Running injuries occur for a variety of reasons. Accelerated mileage progression, increased running intensity, lower extremity and core muscular weakness, asymmetrical running mechanics, inadequate recovery, and trauma are the main causes of running injuries. While it is considered fairly normal to be sore following a challenging run or race, knowing how to effectively address post-running symptoms can be the difference between a single day of soreness and a season-ending injury.

The science behind muscle and connective tissue recovery following the micro-trauma of a hard training run or race is basic. The RICE (Rest, Ice, Compression, Elevation) protocol is sound in theory but often difficult to implement in reality. Here is an example to illustrate: It is Sunday and my legs are trashed from two consecutive days training in the mountains at an intentionally hard pace five weeks out from a 50-mile race. Monday I will be on my feet at work the entire day. The RICE prescription will be impossible to follow. To add to the confusion, individuals recover at vastly different rates. Recovery rate and the associated micro-trauma healing are influenced by fitness, nutrition, lifestyle, age, and stress level. Tissue recovery techniques are all aimed at stimulating blood flow. Our circulatory system carries the by-products of training and racing away from the area(s) of micro-trauma and stimulates healing through a fresh blood supply. Blood flow via capillaries (carry oxygenated blood directly to tissue such as muscle fibers and connective tissue) restore the health of the affected tissue post-running.

With such a fantastic built-in recovery system, why then do injuries occur? The answer lies in the fact that we are humans not machines. The art of treating running-related micro- trauma involves implementing the most effective, realistic treatment in a timely manner to reverse the impact of the micro-trauma and restore tissue homeostasis. Many treatment options exist for post-running soreness. A physical therapist knowledgeable in running injury treatment and prevention first hand will save you days, weeks, or even months of recovery time. Below are a few techniques to effectively reduce soreness associated with post- running soreness based on common injury sites.

Calf Soreness:

The three muscle of the lower leg responsible for most calf pain are the gastrocnemius, soleus, and tibialis posterior. Each of the three muscles function differently but all three aid in the support of the lower leg and ankle. Drastic shoe changes (large heel-to-toe drop to low heel-to- toe-drop), lower leg weakness, intrinsic foot weakness, and high mileage/high impact running all contribute to calf soreness. Compression socks or a compression sleeve is an easy way to apply compression while going about your day. Do not forget to ice, release the calf musculature via active release, rolling, gentle stretching, and consider a physical therapy consultation to address chronic calf issues.

Foot Soreness:

Foot soreness can be expected after a long run or race. Summer heat, rocky trails, blisters, and worn out shoes can cause foot pain. If the onset of foot pain is sudden and severe, however, the cause may be in the structure or muscular support of the foot itself. While we spend countless hours training and cross training to build our leg strength and endurance, runners seldom take the time to strengthen their feet! Walk barefoot in sand or on grass for fifteen minutes twice a week. Walk barefoot at home. Ask for some intrinsic foot strengthening exercises. In the mean time, a great way to calm down plantar foot pain (bottom of the foot) is to roll your foot over a frozen can of vegetables with some pressure through the bottom of your foot. Remember, chronic foot pain issues may be structural in cause or even referred pain from a location as far away as your lumbar spine (nerve root issue).

Shin Soreness:

The term “shin splints” represents a variety of possible running-related injuries. From tibialis posterior tendonitis to tibia stress fractures, shin soreness should not be taken lightly. Increased torsion through the tibia due to overuse or associated muscular weakness placed excessive stress through the lower leg. Tightness and soreness due to tendonitis (muscle attachment inflamed due to excessive use) is different than the deep aching weight bearing and/or pain at rest associated with stress fracture symptoms. Because an X-ray often does not reveal a stress tibia fracture in the early stages, further diagnostic treatment is indicated if symptoms do not subside with conservative treatments such as physical therapy. Taping, manual therapy, foot and gluteal strengthening, and modified activity are appropriate conservative treatments. The presence of swelling, bruising, and night pain should not be ignored.

Iliotibial Band Soreness:

Iliotibial band (ITB) soreness is associated with excessive force associated with downhill running. In reality, the cause of ITB pain is often elusive. The chronic nature of ITB injuries is due in part to the difficulty determining the cause of the ITB symptoms. Gluteal weakness, hamstring overuse, low back dysfunction, and hip tightness/restriction are among the probable causes. Treatment historically included deep tissue massage to the ITB attachment on the lateral knee. In reality, however, the tissue below the ITB attachment has a high concentration of nerve endings. Deep tissue (cross friction) massage to this area, therefore, may exacerbate the pain symptoms. Ice, proximal hip stretching, rolling, and dry needling are all effective conservative treatment.

Hamstring Soreness:

Our hamstrings are often over utilized when we run. Running fast and running fast downhill creates an eccentric (muscle contraction in a lengthened position) force through the hamstring muscle. Coupled with gluteus maximus weakness or inhibition, and the hamstring may become inflamed, hypertrophied (larger than expected) and painful. Active release techniques, dry needling, and stretching may relieve hamstring tightness and soreness, but often a weak or lazy muscle is the underlying cause of hamstring pain.page2image26480

Knee Soreness:

The knee is a unique joint. When we run, our ankle accommodates to ground impact and uneven surfaces while our hip stabilizes and transfers the ground reaction force into a linear running stride. The knee is the joint which often is “stuck in the middle.” Knee torsion results from poor muscle strength in either the foot & ankle or hip. Knee pain may also arise from poor knee joint mechanics due to prior injury history, lateral patella tracking, or cartilage/meniscus damage. Knee pain combined with swelling requires medical attention. Ice may calm the symptoms, but unlocking the cause of the pain is necessary.

Hip Soreness:

As runners we commonly overuse our hip flexors (front of the hip) and underuse our hip abductors (the famous gluteus medius muscle). Hip flexor tightness results and hip joint compression may result. Basic him opener stretches and manual physical therapy techniques can restore the normal joint mechanics of the hip. Functional strengthening will train you to use the proper hip musculature while running.

Low Back Soreness:

Weak core musculature, poor posture at work or while running, and stiffness in the lumbar spine all contribute to running-related low back pain. The fact that our lumbar spine and pelvis are attached yet move in opposite planes is something runners take for granted until low back pain is present. Lumbar stretches, abdominal and gluteal muscle strengthening, and hands-on manual therapy physical therapy techniques will restore the mobility and stability to your lumbar spine. Initial self-treatments include ice alternating with heat, deep tissue work, pelvic tilts, and lower abdominal exercises.

A wise rule of thumb is to seek medical advice of a physical therapist or physician if your symptoms do not resolve in one week with rest and cross training. As a physical therapist, I look for a positive healing trend by the fourth treatment. If a 50% reduction of symptoms is not present by the fourth physical therapy treatment, a change in treatment technique and/or further diagnostic testing is indicated. Run hard, recovery completely, and do not forget proper rest and nutrition. Your body will reward your efforts with pain-free running.

John Fiore, PT Sapphire Physical Therapy