Ask a Physiotherapist: Preventing and treating the most common running injuries

Athletes understand that it’s a classic catch-22. Running is one of the best ways to stay in shape, and yet running can be hard on the body. In fact, according to Statistics Canada, 35% of all injuries nationwide happen while Canadians are participating in sports or exercise. That’s more than a third! Considering how many sports and training regimens include running, it begs a question this census didn’t address specifically: What is the most common injury associated with running? Is it knee pain? Hip pain? Heel, or ankle damage? 

Mike Gauvreau OptimizeAccording to Mike Gauvearu, owner of Optimize Physio & Sport Medicine in Ottawa, that’s the wrong question for runners to ask.

“It’s about root causes,” he smiles, in a friendly way that reveals he’s had to explain this before, many, many times. “It’s usually not about the joint itself, or where you feel the acute pain.” 

Based in Ottawa’s Riverside South near the airport, Optimize has been open since 2015, offering services from physiotherapists, sports-specific physicians, physical therapists and massage therapists who work in concert to offer integrated treatment for athletes of all levels. 

“Many clinics are very modality-based and focus on things like electrical stimulation,” Mike explains, “But we pride ourselves on strength movement, and our mobility focus.”

With Mike’s organic approach in mind, we picked his brain about prevention and treatment of the most common injuries runners encounter year-round.

SI injury (a literal pain in your butt)

When we profiled Lindsay Khan for Runner of the Month, we discussed her recovery from an SI injury, so we were curious to learn more from a professional. Sacroiliac (SI) joint pain manifests in your low back and buttocks. According to Mike, low-back pain goes hand-in-hand with core strength.

“Running is about controlling your torso via your core, to prevent unwanted movement happening at your spine,” he explains. “Most runners need way more strength training than they’re getting. You can’t do enough if you’re a runner.”

He recommends squats, deadlifts, and single leg squats, but points out that HOW you do these weighted exercises is more important than simply doing them. “You need to ensure you have good form, because you don’t want to feed into what’s going on and make it worse.” Here are some tips for mastering these exercises.

Knee pain and injuries (you “kneed” to treat immediately)

Your knees have bones, cartlidge, ligaments and tendons, so there are multiple types of knee pain – and a number of potential causes. 

Ankle mobility is sometimes the culprit, and so are tight muscles and quads, but it turns out most knee pain is probably more about the hips. “Your hips control your knees and everything below them,” Mike explains. “So it comes down to how you’re moving and balancing. He also says that improving your leg strength can make a big difference. 

“Running is a series of single leg impacts, bounding from step to step,” he says. “You need really good single leg strength. When people hit the ground, their knees shift around and that can cause a range of issues.”

Pain in the front of the knee and around your kneecap, called patellofemoral pain syndrome, is one of the most common knee injuries Mike sees at his clinic. His advice? “As soon as you feel the knee pain, get it looked at right away. Usually people get just a little pain, ignore it, and it gets worse and worse over time – and it’s much harder to treat.”

Heels (tissue is the issue)

When it comes to your heels, you need to listen to your body every step of the way. 

The tendon that connects your calf muscle to your heel bone (the achilles tendon) or the tendon that connects your heel bone to you toes (the plantar fascia) are responsible in almost every case Mike encounters.

If you feel stiff in your heel cord or your ankle, it’s a warning sign. Stiffness precedes pain,” Mike says. “The main issue is tissue tolerance, and pain is when the problem has fully manifested itself. That’s when you’ve overloaded the tissue.”

Heel pain is a common problem for new runners who haven’t been guided on their mileage yet, and too much strain on the tendons will cause painful inflammation.

Mike’s best advice is to do walk-run combos. “Try five to ten minutes of walking, then one minute of running and start with that for 20 minutes or so. If it feels pretty good, repeat and slightly increase your intervals. They key message is taking it super slow when you get into running or are recovering.”

Hamstrings, and shin splints (maybe it all really is about the hips)

With these injuries, you need to think about running mechanics and not overloading your legs, and hip extension mobility plays a key role. Mike says people who work at desks need to prioritize hip mobility work, making sure their hips are moving well, otherwise you are prone to stiffness as a result of prolonged sitting.

“If we can’t get our hips into our running strides properly, our hamstring has to do more work. There will be too much pull on the bone, and it becomes painful at the attachment,” Mike says. 

Shin splints are very similar – its an overload of the lower leg. “It’s more muscle related, but it feels like the bone,” Mike explains. “With shin splints, we look at how you are landing, how you interact with the ground. Remember, if you’re a heel smasher when you walk, think of how much impact you’ll have when you’re running.”

… By the way, your “quick fixes” for running injuries aren’t really helping you. 

In general, most running injuries and pains are preventable when you have adequate joint mobility, control, and strength. It’s important to respect tissue tolerance when starting to run or getting back into running after an injury, too.

“I often have to look at running technique and mechanics, because that’s always the big underlying reason why people get injured or develop pain,” Mike says. “Of the common injuries I see, they are all reversible… If the root cause is addressed.”

And therein lies the problem – many runners are resorting to band-aid solutions. “Foam rolling, icing, Advil – these things don’t get to the root cause,” he says. “Rolling loosens the muscles, but it won’t fix the pain long term.” 

Core strength, stretching and mobility are what runners should focus on to avoid and treat injury. And as Mike says, by the time you feel pain, you’ve already overloaded your tissue and then it’s time to consult with a professional about a recovery plan. 

Questions for Mike? Contact the Optimize team.