Common Running Injuries: Evaluation and Management

 

Am Fam Physician. 2018 Apr 15;97(8):510-516.

  Patient information: A handout on this topic is available at https://familydoctor.org/running-preventing-overuse-injuries.

Author disclosure: No relevant financial affiliations.

Running is a common form of exercise but predisposes athletes to several running-related injuries. Most running injuries are due to overuse and respond to conservative treatment. Tendinopathies in the patellar, Achilles, and hamstring tendons are common, and are primarily treated with eccentric exercise. Iliotibial band syndrome and patellofemoral pain syndrome are less common than patellar tendinopathy and are treated by strengthening exercises for the core and legs in addition to flexibility exercises. Acute hamstring strains and medial tibial stress syndrome require a period of relative rest, followed by stretching and graded return to activity. Tibial stress fractures require an extended period of relative rest, followed by a more gradual return to activity. Early mobilization improves recovery from ankle sprains, and exercise therapy and functional bracing while running for six to 12 months prevents reinjury. Plantar fasciopathy (plantar fasciitis) can be significantly improved with stretching, heel raises, and orthoses that provide arch support.

Approximately 1% of Americans run on an average day, nearly twice as many as those who golf or cycle.1 Running is an excellent form of exercise; even at a slow pace, it is matched in metabolic equivalents only by vigorous swimming or cycling.2,3  However, injuries are common among runners (Table 1).4 A systematic review showed a one-year injury rate of 27% in novice runners, 32% in long distance runners, and 52% in marathon runners.5 The lower prevalence for novice runners seems to be secondary to less running time. Another systematic review found that novice runners were injured twice as often as recreational runners.6

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Eccentric exercises are primary therapy for patellar and Achilles tendinopathies.

A

11, 12, 14, 15

Exercise therapy for patellofemoral pain should consist of core and leg strengthening as well as leg flexibility exercises.

A

23

Exercise therapy for iliotibial band syndrome should consist of hip abductor strengthening and hamstring and iliotibial band stretching.

B

29

Functional bracing while running should be continued for six to 12 months after an ankle sprain to improve stability and prevent recurrence.

A

37

Foot orthoses are beneficial for plantar fasciopathy (plantar fasciitis). There is no evidence that custom orthoses are superior to commercially available products.

A

46, 47

Eccentric exercises should be considered for treatment of hamstring tendinopathy.

C

18, 54


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Eccentric exercises are primary therapy for patellar and Achilles tendinopathies.

A

11, 12, 14, 15

Exercise therapy for patellofemoral pain should consist of core and leg strengthening as well as leg flexibility exercises.

A

23

Exercise therapy for iliotibial band syndrome should consist of hip abductor strengthening and hamstring and iliotibial band stretching.

B

29

Functional bracing while running should be continued for six to 12 months after an ankle sprain to improve stability and prevent recurrence.

A

37

Foot orthoses are beneficial for plantar fasciopathy (plantar fasciitis). There is no evidence that custom orthoses are superior to commercially available products.

A

46, 47

Eccentric exercises should be considered for treatment of hamstring tendinopathy.

C

18, 54


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

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BEST PRACTICES IN ORTHOPEDICS

Recommendations from the Choosing Wisely Campaign

RecommendationSponsoring organization

Do not routinely order radiography for diagnosis of plantar fasciitis/heel pain in employees who stand or walk at work.

American College of Occupational and Environmental Medicine

Avoid ordering knee magnetic resonance imaging for a patient with anterior knee pain without mechanical symptoms or effusion unless the patient has not improved following completion of an appropriate functional rehabilitation program.

American Medical Society for Sports Medicine

Do not perform surgery for plantar fasciitis before trying six months of nonoperative care.

American Orthopaedic Foot and Ankle Society


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org.

The Authors

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MICHAEL J. ARNOLD, MD, is faculty in the Department of Family Medicine at Naval Hospital Jacksonville (Fla.)....

AARON L. MOODY, MD, is a third-year resident in the Department of Family Medicine at Naval Hospital Jacksonville.

Address correspondence to Michael J. Arnold, MD, Naval Hospital Jacksonville, 2080 Child St., Jacksonville, FL 32214 (e-mail: michael.j.arnold4.mil@mail.mil). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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