Marathon Season Injuries: Part 1

Following on from our running series on speed, we thought it would be good to speak about some of the injuries that we often see in the distance running community. Being based in Melbourne means that leading into the Melbourne Marathon we start to see runners come into the clinic as they prepare for the October marathon festival. In this series we thought we would look at some of the injuries that commonly crop up during a marathon preparation and what can be done to aid in reducing the likelihood of injury.

In this article we are going to discuss Iliotibial band (ITB) pain. Commonly referred to as runners knee, it is characterised as lateral (outside) knee pain that typically presents in distance runners during runs after a short period of continuous running (i.e after 10 minutes or 1-2 km’s). Several contributing factors have been identified to include running gait variations, hip weakness and loading and strain rates (Baker and Fiedrickson 2016). These factors tend to fall into three clear groups; the bio-mechanics of the task, the tissue capacity (strength, length, tissue compliance) and the training loads and the rates at which training loads change.

With this in mind it is clear that if you develop ITB pain from running there are several factors that need to be addressed to make changes to reduce the likelihood of attachment pain. The first we will look at is running bio-mechanics. The literature suggests that there are a few reasons why someone may overload the ITB at the lateral knee. The most common ones include a crossover sign or reduced step width. That is the occurrence that the distance between the feet upon landing has been reduced from the alignment that occurs when you stand with our feet under your hips. It is natural for the step width to be less than hip width upon landing during running, however those that develop biomechanical ITB pain tend to have reduced step widths, as suggested even having the foot cross the midline of the centre of mass. Secondary to this there may be a shunt of the hip causing increased sideways shift, which further exacerbates the problem. For this reason runners with ITB issues tend to find running at faster speeds have less pain as they tend to create wider step widths and cause less compression of the ITB attachment on the attachment at the knee.

Reduced Step Width

Reduced Step Width

To address step width the runner is instructed to maintain a small distance in step width with each stride. A basic exercise that we often prescribe is running on the lane dividing line on an athletics track.

Normal Step Width

Normal Step Width

Another factor that also increases the loading of the attachment and compression of the ITB at the knee is increased bending (flexion) at the hip, knee and ankle in full support position. This can independently cause compression without reduced step width as it often associated with knee valgus (knee tracking towards opposite knee) and increased translation of the ITB. Running retraining to increase landing stiffness and loss of limb height upon full support is another retraining factor that will assist with reduced compression of the ITB at its attachment.

Increased knee flexion and valgus knee position.

Increased knee flexion and valgus knee position.

To manage lower limb stiffness (that is the ability to not collapse into increased ankle, knee and hip bend upon loading of full body weight) is also highly controlled by strength of the lower limb at the hip. Exercises that increase load absorbing and propulsion ability such as double leg and single leg squatting and lunging motions as well as tasks that increase loading at high velocities such as plyometrics, on double and single leg, allow runners to control loading at fast and slow speeds.

Finally increases in training loads (increased running volumes) or loading intensities (often associated with uphill or particularly downhill) will increase the loading through the ITB. To manage this loading, training to reduce injury risk should look to increase gradually and introduce courses with undulating terrains sparingly.

So as you can see there are several factors that contribute to the development of ITB pain, however with clever programming and physical preparation there is opportunity to reduce the likelihood of developing ITB pain.

If you are interested in learning more about managing running injuries, check out our upcoming injury courses.