Running with Pain Part 2

Do you like to run for your exercise? Running is one of the most popular and simplest exercises to help you stay fit and to tackle those health goals that you want to achieve. Running can also be an easy way to acquire an injury to your legs and body due to its repetitive nature. With this type of exercise you are burning tons of calories, increasing your leg strength and tone, allowing your body to become more in-tune with itself, and it also increases your lung capacity. However even with these added benefits to your body, there can be some other issues that arise that will hinder your ability to run as much as you would like.


When looking at different styles of running, distance people run, length of time spent running daily or weekly, and the sports clothes and shoes people wear, can give you an idea of what type of injury you may acquire. Some people will state that running will allow them to take around 200 strides or steps for every minute they are running. With each step or stride when running you are creating an impact with your feet to the ground. This impact creates more force that has turns into energy going through your feet, into the ankles, up through your shin, around to the calves and transmits this force into the knee and hip. This additional energy that is created from running has to be taken into the joints of the body and creates movement with each muscle that is used from the feet up into the legs, hips, abdomen and lower back. After time running with good or bad running posture, these impacts that are occurring will inevitably cause your body some sort of pain. With running on average of about 100 hours, you will inevitably have 1 running injury. Some don’t realize that when you are running it isn’t just about exercising your legs, this is a full body workout from your legs moving you down the path, your hips supporting your leg movement, the core muscles of your stomach and back have to create good posture to support the pace your running, the lungs have to be able to keep up the increase in blood flow and oxygenation of your body and muscles, up to the arms that are pumping in an alternating pattern, and ends with your neck muscles that control your head with the impact of running on any surface.


With running being a full body exercise, lets talk first about why most people get pain in the feet, legs, and hips. Looking at your feet, there is more than meets the eye, as there are 26 bones in each foot and this adds up to about 25% of the bones in your entire body. Attaching to each of these bones are ligaments, tendons, muscles, and fascia. When one of these bones are out of place due to the constant impact with running, it can put additional pressure and stress on the muscles, ligaments, tendons and fascia which can cause you pain and tenderness. Most people when they run the first thing that may start to feel in the foot is some sore of plantar fascia pain, as this is a connective tissue on the bottom of your foot that connects the heel to the base of the toes. When running there will be tenderness and pain in the bottom of the foot closer to the heel, and when this occurs people usually run different because of the pain. Running in a different pattern than you body is used to can create additional stress and strain on the other parts of your legs and hips. If you are having this type of pain, first look at the arch of your feet, are they flat or do you have an arch? If you have more of a flat foot then you would need to seek out some sort of arch support, this will give your foot that additional cushion that is needed when running on any surface. Another way to help break up the tension in the foot is get a golf ball and put it on the floor, while sitting in a chair put the arch of the foot on top of the golf ball and slowly roll your foot front and back over the golf ball, and you can increase pressure if you like. This will create pain in the foot, but it also breaks up the tension in the plantar fascia. Do this for about 5-10 minutes, and when you are done you will need to ice the arch of your foot. The way to ice your arch of the foot is to put a plastic water bottle full of water in the freezer, and when your done with this golf ball exercise, pull the water bottle out of the freezer when its frozen, lay it on the ground where you can just roll your arch over the water bottle just as you did the golf ball. This will calm down some of the muscles, and tendons on the bottom of your foot, and cool down any unwanted inflammation.


Going up to the ankle is the next problem area for most people who are avid runners or just running in general. The ankle can give people problems just from walking down the street and stepping into a hole, to running on an awkward surface and twisting one’s ankle. Most of the time when your roll or tweak the ankle it will happen where your foot will roll to the inside, and this will create a stretch or strain of the outer ankle ligaments and tendons. When this occurs there can be inflammation immediately to the outside of the ankle to help support what just occurred, due to the fact that the outer ankle ligaments and tendons are smaller and weaker than the inner ankle tendon and ligaments. There is more to just the ankle pain when this occurs, as the fibula (which is the small bone on the outside of the leg) has been pushed down into the outside of the ankle and this can cause a high ankle sprain. This high ankle sprain can take longer to heal, as it involves more tendons, ligaments and muscles compared to just tweaking or rolling your ankle. The treatment of choice for an ankle sprain is rest, ice the ankle for 20 minutes on and 2 hours off during the daytime, compress the ankle to help with suppressing the inflammation, and elevating the ankle above the heart to allow the inflammation to subside due to gravity. After icing the ankle it would be good to increase movement with just the ankle without putting additional weight on the foot. The exercise that will help the increase blood flow and motion is to write the ABC’s in the air with the foot that is injured. Raise your foot off the ground while sitting and then write ‘in the air’ the ABC’s with that ankle. This motion will increase blood flow to the region, increase motion within the little ligaments, tendons and muscles of that foot, and this will also decrease the amount of time that it takes for your ankle to fully heal.


Next we start to go up into the lower leg to the shins. When running some people run heel to toe, some people run flat footed, and other run on the balls of their feet. When you are getting pain in the shins it could be from the way your feet are moving, foot arch’s that are flat, bad pair of running shoes that offer no support, muscles are weaker than normal, running on awkward surfaces that are not even or solid, and poor mechanics during the run. Shin splints are very painful and the pain is just above the ankle on the front of the leg and can be on the inside or the outside of the lower leg. If these shin splints continue to give you pain, and you still run with the same running style that created the shin splints, they could turn into something bigger and become a stress fracture. Stress fractures are tiny micro-fractures in the lower leg bones, around the same area that shin splints give you pain. This stress fracture is a result of overuse of the lower leg bone with increased intensity or distance that you are running. The only real intervention for stress fractures is to stop running for a while, as the fracture needs to heal and it just takes time for bones to heal. If you suspect that you have a stress fracture, you will need to get an X-ray, but you may not see this on an X-ray as stress fractures are very small and it may take weeks to show up visibly on an X-ray. The other tests you can do to rule in or rule out a stress fracture is to get a Bone Scan or MRI, as these will be more in-depth of an X-ray and will be able to determine if there is a fracture or not. To help out with shin splints the thing to do is ice the shin, and there is an easy way to provide friction icing to help increase recovery time. Take a small paper cup, like a little Dixie cup, fill it three quarters the way up with water and put it in the freezer. After you run, and when you are cooling down, pull out the cup from the freezer and tear off the top of the Dixie cup where you can grab the bottom of the cup with your hand and the top of the ice in the cup is exposed. Once exposed sit down on the ground and rub the ice up and down the shin where the pain is. This will allow for any inflammation and deep pain to slowly calm down and cool off. You should rub the ice up and down for about 10-15 minutes after you cool down.


Going up the leg continues to the knees, where most runners get some sore of pain or tenderness during or after their run. The knee pain that is most common is inner knee pain, and this could be caused by over pronating the foot when running adding additional pressure and compression of the inner knee joint attaching to the femur and tibia. This additional pressure could be due to the tibia being rotated externally, or due to bad running form and posture. When you get inner knee pain it can lead down the path to a MCL tear, medial cartilage or meniscus tear, and long term can lead to some sort of arthritis of the knee joint. The second common location of knee pain is the outer knee pain and this could be caused by over supination of the foot when running, or irritation and inflammation of the iliotibial band that attaches to the outside of the knee joint.


The next post I will go further in detail regarding the knees and the potential problems with knee pain and running. Also we will continue up the leg to the hips and lower back, to explain why running gives you some sort of pain in the knees, hips, and back.


At PrimeSpine in Bellevue, we understand running injuries and how to help prevent and take care of the aches and pains that come with running. Call us Today at (425) 590-9619 to schedule an appointment to find out how we can help with your running pain, so you can live the life you deserve, one free of pain and limitation!