Kumar passed the physical examination and joined the academy.
While runners are susceptible to a variety of injuries, and managing and preventing these is an obsession with serious runners, too many people are ignorant about the real reasons why injuries take place, or what to do to prevent them.
Simply put, the body is a series of segments composed of muscles, bones, ligaments and other tissue that form a complex motor unit. When you run, each of these segments has to play its respective part—some muscles contract and relax in coordinated wave-like patterns, others are required to generate opposing forces. For example, when your foot hits the ground as you run, the muscles of the hip, glutes, quadriceps (or quads), hamstring, calves, feet, and core perform a highly coordinated and interconnected movement to produce force. If any one muscle in this sequence is not functioning properly—is stiff, or not strong enough—some other part will have to compensate, and this muscle imbalance is what causes the majority of running injuries. Most hamstring injuries are caused by stiff calf muscles, tight hip flexors, or weak glutes—not because there is something wrong with the hamstring itself.
There are other common causes for running injuries as well. Overtraining, or increasing the weekly running distance or time by more than 10% is a sure invitation to injury. Not doing any strength-training or not following a stretching protocol is an obvious one. A rapid transition to barefoot or minimalist running can put unnatural stress on your joints.
Here’s the essential low-down on the most common running injuries.
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Symptoms: Pain in the lower back. May or may not radiate down the leg.
Myth: Running causes disc bulge, which causes back pain. If you have back pain you should not run again.
Fact: A light run on an even, soft surface like grass is therapeutic for most back pains. The majority of back problems are caused by poor posture and weak muscles leading to muscle strains, not disc bulges. A good strengthening and stretching programme will address most backaches.
Symptoms: Pain radiating down the back of the leg.
Myth: Tightening of piriformis muscle, a pear-shaped muscle in the buttock region, just over the sciatic nerve, is the primary cause.
Fact: Muscle imbalances, poor posture and too much sitting lead to piriformis injuries. A strengthening and stretching regimen that focuses on the entire lower body prevents piriformis syndrome.
Symptoms: Pain in the back of the thigh.
Myth: Improper warm-up or no warm-up or tight hamstrings cause it.
Fact: Stiff or weak glutes or calves are often responsible for hamstring strains. Again, the issue of overall muscle imbalance has to be addressed, and the posture needs to be corrected always.
Symptoms: Sharp pain in the middle of the lower leg, sometimes accompanied by a popping sound.
Myth: The sole cause is tight calf muscles, so calf stretches will prevent it.
Fact: Lack of proper mobility or stiffness of the ankle and foot, running gait and muscle imbalances are major causes. Sudden shift to barefoot and minimalist running is a big cause too.
Symptoms: Pain where calf muscle attaches to the heel bone.
Myth: Chronic overuse of the foot is the cause.
Fact: Muscle imbalance like weak or stiff calf muscles, improper footwear and wrong running techniques also contribute to it. All these need to be addressed.
Symptoms: Pain in the heel usually first thing in the morning.
Myth: A heel spur, or excessive calcium deposits on the bottom of the heel bone due to chronic stress in the region is the only reason.
Fact: Heel spurs have been shown not to be associated with this injury, although many people who have plantar fasciitis can have heel spurs. Rapid transition to barefoot or minimalist running can cause it. So can a sudden increase in running on concrete or asphalt, or ill-fitting shoes. Stiff calves, quads, glutes or hamstrings contribute too, so keep those limber.
Symptoms: Pain in the shins while running, or even while walking or resting.
Myth: Stress fracture due to overuse is the primary reason.
Fact:Vitamin D deficiency, or rapidly increasing the volume of training can cause it. Muscle imbalances in both lower and upper body are major causes. Always follow the rule of 10%—increase mileage by only 10% every week. Only increase one thing at a time, time on feet (i.e., time spent walking or running), distance or speed. It’s always advisable to first focus on time on feet, without bothering too much about distance or speed.
Symptoms: Pain under and around the kneecap (patella).
Myth: It’s the beginning of knee arthritis and running will make it worse.
Fact: Caused by muscle imbalances. For example, if the glutes don’t activate properly, the hamstrings will compensate by being hyperactive, and this will lead to knee pain. Poor running technique and weak core muscles are major causes. Strengthening and stretching the muscles that surround the knees will fix this.
Iliotibial band (ITB) syndrome
Symptoms: Pain in the outside of the knee or the thigh.
Myth: Easily confused with knee pain. Stretching the ITB is often advised as the only therapy.
Fact: A tight ITB is only a secondary effect of muscle imbalances all over the body, so just stretching the ITB will not solve the problem. On correction of muscle imbalances, there is relief from ITB syndrome.
Dr. Rajat Chauhan