In an ideal runner’s world, every step of every mile would be 100 percent pain-free. No aches, no twinges, no lingering soreness from yesterday’s workout. The reality is that many runners constantly deal with a slight (or not so slight) disturbance—a tender foot, a tight hamstring, a whiny knee. While these nagging issues often aren’t serious enough to require a time-out, they are annoying, especially when they don’t let you fully enjoy your time on the roads.
Think of running pains in terms of a spectrum. At one end you have severe, full-blown injuries—call it the red zone, which includes stress fractures that require time off. The other end, where you’re in top form, is the green zone. Mild, transient aches that bug you one day and disappear the next sit closer to the green end. Unfortunately, many runners get stuck in the middle—the not-quite-injured but not-quite-healthy yellow zone.
Whether you land in the red, linger in the yellow, or return to the green end of the spectrum depends largely on how you react when that first stab of pain hits, says Richard J. Price, M.D., a sports physician at Rocky Mountain Orthopedic Associates in Grand Junction, Colorado. “Often it comes down to whether you take a little time off now or a lot of time off later,” he says. You can reduce your risk of ending up in the red zone if at the first sign of an issue, you back off your mileage, reduce the intensity of your runs, start a treatment program, and develop a proactive long-term injury-prevention strategy, such as strength training, stretching, and regular foam-rolling. “Physical therapy is like homework,” Dr. Price says. “None of us likes having to do it, but if you don’t do it, the issue will come back.”
According to Price and a team of doctors and physical therapists consulted in the following pages, there are seven injury hotspots that most frequently plague runners. If you don’t get a handle on them, these issues can trap you in that nefarious yellow zone, or worse, turn into an acute injury that forces you to take a layoff. Here’s how you can keep annoying pains in check so you can move into—and, with hope, stay in—the green zone.
1. Runner’s Knee
Patellofemoral pain syndrome (PFPS), or “runner’s knee,” is the irritation of the cartilage on the underside of the patella (kneecap). About 40 percent of running injuries are knee injuries. And 13 percent of runners suffered knee pain in the past year, according to 4,500 respondents to a runnersworld.com poll. PFPS typically flares up during or after long runs, after extended periods of sitting, or while descending hills and stairs.
Who’s at Risk?
Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, says Bryan Heiderscheit, Ph.D., P.T., director of the University of Wisconsin Runners’ Clinic. Risk factors include overpronation (excessive inward foot rolling) and weak quads, hips, or glutes.
Can You Run Through it?
Yes, but taking extra rest days and reducing your mileage is necessary. Run every other day and only as far as you can go without pain. Some runners find that uphill running is less painful, so Heiderscheit recommends simulating hills on a treadmill. Uphill running has the added value of working your glutes. Strong gluteal muscles help control hip and thigh movement, preventing the knees from turning inward. Avoid running downhill, which can exacerbate pain. Bicycling may speed your recovery by strengthening the quads. Elliptical training and swimming are other knee-friendly activities.
Rehab it: Strengthen weak hip and glute muscles with lateral side steps, says Charlie Merrill, M.S.P.T., a physical therapist at ALTA Physical Therapy in Boulder, Colorado. Place a loop of resistance band just above your ankles or your knees. Separate your feet and bend your knees, lowering down into a slightly crouched position. While staying in this position, walk sideways 10 to 15 steps, keeping your feet straight and your upper body still. Then reverse directions. Keep your feet separated to maintain band tension. When this becomes easy, try doing this on your toes with your heels off the ground. If there’s a problem in the way your kneecap tracks, athletic tape may reduce pain (Merrill demonstrates knee taping at runnersworld.com/kneetape). Postrun icing also provides relief in the early stages of this injury. Heat works best once the injury is healing and no longer in an acute stage.
Prevent a Relapse: Heiderscheit recommends shortening your stride length and landing with the knee slightly bent, which can take up to 30 percent load off the joint. Count the number of steps you take per minute and increase by five to 10 percent per minute. Keep your knee tracking correctly by strengthening your knee’s support muscles like quads and glutes with exercises like lateral side steps and squats. It’s also important to stretch your hip flexors.
Elite Treatment: Marathon silver medalist Meb Keflezighi was building up for the 2010 Boston Marathon when he slipped on ice and tweaked his knee. He took two weeks off, ran only every other day for the next two weeks, and then decided not to run a half-marathon in March. The strategy worked: He was the second American at Boston in 2011, running a 2:09.
How to Proceed
Stop: Pain on the inside or outside of the knee immediately upon waking, which doesn’t go away as the day progresses.
With Caution: Twinges early in run, dissipate, come back after run. Bothersome after prolonged sitting.
Go Run: Completely pain-free even after sitting through a two-hour movie or after going on a hilly long run.