A major part of a strength and conditioning coach’s job is to address the injuries common to a sport and to develop a prevention strategy as part of the individual’s training program. Injury is obviously a situation that both athlete and coach want to avoid in order to maximise training time and adaptation to that training. In the endurance athlete, time out of training has a big impact due to the speed of detraining on the cardiovascular system and associated metabolic processes. A relatively large reduction in a number of physiological performance variables has been seen after detraining for up to 3 weeks⁷.

Taunton et al (2002)⁹ conducted a retrospective analysis of running injuries finding that patellofemoral pain syndrome was the most common injury, followed by iliotibial band syndrome, plantar fasciitis, meniscal injuries of the knee and tibial stress syndrome. This piece will now review these injuries and their probable causes.

The patella (knee cap) articulates in the patellofemoral groove on the femur and it’s movements are multiplanar dependant upon the forces from surrounding musculature. Patellofemoral pain syndrome presents as pain behind or around the patella and is not to be confused with pain from the patellar tendon itself usually as a result of patellar tendonitis. Below is a list of possible reasons for patellofemoral pain syndrome and why they cause it⁵ :

• Weakness of the quadriceps – Weakness may adversely affect the patellofemoral mechanism
• Weakness of the medial quadiceps, specifically vastus medialis oblique  (VMO)- Weakness of the VMO allows the patella to track too far laterally
• Tight iliotibial bands – A tight iliotibial band places excessive lateral force on the patella and can also externally rotate the tibia, upsetting the balance of the patellofemoral mechanism. This problem can lead to excessive lateral tracking of the patella.
• Tight hamstring muscles – The hamstring muscles flex the knee. Tight hamstrings place more posterior force on the knee, causing pressure between the patella and femur to increase.
• Weakness or tightness of the hip muscles – Targeted conditioning can help to solve tracking issues
• Tight calf muscles – Tight calves can lead to compensatory foot pronation and, like tight hamstrings, can increase the posterior force on the knee.

The second most common injury on the list is iliotibial band syndrome. The iliotibial band is a thick band of fibrous tissue running from the lateral hip to the lateral knee and is the most common form of lateral knee pain in runners. This is primarily due to increased friction between the band and the lateral femoral condyle (hip bone) during flexion and extension of the knee. This can be exacerbated by weak hip abductors allowing increased internal rotation of the femur and increased movement of the band over the femoral condyle. The syndrome can also develop as a result of an increase in training mileage, training on uneven surfaces and excessive pronation³.

Plantar Fasciitis is a condition that commonly presents as heel pain. This is as a result of inflammation to the plantar fascia, the fibrous connective tissue that runs from it’s origin at the calcaneous (heel) to the insertion at the metatarsophalangeal joints (ball of the foot). A possible cause of this condition is a tightness in the gastrocnemius and soleus (calf) muscles⁸. As they insert on the posterior calcaneous through the Achilles tendon, tight musculature would result in limited dorsiflexion (raising) of the ankle potentially causing a compensating pronation (rolling in) of the ankle or dorsiflexion of the big toe. Both of these movements increase the stress on the plantar fascia and could lead to the inflammation that is seen in the fasciitis condition.

Medial tibial stress syndrome is the most common form of tibila stress injury⁴ and presents as a pain in the inner part of the shin. The underlying mechanism is believed to be repetitive microtrauma to the periosteum and fascial attachments as a result of traction forces from the soleus (primarily) and the flexor digitorum longus⁶. There is a body of evidence though that suggests medial tibial stress syndrom, like tibial stress fracture, is a bone stress reaction caused by chronic repetitive loads that induce tibial bending forces² and because these bending forces occur at the bone’s narrowest point it coincides with the site of pain in medial tbial stress syndrome.

The menisci of the knee are two pads of cartilage that serve to reduce friction and disperse weight between the medial and lateral condyles of the femur and the tibia. The majority of meniscal injuries are as a result of trauma from impacts and twists or with associated twisting motions and occur more frequently on the medial side (inside) of the knee¹. Injury can also occur with age and a wearing down of the cartilage as a result of force due to impact.

Prevention exercises for these injuries can be included as part of a periodised training program, the design of which should be conducted by a qualified strength and conditioning coach. One piece of important prevention outside of a coach’s remit though is equipment and should be addressed by everyone partaking in running activities. Shoes should be sport-specific and patients should change running shoes every 250 to 300 miles. Studies have shown that a running shoe may lose greater than 60 percent of its shock-absorbing capacity after as little as 250 miles¹⁰.

1 Baker, B.E., Peckham, A.C., Pupparo, F. & Sanborn, J.C. (1985). Review of meniscal injury and associated sports. The American Journal of Sports Medicine, 13(1) pp. 1-4.

2 Beck, B. (1998). Tibial stress injuries: An aetiological review for the purposes of guiding treatment. Sports Medicine 26(4) pp. 265-279

3 Fredericson, M., Guillet, M. & DeBenedictis, L. (2000). Quick solutions for iliotibial band syndrome. The Physician & Sportsmedicine 28 pp. 52-68

4 Hester, J.T. (2000). Conquering medial tibial stress syndrom. Podiatry today, 1 pp. 48-55.

5 Juhn, M.S. (1999). Patello-femoral pain syndrome: A review and guidelines for treatment. American Family Physician 60 pp. 2012-22

6 Kortebein, P.M., Kaufman, K.R., Basford, J.R. & Stuart, M.J. (2000). Medial tibial stress syndrome. Medicine & Science in Sports & Exercise, 32(3) pp. S27-33

7 McArdle, W.D., Katch, F.I. & Katch, V.L. (2001) Training for anaerobic and aerobic power. Exercise Physiology: Energy, Nutrition and Human Performance (5th ed) Philadelphia, USA: Lippincott, Williams and Wilkins pp. 464

8 Ross, M.D. (2002). Gastrocnemius and soleus stretching for athletes with plantar fasciitis. Strength and Conditioning Journal, 24(6) pp. 71-72

9 Taunton, J., Ryan, R., Clement, B., McKenzie, C., Lloyd-Smith, R. & Zumbo D. (2002). A retrospective case-control analysis of 2002 running injuries. British Journal of Sports Medicine 36 pp. 95-101

10 Touliopolous, S. & Hershman, E.B. (1999). Lower leg pain: Diagnosis and treatment of compartment syndromes and other pain syndromes of the leg. Sports Med 27 pp. 193-204