Tag Archives: Patellofemoral pain Syndrome

Five common running injuries…

Sooner or later, we all seem to deal with an injury, and sometimes they can become prolonged nagging nuisances. The following information was prepared by Chiropractor Dr. Elizabeth Douglas as a resource for runners to better understand some of the common injuries that they may face, how to treat them and more importantly, how to prevent them. Of course, it’s always important to consult your health professional of choice when making decisions about your body and any potential injuries you may have. There are many opinions on running injuries and the following is presented for informational purposes only.

[picapp align=”left” wrap=”true” link=”term=stretching&iid=5068665″ src=”8/0/8/4/Woman_in_running_c6ec.jpg?adImageId=10205690&imageId=5068665″ width=”234″ height=”299″ /]1. Achilles tendonitis: Inflammation of the Achilles tendon — a large tendon connecting the two major calf muscles (the gastrocnemius and soleus muscles) to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard causing it to become inflamed. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Symptoms: Dull or sharp pain anywhere along the back of the tendon, usually close to the heel. Limited ankle flexibility, redness or heat over the painful area.


  • Tight or fatigued calf muscles (due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed work).
  • Inflexible running shoes.
  • Runners who over-pronate (feet rotate too far inward on impact).

Preventative measures:

  • Stretching of the gastrocnemius (keep knee straight) and soleus (keep knee bent) muscles.
  • Correct shoes should be worn — specifically motion-control shoes and orthotics to correct over-pronation.
  • Gradual progression of training program.
  • Avoid excessive hill training.
  • Incorporate rest into training program.
  • Address muscular imbalances early with the help of a health professional.

2. Iliotibial Band Syndrome: Pain and inflammation located on the outside of the knee due to continual rubbing of the band over part of the femur (thigh bone). The rubbing occurs during the bending and straightening motion of the knee and can result in irritation. Initially, a dull ache on the outside of the knee one to two kilometers into a run, with pain remaining for the duration of the run. The pain disappears soon after stopping running, later, severe sharp pain that prevents running. The pain is generally worse when running down hills, or sloped surfaces and may be present when walking up or down stairs. Iliotibial Band Syndrome can be the result of poor training habits, equipment and/or anatomical abnormalities.

Training habits:

  • Running on a banked surface.
  • Inadequate warm-up or cool-down.
  • Increasing distance too quickly or excessive downhill running.
  • Worn out shoes.
  • Over striding.

Abnormalities in leg/feet anatomy:

  • High or low arches.
  • Over-pronation of the foot.
  • Wide hips.
  • Uneven leg length.
  • Bowlegs or tightness about the iliotibial band.

Muscle Imbalance:

  • Weak hip abductor muscles.
  • Limited ankle flexion.


  • Change running shoes every 500 to 800 kilometres (300 to 500 miles), or every three to four months, when they have lost approximately 40 to 60 percent of their shock absorbing abilities. High mileage runners should have two pairs of shoes to alternate between, to allow 24 hours for the shock absorbing material to return to its optimal form. Do not underestimate the importance of good shoes in the prevention of many types of injuries. It’s worth the cost in the long run. Always slowly increase running mileage and if adding hills, do so gradually. Downhill running especially increases friction on the IT band as well as fatiguing the quadriceps, which are the main stabilizers of the knee.
  • Avoid training on uneven surfaces, as the down leg may be predisposed to ITBS.
  • After a run, cool down and stretch; ice if necessary.
  • Foam rollers can help keep the tissue mobile.
  • Strengthen stabilizers of your iliotibial band. Seek a health specialist for individual assessment of muscular imbalances.

The prognosis is generally good with appropriate treatment and correction of precipitating factors.

[picapp align=”right” wrap=”true” link=”term=knee+injury&iid=5245099″ src=”b/8/1/2/closeup_of_a_f15b.jpg?adImageId=10205344&imageId=5245099″ width=”234″ height=”234″ /]3. Patello-femoral Pain Syndome (PFPS): Patello-femoral Pain Syndrom is a degenerative condition of the cartilage surface of the back of the knee cap, or patella. It procues discomfort or dull pain around or behind the patella. It is common in young adults, especially soccer players, cyclists, rowers, tennis players and runners. The condition may result from acute injury to the patella or from chronic friction between the patella and the groove in the femur through which is passes during motion of the knee.


  • Pain beneath or on the sides of the kneecap.
  • Crepitus (grinding noise), as the rough cartilage rubs against cartilage when the knee is flexed.
  • Pain is most sever after hill running.
  • Swelling of the knee.


  • Muscular imbalances — weakness of the quadriceps (specifically VMO), tight ITB, tight hamstrings, weak or tight hip muscles, tight calf muscles.
  • Over-pronation/over-supination.
  • Wide hips.

Preventative measures:

  • Stretching of the quadriceps, hamstring, ITB and gluteal muscles. Remember to stretch well before running, strengthening of the quadriceps, hamstring and calf muscles.
  • Correct shoes.
  • Orthotics to correct over-pronation.
  • Avoid excessive downhill running and cambered roads (stay on the flattest part of the road).
  • Gradual progression of training program.
  • Incorporate rest into training program.
  • Address muscular imbalances early with the help of a health professional.

4. Shin splints (medial tibial stress syndrome): The term “shin splints” refers to pain along the shinbone (tibia) — the largest bon in the front of your lower leg. The pain is the result of an overload on the shinbone and the connective tissues that attach your muscles to the bone.

Pain or tenderness along the inside of the shin (usually about halfway down the shin) that may extend to the knee. Pain is most severe at the start of a run, but may disappear during a run, as the muscles loosen up. This is different to a stress fracture, where there is pain during weight bearing activities (walking, stair-climbing, etc.).


  • Inflexible calf muscles and tight Achilles tendon place more stress onto the muscle attachments.
  • Over-pronation.
  • Excessive running on hard surfaces such as concrete pavement.
  • Incorrect or worn shoes.
  • Overtraining or a rapid increase in training load or intensity.
  • Beginner runners are more susceptible to this problem for a variety of reasons, but most commonly due to the fact that the leg muscles have not been stressed in such a way before they started running.


  • Prepare for exercise/activities — understand what muscle groups will be used and slowly start conditioning them by strengthening them. Talk with a PM&R physician to determine the appropriate type of exercises.
  • Properly stretch muscles before running — muscles and joints need to warm up before beginning a run. Also be sure to allow for a “cooling down” period afterwards.
  • Use an appropriate running shoe — there are several brands and models of running shoes. Make sure you are using the type best suited for your feet and your running style. Running shoes should also be replaced regularly. Consult a specialty running store to choose an appropriate shoe.
  • Incorporate hard days and easy days into your training program — mileage should only be increased approximately 10 per cent each week. Runners should make sure to decrease their mileage slightly every third week as a way to allow for recovery prior to additional mileage increases. Runners should also be patient with their development, being careful not to push themselves too far or too fast.
  • Active Release Therapy (ART) or Soft Tissue Therapy can be used to correct muscular imbalances.

[picapp align=”left” wrap=”true” link=”term=sports+injury&iid=5167506″ src=”9/1/d/9/Closeup_of_a_3034.jpg?adImageId=10205489&imageId=5167506″ width=”234″ height=”234″ /]5. Plantar fasciitis: An inflammation of the plantar fascia, a thick fibrous band of tissue in the bottom of the foot that runs from the heel to the base of the toes. When placed under too much stress, the plantar fascia stretches too far and tears, resulting in inflammation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and only aggravates the problem.


  • Pain at the base o the heel or bottom of the foot.
  • Pain is most severe in the mornings on getting out of bed, and at the beginning of a run. The pain may fade as you walk or change running stride, in an attempt to alleviate the pain.


  • Stress, tension and pulling on the plantar fascia.
  • Inflexible calf muscles and tight Achilles tendons (placing more stress onto the plantar fascia).
  • Over-pronation (Feet rotate too far inward on impact).
  • High arches and rigid feet.
  • Incorrect or worn shoes.
  • Overtraining.

Preventative measures:

  • Stretching of the gastrocnemius and soleus muscles. Repeat stretches two to three times per day. Remember to stretch well before running and to stretch the plantar fascia.
  • Place a golf ball under the foot, and roll the foot over the ball. Start with the ball at the base of the big toe, and roll the foot forwards over the ball, then back again. Move the ball to the base of the toe and repeat. Always exert enough pressure so that you feel a little tenderness.
  • Correct shoes.
  • Orthotics to correct over-pronation (can try taping to see if this provides relief prior to orthotics).
  • Active Release Therapy (ART) or Soft Tissue Therapy to calf musculature.

For more information on stretching, or to learn different stretches to help prevent some of the above injuries, check out Runner’s World’s page on stretching here.