With a number of our clients participating in The Melbourne Marathon Festival our thoughts at The Melbourne Sports Medicine Centre turn to the underlying causes of running related injuries.
Amongst others, common running related injuries include patella femoral pain, achilles tendinopathy, “shin splints”, iliotibial band friction syndrome, foot derived pain and muscle strains. Recent research thoroughly examined the risk factors for running injuries grouping them into three categories-
1) personal (age, sex, height, genetic imprinting),
2) running/ training (weekly running days, distance, running shoes)
3) health and lifestyle (smoking, related illness, previous injury)
There was strong evidence that clearest and most consistent risk factor for developing a new injury was for runners to have previously experienced another running injury. Hence previously injured runners are more vulnerable to subsequent injury. It follows that we need to ask the question of whether or not this has to necessarily be the case or not? Perhaps runners are returning to training and competition without fully recovering from their injuries creating a situation where they will either suffer a recurrence or sustain a new injury.
It’s important to consider that after injury there is the potential for secondary inhibition of lower limb muscles – in particular the calf and hamstring. For instance, it has been established that after knee injury and muscle strain there is often a lessened ability of the muscles to produce high levels of force. This is occurs particularly when the relevant muscle is lengthened. It is this type of secondary effect of previous injury that should be addressed in a tailored rehabilitation program in order to fully recover from previous injury which potentially can reduce the risk of subsequent injury.
Similarly, post injury rehabilitation should be specific to the diagnosed injury and functional deficits of the individual runner. For instance, with regards to calf injuries it is relevant to identify whether the superficial gastrocnemius or the deeper soleus and/or plantaris are involved. This type of specific diagnosis can help focus the exercise program on the appropriate length /tension relationships. As the soleus has an enhanced endurance component, this specific diagnosis can help guide and the emphasis of endurance work in the exercise program. Also the return to running programs will differ based on the specific nature of the calf injury. Rehabilitation specificity is the key and using generic rehabilitation plans can be a recipe for further injury down the track as they can leave outstanding issues not fully resolved.
At the end of the day the ”take home” message from the research is that running injuries have many and varied causes and that efforts to prevent injury should focus on runners with a history of running injuries by providing customized training along with specific exercises and treatment.
This article was prepared by Simon Nelson, Physiotherapist at the Melbourne Sports Medicine Centre.