Ask The PT: Common Causes of Running Injuries

Running injuries might run the gamut, but they have more in common than you’d think.

As an orthopedic physical therapist for more than 30 years (with an emphasis on the treatment of the distance runner), several things have become clear to me. Runners may show up in my office with seemingly different complaints, but the root causes have come to develop a similar pattern.

Causes, Running, Injuries

How can this be? Piriformis syndrome, patellofemoral syndrome, hamstring and calf strains, shin splints, stress fractures (to name just a few) all appear symptomatically in very different areas of our bodies. But, during the course of many an evaluation over the years, I’ve noticed common underlying causes for these complaints:

1. Poor Posture

Poor posture can plague runners of all ages (the adolescent as well as the masters athlete). It can mean slumped, rounded shoulders with a forward head posture or the opposite-excessively increased low back curvature (lordosis).

Each scenario represents its own unique problems, but both result in an inability to get your center of mass over your lower body joints and to properly activate the associated core and postural muscles. Over time, this will develop in muscle weakness and muscle or joint tightness.

2. Fixed Structural Problems

Fixed structural problems cannot be reversed, but they do need to be addressed. Such problems include:

  • scoliosis (even if developed later in life because of an arthritic spine or osteoporosis)
  • rigid, high arched feet
  • torsions of the hip, femur and/or tibia
  • true leg length differences (diagnosed via x-ray imaging)

These all need to be accommodated, usually with an orthotic first.

3. Tightness

This can be either a muscular or joint restriction to movement. It is important to note that a muscle gets tight when there is weakness somewhere else (this needs to be uncovered); joint tightness can occur when there is excessive mobility somewhere else! I will give examples of this in future articles.

4. Poor Muscle Activation

Weaknesses come under this category, but note that I chose to say activation instead. Prolonged muscle tightness/restrictions will eventually shut the muscle down to the point that no activation can occur. The affected muscle needs to be isolated and targeted first, before “strengthening” or higher-level functional activities involving multiple joints or muscles can begin.

5. Poor Movement Patterns

Poor movement patterns develop as a result of any combination of the above and ultimately, will also affect balance and coordination. Running is a series of “single leg hops” from one foot to the next-everything better be in sync!

I know many of you will have questions about what I’ve presented here! This article is intended to serve as an “outline” for upcoming articles as I deal individually with common injuries (like the ones mentioned above) and how to conquer them (for good). I also encourage you to send me your questions at: Due to the high volume of emails we receive, I may be unable to respond to your individual questions, but hope to address common concerns!

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