The Runner’s Dilemma: Pain With Running That Nobody Understands

Let’s face it, being injured and having to stop running stinks.  I like to run for fitness for multiple reasons including time, cost, and the great cardiovascular fitness value.  It is more than just fitness.  There is something unique to running that is difficult to replicate with other forms of exercise.  The feeling of satisfaction following a run is hard to match.  Having an injury that limits running in any way is a hit to the body and maybe more importantly the mind.   I crave being outside and getting lost in the pace of mind and rhythm of my run.  I am sure many runners out there feel the same way.  When an injury happens and our running release gets taken from us there is a sense of stress and anger and it shifts the balance and control we were so proud of.  We start looking for the best ways to get rid of our pain with running.

Knee pain is by far the most common running injury.

The first line of defense for many is a few days of rest and maybe some anti-inflammatory medication.  This may help with the day to day pain but usually, once running is resumed again, the pain returns.  So the next tactic is to visit the local running store to buy a new pair of shoes.  We follow the old change your shoes every 500 miles rule even though there is no research basis for this recommendation (except those produced by shoe companies).  They have found that running shoes lose 75% of the cushioning in the first 50 miles!  Having the confidence our new $120 pair of shoes is the answer we lace them up and head out on our typical route.  It feels great to be out running again but by mile 3 the pain is back.  We continue our running routine for the next 2 weeks thinking we just need to “break in” the new shoes only to find the same old pain in the same old place.

Our next option is to visit out primary care doctor to get a diagnosis.  The doctor tells us we are running too much and that running is bad for the body.  They tell us what structure might be injured and advise we go to the physical therapist.  At the PT office we undergo another evaluation where they have us run up and down the clinic or maybe on a treadmill while they watch.  After watching us run they state, “I think you are landing wrong on your right side.” We go through an exercise program that involves iliotibial band stretches and hip strengthening. After 4 weeks with the PT we head back out on a run and things feel better.  We are able to complete 2 runs only to find that by the 3rd run the pain is back again.  We are then prescribed orthotics and some additional exercises which we consciously complete over the next 3 weeks.  Yet again we head out on a run only to find continued pain and a new level of frustration.

Stretching may help improve IT band mobility, but it will not improve running form.

Does this process sound familiar?  It is the typical progression of most runners when encountering an injury.  Currently, the medical model is limited in its diagnosis of running related injuries.  I have worked in the physical therapy field for many years and have experienced the frustration of trying to help runners return to what they love most.  I realized, as many others have, there is a lack of objective measures to test runners to observe exactly what is causing their problem.  Many highly educated professionals do they best they can to help decrease a runner’s pain but they lack the necessary tools to make the definitive diagnosis.  Without the right equipment to evaluate a runner it is very difficult eradicate their pain.

Medicine has many technological advances that help to see and evaluate parts of the body in precise detail.  To test musculoskeletal problems there is an MRI, to detect a fracture there is an X-ray, to observe pathogens there is a culture or blood test, and to detect cancer there is a PET scan.  In physical therapy, up till the last 15 years, there has not been a test to detect movement errors that occur at fast speeds.  Now, with the advent of high speed slow motion video, physical therapists and sports professionals can observe fast motions frame by frame.  This ability has transformed the way we evaluate and treat athletes and those with movement dysfunction.

Slow motion video with pressure analysis and joint angle tracking.

Running is an activity that occurs at fast speeds, many of which are incapable of being processed by the naked eye.  For instance, to observe a heel strike or initial contact, you have to be able to recognize about 100 frames per second of movement.  The capacity of the human eye is around 30-60 frames per second.  So no matter how hard I have tried to look at a runner’s heel strike I am unable to correctly observe it.  Additionally, to pinpoint precise range of motion measurements during running is impossible in real-time observation.  With 100 frames per second video you can capture all phases of the running gait cycle for range of motion and movement analysis.

If you want to fix a problem you have to first correctly define the problem.  Until recently, those who treat runners have been trying to fix a problem they have not defined to its most basic of parts.  Now that we are starting to understand the precision and depth of the running movement pattern we are achieving great success with eradicating pain and improving running performance.  It is essential to view running with the latest in video and movement analysis equipment to figure out the heart of the problem.  With poor data input you get poor information output.  With precise data input you get more exact data output.

If you are a runner and have not been able to return to running despite receiving care from your medical team it is time you had a full running gait analysis.  I believe a running gait analysis should be a first line of defense in treating an injured runner. Knowing exactly how you perform a movement can pinpoint the biomechanical movement errors that are creating the painful tissue.  It can provide you exact data on your running form to correct movement errors causing pain or even highlight inefficiencies that are slowing you down.

It is estimated that up to 79% of runners are injured in a given year.  That is a huge number for one sport and I know we can have an impact on decreasing injury.  If you are injured or want to avoid injury then a running gait analysis is your ticket to return to running.  At Competitive EDGE we offer the best in running gait analysis.  Our state-of-the-art 3D motion sensors, high frame rate video, muscle tracking EMG, and pressure treadmill can highlight every detail of your running form.  We have a detailed multi-point assessment of running gait and will tailor a return to running program to get you back to what you love most.  I hope you stay injury free with running.  If injury occurs I am here to help.  Keep on running!

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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