When running becomes a pain in the heel . .
In keeping with the theme of 'road running' and having discussed anterior knee pain earlier this week, I would like to delve further into other common overuse injuries that develop due to the sudden change in demand on the joints and soft tissue structures.
Today we will briefly discuss :
Achilles Tendinopathy
Medial tibial stress syndrome (commonly known as “shin splints”)
Plantar heel pain
Achilles Tendinopathy
The achilles tendon is the largest and strongest tendon in the body. It's function is to attach the gastrocnemius and soleus muscles (calf muscles) to the calcaneus (heel bone) while transmitting force generated by the muscles to the bone, and functions like a spring for pushing/explosive movements. The calf muscles produce forces 6-8 times body weight during running. In order to produce this force consistently, a solid base of strength is needed. If the calf muscles fatigue considerably, this can increase the risk of the achilles tendon becoming overloaded.
Such rapid overload of the tendon can cause its structure to change resulting in a tendon less capable of sustaining repeated load (Malliaris et al, 2013). Repetitive overloading of the achilles tendon and training errors, such as rapidly increasing activity, training intensity or duration, are reported to be contributing factors in 60 - 80% of those who develop achilles tendinopathy.
Achilles tendinopathy is characterised by localised tendon pain with loading and it is primarily managed with a combination of isometric, eccentric and concentric tendon loading exercises. (among other interventions)
Medial tibial stress syndrome (shin splints)
Medial tibial stress syndrome is another overuse, exercise-induced injury and it is very common in those who partake in recurrent impact exercise eg. running. Reported pain is typically located along the inside of the shin bone and quite often can involve tibialis posterior to a greater or lesser extent, depending on the individual case. The tibialis posterior’s primary function is to control the medial (inside) arch of the foot. When tibialis posterior lacks sufficient strength and control qualities, we can struggle to control movement at the arch. Similarly this can alter the lower limb’s ability to absorb shock on impact thus increasing the stress on the medial aspect (inside of) the tibia. We must also consider the ability to control the hip and knee higher up the chain, as weaknesses in this area can also add fuel to the fire.
In clinic, we generally see a combination of training errors (spike in running load or volume, change in footwear, change in surfaces etc) and biomechanical inefficiencies (in many cases previous lower limb injuries that haven't been adequately rehabilitated) as key risk factors for overuse injuries.
Plantar Fasciopathy
The plantar fascia is a thick connective tissue that supports the arch of the foot and acts as a shock absorber to dissipate force on loading. It attaches at the calcaneus (heel bone) and connects with the metatarsal bones. The tibia loads the foot during weight-bearing, creating a tension in the plantar fascia. The tension in the fascia is created by pulling your big toe up towards the sky. This is called "The Windlass Mechanism" and it helps stabilise the foot by aiding control of the medial arch of the foot.
Pain associated with the plantar fascia is more often than not worse in the morning or during the initial steps after a period of rest (Hunt et al, 2008). The pain can ease with exercise but can worsen after intense training. Similar to the previous two injuries, biomechanical inefficiencies (suboptimal single leg control, below-par calf muscular strength, reduced tibialis posterior strength) in combination with training errors and reduced plantar tissue tolerance are known factors which can lead to irritation of the plantar fascia. As is the case with all of the aforementioned injuries, we strive to achieve efficiency of human movement to reduce the risk of overload injuries.
Take home message:
How can we help ourselves ?
Optimise single leg/foot control
Sufficient lower limb muscle & tendon strength/resilience
Be mindful of other factors such as a change in running surface, spike in running volume etc
If you have any questions in relation to the above, don't hesitate to contact me or any member of our team, we will be more than happy to discuss it with you.
Aodhán McEntee
Chartered Physiotherapist
BSc Sports Science
MSc Physiotherapy
Corú Registered
email: aodhan@mcenteephysio.com