Do you like to run for your exercise? Running is one of the most popular and simplest exercises to help you stay fit and to tackle those health goals that you want to achieve. Running can also be an easy way to acquire an injury to your legs and body due to its repetitive nature. With this type of exercise you are burning tons of calories, increasing your leg strength and tone, allowing your body to become more in-tune with itself, and it also increases your lung capacity. However even with these added benefits to your body, there can be some other issues that arise that will hinder your ability to run as much as you would like.
When looking at different styles of running, distance people run, length of time spent running daily or weekly, and the sports clothes and shoes people wear, can give you an idea of what type of injury you may acquire. Some people will state that running will allow them to take around 200 strides or steps for every minute they are running. With each step or stride when running you are creating an impact with your feet to the ground. This impact creates more force that has turns into energy going through your feet, into the ankles, up through your shin, around to the calves and transmits this force into the knee and hip. This additional energy that is created from running has to be taken into the joints of the body and creates movement with each muscle that is used from the feet up into the legs, hips, abdomen and lower back. After time running with good or bad running posture, these impacts that are occurring will inevitably cause your body some sort of pain. With running on average of about 100 hours, you will inevitably have 1 running injury. Some don’t realize that when you are running it isn’t just about exercising your legs, this is a full body workout from your legs moving you down the path, your hips supporting your leg movement, the core muscles of your stomach and back have to create good posture to support the pace your running, the lungs have to be able to keep up the increase in blood flow and oxygenation of your body and muscles, up to the arms that are pumping in an alternating pattern, and ends with your neck muscles that control your head with the impact of running on any surface.
With running being a full body exercise, lets talk first about why most people get pain in the feet, legs, and hips. Looking at your feet, there is more than meets the eye, as there are 26 bones in each foot and this adds up to about 25% of the bones in your entire body. Attaching to each of these bones are ligaments, tendons, muscles, and fascia. When one of these bones are out of place due to the constant impact with running, it can put additional pressure and stress on the muscles, ligaments, tendons and fascia which can cause you pain and tenderness. Most people when they run the first thing that may start to feel in the foot is some sore of plantar fascia pain, as this is a connective tissue on the bottom of your foot that connects the heel to the base of the toes. When running there will be tenderness and pain in the bottom of the foot closer to the heel, and when this occurs people usually run different because of the pain. Running in a different pattern than you body is used to can create additional stress and strain on the other parts of your legs and hips. If you are having this type of pain, first look at the arch of your feet, are they flat or do you have an arch? If you have more of a flat foot then you would need to seek out some sort of arch support, this will give your foot that additional cushion that is needed when running on any surface. Another way to help break up the tension in the foot is get a golf ball and put it on the floor, while sitting in a chair put the arch of the foot on top of the golf ball and slowly roll your foot front and back over the golf ball, and you can increase pressure if you like. This will create pain in the foot, but it also breaks up the tension in the plantar fascia. Do this for about 5-10 minutes, and when you are done you will need to ice the arch of your foot. The way to ice your arch of the foot is to put a plastic water bottle full of water in the freezer, and when your done with this golf ball exercise, pull the water bottle out of the freezer when its frozen, lay it on the ground where you can just roll your arch over the water bottle just as you did the golf ball. This will calm down some of the muscles, and tendons on the bottom of your foot, and cool down any unwanted inflammation.
Going up to the ankle is the next problem area for most people who are avid runners or just running in general. The ankle can give people problems just from walking down the street and stepping into a hole, to running on an awkward surface and twisting one’s ankle. Most of the time when your roll or tweak the ankle it will happen where your foot will roll to the inside, and this will create a stretch or strain of the outer ankle ligaments and tendons. When this occurs there can be inflammation immediately to the outside of the ankle to help support what just occurred, due to the fact that the outer ankle ligaments and tendons are smaller and weaker than the inner ankle tendon and ligaments. There is more to just the ankle pain when this occurs, as the fibula (which is the small bone on the outside of the leg) has been pushed down into the outside of the ankle and this can cause a high ankle sprain. This high ankle sprain can take longer to heal, as it involves more tendons, ligaments and muscles compared to just tweaking or rolling your ankle. The treatment of choice for an ankle sprain is rest, ice the ankle for 20 minutes on and 2 hours off during the daytime, compress the ankle to help with suppressing the inflammation, and elevating the ankle above the heart to allow the inflammation to subside due to gravity. After icing the ankle it would be good to increase movement with just the ankle without putting additional weight on the foot. The exercise that will help the increase blood flow and motion is to write the ABC’s in the air with the foot that is injured. Raise your foot off the ground while sitting and then write ‘in the air’ the ABC’s with that ankle. This motion will increase blood flow to the region, increase motion within the little ligaments, tendons and muscles of that foot, and this will also decrease the amount of time that it takes for your ankle to fully heal.
Next we start to go up into the lower leg to the shins. When running some people run heel to toe, some people run flat footed, and other run on the balls of their feet. When you are getting pain in the shins it could be from the way your feet are moving, foot arch’s that are flat, bad pair of running shoes that offer no support, muscles are weaker than normal, running on awkward surfaces that are not even or solid, and poor mechanics during the run. Shin splints are very painful and the pain is just above the ankle on the front of the leg and can be on the inside or the outside of the lower leg. If these shin splints continue to give you pain, and you still run with the same running style that created the shin splints, they could turn into something bigger and become a stress fracture. Stress fractures are tiny micro-fractures in the lower leg bones, around the same area that shin splints give you pain. This stress fracture is a result of overuse of the lower leg bone with increased intensity or distance that you are running. The only real intervention for stress fractures is to stop running for a while, as the fracture needs to heal and it just takes time for bones to heal. If you suspect that you have a stress fracture, you will need to get an X-ray, but you may not see this on an X-ray as stress fractures are very small and it may take weeks to show up visibly on an X-ray. The other tests you can do to rule in or rule out a stress fracture is to get a Bone Scan or MRI, as these will be more in-depth of an X-ray and will be able to determine if there is a fracture or not. To help out with shin splints the thing to do is ice the shin, and there is an easy way to provide friction icing to help increase recovery time. Take a small paper cup, like a little Dixie cup, fill it three quarters the way up with water and put it in the freezer. After you run, and when you are cooling down, pull out the cup from the freezer and tear off the top of the Dixie cup where you can grab the bottom of the cup with your hand and the top of the ice in the cup is exposed. Once exposed sit down on the ground and rub the ice up and down the shin where the pain is. This will allow for any inflammation and deep pain to slowly calm down and cool off. You should rub the ice up and down for about 10-15 minutes after you cool down.
Going up the leg continues to the knees, where most runners get some sore of pain or tenderness during or after their run. Knee pain is one of the most common injuries from running that you can acquire, due to the repetitive nature of this type of sport and exercise. With running being a forward motion, there are different muscle groups in the legs that get overused and overdeveloped compared to smaller muscle groups. With this type of overuse on some of the leg muscles there can be common syndromes that will be more prevalent among runners. Inner knee pain can be one of the Most Common and painful injures that can occur while running. Mostly this pain on the inner knee is caused by an over pronation of your feet, putting additional pressure and stress on the inner part of the knee joint, ligaments and tendons. When you have additional pressure on the inner part of the knee joint, the MCL is the ligament that takes the brunt of the pressure and stress, along with the medial cartilage and the meniscus.
The next Most Common knee pain from running is outer knee pain. When you have pain in the outside of the knee joint, this is caused from your running style with having an over supination with the foot. This causes additional stress and strain on the outside of the joint, ligaments and tendons, and puts more pressure on the LCL, lateral cartilage and the meniscus. With your running style either being more of a over pronation or over supination, there is a lot more pressure, strain, and stress on the inside and outside part of the knee joint. This additional stress can lead you down the path of an MCL or LCL partial tear or complete tear, potential arthritis in the joint (which is inflammation inside of the joint created more pressure and strain from the inside), and eventually you could end up with a tear of your meniscus, which is the disc part of your knee that takes on the shock absorption when walking, jogging, running, and standing. A quick and easy assessment that you can do to see if your knees and legs have more of a chance to get knee pain, you can do one simple visualization and exam. When looking at your knee, just below the kneecap is your leg bone called the Tibia, and right below the knee joint you have a Bump that is called your Tibial Tuberosity. Put your finger on this bump, which your palm on your knee, and this bump should be in the center of the knee. Most of the time, as a chiropractor assessing the knees, I find that people have some sort of external rotation of the tibia, and with this external rotation of the tibia, puts additional pressure on the knee joint itself. This can create multiple problems, because now with this external rotation the alignment is off, and when walking, jogging or running the way that your knee joint connects with the Tibia is not a fluid contact. The external rotation puts additional stress and compression on the knee joint when the femur connects and pounds against the tibia, there is additional stress placed on the ligaments, tendons and muscles that have to reposition themselves to allow proper movement of the knee. This reposition of the ligaments and tendons is more stress related, because now they have to stretch (which tendons and ligaments don’t really stretch compared to muscles) and this is what causes the pain in the MCL, LCL, lateral and medial meniscus. The only way this can be fixed or helped out is by seeing a chiropractor to start to rotate the tibia back into its normal position. This allows your knee joint and tibia to regain its normal motion and compression, which alleviates the additional stress put upon the ligaments, tendons and muscles.
Moving up past the knee you start to have tension and soreness with the Iliotibial Band (IT Band). This ligament is a broad ligament that attaches from the outside of the ilium (the hip bone), and continues down on the outside of the leg and becomes a round ligament, passes around the knee joint and attaches on the outside part of the tibia. The IT Band pain occurs when your leg muscles, tendons and ligaments are tighter than normal, and creates additional tension and strain on the hip bones and the knee joint. When this IT Band isn’t working like it should, the knee movement will not work like it is supposed to and it becomes painful to walk or run. The symptoms that you will get are pain and swelling on the outside of the knee. To determine if you have an IT Band problem or a knee problem, what you can do is bend the knee that is in pain to a 45 degree position, and if there is pain on the outside of the knee only then you have a problem with your IT Band. This IT Band Syndrome can be caused by wearing shoes that are worn out, running on surfaces that are banked and not flat, running downhill to much, or just running more than your fare share of workouts on the track going the same direction. Things that you can do to help this problem from occurring more frequently, is look at your shoe wear and tear on the bottom of the outside sole and replace the shoes if its worn down differently from the other shoe. Next thing would be to run on a flat surface, run on a surface that is NOT concrete or too hard. If you like to run around a track, make sure to change your directions so you are not just running around the same circle putting pressure on the same knee and IT Band, which will lead you to overuse of that ligament. One thing that you could purchase that will help you stretch the IT Band is a massage bar. This massage bar will have a handle on each side, it will have some sort of rollers along the bar, and it will be a little flexible when putting pressure in the middle of the bar. When you have this massage bar, you will be able to roll it up and down the outside of the leg, massaging and stretching the IT Band and other muscles around this IT Band, and this will allow you to alleviate stress and tension that has built up in the leg. After running or using the massage bar, you will need to ice the ligament, as it will be inflamed. You will need to put a small paper cup filled with water in the freezer, and once it frozen take it out of the freezer, peel off the top third of the cup, so the bottom of the cup you can use as a handle, and rub the ice up and down the outside of the leg for 10-15 minutes, as this will help alleviate any unwanted inflammation and pain.
Once we get past the legs, we move up to the hips where all of the motion your legs are putting into action comes from. When looking at the hips, you want to make sure they are level, not getting stuck in a position that could be creating the appearance of a shorter leg. When your hips are un-level or not working properly, this gives you a non-normal walking and running style with your gait. When the hips are not moving correctly or just out of place, this puts additional strain on the hip joints, which creates more of a hitch when running or walking. This hitch in your step creates stress, which will lead to pain in the lower back region, hip joint, IT Band, knees and feet. With the appearance of a longer leg, this will also put additional strain on the hamstring of the longer leg, which this can lead you down the path of more hamstring strains or pulls. Also with having your hips not working properly, this causes your lower back and spine to have more stress related problems. When your lower back and spine start having pain, this means there is additional stress and strain on the ligaments, tendons, muscles, and the nerves that exit out of the lower spine. If the strain is on the nerves exiting out of the lower spine, you will start to get some type of pain, tingling or numbness in the lower back, hips, and potentially down the leg giving you the impression that you have a sciatic type of pain. One way to help this scenario of your hips not moving correctly is seek out a chiropractor for help with your hip alignment. As a Chiropractor in Bellevue, WA, I would first evaluate your hips and sacrum for proper alignment, making sure they are moving correctly, then I would asses the lower part of the spine to assure proper mechanics and structure are in alignment for correct motion. As a chiropractor, I take a deeper look into the way the structure is put together with the spine, hips, and legs, so that when you are running there aren’t any misalignments in the structure and the way your body moves to give you that additional stress and strain, which inevitably leads you down the path of having some sort of pain when you run.
There are some things with how you warm up your body and legs before you run that will help lessen your chances of getting some sort of pain when you run. First ask yourself, how do I warm up before running, or do I warm up my legs before running? When you are starting to get ready for your run, first you should start out walking or do a lighter jog, as this will warm up your muscles by increasing the blood flow to your muscles getting them ready for a workout. Next after the walking or light jog, if you find some tender spots or tightness, you should give yourself a light pinpoint massage on the areas that are sore or tight with short light strokes. You don’t want to give yourself a deep tissue massage, as this may irritate all of the surrounding muscles before you set out on your run. After the self-massage, you will need to start your body moving in more of a dynamic warm up routine rather than a static stretching routine. Below are some dynamic stretches that will get your routine warmed up correctly for your running workout:
- Hip Circles – Just stand up straight with your legs as wide as your hips, put your hands on your hips and then just rotate your hips in a circle motion. First the circles should be in a clockwise position for at least 10 rotations, and then switch it up and go counter-clockwise for at least 10 rotations.
- Walking Lunges – This is basically a slow walking long stride, where your knee is just over your foot when you step forward, allowing your back leg to drop to the ground and almost touch your back leg knee on the ground. Then when your back knee has almost touched the ground, continue walking with the other leg and step out in front, just as the first step occurred and repeat for 10 steps or lunges on each leg.
- Butt Kicks – You can do this exercise either slow or a little quicker depending on your flexibility. First walk forward while you slowly kick your heels into your buttocks and then continue this with each ankle hitting your buttocks 10 times for a total number of 20 kicks.
- Walking like a Monster – Standing tall, walk forward and lift the lead leg up very straight in front of you like a board with your toes pointed to the sky, and you will do this 10 times with each leg, taking a total number of 20 strides.
- Leg Swings – Get somewhere you can hold onto something, and when standing next to it you can swing one of your legs forward and back (like your kicking something) for a total number of 10 leg swings, and then repeat on the other leg for a total number of 10 leg swings forward and back. Next turn and face the object your are holding onto and lift one of your legs up to the side and swing it left and right across your body for a total of 10 cross leg swings, and then repeat with the other leg for a total of 10 cross leg swings.
- Twisting your Hips and Thoracic Region – Stand in place, raise your arms to chest level where you put your fists facing each other and your elbows are bent and parallel to the ground. Then all you do is slowly and gently twist your torso, hips, and upper body left and right, do this for a total of 10 twists, as this will activate the rib cage, getting it ready for movement while running.
At PrimeSpine, we understand injuries while running and doing other types of sports that require running and stress on the body. We can help you understand why you may be having some sort of pain when you run, help prevent these aches and pains from recurring, and give you your life back one free of pain and limitation! Call us Today at (425) 590-9619, and let PrimeSpine in Bellevue, WA assist you on your way to get your running back to where you want it to be.
By: Dr. Jason Matthews
