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Return to Running Following a Running-Related Injury

Jul 31, 2013

Introduction Running injuries occur frequently in the recreational running population and the return to running process can be challenging. Iliotibial band syndrome (ITBS) and patellofemoral pain syndrome (PFPS) are two of the most common running injuries linked to overuse, hip dysfunction, and running mechanics. Both of these injuries typically include pain located around the lateral side of the knee (6). The exact causes may be different, but the prevention and recovery is similar, thus giving runners a uniform plan (e.g., strength training, volume progression, and flexibility/range of motion (ROM) exercises) to follow as they return to a running program. Initial Treatment Stage ITBS and PFPS may be overuse injuries or related to hip dysfunction, hence the importance of proper progression following a running-related injury (5). The adaptation of the musculoskeletal system to running is a slower process than that of the cardiovascular system (3).

A walk/run ratio increases foot contact time, while decreasing stresses on the musculoskeletal system. The ratio of walking to running should gradually increase each week, and is a method to ease back into continual running without increasing risk of injury re-occurrence (7). Once the runner has achieved 30 minutes of continual, pain free running, the 10% rule of increasing either distance or time is an effective method to return to pre-injury volume based on the guidelines of general exercise progression (1). Intermediate Treatment Stage There is a strong correlation between weak core musculature, the muscles of the lower back, trunk, and hips, and ITBS/PFPS (6). In addition, research shows that hip strengthening programs (e.g., targeting the gluteus medius) are effective in decreasing pain and improving function of the lateral hip musculature (frontal plane stabilizers). Proper stability and alignment of the hips during all phases of running is key for reducing the incidence of overuse knee injuries such as ITBS/PFPS (8).
Appropriate selection and execution of exercises is highly important in targeting the specific weakened muscles. Beginner level core exercises include band walks and hip bridges whereas squats, planks, and side planks are considered a more advanced exercise.
Final Treatment Stage
Increasing flexibility and range of motion (ROM) can help to improve running mechanics via an increase in stride length/stride rate (2). There are two different types of stretching (static stretching and partner passive stretching) that are the most widely used techniques for increasing flexibility and ROM, which each may be appropriate in different settings.
Static and partner-assisted stretching exercises to improve ROM and flexibility should be performed after running. However, recreational runners should implement a dynamic warm-up prior to their runs to ensure proper muscle temperature, activation, and responsiveness to prevent muscle compensation and/or fatigue. Among the benefits of the dynamic warm-up, many scholars point to their similarities between the sport-related tasks of the individual, thus serving as a more effective preparatory activity for the demands of running (4).
Having sustained a running-related injury increases the risk of re-occurrence. Engaging in a return to running program that has a structured volume progression plan and includes dynamic warm-up, strength training, flexibility, and ROM can decrease the risk of developing an overuse injury.
1. Baechle, T, and Earle, R. Essentials of Strength Training and Conditioning. Champaign, IL: Human Kinetics; 497, 2008.
2. Caplan, N, Rogers, R, Parr, MK, and Hayes, PR. The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics. Journal of Strength and Conditioning Research 23(4): 1175-1180, 2009.
3. Lopes, AD, Hespanhol Jr., LC, Yeung, SS, and Costa, LOP. What are the main running-related musculoskeletal injuries? A systematic review. Sports Med 42(10): 891-905, 2012.
4. Prentice, WE. Arnheim’s Principles of Athletic Training. New York, NY: McGraw-Hill, 94-134, 2008.
5. Rasmussen, CH, Nielsen, RO, Juul, MS, and Rasmussen, S. Weekly running volume and risk of running-related injuries among marathon runners. The International Journal of Sports Physical Therapy 8(2): 111-120, 2013.
6. Whiting, WC, and Zernicke, RF. Biomechanics of Musculoskeletal Injury. Champaign, IL: Human Kinetics; 154-201, 2008.
7. Wilcox, R. Running injury prevention tips and return to running program. The Brigham and Women’s Hospital, Department of Rehabilitation Services. Boston, Massachusetts, 2007.
8. Willy, RW, and Davis, IS. The effect of a hip-strengthening program on mechanics during running and a single leg-squat. Journal of Orthopaedic and Sports Physical Therapy 41(9): 625-632, 2011.


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