Pace Setter : May 2021

Doc! I can’t run! My leg hurts!

by Todd Shatynski, MD, CAQSM

Anyone who has run for a significant amount of time has likely coped with a bout of leg pain – especially in the knee or the Achilles tendon.  Some see it as a rite of passage for running mile after mile and hope that just taking time off will let things calm down.

While time off can be part of the strategy to heal, it is common for the problem to flare up when returning to training in a few weeks or months.  That is because many running injuries are more than just overuse.  Pain not only indicates irritated tissue but also an overload in the body’s ‘weak link’.  It may require more investigation into the problem that is causing stress to the sore area.  Is there a flaw in the gait?  Is the runner overstriding?  Is there a hip imbalance? Inflexibility in the quad or calf muscles?  Figuring out the ‘culprit’ problem causing the ‘victim’ injury is where a good sports medicine physician or physical therapist can help.

The most common running problems I see in my practice are patellofemoral syndrome, iliotibial band syndrome, and Achilles tendinitis.  These problems are not necessarily due to damage to the tissue but an overload of the tissue.  Patellofemoral syndrome occurs when the kneecap “tracks” asymmetrically in the knee and loads the cartilage.  Iliotibial band syndrome often results from friction over the outside/lateral part of the knee from the band running from the hip to the knee.  Achilles tendonitis develops when the tendon is stressed from the traction load and torsional and shearing forces.

Making adjustments to one’s running gait may be necessary to help control the forces on these body parts.  Runners can do this by working on one leg balance, strength and flexibility.  Often the hip flexor is too tight, and the hip abductor (gluteal) muscles are too weak.  The quadriceps or calf muscles can be too tight and imbalanced, causing asymmetric forces through the knee and the foot.  While a rest from running helps reduce the pain and inflammation, imbalances and weaknesses must be addressed, or the injuries will linger or recur!  The pain may subside faster with anti-inflammatory medication like ibuprofen or naproxen, but caution with its use is necessary due to potentially serious side effects.  I would recommend avoiding corticosteroids (cortisone) injected or dosed orally as they can have even more severe side effects and can worsen the overall problem in the knee or Achilles.

The first step is to get a proper diagnosis and then work on the imbalances.  Cross-training can usually continue to help maintain fitness and sanity while away from running.  It may even help to deal with asymmetry in the body.  If help is needed to rehab, a good sports physician, physical therapist, or chiropractor can help educate and coax the muscles and tissues back into better coordination.

Often, manual therapies can help release some of the tight “knots” in the muscle.  These “knots” can also be addressed with foam rolling, massage, and stretching.  If they are persistent, some practitioners can perform therapeutic needling to reduce the irritability of the trigger points.  Most commonly in the quads and calves, these trigger points can contribute to the overload on the knee and the Achilles and sometimes cause directly referred pain.

Remember, running doesn’t have to be painful!  While we have all walked the line between injury and health, you can do a lot to make yourself more injury resistant.  If you find yourself with worsening pain that doesn’t let up - especially if it makes you limp - take some time off.  If it continues, see a professional, preferably someone who won’t say, “why do you run, anyway? It’s bad for you!”

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