Running injuries are common and 50% of runners have more than 1 injury per year. Most of these injuries are due to over-use, although some are caused by trauma. Knee injuries are 3-4 times more common than hip injuries. Risk factors include poor diet, being over weight and running long distances (1).
The most common lower-limb problems are anterior knee pain, shin splints (due to tibial stress syndrome, chronic exertional compartment syndrome and stress fracture), achilles tendinopathy, plantar fascitis, runners knee (iliotibial band friction syndrome), stress fractures (metatarsals, tibia and hip), hamstring injuries and groin injuries.
Anterior knee pain is very common (3) and pain in the knee-cap region aggravated by loading of the patellofemoral joint. Examples of loading include, squatting, stair climbing, running, jumping and hopping. Risk factors for pain are either extrinsic or intrinsic. Extrinsic factors include the sports activity, surface, and equipment used. Intrinsic factors include those above the knee (Pelvis, hip, thigh), at the knee (cartilage, knee cap position and patella tendon) and below the knee (Osgood-Schlatter’s Disease). The specific conditions can be described as anatomical (increased femoral anteversion, trochlear dysplasia, patella alta/baja, increased foot pronation) or biomechanical (muscle tightness or weakness, joint laxity, gait abnormalities (3). The treatment options would initially include doing nothing, pain relief and activity modification. Rehabilitation can be very effective. Injections and shock-wave therapy may be helpful. Sometimes surgery is required.
Other common knee injuries are anterior knee pain, illiotibial band syndrome, meniscal injury and patellar tendinopathy.
Stress injuries or fractures of the lower limb can develop in low and high performance runners. In the hip, the main symptom is pain. Initially the pain may settle with rest; the bone has a stress response or reaction. If this problem is unrecognised and running continues then this could progress to a break in the bone called a stress fracture. If picked up early, the treatment may involve rest, using crutches and investigations for your bone health. If a fracture develops then surgery may need to be considered. Stress Injuries of other bones occur in similar circumstances. The principles of treatment are also similar, with rest and protected weight bearing. Sometimes surgery will be needed.
If symptoms are severe or do not respond to conservative treatment, specialist advice should be sought. You would be asked questions and examined. Investigations including x-rays and MRI scan may help with diagnosis and planning treatment.
- Tschopp M, Brunner F. [Diseases and overuse injuries of the lower extremities in long distance runners]. Z Rheumatol. 2017;76:443-450.
- Neubauer T, Brand J, Lidder S, Krawany M. Stress fractures of the femoral neck in runners: a review. Res Sports Med. 2016;24:185-199.
- Halabchi F, Abolhasani M, Mirshahi M, Alizadeh Z. Patellofemoral pain in athletes: clinical perspectives. Open Access J Sports Med. 2017;8:189-203.