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2 Common Run Injuries
Plus lululemon Ambassador Alex Bell’s tips on how to treat them 

It’s that time of the year again, and run events are fast approaching. As training amps up in preparation, in some cases, so do the running injuries. To ensure runners can crush their goals and stay injury free, Alex Bell shares his knowledge and experience in treating 2 of the most common running-related injuries seen at The Running Room.

Runner’s Knee - Patellofermoral pain

What better place to start than with the most common running related injury of all - Runner’s Knee. It’s a common injury, but one that we love to treat at The Running Room, as there are often some great ways that we can assist athletes in overcoming this injury and allowing them to get back out there and continue running holistically.

What is Runner’s Knee?

To put it simply, Runner’s Knee presents itself as pain around the front part of your knee, often underneath the kneecap, but can also be described as a more vague type of pain that surrounds the front aspect of your knee. Activities that typically aggravate a runner's knee are things that put more load onto the patellofemoral joint. These include but are not limited to; squatting, lunging, stairs (especially down), running and also sitting for long periods of time. Essentially, movements that will involve a lot of bending of the knee whilst loaded.

What causes Runner’s Knee?

1. Training Load
Perhaps the biggest contributor to all running related injuries is sudden increases in training load. Runner’s knee is no exception and doing too much, too quickly is a risk factor for developing runner's knee. When we are looking at training load, we are looking at a runner’s overall training load, taking into consideration distance, dusaation, type of running (speed, tempo etc), the terrain (hills, road, trail etc), as well as exercise outside of running.

2. Biomechanical Factors
These factors address the way you move and the strength that you possess which have shown to play a role in the development of patellofemoral pain or runner’s knee. Things such as reduced muscular strength of the quadriceps, as well as factors or contralateral pelvic drop (hip drop), internal rotation at the hip, internal tibial rotation and foot pronation. To put it simply, if your knee is falling inwards whilst you move, this can play a role in runner’s knee.

3. The Way You Run
Running technique can play a role in the development of runner’s knee. Typically, overstriding (landing with an extended / straight knee) whilst heel striking as well as hip adduction and internal rotation (your knee falling inwards or touching when you run) can play a role in runners knee.

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How can you fix Runner’s Knee?

The thing everyone wants to know once you are injured or have pain - how do I fix this and get back to running pain free? At The Running Room, the top 3 tips in treating Runner’s Knee are:

1. Manage Training Load
Firstly, you need to manage and reduce training load appropriately. This often doesn’t require complete rest but more so is about determining how much capacity the irritated tissue can handle and then slowly increasing the training load as able. Sometimes this may mean that you decide your higher intensity or hill based sessions but maintain your running on a flat surface at a slower pace.

2. Exercise Therapy - Targeted Strength & Conditioning
So important and something that so many runners often neglect. The best approach to treating Runners Knee from a strength strand point is a combined approach of strengthening the hip and knee. More information on strength training for runners here. (link to editorial - https://www.lululemon.com.au/en-au/c/community/stories/strength-training-for-runners)

3. Gait Retraining - Changing The Way You Run
This can be massive for many runners and such a quick win in reducing the loads occurring at the knee and subsequently reducing pain. An increase in cadence (how many steps you take per minute) can have a positive impact and address some of the biomechanical factors that relate to runner’s knee as well as reducing the joint loads seen at the knee. A simple increase in step rates (cadence) of 5% can decrease the loads occurring at the knee by up to 20% in some cases. This approach needs to be individualised and this is a technique change that we use in the clinic with many of our runners experiencing knee pain. Note that for the increase in cadence to have a positive impact, we must keep the speed of running constant. The best way to change this is to change your step rate at your easy pace and then it should naturally increase as you increase your running speed.

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Achilles Tendinopathy

Another common presentation that we see in people who run and one of our favourite conditions to treat. Let’s break down Achilles tendinopathy and give you The Running Room’s approach so you can overcome your achilles stiffness and pain.

What is Achilles Tendinopathy?

Literature suggests that Achilles Tendinopathy accounts for around 10% of running related injuries. It is a condition that is localised to the Achilles tendon, which is the thickest tendon in the body and connects the calf musculature to the heel bone. Your tendons are connective tissues that connect muscles to bone and act in such a way to absorb, store and release energy with loading.

Achilles tendon pain is often categorised by what we term:
- Insertional Achilles Tendinopathy (focal area of pain close to the heel bone)
- Midportional Achilles Tendinopathy (focal area of pain towards the middle part of the tendon)

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What causes Achilles Tendinopathy?

Achilles Tendinopathy has many different risk factors, however the main one being sudden changes in load that requires the tendon to either store energy, such as walking, running, jumping or load that compresses the tendon. Essentially, it is an overuse type injury that will ultimately result in the degeneration of the structure of the tendon and occurs when the load placed upon the tendon outweighs the time in which the tendon needs to recover which leads to pain and stiffness. I also want to highlight that rest does NOT fix tendinopathies. We will go into this later.

How can you fix Achilles Tendinopathy?

Okay - the thing everyone wants to know when injured.. How do I fix this and get back to running pain free? Here are The Running Room’s top 5 tips in treating Achilles Tendinopathy.

1. Modify Training Load - REST IS NOT BEST
Complete rest does NOT fix tendons. Tendons require loading to be rehabilitated. With rest they will often feel temporarily better but too often we see people return to their chosen sport or activity and their pain returns quickly and often worse. We must increase the tissue capacity of the tendon and we do this through structured and individualised loading. Having said that, modifying training load is important in settling achilles tendon pain. This often looks like reducing loads to the tendon that will involve higher and more substantial amounts of energy storage and compression and may mean that we reduce your running in the short term, especially speed work and often hills.

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2. Exercise Is King
Exercise is the most valuable tool for rehabilitating tendons. Tendon loading needs to be both progressive and specific to the individual. In this case, calf raises are essential to load the achilles tendon. One size does not fit all with tendon rehab so see a health professional who has experience in treating tendons to ensure your loading is optimal. At the Running Room, our approach is that if the tendon is highly irritated or ‘reactive’ we want to apply loading to the tendon isometrically or slowly (calf raise holds, heavy slow calf raises). As we progress through rehabilitation, start to apply loads that make the tendon store and release energy more quickly, such as plyometrics (hopping, jumping, running).

3. There Are No Shortcuts With Tendons
The achilles can be slow to respond and can take time to fully recover. The good news is that complete rest is rarely prescribed and often you will continue running with modifications through this process.

4. Footwear - It Doesn’t Matter Until It Matters
If there has been a recent or dramatic change in footwear it can play a role in achilles tendinopathy. Especially if we move quickly towards a shoe that is more minimalistic with a lower amount of heel to toe drop. If you are planning on changing to a different shoe type ensure that this transition is done gradually and with good reason.

The lululemon Seawheeze 2021 Virtual Half Marathon and 10km is back. From 18th - 26th September 2021, run for your best time, a great time and to support some inspiring organisations. 100% of entry funds raised will be distributed to three non-profit organisations through our social impact program, Here to Be. 

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