Beat the Seven Body Breakdowns

In an ideal runner's world, every step would be pain-free. No aches, no twinges and no lingering soreness from yesterday. But in the real world, we constantly deal with slight (or not-so-slight) niggles.

There are 'red light' full-blown injuries that require time off, and there's the 'green light' with only transient aches that bug you one day and disappear the next. Unfortunately, many of us get stuck in the middle, ploughing through those not-quite-injured-but-not-quite-healthy amber lights.

Whether you hit red, linger on amber or get the green depends largely on how you react to that first stab of pain. "Often it comes down to whether you take a little time off now, or a lot of time off later," says sports injury specialist Dr Richard Price.

You can cut your risk of amber turning red by dropping mileage, reducing intensity or starting treatment. You can dodge red lights altogether with a proactive long-term injury prevention strategy, including strength training, stretching and regular foam rolling.

"Physical therapy is like homework," says Price. "None of us like having to do it, but  if you don't, the issue will recur."

Price and the team of top sports injury experts you'll hear from over the following pages have isolated the seven running injury hotspots that are the most frequently affected. Learning to read the signs and take the right action for rehab and prevention will keep your running in the green light.

Illustrations: Jonathon Rosen

1. Runner's Knee

Patellofemoral pain syndrome is even more annoying to get than to try to say during a fartlek session. Also known as PFPS or 'runner's knee', it is the irritation of the cartilage on the underside of the patella (kneecap).

About 40 per cent of running injuries are knee complaints and 13 per cent of runners have suffered knee pain in the past year, according to an RW survey.  

PFPS typically flares up during or after long runs, after extended periods of sitting down or while descending hills and stairs.

Are you at risk?
Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, according to Dr Bryan Heiderscheit, director of the University of Wisconsin Runners' Clinic, US. Those factors include overpronation (excessive inward foot rolling) and weak quads, hips or glutes.

Can you run through it?
Yes, but you need to take extra rest days and reduce your mileage. Run every other day and only as far as you can without pain. Some runners find inclines less painful, so Heiderscheit recommends simulating hills on a treadmill. Running uphill works your glutes: strong glutes help control hip and thigh movement, in turn preventing your knees from rolling inwards. Cycling may speed recovery by strengthening the quads, and elliptical training and swimming are also knee-friendly. Just avoid running downhill, which can exacerbate pain.

Rehab it
 Strengthen weak hip and glute muscles with lateral side-steps, says physiotherapist Charlie Merrill. Loop a resistance band just above your ankles or knees. Separate your feet and bend your knees to lower into a crouch. Now walk sideways for 10-15 steps, keeping your feet straight and upper body still.

Maintain band tension throughout, then reverse the direction. When this gets easy, try it on your toes. If there's an issue with the way your kneecap tracks, athletic tape may reduce pain.

You can watch Merrill demonstrating knee taping at runnersworld.co.uk/kneetape. Post-run icing helps in the early stages; heat works best as the injury is healing.

Prevent a relapse
Heiderscheit recommends shortening your stride length and landing with your knee slightly bent, which can take up to 30 per cent of the load off the joint. Count the number of steps you take per minute, then increase by five to 10 per cent. Keep your knee tracking correctly by strengthening its supporting muscles - your quads and glutes - by doing side-steps and squats.

Elite tip
Olympic marathon silver medallist Meb Keflezighi had knee trouble in the buildup to last year's Boston Marathon. He took two weeks off and ran only every other day for the following two weeks. The strategy worked: he clocked 2:09 at Boston.


Knee-d to know: How to proceed

Stop running
Pain on the inside or outside of your knee on waking, which doesn't ease through the day.

Run with caution
Twinges early in a run that dissipate, then come back post-run. Flares after prolonged sitting.

Go Run!
Pain-free, even after sitting through a two-hour film or tackling a  long hilly run.

2. Hamstring Troubles

Your hammies bend your knees, extend your legs, drive you up hills and power finish-line kicks. In fact, they do pretty much everything except hand you your sports drink, so when they're too tight or weak to perform, you notice it.

Seven per cent of RW survey respondents said their hamstrings have bothered them in the past year.

Counterintuitive as it might seem, very flexible people are prone to hamstring issues because their overly stretched muscles are more vulnerable. If you can barely touch your toes, stop looking smug - you're also at risk.

Sitting for long periods is another risk factor, as is muscle imbalance: many runners' quads overpower their hamstrings, which sets them up for injury.

Can you run through it?
If the pain comes on strong and suddenly, and the area bruises, you may have a pull and need months of rest. If it's a less severe overuse injury, you can usually run - but it'll take time before you're on green again. Running an easy pace is usually less painful than intervals or hill reps. Cycling, aqua running and swimming are alternatives.

Rehab it
Strengthen your hamstrings with single-leg hamstring curls (raise the bar with both legs, then slowly lower it one leg at a time) and single-leg deadlifts (stand on one leg with the other in the air behind you, keep your back straight and reach your hands towards the ground). Merrill recommends using a foam roller to alleviate tightness.

Prevent a relapse
Build with bridges: lie on your back with your feet on an exercise ball. Raise your hips, then lift one leg into the air. Lower your hips back down. Repeat with your other leg. Wearing compression tights post-run can also help by aiding blood flow (Skins Long Compression Tight, £52, runnersworldstore.co.uk).

Elite tip
When champion miler David Torrence felt his hamstring tighten, he took the next day off and went to his chiropractor. "I took it easy, iced the hamstring four times daily, and it improved within a week," he says.


Hamstring warning: How to proceed

Stop running
You feel a sharp, sudden pain, especially with a 'snap' or a 'pop'. You have bruising.

Run with caution
Chronic achiness and tightness that forces you to slow your pace and shorten your stride.

Go run!
Pain-free on hills and speedwork - even after long periods of sitting down.

3. Achilles Tendinits

Your achilles tendon connects the two major calf muscles to the back of the heel. Under too much stress, it tightens and becomes irritated. Tendinitis accounts for 11 per cent of all running injuries; eight per cent of RW survey respondents have had it in the past year.

Are you at risk?
If you've dramatically intensified your training, have tight, weak calves or have been imperfectly dipped in the waters of invincibility, you're vulnerable.

Can you run through it?
Forget the classic PE teacher's mantra. "If you have any pain during or after running, stop," says sports podiatrist Amol Saxena. Catch minor strains early and a few days off can heal them; keep running and it could take six months to clear.

Rehab it
Ice five times a day and strengthen your calves with eccentric heel drops: stand with the balls of your feet on a step. Raise up on both feet, then take your strong foot off the step. Lower on your injured foot, dropping your heel below the step. Raise, and put your other foot back on the step. Do 20 reps.

Prevent a relapse
Strong calves protect your achilles, so do those heel drops daily. Avoid aggressive calf stretching, and wearing flip-flops and high-heeled shoes.

Elite tip
Shannon Rowbury, 1500m bronze medallist at the 2009 World Championships, wears compression socks for hard workouts to relieve achilles tightness (X-Socks Energizer Compression Socks, £17.50, runnersworldstore.co.uk).


Ankle alert: How to proceed

Stop running
Severe pain and swelling above your heel - even when you're not running.

Run with caution
Severe pain and swelling above your heel - even when you're
not running.

Go run!
No pain when you pinch the tendon, starting at the heel and working your way up towards your calf.

4. Shin Splints

If you want to get technical, shin splints refers to medial tibial stress syndrome. It's a pain caused by tears in the muscles around the shin and accounts for 15 per cent of running injuries; 10 per cent of RW survey respondents have suffered in the past year.

Are you at risk?
Shin splints are common among new runners and those returning after extended layoffs. They're a sign you've done too much, too quickly, says Price. High arches or flat feet put you at extra risk, as does wearing the wrong shoes, or a pair with too many miles on the soles.

Can you run through it?
At the very first twinge, cut back to a comfortable level for a few days to a week, then slowly up your mileage using the 10 per cent rule (a maximum 10 per cent mileage increase each week). You can also bike, aqua run, and swim.

Rehab it
Rest, ice and take ibuprofen to ease the pain. Conventional wisdom has preached that calf stretching is the key to recovering from shin splints, but Price says there's little evidence it helps.

Taping your shin with Kinesio Tex tape (£12.50, physiosupplies.com) can relieve pain and speed healing. See how at runnersworld.co.uk/shintape. Wearing an Aircast ankle brace (Aircast A60, £44, physioroom.com) throughout the day, even while running, can also speed recovery. These braces stabilise the ankle so the shin muscles don't have to work so hard, Saxena says.

Prevent a relapse
The easiest and best way to dodge shin splints is to increase mileage gradually. Saxena also recommends ensuring you're in the right shoe. Beginners, especially, can benefit from professional help at a specialist running shop.

If you have high arches, you may need a cushioned shoe. If you have flat feet, a rigid shoe might be the solution.

Elite tip

Once or twice a month, miler David Torrence cross-trains by playing football. "The lateral movement uses your muscles in a different way than when you're running forwards," he says. "It's helped me manage my shin splints." Tennis or netball would do the trick, too.


Shin signs:  How to proceed

Stop running
Tenderness down your leg, especially if you hop on it. If walking hurts, it could be a fracture.

Run with caution

Tight, aching pain when running, but eases when you stop. Hopping isn't painful.

Go run!
Completely pain-free running, even long after you stop icing and taping your shins.

5. Iliotibial Band Syndrome

This sounds like a psychological condition common in NME-reading teenagers - and feels even more irritating. Your iliotibial (IT) band runs hip-to-knee along the outside of your thigh.

When you run, your knee flexes and extends, which causes it to rub on the side of the femur and cause irritation. Fourteen per cent of RW survey respondents have experienced ITBS in the past year; the complaint makes up 12 per cent of all running injuries.

Are you at risk?
You're vulnerable if you hike up your mileage too quickly, especially if you're doing a lot of track work and downhill running or if you overpronate, have a leg length discrepancy or have weak hip abductors and gluteal muscles. "If your hip motion isn't well controlled, your IT band gets stretched with your running stride, and that can irritate it," says Heiderscheit.

Can you run through it?
ITBS is a stubborn injury. Take a rest day  or two and cut back your mileage for a week, and you could avoid a full-blown    flare-up, Price advises. Ignoring early symptoms and sticking with your usual mileage and intensity can exacerbate it.

Rehab it
Strengthen your hip abductors with side-steps, side leg lifts and single-leg squats. Also use a foam roller before and after running: rest the outside of your thigh on the roller and roll your IT band from knee to hip. Hiking and cycling can aggravate ITBS, so swim, aqua run or use the elliptical trainer.

Prevent a relapse
Continue the exercises and foam rolling. Change directions every few laps while on a track, and limit your hill runs, says Heiderscheit. IT band issues often clear if you can learn to shorten your stride so your weight centres on the front of the heel or the midfoot as you land. "A five to 10 per cent difference in your stride length can make a huge difference," says Heiderscheit.

Elite tip
Olympic 5000m runner Bolota Asmerom had to deal with ITBS when he upped his training to 70 miles a week. "I got relief through massage plus strength and flexibility work," he says. "I've stayed injury-free since because I take care of every ache  with massage and ice. I also avoid doing  too much track running."


Thigh anxiety: How to proceed

Stop running
Pain on the outside of your knee that travels up and down your leg when walking down the stairs.

Run with caution
Pain on the outside of your knee that travels up and down your leg when walking down the stairs.

Go run!
Outer knee and thigh are completely pain-free - even after running on hills or on a track.

6. Plantar Fasciitis

When you consider that with each step our feet absorb a force several times our body weight, it's not shocking that about 15 per cent of running injuries strike the foot.

The nagging bite of plantar fasciitis - tears or inflammation of the tendons and ligaments that run from your heel to your toes - is the top foot complaint among runners. The RW survey found that 10 per cent have struggled with it this past year.

The pain typically feels  like a dull ache along your arch or the bottom of your heel. And watch for an urge to sprinkle ibruprofen on your corn flakes: the pain usually peaks first    thing in the morning.

Are you at risk?
Runners with very high or very low arches are vulnerable to plantar fasciitis, according to Saxena, because both foot types stretch the plantar fascia away from the heel bone.

Other causes are extreme pronation (excessive inward rolling of the foot), supination (excessive outward rolling of the foot) and upping your mileage too quickly.

Tight hip flexors, weak core muscles and a history of lower back pain can also contribute. "Back problems and core weakness can lead to subtle changes in your stride that you will feel in the feet," says Merrill.

Can you run through it?
This is a notoriously nagging injury and running through it, while possible, can delay the healing process. Recovery time can range from three months to a year, but six months is typical, Saxena says. In chronic cases, a complete break is best.

Pool running and swimming keep pressure off your feet, while cycling and elliptical training help to maintain fitness - but avoid them if they cause pain.

Rehab it
Roll your foot over a frozen water bottle for five minutes, five times a day, Saxena says. To stretch your plantar fascia, sit with one leg crossed over the other so your ankle rests on your knee.

Grab the toe end of your raised foot and gently pull back. Because calf tightness can be a factor, Merrill recommends using a foam roller to loosen them up. He also stresses the importance of core work such as planks and back extensions.

"When I see someone who has had plantar pain for years, they're almost always lacking core strength," says Merrill. "Sometimes all they need is to do some core work and their heel gets better. A stable core reduces stress on the spine and stops the transference of pain to the foot."

Prevent a relapse
Make sure your shoes match your foot type by getting your gait analysed by a specialist running shoe store, podiatrist or physiotherapist. Custom-made orthotics may help the problem.

Stretch and massage the plantar fascia several times a day, and in the morning, hang your feet over the edge of your bed and roll your ankles. Schedule in some core work at  least twice a week.

Elite tip
Magdalena Lewy Boulet, who is a 2:26 marathoner, struggled with plantar fasciitis that became so severe, she contemplated ending her career.

"I got on a rehab routine that included active-isolated stretching and it cured me," she says. "Now it's part of my maintenance routine - 15 minutes, twice a day."


Plantar pain: How to proceed

Stop running
Arch pain and tenderness that doesn't fade - even once you've warmed up on your run.

Run with caution
Pain when you get up after sitting for a long time, or during the first few minutes of a run.

Go run!
Pain-free all day, including your first steps in the morning. Walking barefoot on hard ground is fine.

7. Stress Fracture

Unlike acute fractures resulting from slips or falls, stress fractures develop as a result of cumulative strain on the bone.

They're no picnic, though. In fact, they're one of the most serious running injuries, striking runners most often in their tibias (shin), metatarsals (feet), or calcaneus bones (heels). Six per cent of RW survey respondents have been struck in the past year.

Are you at risk?
Are you overtraining? Give yourself an honest answer. Bones need downtime to rebuild after workouts and if you increase the duration, intensity or frequency of your running too soon, your bones can't repair themselves fast enough.

Stress fractures are more common in women than men, usually because of nutritional deficits, low oestrogen levels and inadequate calorie intake. Luckily, weight-bearing exercise like running is actually protective, which means experience is on your side: "The longer you've been running, the lower your risk," says Price.

Can you run through it?
In a word: no. Expect to have to take eight to 16 weeks off, depending on the location and severity of the fracture.

Bones in the foot heal slower than those in the shin, for example. Run through the pain and you'll be spending some more time on the sofa, warns Merrill. Avoid all impact exercise - aqua run and swim instead.

Rehab it
Listen to your body. "Once you can walk without pain, try a bit of jogging," says Price. "Back off if there's lingering pain, and it's crucial to build your mileage slowly - start with just a few minutes."

Prevent a relapse
Improve bone density with weight training, and make sure you're getting enough calories and nutrients.

Also, running surfaces don't seem to make a difference: "It makes sense that soft surfaces would be better for you than roads, but studies have not borne that out," says Price.

Elite tip
Maintain your fitness by introducing  aqua running to your training regime. "When [US long-distance runner] Deena Kastor broke a bone in her foot during the 2008 Olympic Marathon, she had to take six weeks off for recovery," says Price. "Daily pool running kept her strong."


Bone breaker: How to proceed

Stop running
Pain builds as you run, but doesn't stop when you stop. Just being on your feet is uncomfortable.

Run with caution
Sorry, there's no middle ground here. With this one, it's either red or green.

Go run!
Pain-free during a run and no lingering pain after - even when you've been on your feet all day.