Endurance

Running Rehab | Injury Rehab Tips For Common Knee & Foot Pain

 

By Melody Coleman |

Personal Trainer & Swim Coach

It’s that time of year again, when poor weather conditions can increase the likelihood of a whole host of common running injuries. Don’t let a slip, trip or strain hinder your outdoor training. Take advantage of my best advice for a speedy recovery to get you up and running again as quickly, and as safely, as possible!

When you’ve injured yourself, more than anything you want to get back to your normal training in the shortest space of time. This is why it’s effective to make a plan. I use an injury protocol when it comes to these things, to help prioritise the important stuff, and cover all areas. Whatever the weather, your approach to tackling an injury should be more or less the same year-round:


Injury protocol

 
First Aid. Follow all recommended guidelines for immediate injury care. Ask yourself: do you need to see a doctor or specialist? Or can you take care of your injury at home? A combination of rest, ice, compression and elevation is normally a pretty safe bet when it comes to connective and soft tissue injuries. Always consult a doctor or pharmacist before taking any medications;

Assess the problem and its potential roots. Injuries are normally pretty clear indicators that something isn’t working as it should. How and why did you become injured? Is there an underlying cause?

Check your movement mechanics! Many runners would benefit from checking their squat patterns and gait, or having an expert do so for them;

Always check upstream and downstream of the affected tissues. Remember – pain in your lower back, for example, could originate from a problem in your feet or hamstrings. A holistic approach often yields the best results overall;

Soft tissue massage and gentle stretching are reliable techniques to create slack in the tissues around an injury to promote healing and aid pain relief, whilst working towards tackling the root cause;

Start exercise-based rehab as soon as it’s safe (discuss your healing with a good physio or specialist), and continue to progress yourself as long as necessary. Your injury might pose a short-term problem, but once you’re back to training, much of your effort should be on remedying any mechanical issues to prevent old injuries flaring up, or new ones emerging. You can start with very basic “physio” exercises, and progress these appropriately over time.


Movement screening

 
There are a number of techniques at your disposal to help you assess the underlying causes of injuries during the rehabilitation process.

In my experience, these six movement screens are extremely effective for identifying the incorrect or unsafe patterns that can lead to, or stem from injuries.

Many of them double up fantastically as stretches or rehabilitative exercises in themselves, and so will prove to be a useful tool in your recovery and future training.

Before embarking on any exercise programme, you must consult a doctor (and a physiotherapist, ideally) to give you the all-clear!

running injuries in winter

✓ Deep squat range of motion test

You should comfortably be able to balance at the bottom of a squat, with your feet flat on the ground, arches not in contact with the ground, knees in line with toes, and no excessive spinal flexion. Try using this position as a stretch, and accumulate a few minutes daily resting here. You could twist, lean and rotate to further the stretch and improve your balance.

✓ Box squat technique test

As you squat (try squatting towards a box lower than knee height), you should be able to maintain a neutral spine and keep your knees in line with, or pointing outwards of your toes. Check your ankles – do they allow your knees to travel comfortably? Do your feet remain firmly on the floor? You should not need to lean forward excessively, or lift your heels to perform this movement.

✓ Kendo resting pose test

A great test of ankle range of motion, as well as knee flexion, and doubles up as a fantastic stretch for the ankles, shins and quadriceps. Are you able to sit upright in this position, with your knees together? How about leaning back with your hands on the ground?

✓ Toes and knees squat test

Similar to the Kendo resting pose and a brilliant test of toe flexibility, which has a surprising impact on running technique and the health of the tissues above it. Also an extremely effective foot stretch.

✓ Standing postural test

Whilst standing, the arch of your foot should not be in contact with the floor, and your knees should be pointing roughly in the direction of your middle toe. From the side, you should see that your pelvis is neutral, and your ribcage balanced directly above it. Your shoulders should be depressed and slightly externally rotated, with neutral or slightly retracted scapula. Look straight forward so that your chin is level with the floor.


Walking/running gait test

 
Contrary to popular belief, there is no one “perfect” running style. Take a look at Usain Bolt, for example. He “inefficiently” sways his hips and is far taller than a typical sprinter, and yet he is the fastest runner of all time.

Your gait can be described as how you walk or run. Whether you heel strike, run forefoot, or flap your arms like a butterfly, there are some rough guidelines to follow with regards to body positioning when you run:

Ask yourself whether the change in season has affected how you run. Our mechanics change in cold, slippery surfaces and on slushy/muddy ground;

✓ Tread lightly. Too much impact can be detrimental to joint health. If you’re landing too hard, or smashing into your heel, make a change. Many people would benefit from landing closer to the midfoot and following through from there;

The arch of your foot should not make contact with the ground. This small fault can affect numerous joints and tissues upstream;

Keep your knees in line! Knees swaying inwards (known as valgus knee) is a common, damaging, and very fixable problem;

Your spine, pelvis and ribcage must be more or less neutral with some trunk rotation. Running with extremely stiff posture is a problem in itself. If you have no spinal movement at all, this can be as much of an issue as having excessive flexion/extension/lateral sway or rotation;

If you’re unsure, ask a professional! This may not be someone who is paid to sell you running shoes. Find a recommended expert who understands biomechanics and can discuss your training and injury history with you.

Each of these tests has relevance and applications for different issues. For your reference, I have listed below the six most common running injuries my clients report during winter. We always use the injury protocol (above) to come up with a rehabilitation plan.


Common winter injuries

 
running injuries in winter

Rolled/twisted ankle

Typically this means damage to the connective tissue in the ankle after landing on it at an uncomfortable angle, and is characterised by swelling, bruising and sometimes loss of strength or flexibility during healing. 

• Upstream and downstream joints: toes and knees

• Upstream and downstream tissues: plantar fascia, Achilles’ tendon, anterior tibialis, calves

• Assess your mechanics: standing postural test, deep squat test, toes and knees squat test, gait

Protocol: gain any lacking range of motion by stretching and rolling the surrounding tissues in your feet, shins and calves. Recover any lacking stability with strengthening exercises such as squats, lunges and calf raises.

Knee pain

Can be the result of a number or issues, but is often solved by correcting poor movement. For pain on the outside of the knee, you may like to also see my recommendations for “IT band syndrome”. 

• Upstream and downstream joints: ankles and hips

• Upstream and downstream tissues: calves, anterior tibilalis, quads, hamstrings, glutes

• Assess your mechanics: deep squat test, box squat test, kendo resting pose, standing postural test, gait

Protocol: Give the surrounding tissues a really good massage. In my experience, the quads and hips are common culprits. Work on your mechanics – make sure you can perform a stable squat to good range with great technique (and no pain)

TIP: using physio tape, or a knee support can provide compression and sensory feedback on your movements throughout the day.

Plantar Fasciitis

Pain on the fascia on the bottom of the foot, normally caused by inflammation after impact or due to poor movement/tightness in the surrounding tissues. 

• Upstream and downstream joints: toes and ankles

• Upstream and downstream tissues: heel cords, shins, calves

• Assess your mechanics: deep squat test, kendo resting pose, toes and knees squat test, gait

Correct the problem:

spend time resting in a deep squat, the kendo pose and toes and knees squats to stretch the tissues of your feet and ankles. Rolling and massage of the feet and ankles will also work wonders, alongside strengthening and balance exercises. These could include calf raises (try popping a folded towel under your toes) and single-leg balancing.

Shin splints

Pain in the shin or the muscle next to it (anterior tibialis), normally after running or impactful exercise. 

• Upstream and downstream joints: ankles and knees

• Upstream and downstream tissues: anterior tibialis, calves, quads, plantar fascia

• Assess your mechanics: deep squat test, kendo resting pose, toes and knees squat test, gait

Correct the problem:

Typically, rolling the anterior tibialis (the muscle next to the shin bone on the outside) will solve many shin splint problems. If this is not enough, massage of the tissues in the tops of the feet and the quads, along with strengthening and balance work should help. You could try squats, lunges and single-leg balancing.

Groin strains

Common in winter as these are often caused by unexpected or overreaching lateral movements. 

• Upstream and downstream joints: knees, hips and lumbar spine

• Upstream and downstream tissues: adductors, hamstrings, hip flexors, quads, glutes and interior/exterior abdominals

• Assess your mechanics: deep squat test, box squat test, standing posture, running mechanics

Correct the problem:

Groin strains can occur for a number of reasons, but poor flexibility and tissue quality increase your chances of having one. Be sure to take care of your hamstrings, hip flexors and adductors with massage, rolling and gentle stretching (both static and dynamic are important here). Promote good hip mobility by regularly performing a wide range of movements to stretch and strengthen this complex joint.

IT band syndrome

This could relate to a number of issues, and normally presents itself with pain on the outside of the knee or hip (these are the joints to which the IT band attaches). 

• Upstream and downstream joints: knees and hips

• Upstream and downstream tissues: quads, hamstrings, glutes, calves

• Assess your mechanics: deep squat test, box squat test, standing postural test, gait

Correct the problem:

Getting a foam roller (or your masseuse’s elbow) into the side of your hip can work wonders for IT band related injuries. Following that, it would be well worth rolling your quads and hamstrings to create slack in the surrounding area, and correcting any inefficiencies in movement (commonly knees collapsing inwards.)

Please note that this advice is intended for general use after being given the all-clear to exercise post-injury by an appropriate professional. These are, as always, my best recommendations, however it’s important to remember that each of us are different, and should follow a relevant exercise programme suited to ourselves and our goals.


Take Home Message

 
Nothing is better in winter than the refreshing taste of cold crisp air in your lungs, and the satisfying feeling of warming your fingers and toes after a tough run outdoors.

Remember to stay safe out there, and don’t let an injury get in the way of a great training season that brings with it all sorts of new challenges.

Rest, rehab then run again!

running injuries in winter

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