Injuries impact nearly 80% of all runners (Br J Sports Med 2007). While some runners rarely miss a training run or race due to injury, many experience a variety of injuries and/or recurrent injuries. The key to effectively treating and preventing running injuries lies in effectively determining the cause of injury rather than treating the effect or symptoms alone.

The strongest predictors of of running injury include a prior history of running injury, running throughout the year without a break, and a rapid increase in running mileage of >10% per week (Br J Sports Med 2007). While the ideal running technique for an individual is dependent upon running experience goals, body type, and terrain, experts agree that reducing force impact at foot strike greatly reduces injury risk in runners. A 2015 study in the British Journal of Sports Medicine followed 245 female runners who ran >20 miles per week over a two-year period. Of those 245 athletes, 140 sustained running injuries. Of the 103 who were injury-free over the two-year period, 21 reported no running injury history whatsoever. When researchers compared the impact forces of the injured runners and the never-injured runners, they found significantly higher impact force values in the injured runners (Davis et al).

As a physical therapist and a runner, I have treated and experienced a multitude of running-related injuries. Over the past twenty-three years of practice, have noticed several patterns of movement dysfunction which lead to weakness and/or asymmetries in runners with injuries. One such pattern involving the hip flexor musculature relates to many lower extremity running injuries. The hip flexor musculature includes the following muscles: IlioIMG_2787psoas (iliacus + psoas), tensor fascia latae (TFL), sartorius, and rectus femoris. Collectively these muscles drive our leg forward as we run. Often the hip flexor musculature becomes the dominant muscle in our running stride which creates a muscle imbalance. The TFL becomes the go-to muscle in the presence of gluteus medius weakness. The hip flexors become shortened with prolonged sitting in conjunction with lower abdominal weakness. Deep to the abdominal region is the psoas muscle. The psoas originates on the lumbar vertebra. Its cohort, the iliacus, originates on the inside of the ilium (pelvis). Both muscle blend together and attach to the upper femur. The iliopsoas muscle group flexes the hip but also serves as a secondary “strut” or stabilizer of the hip. Often tight and short in runners and cyclists alike, iliopsoas tightness in runners can be particularly problematic. Every running stride results in up to eight times our body weight per step. The iliopsoas is a muscle which will try to do it all in the presence of surrounding gluteal and core muscle weakness.

Assessing iliopsoas muscle length and function are crucial components in the prevention and treatment of running injuries. Deep tissue mobilization, manual physical therapy techniques, and running gait analysis are effective means of reducing iliopsoas overuse and/or tightness prior to addressing strength deficits.

Once compensatory movement patterns are addressed through a comprehensive physical therapy evaluation, underlying strength deficits can be effectively addressed. Strengthening, however, is not as simple as following a home or gym exercise routine. In order to utilize proper muscle patterns to reduce injury risk/recurrence while running, one must first learn to fire the weak muscle. Activation of weak musculature requires isolating the muscle, fatiguing the muscle, and repeating the task over time. Strengthening the muscle in question follows, and ultimately, one must strengthen the target muscle in functional, single leg positions found in running (Souza, Powers JOSPT 2009, 2010). Single leg compensations are as varied as running shoe models. It takes an experienced eye to detect compensations and target underlying weakness (cause) responsible for pain

experienced while running (effect). Sapphire Physical Therapy is committed to helping Missoula runners achieve their goals through comprehensive evaluation and individualized, functional injury treatment and prevention techniques. Our new 2D high speed video running analysis system provides the technology necessary to accurately document running stride deviations and compensations. The net result is an individualized, efficient, and effective treatment approach. Move well and run well with Sapphire Physical Therapy!

John Fiore, PT
Sapphire Physical Therapy