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Running Injury Treatment Program

Running Injury Mechanism

Body’s recoil ability after landing on the ground is the source of the power while running. Once you begin to lose flexibility and elasticity of your foot and leg, you are more prone to injuries in the muscles and joint.

If you keep using your muscles without good stimulation such as stretching and massage, you will slowly loss muscle elasticity and flexibility resulting in muscle weakness (deactivation).
Your muscles will be unable to contract well due to accumulated tightness (myofascial restriction) and joint alignment will begin to collapse in the weight bearing phase. Under the condition, your foot, knee, hip, and even your spine will be stressed due to instability of the joint.

The importance of arch muscles in running

When the foot is landing on the ground while running, the foot arch is being slightly pronated after which it is rebounding back into the original shape. Through this process, the body can gain the power to move forward. If the arch muscles get weak and less flexible, the arch will begin to collapse without enough rebounding forces.

Using the orthotics can be helpful but it is not the fundamental solution. We need to restore the natural power of the foot. The foot muscles have to be activated again and it can be achieved by scar tissue release, myofascial trigger point therapy and muscle re-training exercise program.

Can I recover my arch strength and flexibility?

Unless you were born with disability and deformity, you can restore your arch strength and foot elasticity through proper treatment, self-releasing skills, and specific exercise program to activate your toe and foot intrinsic muscles

Why is it hard to keep good running form?

Most running injuries comes with poor connective tissue (muscle, tendon, fascia) quality which is accumulating over time with overuse and lack of releasing (stretching, massage, form roller stretch, etc). Without good muscle group activation, the joint alignment will be misplaced while running due to decreased stabilization effect.

Most common features of alignment dysfunction in running:

1. Collapsed arch (over pronation during weight bearing phase)

2. Leg is turning inwards in the weight bearing phase

3. Knee is shifting towards mid-line (it gives Valgus stress in the knee joint)

4. Pelvis drops on the other side after bearing your weight in the leg

Most Common Running Injuries and Treatment Strategy

1. Runner’s knee, IT Band syndrome, Patella femoral pain syndrome, Patella tracking dysfunction
This is the most common running injuries. The cause of this injury is poor connective tissue quality in Quadriceps muscle with adhesion between other muscles (IT Band, pes anserinus muscle group). If the muscles are not gliding smoothly with knee movement, you will begin to feel discomfort. IT Band and Quadriceps tightness pull the patella bone outwards resulting in pain inside or outside of patella bone while running. In addition, tight muscles easily make trigger points, and it becomes the main source of pain.

Treatment: Perform Quadriceps, IT band, Pes anserinus muscle group Myofascial and Trigger point release followed by stretching to lengthen the muscle, Educate how to use form roller and ball for self-release Home exercise program. Once connective tissue quality improves and discomfort is minimized, strengthening program will be added.

IT Band syndrome link ➡️

2. Foot pain (Plantar fasciitis, collapsed arch, heel pain)
Foot muscles and plantar fascia become tight and inflexible with accumulated myofascial tightness due to overuse, wearing poor shoes, and lack of stretching and massage. Eventually, myofascial tightness and adhesion lead to muscle weakness and inflammation. Once the muscles are not activating well during weight bearing phase, arch muscle begins to collapse resulting more stress and damage in the arch muscles and tendons (Tibialis posterior).

Treatment: release myofascial restriction and trigger points on the foot, calf and shin muscles (Myofascial release, Trigger point therapy), shockwave therapy on the heel area is very effective, eccentric stretching program, strengthening program, home exercise program for self-release

3. Hip pain (hip flexor, groin pain, gluteus pain, clicking sound)
Most commonly injured hip muscles include hip flexors (iliopsoas muscles), Gluteus medius, maximus and piriformis.

Treatment: perform myofascial release in abdominal area first which decrease tension in your hip joint followed by the specific hip muscle myofascial and trigger point release. Stretching and strengthening program

4. Piriformis syndrome
Myofascial tightness and trigger points in piriformis (hip external rotators) cause pain in the back of your hip with/ without radiating pain down to upper or lower leg. It sometimes presents with just calf tightness and discomfort without any symptom of piriformis muscle.

Treatment: Need to release trigger points in Gluteus maximus, piriformis and other hip external rotators.

Piriformis syndrome link ➡️

5. Achillis pain (Achillis tendinitis, Achillis tendonitis)
Achilles tendon is the structure transmitting lots of tension between the foot and calf muscle. This tendon can get excessive stress due to high impact exercise including jumping and running. Achilles tendon has more damage if the calf and arch muscles are not functioning well due to inflexibility and tightness. Under these conditions, the tendon accumulates scar tissues and adhesion in the tissues resulting in pain and stiffness.

Treatment: stretching and flexibility exercise program for foot and calf muscles, shockwave therapy is very effective, manual therapy including myofascial trigger point therapy and Glaston scar tissue release tool, eccentric exercise program

How to diagnose your injury? (Physical Exam/ Functional Test)

1. Gait/ Running Analysis
Through observing walking/ running movement, the practitioner can get the information about muscle reaction speed, weak muscles, joint alignment dysfunction while weight bearing phase, flexibility and elasticity

2. Physical Exam
Checking more detail using special test to see if there is any damage in ligament, meniscus, tendon and muscle

3. Muscle strength and Reaction speed test
In supine position, the skilled practitioner can find out weak muscles and slowly responsive muscles by checking each direction of movement. This is performed manually with the patient’s muscle contraction following the instruction.

4. Step down test/ Single leg squat


This test is one of the most important functional test in running injuries. When stepping down the 8 inch box or performing single leg squat, the practitioner observes your leg alignment. If your knee is moving towards or across the mid-line or your hip cannot hold your body, it indicates lateral side muscle group weakness due to accumulated scar tissue (Myofascial tightness). This muscle group consists of Vastus lateralis, IT Band, Gluteus Medius. In addition, ankle joint dysfunction and deactivated core muscles can be another cause of the positive sign in this test.

5. Palpation test
Palpation is hands-on technique finding out the problem area causing your pain and dysfunction. The practitioner is mainly trying to find myofascial tightness, scar tissue, adhesion, joint stiffness and most importantly, trigger points in your connective tissue. Once the problem spot is palpated, then the treatment success rate will be much more increased.

Treatment methods and protocol

1. Myofascial Release Therapy ➡️

2. Trigger Point Therapy ➡️

3. Using the instrument for scar tissue break up ➡️

4. Shockwave Therapy ➡️

5. Educate self-releasing technique using the Form roller and ball

6. Stretching the muscle length after myofascial trigger point therapy

7. Begin strengthening program once the tissue quality improves with minimal discomfort

8. Begin jogging with small distance at slow pace in conjunction with self-releasing and stretching protocol before and after jogging

9. Increase the running distance progressively only if you don’t feel any discomfort