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I'm a high school cross country coach. For the first time in 20 years of coaching, I've got almost an entire team out with leg injuries. Most of them are ankle or knee problems. Could it be the shoes these kids are wearing? I've gone over and over in my mind the training approach I use -- but it hasn't caused injuries in the past, so why would it now?
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Studies show that running is one of the most common causes of leg injuries in all athletes. In fact, it's estimated that up to 70 per cent of distance runners experience an overuse running injury during any 12-month period of time. As you have discovered, the knee is affected most often. Injuries to the foot and ankle take a close second.
Patellofemoral pain syndrome, iliotibial band syndrome, plantar fasciitis, Achilles tendinitis, and shin splints are just a few of the more common problems reported. Taking a look at your training schedule is always a good idea. Shoe wear can be equally important.
But a recent study on the cause of overuse running injuries reported two main reasons for overuse running injuries: abnormal foot pronation mechanics and weak hip-stabilizer muscles. Abnormal foot position called pronation describes an ankle that is angled inward and a foot that is flat (collapsed arch).
With a flattened arch, when the foot strikes the ground, the (flat) arch absorbs some of the shock that the heel would normally absorb in a foot and ankle that has a more normal alignment. If this misalignment occurs over and over with each stride, it can lead to foot pain as well as knee pain.
Some runners develop pain up the front of the lower leg (shins) as a result of this transfer of energy on impact. This condition is called shin splints.
Studies have shown that a small amount of foot pronation during mid-stance (when weight is on the foot) works to the runner's advantage. But too much for too long in the stance cycle and problems develop. If the foot and ankle don't roll back away from the pronated position, there isn't a rigid enough column of support to allow for toe-off in the propulsion cycle. The tibia (lower leg bone) tries to compensate by rotating. The risk of injury goes up with the large twisting force placed on the lower leg.
The second common risk factor in overuse running injuries of the knee involves the hip-stabilizing
muscles. Weakness of the gluteus medius and other muscles that control hip internal rotation and abduction (moving the leg away from the body) play a big role in knee injuries.
When these muscles don't stabilize the hip, the leg pulls into internal rotation. As the foot hits the ground, too much internal rotation increases the force placed on the arch and midfoot. The result is to transfer load through the foot and ankle up the lower leg to the knee. Multiple studies have shown the relationship of weak hip muscles to knee injuries. Even a small loss of hip abduction and external rotation due to weakness can affect the biomechanics of the lower leg.
Normally, as the hip moves toward the midline, the iliotibial band functions as a passive restraint system to hold the leg in a more neutral position. The iliotibial band is a long fibrous band of connective tissue along the outside of the hip. It goes from the pelvis to the tibia (lower leg bone).
Some of the hip muscles join together with the iliotibial band. When a runner with weak hip stabilizers runs, the iliotibial band gets overworked and they can end up with knee pain and/or iliotibial band syndrome (ITBS). ITBS is a painful lateral thigh from friction of the band against the muscle, bursa, and bone.
Runners can be screened for these problems and start on a special rehab program before injuries develop from overtraining. If this theory is correct, rehab should reduce the large number of knee injuries that occur in runners.
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