by Caroldee Nienaber
Achilles tendinopathy (often referred to
as Achilles tendonitis) is a very common injury in runners. The Achilles tendon
is the thickest and strongest tendon in your body and connects the calf muscles
to the back of the heel bone. A force of up to 7x your body weight is
transferred through the Achilles tendon when running.
Achilles tendinopathy usually presents
as a dull pain at the back of the ankle at the start of a run which gradually
eases as the area warms up. The pain returns after you have finished the run
and it tends to be painful first thing in the morning. This eventually can
progress to a sharper pain during running eventually impeding your ability to
jog lightly. The tendon is often very tender to touch when gently squeezed.
The most common cause of Achilles tendinopathy
is over training, including too high mileage, too many hills and too much speed
work without building up properly. Other causes include weak and/or stiff calf
muscles, poor ankle range of motion, excessive pronation (“flat” feet) and
Initial self-treatment should involve
icing after a run, stretching the calf muscles, decreasing training to
alternate days, decreasing mileage by half and avoiding hill training and speed
work for 3-4 weeks. A heel raise, which is worn in your running shoe, can help
in the early stages to take the tension off the tendon and therefore ease pain.
It is important to have your footwear assessed to make sure you are in the right
shoe for you.
Should the problem persist your Physiotherapist
can assist you with an assessment to identify any underlying biomechanical
problems, manual therapy and rehabilitation. The most important component of
Achilles tendon rehab is an eccentric loading program, this involves
strengthening and lengthening the calf muscles to improve the tendon’s
tolerance to load. The average recovery time for the injury
is between 3 to 6 months.
Surgery may be considered as a last
resort if there has been no response to conservative management after a period
of at least 6 months.
By Glen Nunes
Plantar fasciitis is an overuse condition of the plantar
fascia at the calcaneal (heel) attachment. The plantar fascia connects the heel
to your toes underneath your foot along the inner side and supports your
foot arch. Plantar fasciitis is common in runners due to the repetitive pushing
off the forefoot. Plantar fasciitis typically presents as a sharp stabbing pain
underneath the foot on weight bearing with the pain generally being worse in
the morning and after rest periods. This pain normally decreases with increased
Risk factors include age (more common between 40-60 years),
foot biomechanics (flat foot or rigid high arches), running or jumping activities, activities involving more time
spent standing on your feet, and being overweight.
Initial treatment involves reducing milage by half, no speedwork and flatter
routes. Rolling a frozen half litre coke bottle filled with water, back and
forth under the foot arch for 10 minutes also helps control the pain.
If the condition persists, it is important to address the
underlying cause of the development of plantar fasciitis. A physiotherapy
assessment is recommended to assess, correct
and rehabilitate your lower limb
biomechanics (hip, knee, ankle and foot). Physiotherapy treatment may also
involve footwear assessment, stretching and mobilisation of the plantar fascia
and calf muscles, taping, advice on wearing heel supports and/or a night
In more severe cases, surgery may be required to “clean up”
the fascia and even “trim” extra bone formation if a heel spur is detected.
By Brandon Jackson
knee is a general term for pain around and under the knee cap. It usually
involves mal-tracking of the knee cap, resulting in pain and inflammation of
the cartilage lining under the knee cap.
As with most
running injuries it is caused by too-much-too-soon or over-use and all linked
to poor knee and leg biomechanics. These include weak gluteal (bum) muscles,
weak quads and pronated feet (flat foot arches).
Pain may be
anywhere around or under the knee cap, often difficult to pinpoint. It is
pronounced when running downhills or going down stairs.
Self management at first involves resting for
at least 7-10 days to allow the inflammation to settle and avoiding
anti-inflammatory medications. Then try
to start running flat routes, half your normal training distance, slowly and no
speedwork for the next 2 weeks.
Thereafter, slowly return to normal training over another 2-3 weeks,
increasing distance by about 20% per week.
It is however recommended to have
a physio or biokineticist assess your lower limb mechanics and prescribe you a
graded leg strengthening routine as well as assessing your feet and running
shoes. Anti-pronation/motion-control running shoes are advisable and in more
severe cases, in-shoe orthotics fitted by a podiatrist.
This injury usually settles in a
few weeks with the above management and corrective measures.
Surgery to “clean” up the
cartilage under the knee cap is rarely required and only after exhausting all of
the above options. It will then post-operatively require intense rehab as above
ITB friction syndrome
By: Brandon Jackson
The dreaded ITB injury, medically known as IlioTibial Band friction
syndrome, is one of the more common running injuries.
Symptoms are very specific, presenting as a
pain on the outside of the knee, especially when running downhill or going down
stairs. The ITB is a thick strap of
‘sinewy’ tissue which runs from the hip to the outside of the knee
Where it crosses over a bony protruberance on
the outside of the knee is where the trouble starts – as we run along and the
band rubs back and forth across this bony protruberance, so friction develops,
leading to inflammation and pain, locally over this area.
It is one of the few running injuries that
virtually stops you in your tracks. The
pain is excruciating and often leads to walking the downhills and
running/hobbling the uphills.
The cause is weak or severely fatigued
(overtrained) gluteal (bum) muscles. The
glutes are connected directly to the ITB which extends down the outside of the
thigh. As our leg strikes the ground,
the glutes contract to stabilize the hip and leg by pulling the ITB tight. The ITB is thus a kind of shock absorber,
hence the problems when running downhill. The weak/fatigued/overtrained glutes
cannot control and tension the ITB properly and so it starts rubbing
uncontrollably over the bony protruberance on the outside of the knee causing
inflammation and “ouch”!
Self treatment involves icing the area for 15
minutes 3 x daily, resting initially for at least 7-10 days to allow the
inflammation to settle, and avoiding anti-inflammatory medications. Then try to start running flat routes, half
your normal training distance, slowly and no speedwork for the next 2 weeks. Thereafter, slowly return to normal training
over another 2-3 weeks, increasing distance by about 20% per week.
If the condition persists, you need to
address the weakness and tightness of the glutes and ITB by getting your physio
to release these structures and starting you on a glute strengthening and hip
stability programme. This involves
exercises such as lunges and one-leg-squats, but needs to be carefully
integrated with your running training.
The physio should also assess your running
style and foot mechanics, since a foot that falls flat (pronates) when you run
may contribute to the problem, hence the need for a more supportive running
In very persistent cases and as a last
resort, surgery may be indicated to ‘clean’ up the band over the bony
protruberance. This has the risk of
creating more scar tissue over the area and you should thus consult with an
orthopaedic surgeon experienced in treating this condition. You would then
still have to do all the above-mentioned treatment and rehab, expecting about
3-6 months return to normal running.
However, prevention is always better than
cure, so stretching of the glutes and ITB, strengthening of the hip and thigh
muscles as well as the correct footwear when running the ‘silly’ distances we
do is vital to side-step this dreaded injury.
By: Thirona Naicker - B.Sc Physiotherapy
Stress fractures are
an overuse injury as a result of repetitive minor trauma. It may occur when
muscles become fatigued and are unable to absorb added shock. That muscle, will transfer the overload of
stress onto the bone.
Stress fractures are
often the result of increasing the amount of intensity of an activity too
quickly. You will have a sudden onset of
pain that is localized over the fracture site.
You will experience intense pain at the start of a run, this will get
worse to the point where you have to stop running. You may also experience pain at rest or at
Stress fractures may be
diagnosed by your physiotherapist. The
clinical suspicion can be confirmed with
an x-ray, however an x-ray may not always show stress fractures. In those cases, a bone scan, MRI or a CT scan
may be more successful with diagnosis.
rest from aggravating activity for 6 – 8 weeks, with gradual return to
sport. You may still engage in pain-free
activities while healing takes place.