This article is provided by Teri Burgess, resident Physiotherapist fromTime-to-Run Cape Town, covering the 5 most common running injuries, aptly named by Teri as The BIG Five.

Welcome to the BIG 5

That is, if you know what you are doing! And to help you, we have picked the Big Five. The five most common running injuries: Achilles tendonitis - chondromalacia (runner's knee) - iliotibial band (ITB) syndrome - plantar fasciitis and shinsplints. We tell you what they are and how to deal with them - everything from whether or not to run through them, to when it is time to see a doctor. And which doctor or sports practitioner to see. So that you can be back on the road faster - and injury-free.

The BIG five - the 5 most common running injuries

Achilles tendonitis

Definition: Inflammation of the Achilles tendon.The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress, the tendon tightens and is forced to work too hard. This causes it to become inflamed (that is tendinitis), and, over time, can produce a covering of scar tissue, which is less flexible than the tendon. If the inflamed Achilles continues to be stressed, it can tear or rupture.

Symptoms:
Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel. limited ankle flexibility redness or heat over the painful area a nodule (a lumpy build-up of scar tissue) that can be felt on the tendon a cracking sound (scar tissue rubbing against tendon) with ankle movement.

Causes:

• Tight or fatigued calf muscles, which transfer the burden of running to the Achilles. This can be due to poor stretching, rapidly increasing distance, or over-training excessive hill running or speed work, both of which stress the Achilles more than other types of running.
• Inflexible running shoes, which, in some cases, may force the Achilles to twist.

Runners who overpronate (feet rotate too far inward on impact) are most susceptible to Achilles tendinitis

Chondromalacia - Runner's Knee

Definition: A softening or wearing away and cracking of the cartilage under the kneecap, resulting in pain and inflammation. The cartilage becomes like sandpaper because the kneecap is not riding smoothly over the knee.

Symptoms:

• Pain beneath or on the sides of the kneecap crepitus (grinding noise), as the rough cartilage rubs against cartilage when the knee is flexed.
• Pain is most severe after hill running
• Swelling of the knee

Causes:

• Overpronation (feet rotate too far inward on impact) - can cause the kneecap to twist sideways fatigued or weak quadriceps muscle. The quadriceps muscle assists in the proper tracking of the kneecap.
• Weakness, especially of the inside part of the quadriceps, can prevent the kneecap from tracking smoothly muscle imbalance - between weak quadricepsand tight hamstring and iliotibial band (ITB)
• Muscles can also affect proper tracking hill running (especially down hills) and running on cambered surfaces
• Incorrect or worn shoes
• Overtraining

Iliotibial band (ITB) syndrome

Definition: Pain and inflammation on the outside of the knee, where the iliotibial band (a muscle on the outside of the thigh) becomes tendinous, and results in a friction syndrome by rubbing against the femur (thigh bone) as it runs alongside the knee joint.

Symptoms:
Initially, a dull ache 1-2 kilometres into a run, with pain  remaining for the duration of the run. The pain disappears soon after stopping running, later, severe sharp pain which prevents running pain is worse on running downhills, or on cambered surfaces pain may be present when walking up or downstairs. Local tenderness and inflammation.

Causes:
Anything that causes the leg to bend inwards, stretching the ITB against the femur overpronation (feet rotate too far inward on impact) tightness of the ITB muscle lack of stretching of the ITB incorrect or worn shoes excessive hill running (especially downhills) and running on cambered surfaces overtraining

Plantar Fasciitis

Definition: An inflammation of the plantar fascia, a thick fibrous band of tissue in the bottom of the foot which runs from the heel to the base of the toes. When placed under too much stress, the plantar fascia stretches too far and tears, resulting in inflammation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible than the fascia and only aggravates the problem.

Symptoms:

• Pain at the base of the heel
• pain is most severe in the mornings on getting out of bed, and at the beginning of a run. The pain may fade as you walk or change running stride, in an attempt to alleviate the pain. This provides only temporary relief

Causes:

• Stress, tension and pulling on the plantar fascia
• Inflexible calf muscles and tight Achilles tendons – place more stress onto the plantar fascia.
• Overpronation (feet rotate too far inward on impact)
• High arches and rigid feet
• Incorrect or worn shoes
• Overtraining

Treatment Methods

Self-treatment:

• Stop running, especially in the case of severe pain, if pain is mild, then reduce training load and intensity take a course (5 – 7 days) of non-steroidal anti-inflammatory drugs (ibuprofen/voltaren/cataflam/mobic) available from your general practitioner or pharmacist
• Apply ice to the plantar fascia – for 10 minutes every 2 hours, in order to reduce the inflammation. An effective way of icing is to fill a plastic 500 ml Coke bottle with water, and to freeze it. Apply the ice as instructed by rolling the bottle under the foot
• Self-massage, using arnica oil or an anti-inflammatory gel, to the plantar fasciastretching of the gastrocnemius and soleus muscles
• Return to running gradually
• Full recovery is usually between six to eight weeks

Medical treatment:

• Physiotherapy, if injury doesn’t respond to self-treatment in 2 to 3 weeks
• Orthotist or podiatrist for custom-made orthotics to control overpronation, or to reduce stress on the heel area
• X-rays – to check for a heel spur
• Orthopaedic surgeon – if injury does not respond to physiotherapy treatment, a cortisone injection, or surgery to release the plantar fascia may be indicated

Alternative exercises:

• Swimming, pool running, cycling (in low gear) “spinning”
• Avoid any exercise that places strain onto the plantar fascia

Preventative measures:

Stretching of the gastrocnemius and soleus muscles. Hold each stretchfor 30 seconds, relax slowly. Repeat stretches two – three times per day.

Remember to stretch well before running stretching of the plantar fascia. Sit on the floor with one knee bent and theankle flexed towards you. Pull the toes back towards the ankle. Hold for 30 seconds. Relax slowly. Repeat to opposite foot. Repeat 2 – 3 times per day. Remember to stretch well before running strengthening of the muscles of the foot. 1) Pick up marbles or golf balls with your toes. 2) Pull a towel towards you with your toes. Grab some of the towel with your toes and pull, then release, grab, and pull some more to loosen the plantar fascia, place a golf ball under the foot, and roll the foot over the ball. Start with the ball at the base of the big toe, and roll the foot forwards over the ball, then back again. Move the ball to the base of  toe and repeat. Repeat for each toe. Always exert enough pressure so that you feel a little tenderness. correct shoes, specifically motion-control shoes and orthotics to correct overpronation.

• Always apply ice after running
• Gradually progression of training programme
• Incorporate rest into training programme

Shinsplints

Definition: Inflammation of the muscle attachments and interosseous  membranes to the tibia (shin bone) on the inside of the front of the lower leg. Note: "shin splints" is a very widely used phrase and can refer to several lower leg injuries. The focus of this description is specifically on the inflammation described above.

Symptoms:

• Pain or tenderness along the inside of the shin, usually about halfway down the shin. Pain and tenderness may extend to the knee
• Pain on palpation of the shin
• Pain is most severe at the start of a run, but may disappear during a run, as the muscles loosen up. This is different to a stress fracture, where there is pain during weight bearing activities (walking, stair-climbing)

Causes:

• Inflexible calf muscles and tight
• Achilles tendons - place more stress on to the muscle attachments
• Overpronation (feet rotate too far inward on impact) excessive running on hard surfaces, such as concrete pavementsIncorrect or worn shoesOvertraining, or a rapid increase in training load or intensity

Beginner runners are more susceptible to this problem for a variety of reasons, but most commonly due to the fact that the leg muscles have not been stressed in such a way before they started running.