It seems every weekend from mid-May through fall ushers in a new road race for runners, whether it be a 5K, 10K, half marathon, or triathlon. As physical therapists, we see an influx of new patients with running injuries not only of the foot, ankle, knee and spine but also with new complaints of incontinence, pelvic pain and prolapse. It is always our goal to get the client back to running, especially since for many it’s their preferred way to stay fit and also acts as a social, stress reducing activity that they are passionate about. What we find out during the initial Physical Therapy evaluation is that the source of their running injury can be a distant site from where they feel the pain. We often find that a misaligned pelvis or tight hip is causing foot pain or calf strains. Since the pelvic and hip muscles are anatomically and functionally related to the core and pelvic floor, we often see runners with symptoms of incontinence who also have other complaints such as back, hip or foot pain. Therefore the core and pelvic floor is where we begin our focus.
Perhaps one of the most common sources of running dysfunction is the iliotibial band, which runs along the outer seam of each thigh from the side of the hip to the side of the knee. It is a dense fibrous band and prone to adhesions, which can inhibit full excursion of the hip and the knee. Foam rolling has become a hot option for self-treatment, and can keep the fibers of the ITB from adhering to the surrounding fascia and muscular fibers. However, that is addressing the symptoms and for long-term benefit, the runner also needs to address what is making the ITB tight. Again, this is often back, hip, and/or pelvic weakness.
Ankle sprains, perhaps seeming more straightforward, are initially treated as any acute injury with rest, ice, compression, elevation, and gentle range of motion. However, the way the foot strikes the ground and the runner’s stride may have predisposed them to the inversion force that turned the ankle. Again, looking at core and pelvic floor strength and coordination as well as hip flexibility and stability can prevent the runner from being sidelined again.
Many of the same mechanical principles apply to other common conditions, such as plantar fasciitis, patellofemoral syndrome, and stress fractures. In order to address the urinary or pelvic dysfunctions, the therapists at Oceanside are specifically trained to evaluate the pelvic floor muscles and rehabilitate the core from the deepest layer. It takes a highly trained eye and an expertise in the anatomy and kinesiology of the body and the way it moves to get to the root of the injury and prescribe the most effective and appropriate rehabilitation strategies. We set the patient on a course of the right stabilization and stretching routine coupled with an alternative cardiovascular activity until running can be safely reintroduced at a lesser intensity with a clear plan for progression and full return. After rehabilitation they may find that many things have improved with the core now operating correctly, such as reduced urinary urgency or even urinary leaking during long runs.