Running injuries often arise when we have underlying skeletal/structural or muscular imbalances. One area of weakness can affect functionality of the next. For example weakness in some of the muscle groups can alter the lower limb alignment and place excess strain along the whole of the lower limb chain (pelvis, hips, knees, ankle and foot), inviting injury.
Another main cause of injury is increasing your speed or distance too quickly.
Often our cardiovascular system adapts to exercise quickly, making us feel we can rapidly increase our training. However, it takes time for the strength in our muscles, tendons and ligaments to develop and if you don’t build up slowly you are not giving your body time to adapt and are therefore at risk of overuse irritation injuries.
If the load we place on a tissue is too much and we continue to do this frequently then the amount of tissue breakdown starts to exceed tissue synthesis. The structure of the tissue then starts to change and becomes less efficient at dealing with load.
Your achilles tendon is a band of connective tissue that runs down the back of the lower leg, from the bottom of the calf down to the heel.
It allows you to stand on your tiptoes and push/propel forwards when walking or running.
Irritation of the achilles tendon can cause pain, swelling and stiffness at the back of your ankle. The tendon is usually sore if you squeeze it and you may feel a thickening of the tendon too.
Runners usually describe a gradual onset of pain in the Achilles tendon during or after a run. The pain can become more frequent and can start to be a problem on a daily basis, not just when running.
Your plantar fascia is a band of connective tissue on the sole of the foot running from the heel bone to the toes. Its function is to support the arch of the foot and act as a shock absorber. It also assists in walking/running by acting like a spring to store energy and provide propulsion during the toe-off stage.
Pain is often experienced at the front or centre of the heel, especially with the first couple of weight-bearing steps, when standing for long periods or after increased levels of activity. Like achilles tendinopathy, gradually the pain can become more frequent, experienced along the arch and sole of the foot, occurring on a daily basis.
How would I treat them?
- Rest and ice
Rest from any form of exercise that involves running for 2 weeks, but you are fine to continue with other forms of exercise like strength/weight training. Plenty of rest will allow time for the body to heal without re-irritating the injury again. Ice is also important to ease the pain, decrease any swelling and reduce the inflammation.
Massage techniques to the calf, front of the leg and sole of the foot will reduce any muscle tension and encourage blood flow to the area to promote tissue healing.
Examination of the alignment and movement of the foot, ankle, knee, hip, pelvis and lower back will identify any areas of structural imbalance. Stretches, mobilisations and manipulations to the relevant areas will improve flexibility and quality of movement, reducing strain along the lower limb chain.
Checking for leg-length difference is also important. The majority of people will have one leg slightly longer than the other which can be caused by imbalances of the pelvis and hips. Soft tissue massage, muscle energy techniques and mobilisations/manipulations can help this.
Medical acupuncture is a great complementary treatment to osteopathy. Acupuncutre needles can be placed at or very close to the sight of pain and inflammation resulting in increased blood flow and oxygen to the area.
Acupuncture can also help to relieve pain via the stimulation of sensory nerves, which results in the brain and nervous system producing pain-relieving chemicals, such as endorphins.
- Rehabilitation Programme
All programmes are personalised to each individual but this is a rough guideline of what will be included.
Due to the repetitive motion of running muscular imbalances are common.
Running relies heavily on the hamstrings, quads and calves, which can result in overpowering of other muscle groups including the glutes, back, core and shin muscles.
A rehabilitation programme will begin with stretching the overworked muscles. For plantar fasciitis and achilles tendinopathy stretching the calf muscles is particularly important.
For plantar fasciitis a useful exercise is to roll your foot over a tennis ball or frozen bottle of water.
Strengthening the weaker areas will rebalance your muscle groups and keep them working in complementary fashion.
Strong gluteal (buttock) muscles are incredibly important for lower limb alignment and the forces placed through the foot, ankle knee and hips. Strong glutes also provide stabilisation of the pelvis. When the pelvis is supported and stable your gait and stride become more balanced, reducing stress on the plantar fascia and Achilles tendon.
Your core, comprised of the abdominal and lower back muscles, acts as a dynamic corset in order to maintain control of the trunk. A strong core is important for posture and also running efficiency as the upper and lower limbs have been shown to function better when they have a stable base to operate from.
Incorporating a HIIT (high intensity interval training) to your regime is great for all over body strengthening.
For examples of strengthening exercises for each muscle group please get in contact.
- Kinesio Taping
Kinesio tape can be applied to the achilles tendon and plantar fascia to provide support. Kinesio tape can also encourage blood flow towards the injured area as well as assisting lymphatic drainage. The lifting motion of the tape creates a space between the top layer of skin and the underlying tissues, encouraging fluid flow and accelerating the healing process.
When buying a pair of trainers I would suggest going to a sports shop where they analyse your running gait. This ensures you are getting the right support for your feet particularly if you over-pronate (feet roll in with low arches).
Orthotics are another option, however, I would try the previous steps first and then move on to the orthotics if indicated.
These are just some examples of what I can do to help treat achilles tendinopathy and plantar fasciitis. The specifics of your treatment plan are particular to your pain, level of activity and overall health and individual tailored advice is always given.
So if you’re suffering from a running injury get in touch for advice or why not book in for an appointment today!