In this blog post, our MD Rebecca Garrod reveals how to avoid injuries whilst trail running.
Trail Running is a very popular sport but it is linked with a high injury rate with 19-79% of runners sustaining an injury each year (van Gent et al 2012). Injuries often occur from incorrect training and runners pushing themselves too far too soon as the body needs time to adjust and strengthen to the new demands.
There is a lack of evidence regarding age and gender being factors in causing injuries, however, we do know that as we age our body does take longer to heal. Our body mass index (BMI) and physical fitness impact on how well you can run and train and can predispose you to injury. Terrains are extremely variable with trail running and there is evidence to show that running on softer surfaces can reduce the strain on our musculoskeletal system (Tessuti et al, 2012).
Previous injuries can certainly predispose you to sustaining another injury, either because the original healing did not heal properly or there may be an underlying reason such as abnormal lower limb biomechanics such as increased foot pronation (feet collapsing, or flat feet). Therefore wearing the correct footwear is paramount.
In order to prevent injury it’s important to train and strengthen your body in a variety of ways. Incorporating resistance training, flexibility, interval training, core stability, balance and of course distance running, will give you an all round fitness. Some people are lucky and they never seem to get injured, however, below are some of the most common injuries for trail runners and how you can avoid them.
Sesamoiditis: Pain in the base of the big toe
Cause: Feet pronating, a wide stance during walking or running, and stiffness in the foot including toes.
Symptoms: A gradual onset with pain felt more on the inner aspect of the base of the 1st toe.
Avoid it: Ensure that you’re wearing the correct footwear and if you have any qualms about the biomechanics of your feet, get them checked out, especially if you’re upping the ante and training harder. The joint may need to be offloaded with padding and tape.
Achilles Tendinopathy: inflammation and pain in the tendon within the calf
Cause: Feet pronating and/or tight and weak calf muscles.
Symptoms: Pain felt in the Achilles’ tendon which can present as a niggle to severe pain. The pain is worse after activity.
Avoid it: Ensure that you’re wearing the correct footwear and there are exercises off a step that your physiotherapist can teach to help prevent and sort this problem.
Patellofemoral Pain or Runners Knee: One of the most common complaints of runners
Cause: Feet pronating, tight hip flexors, hamstrings causing the pelvis to tilt forward, and weak gluteal muscles.
Symptoms: Pain behind the kneecap, whilst going downstairs, hill running, especially downhill.
Avoid it: Practice clam, hip flexor and hamstring stretches and foam rollering (again your physiotherapist can show you the most effective ways of doing these).
Patellar Tendinopathy or Jumpers Knee
Cause: Feet pronating, and tight quadriceps, hamstrings, calves, and hip flexors.
Symptoms: Pain just below the kneecap at the front caused commonly by loading the tendon with activities such as jumping.
Avoid it: Good flexibility and/or foam rollering helps as well as strengthening quadriceps, for instance, squatting on a 25% decline board. This puts the quadriceps in the best position to load the tendon. Do this 3×15, twice per day.
Cause: Tight and weak hamstrings and/or incorrect pelvis alignment.
Symptoms: Pain and weakness in the back of thigh and a sudden onset when sprinting.
Avoid it: Stretching your hamstrings and foam rollering is beneficial. Also, do the one legged bridge exercise ensuring that the pelvis doesn’t drop.
Illiotibial Band Friction Syndrome or ITBS
Cause: Incorrect alignment of pelvis and/or weak glut muscles.
Symptoms: Pain felt on the outer aspect of knee which is aggravated by running.
Avoid it: Foam roller, do flexibility training and strengthen your hip abductors.
Tibia Stress Fractures
Cause: Pronated feet and stiff, high arched feet.
Symptoms: A gradual onset and you may have leg or calf pain when resting or at night depending on the location of the stress fracture.
Avoid it: Avoid sudden changes in training especially a significant increase in training over a short period of time, and have your bone density checked out.
Medial Tibial Traction Periostitis or Shin Splints
Cause: Pronated feet and/or a wide stance during walking or running.
Symptoms: Pain along the inner border of the tibia.
Avoid it: Use the foam roller to release the inner aspect of your calf. Also, strengthen your tibilias posterior: With your toes pointing down, place resistance band around your toes and bring your foot in towards the body 3×15, twice per day.
Plantar fasciitis: Painful Heel
Cause: The heel in most runners is the first point of contact and it is exposed to ground reaction forces up to 3x your body weight. Painful heels are often caused by high arches and tight calf muscles.
Symptoms: There is a gradual onset of pain in the inner aspect of the heel, which is worse in the morning.
Avoid it: Stretch the plantar fascia under the arch and use a frozen water bottle or orange under the arch to massage and release tension.
Cause: Unstable ankles.
Symptoms: Pain around the ankle which has a sudden onset and swelling.
Avoid it: Do balance exercises: standing on one leg, with eyes open and then closed. Also, stand on a bosu ball, then squat, and then close your eyes.
Cause: Excessive pronation when running on slopes and/or tight calf muscles.
Symptoms: Outer ankle or heel pain with swelling. Pain felt when moving your ankle in and out.
Avoid it: Ensure you are wearing correct footwear. Also, do strengthening exercises: place a resistance band around your foot and take the ankle outwards.
Are you a runner and have you experienced injuries whilst trail running? Your physiotherapist will be able to show you how to correctly do the exercises above to avoid injury. Let us know your avoidance tips in the comments below or by tweeting us at @Physiotoyou!