Lockdown Running Pain – What could be contributing?
In the first part of this series on Lockdown running pain we covered some of the anatomy and common locations of pain within the lower limb. What we will go onto cover now are some of the contributing factors which may contribute towards the development of lower leg pain whilst running. We also spoke about the names of some common running pains such as overload issues, Achilles Tendon Pain, and Medial Tibial Stress Syndrome aka “Shin Splints”. We will briefly touch upon the specific issues where we can. If you are in pain right now, I would consider downloading our 4 Step Guide to Understanding Your Pain which can be found here – www.aristosfitness.co.uk/physio. The information in this guide will be useful in helping you highlight and reflect upon some potential contributors to your pain.
Here is a brief list of what we will cover in this blog:
Training Error
Biomechanical Factors
General Capacity
Lifestyle Factors
1. Training Error
One of first things I would look to in someone presenting to me with lower leg pain due to running would be their current training schedule. This can give us some great information that we can easily manipulate to see if it helps to address the symptoms. Factors such as changes to or excessive mileage over the course of the week, a recent change in intensity (e.g. going from mainly long slow distance sessions to “speed” sessions), and a recent change in surface can all be contributing factors. In addition to this, I would look at the general structure of the training, looking for things like adequate recovery between sessions. Its common for individuals to just leave their front door and run with no plan. The problem with this is that it can be very hard to track some of the things mentioned above. If possible, and especially if new to running, try to follow a properly prescribed and progressive running plan to get you started. Did you know that most individuals who present with bony pain like Shin Splits do so within their first 4 weeks of running?
2. Biomechanical Factors
Biomechanical factors cover everything to do with our running style. Everyone’s running style is unique to them depending upon their different experiences of running. However, some clues can be taken from an assessment of running style that can be changed to see if symptoms can be managed during running. Do you ever feel your knees brushing together as you run? Or feel as though you are running along a tightrope? If so then this may mean your knee has a tendency to fall inwards as your foot hits the ground – this is known as hip adduction or knee valgus. This can lead to more force being distributed through the inside part of the lower leg and contribute towards things such as MTSS “Shin Splints” or Tibialis Posterior Tendon Pain. It is important to have your running style assessed by a professional to determine if this is the case for sure, but taking a quick video of yourself can sometimes help.
The same goes for what we call “pronation” of the foot. This is where our foot roles inwards – have you ever been told you have “flat feet”? This would be what pronation looks like. Now this isn’t a problematic movement in itself and in fact is an essential part of how our foot works but it is something to look out for. As always, its important to have someone assess you to see if this is something you should change.
Something else I would look at is whether or not you strike the ground with your forefoot (front of the foot) or heel when making contact with the ground. Everyone is different on this one and its even been shown to change for the same person when they change from road onto treadmill running. However, it may be appropriate to consider this for issues such as Achilles Tendon pain. For example, if you are a forefoot striker and experiencing Achilles Tendon pain, we may look to change this for a period to off load your tendon. We would do this because a forefoot striker will load their Achilles Tendon more during contact with the ground. We would likely do this by altering step rate which we will discuss next.
Step Rate or cadence would be next on my list to assess whether or not we need to make any changes. This is the number of steps you take within a minute – if you have a Garmin watch it works this out for you! Altering Cadence has been shown to help the reduce the load and forces on many of the important areas associated with running pain / injury. Generally, it is an increase in cadence that is required. Do not do this yourself! The decision to change anything around running style / technique should be a discussion between yourself and a professional.
3. General Capacity
Next on this list would be everything related to range of motion, control of movement (motor control) and strength. Any loss of range of motion at key joints within the leg may contribute towards altered movement patterns. This is where it would be important to look at your previous injury history. For example, if you’ve had a previous ankle injury, longstanding stiffness at the ankle could lead to changes in your movement patterns that may mean you have to roll your foot in more as you walk / run, therefore placing more load through the inside of your ankle, which then in turn could lead to issues with shin splints or Tib Post tendon pain. Control of movement, especially on a single leg is vitally important. We touched on this above, however its important that we are able to absorb and produce high levels of force under control, so that we can control things like our knee falling in (Knee Valgus). A big part of being able to absorb and control this force is having adequate lower limb strength – particularly in single leg situations. During running we are exposed to 2-3 times body weight per leg with every stride! Therefore, it is encouraged that strength training forms some part of your training week. Strength training has been shown to reduce the risk of sport injuries by almost half! If you have a specific running goal in mind and would like to find out how to balance running and strength training, get in touch to discuss our Aristos Individual Design service.
4. Lifestyle Factors
The national sleep foundation recommends as adult we get 7-9 hours of sleep per night. Those who demonstrate consistently poor sleep patterns and habits are exposed to various negative consequences. Some of these include reduced feeling of wellbeing, reduced recovery from exercise, inhibited immune function and increased likelihood of injury or development of longstanding pain. Therefore, it is extremely important to reflect honestly on your own sleeping quality and habits as its one of the low hanging fruits you can change straight away to get the benefits. Think along the lines of making sure your room is cool and dark, limit electronics before bed, limit caffeine / alcohol intake, and have a consistent sleep and wake time.
Proper nutrition and hydration will improve your recovery from your running and is again one of the low hanging fruits. Prioritise wholefood sources where possible, with adequate amounts of protein, vegetables, carbohydrates and fats to fuel and recover from your running training. Its also extremely important to consider food hygiene to help with things like absorption and to help with over eating. Sit down and chew your food and eat without distraction. For more guidance on your nutrition, contact our Aristos Fitness Nutrition team.
RYAN BARR | LEAD PHYSIOTHERAPIST & ARISTOS ID COACH
To book a consultation with Ryan or to download his 4 Step Guide to Understanding Your Pain, click here.